The VABirthPAC mission is to impact evidence based Maternal/Child Health policies for the citizens of the Commonwealth of Virginia. When developing the NOIRA for professional midwives, it is imperative that informed choice includes the risks and benefits of home birth and that any "evidence" be based on research, not the obstetrical standard of care.

We applaud the Board of Medicine for looking at evidence based maternity care, but feel strongly that this needs to also filter into the current obstetrical system of care. Many women in the care of a physician are given one recommendation for their care without full disclosure about risks, benefits and alternatives. Given the fact that studies show that low risk women who give birth at home with midwives have better outcomes with fewer interventions than low risk women in hospitals, wouldn't if be reasonable to expect home birth to be included in the list of alternatives ALL low risk women should be offered when making maternity care decisions?  

With midwifery care, there is a partnership between the client and the midwife. Informed consent/Informed refusal is the hallmark of midwifery care, which makes this NOIRA somewhat redundant. But it is our hope that the medical model and the midwifery model will come together with more understanding through this process. If we can create a precedent for evidence based care being the standard, whether a woman is in the care of a midwife or a physician, we will be doing a great service for childbearing families in the

Commonwealth.

Sincerely,

Sara Fariss Krivanec

Chair, VABirthPAC