Each of us is the owner of his/her own health and well-being. We are responsible for insuring that the choices that we make which affect our bodies, are made as a result of acquiring enough knowledge about the issues that we can make an intelligent decision that works for our individual living situation. In pregnancy and birth, this is even more important because the choices are made for both mother and baby. So you need to carefully weigh the qualifications of your provider, your choice of location for the birth, and make many decisions during your prenatal period.
Years ago, when I was training as a midwife, I realized that the options available in prenatal care and birth care were presented as absolutes. There was little room for individual education, or support for choices made as a result of that education. My practice has always been based upon this time-honored, ethical principle of Informed Consent. I encourage every client to research all recommended tests and procedures, and discuss any concerns with me. What worked for me when I was pregnant many years ago might not be the appropriate decision for you and your family.
Basic Principles of Informed Consent
1) All recommended tests or procedures must be thoroughly discussed, in terms and language that the client can understand.
This discussion must include:
*Risks and benefits of the proposed action
*All pertinent details of how this information is to be acquired. (i.e. blood test, culture, ultrasound, etc.)
*Any alternative actions to acquire this information (if available)
*An explanation of all possible scenarios, including doing nothing
2) An evaluation of the client’s understanding of the explanation (appropriate language, educational level, etc.)
3) A time and opportunity for questions to be asked and answered
4) A signed document which indicates that the above steps have been successfully completed.
While the practice act governing Licensed Midwives in Florida requires that many tests and procedures be offered, the client always retains the right of refusal, assuming that Informed Consent has been properly given and documented.
In an emergency situation, providing Informed Consent to the client may not be a possibility. In that case, a surrogate should be designated who has the ability to speak for the client. Hospitals refer to this as a Living Will.
INFORMED CONSENT DISCLOSURE
I am providing you with this information to make you clearly aware of my education, training, experience, and the services that I provide, so that you may make an informed choice. Each of us is the owner of his/her health and accepts responsibility for that ownership. Your choice of a birth attendant should mean that you trust that person. You should feel confident utilizing that attendant’s competence and judgment, but never expect that person to be ultimately responsible for you or your baby’s well-being. As your birth attendant, I can function as a resource and guide who will share the experience of pregnancy and birth with you and your family.
LEGAL STATUS OF MIDWIVES
Direct entry midwives are licensed by the State of Florida after completing three years of academic courses, and supervised clinical experience, and successful completion of the licensing examination (through the North American Registry of Midwives). All Licensed Midwives must demonstrate academic knowledge and clinical skills necessary to provide safe care for mothers and infants during the prenatal, intrapartum, and postpartum period. Licensed Midwives must pass written and skills testing, and perform many births under supervision of either physicians, Certified Nurse-Midwives, or other experienced Licensed Midwives, before acquiring a license to practice. Licensed Midwives, by law, may offer services at Home, Birth Center or a hospital setting. Licensed Midwives are not physicians (M.D.’s or D.O.’s), or Certified Nurse-Midwives (C.N.M.’s). Direct entry midwives may obtain a Florida License through a formal training program of either two or three years (depending upon the background of the applicant), and must satisfy all the requirements to legally practice. Some Licensed Midwives may also be R.N.’s (Registered Nurses), or L.P.N.’s (Licensed Practical Nurses), with further experience in maternal child health, but they must still acquire a Florida Midwifery license to practice as a Licensed Midwife. Certified Nurse-Midwives (C.N.M.’s) are Registered Nurses with additional training (usually 18-24 months) in Maternal Child Health, and can also offer some gynecological services (routine exams, family planning, etc.)
In Florida, Licensed Midwives are trained to practice out of the hospital, and provide services mainly in Home and Birth Centers. Certified Nurse-Midwives mainly practice in Hospital Birth and Birth Center situations, although there are some who have Home Birth practices.
I carry Malpractice Insurance.
All services provided by a Licensed Midwife are eligible for reimbursement by your insurance company, provided the company is chartered within the State of Florida. Insurance reimbursement is an issue between the individual client and her insurance company, and I will ask you to sign a Financial Agreement to accept responsibility for your care, regardless of your insurance status. I will be happy to provide the information your insurance company requires to substantiate your claim for reimbursement.
PARENTS’ ROLE AND RESPONSIBILITY
Mothers who request my assistance should: be concerned about the health of their bodies; follow a balanced diet of simple, wholesome foods; receive regular comprehensive prenatal care; get adequate sleep and exercise; refrain from the use of alcohol, tobacco, or recreational drugs; intend to breastfeed; and be feeling good about the birth of their child. You should be able to demonstrate knowledge of the process and skills required for the birth either through completion of a course in prepared childbirth during either this or a previous pregnancy, or a sufficient program of self-education. Parents must also provide supplies and equipment for the Birth, according to a list which will be provided during your 32-34 week prenatal visit.
For a planned Home Birth, parents must complete and clearly post in the home, an Emergency Care Plan, detailing arrangements for moving to the hospital, should the situation warrant transfer. A pediatrician must be designated who will assume care of the newborn 4-6 days after the birth. There are competent physicians in the area providing care in the hospitals, and for newborns. If you need assistance, I will be glad to provide referrals.
As your birth attendant, I reserve the right to consult with a physician of my choice should a complication arise.