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  10:50 pm
Commenter: Peggy Franklin RN,ND,CPM

Preserve Individual Choices

A core belief in the midwifery model of care is that pregnancy and childbirth are a natural life process that with proper nutrition and health will culminate in a healthy mom and baby most of the time. This natural life event has abundantly supplied earth with human beings for hundreds of years.. Some mothers did die, some babies did die. They still do. Unfortunately birth does not come with any guarantees no matter what we do or don't do. No matter what evidence based information we share.  As a CPM with nearly 40 years experience working with childbearing women in the hospital, birth center and home setting, I have always given my clients information about the risks and benefits of every part of their care including their options, helping them understand what, why and when certain tests are done and the effects of various conditions on their health and safety. I also discuss their options for prevention and treatment. I spend about 30-60 minutes at each prenatal, offer classes, handouts, online resources and references from many sources. In short, my midwifery practice is an educational and a relational experience rather than a series of tests, brief review of symptoms and a prescription for treatment. We discuss issues from a holistic perspective that includes evidence from statistics but evaluates a woman's own situation individually rather than from a simple list of rules with protocols that are "one size fits all". I take each piece of the puzzle to see the big picture. Many signs or symptoms by themselves seem to indicate a plan of action, but taken in conjunction with the "big picture" they may indicate a different plan of action, including doing nothing. My request to the board in formulating these evidence-based informed consents is to recognize each individual situation may be personalized according to the midwifery model of care. Many statistics are written from a biased perspective. This is especially true in regard to medical vs. midwifery perspectives.  I believe the intent of this new amendment is to assure that clients are aware of what the studies show not to impose an impersonal protocol that limits their choices. I hope they will complement our care rather than burden it with increased costs of both time and money with little benefit. It is essential that we preserve the midwifery model of care and the client's freedom of choice in their care.

Thank you for your consideration.


Peggy Franklin RN, ND, CPM



CommentID: 10159