Virginia Regulatory Town Hall
Department of Health Professions
Board of Medicine
Regulations Governing the Practice of Licensed Midwives [18 VAC 85 ‑ 130]
Action Disclosure requirements for high-risk pregnancies
Comment Period Ended on 11/25/2009
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11/24/09  9:03 pm
Commenter: Kim Pekin, CPM, Birth by Design, LLC

Informed Choice/Refusal for all maternity care providers

I am a Certified Professional Midwife (CPM) serving women making an informed choice to give birth at home.  I am also a woman who has received care from obstetricians, as well as midwives, for the births of my own children.  From first-hand experience both as a professional and as a consumer, I can tell you that the informed consent process with midwives is thorough, evidence-based, and extensive throughout the maternity care cycle.  This, unfortunately, has not been my experience with the care I received from obstetricians.

As a CPM, I engage in numerous discussions throughout my client’s care regarding the risks and benefits of various prenatal testing options, as well as any relevant variations in normal birth (twins, breech, VBAC, etc.) that may involve special consideration.  My clients are given ample evidence-based information, provided opportunities to discuss the information I have given them, and are encouraged to explore available research themselves in order to make a truly informed choice to accept or refuse interventions and testing I might propose.

The proposed regulatory action is redundant and its implementation is costly to taxpayers.  However, this is an opportunity for ALL maternity care professionals (CPM, CNM, OBGYN, etc.) serving women who choose to give birth both in and out of hospitals, to provide Virginia women with truly evidence-based information upon which they can base their maternity care decisions. 

It is my hope that this evidence-based information will be objective, and that it will come from sources such as the Cochrane Database and the Agency for Healthcare Research and Quality (AHRQ).  Women singled out by the NOIRA should be given balanced, evidence-based information regarding the risks and benefits relative to their intended place of birth and their birth attendant.  This information should include the increased risks of surgical birth arising from the use of common hospital interventions such as continuous electronic fetal monitoring, oxytocin augmentation and induction, and obstetrical anesthesia (amongst others), as well as the increased risk of infection.  In fact, all Virginia women, whether they are considered to be “high risk” or “low risk”, and regardless of their provider’s credential, should be given evidence-based information about the risks and benefits of their intended place of birth, as well as their choice of birth attendant.

Thank you for your consideration of my comments.  I hope that this NOIRA will lead to a greater dissemination of evidence-based information regarding maternity care options available to Virginia women.

Kim Pekin, CPM
CommentID: 10155