Overview of Legislative meeting--next one 3/19

[gremlina]

Alright, it was TERRIFIC!! Here's an overview created on NCFoM group.
I wanted to share with you all, and tell you to mark your calendars so
the Triad can REPRESENT then!! The numbers of supporters really made
an impact, I think. Next time we'll need a bigger room!

Take a look, and let me know if you have questions, I'd be happy to
answer as best I can.

Quoted from Sylvia of NCFoM:
"My impressions: After driving 5 hours I'm tired, so I might miss
something or get something wrong (in general, I will follow the Agenda
provided at the outset of the meeting.) I also didn't get which
specific committee members asked which question...

The sheer numbers of home birth supporters was stunning. It was
standing room only in that room. We need to (and will) pack that room
every time the Committee meets. (I am sad that I won't be there the
next time, March 19, since I will be in Puerto Rico, hopefully helping
my sister catch her baby - with a homebirth midwife in attendance!)

I think it made an impact on all of the members of the committee that
there were so many of there. We had folks from all walks of life in
that room, from all parts of the state.

I. Overview and Introductions:
The co-chair of the committee, Dr. Bob England, called the committee
to order and said that they are "narrowly charged with the
responsibility to investigate whether or not NC should license
Certified Professional Midwives. He said that the committee must
provide a report, or a decision by the end of December, 2008, OR, if
the committee is ready to provide a recommendation by May it can do
so. He also introduced the co chair, Marian McLawhorn. He said that
the chairs determine the length of time allotted for presenters and
speakers (they also decide who gets to present/speak.) I don't
remember Ms. McLawhorn having said very much other than introducing
herself at this time, but the rest of you can correct me if I'm wrong.

II. Presentation:
The president of the North Carolina Medical Society, Dr. Hadley
Callaway, NCMS president spoke first. He said that the NCMS supports
"non physician health practitioners," but it appears that he narrowly
defines those to include only PAs, CNMs, and Nurse Practitioners. He
specifically said that they suuprt nurse midwifery with physician back
up. He said that the NCMS is against the licensing of CPMs because
they feel home birth is unsafe and that birth should be taking place
in hospitals, in hospital birth centers, or in free standing birth
centers. He also made a lengthy presentation on how doctors are
trained, how long they attend school, etc. He then tried to contrast
the training of doctors, CNMs, and CPMs. This was an effort to try to
show the "superior" training that doctors receive. Since, as far as
the NCMS is concerned, safety is assured by these trained
practitioners, and not by non "medically trained, direct entry
midwives and CPMs." Dr. Callaway asserted that these practitioners are
not equipped to deal with safety issues or concerns: they can't deal
with "dangerous high blood pressure, diabetes," other undiagnosed
issues, they don't constantly monitor with EFM, they don't have
surgical facilities, they don't have access to ways to deal with
hemorrhage, etc. He said that would be "unsafe and unfair" to doctors
for midwives to ransfer care to them without them having previous
knowledge of these potentially risky/dangerous patients. He said that
there are liability risks that doctors don't want to take. Though he
said that "healthy women deliver healthy babies most of the time," he
repeated throughout his presentation that doctors should be in control
of birth because unforeseen complications can arise and birth should
be "supervised" by medically trained practioners (those outlined
above) in the settings (outlined above.)

Questions opened up at this time by the committee members. In response
to a question about birthing centers and how they reduce the cost of
health care, Carol Jones, a CNM who had a birthing center in a rural
area of NC (has since closed) talked about the birthing center issue.
There were other questions from the committee about health care costs,
liability, the difference between NCMS and NCMB.

The reminded us (the audience) later that at this time we wouldn't
have the opportunity to address the committee.
III. Presentation
Russ Fawcett, Legislative Chair, North Carolina Friends of Midwives
It was obvious, by contrast how prepared Russ and Sonia were. Russ
presented the committee with a number of statistics, charts, the BMJ
study, and other supporting documents. One of the most eloquent
moments of the day was of himself as a nuclear engineer, and how his
presence there at this committee, spoke to the diversity of the
population that supports midwives and homebirth. He talked about how
in our ranks we include many diverse professions, people of many
different beliefs and that he stood with ALL of our families: Amish,
Christian, Muslim, "Zen", Republicans, Democrats, "even some
Libertarians," who are all united in our belief that women deserve
self determination and the right to birth with the licensed
professional of their choice.

Following Russ's presentation, there were more questions from the
committee, and they asked for more information and statistics that
Russ said he would provide (I believe that they asked for outcome
statistics for homebirth midwives in NC, and Russ alluded to the BMJ
study which includes the statistics for midwives throughout the U.S.)
One question asked for information about disclosure and whether or not
midwives provide a disclosure about their scope of practice, etc. Russ
said that midwives as a routine part of their practice disclose that
they are CPMs, not physicians, nor CNMs, and that they are currently
not licensed by the state. He said that he would try to gather any
documentation of disclosure that he could locate. Another question
(my personal favorite) had to do with the fact that Russ kept alluding
to "healthy women," and healthy pregnancies. The committee member
asked, "who determines that this is a 'healthy woman?" This question
came back again after the last speaker presented.

IV. Presentation:
Sonya Stone, Ashville Area Birth Network. Sonia spoke about the
inevitability of legislation passing to license CPMS in this state.
She talked about our surrounding states and their support of homebirth
practitioners. She spoke both as a home birth mother, and but also as
a person with experience in hospital administration (I think she made
a huge impact.) Everyone was listening to every word she said. She
mentioned her own story of how she arrived at the decision to birth at
home, and she referred to the lack of access that other women have to
this option. Sonia also spoke about a recent woman who had contacted
her who didn't qualify for Medicaid (w/ her husband's income), [and ...
I don't have notes on the rest of this story, so please fill in here!]

Following Russ and Lisa's presentation, there were more questions
having to do with cost, with the % of Medicaid/noninsured families who
seek homebirth, and other questions.

V. Presentation.
Thomas Mansfield, Director, Legal Department, North Carolina Medical
Board (the "Medical Board") was supposed to address the committee
concerning legal issues pertinent to this legislation. He mentioned
that the Medical provides oversight, regulation, and that it "polices"
doctors practicing in hospital. The Medical Board also "polices" those
who are "not licensed" to practice medicine. He said he would be glad
to get information about anyone in the state practicing medicine
without a license. He said that last year the Legislature "tightened"
the scope of what "medical" practice is, and that this includes the
practice of ob (you can read more about this at
http://www.ncmedboard.org/Clients/NCBOM/Public/Physicians/mpachangesforum.pdf
an article that Mr. Mansfield himself wrote concerning the changes
made this summer. Interestingly, if you also look further at the
Medical Board's Website, they have a long list of all of the folks
that they don't regulate, and that includes midwives (7) The
practice of midwifery as defined in G.S. 90-178.2. He also said that
he had reviewed the books and had found no examples about any specific
cases in which the Medical Board is currently prosecuting or policing
unlicensed practioners of medicine. He said that the Review Panel
consists of 9 members, one of which is a non medical, lay person.
A few questions followed about the scope of the Medical Board, who
they regulate, etc. and if there was already a regulating body that
should be looking at whether or not to license CPMs [I think this was
the gist of the main questions.)

VI. Presentation.
Dr. Frank Harrison, Carolinas Medical Center, Past President, North
Carolina OBGYN Society. This was the last speaker. He has been an ob
for many years. He spoke again about the safety issue. He mentioned
two cases that he had had within the last few weeks, one a low risk
patient who had a hemorrhage and an amniotic embolism in the hospital
but had gone on to have a "natural" delivery in the hospital. Another
patient, one who would be called high risk, had also been "delivered"
safely in the hospital. He questioned the ability of out of hospital
professionals to identify emergencies.

Questions from the committee followed: why are so many obs leaving the
profession? Dr Harrison said it was liability. They're alarmed by the
lack of practitioners and especially young people wanting to go into
the profession of obstetrics. A question followed about what the rates
of those dying in childbirth prior to the licensing of physicians was
and the doctor didn't have the exact numbers. Another committee member
returned to the question of who determines what is a "healthy woman."
Dr. Harrison said, "the highest trained professional should determine
who is a healthy woman." (or something along these lines.)

A group of us spoke with Ty Harrell afterwards, and he encouraged us
all to write to the committee members. He said that we know more about
this topic than they do and that we should take the opportunity to
clarify or argue any points that were made with which we disagree.
Even though we weren't able to speak, he said that it was powerful
that we were all there. That it makes an impact and that we should
continue to pack the room..."