Last week’s post about the Survey Monkey Protest brought mixed responses from midwives and midwifery consumers, which was not a surprise and why I apologized to the midwives ahead of time for the trouble caused. What did surprise me was how many people (ok, granted is was less than 10 people), via Facebook posts and emails, cited either ethics or the trouble it would cause midwives as the reasons they were not in favor of this form of civil disobedience. Legality and ethics are not the same; sometimes what is illegal is actually the most ethical option. Midwives are already eyeball deep in harassment from the state, with most if not all practicing midwives charts now under investigation, so a few more false reports to deal with doesn’t add much. This general resistance to causing trouble or behaving illegally is very relevant to what is occurring in midwifery practice in Arizona right now.
Midwives are every day in a position of deciding whether or not to be compliant to rule and statute as they are currently being interpreted (as suggested by AzDHS in their training) therefore remaining legal or deciding to behave ethically within their practice and breaking the rules. Increasingly, remaining compliant is forcing midwives to either behave unethically or stop practicing entirely. At this point, and I think most midwives would agree with me, there is NO WAY to be compliant (aka legal) and continue a midwifery practice at all, let alone an ethical midwifery practice. To illustrate, here are a few of the more absurd instructions given to midwives by the state for how to legally practice:
- Terminate care for any client who misses an appointment for any reason. Car broke down, your midwife is at another birth, Taking a vacation, you are sick, your 2 year old is sick – doesn’t matter, no more midwife.
- Do vaginal exams in labor, regardless of need, regardless of whether the client consents, regardless of efficacy, regardless of circumstance at all. Convince all clients of the need for a vaginal exam whether there is a need or not.
- If 911 is needed for any reason, terminate care and walk out as soon as emergency medical professionals arrive. Do not resume care at any point postpartum.
- Weigh, take vitals, do a pee stick at every appointment. If your client doesn’t want to get weighed, your BP cuff breaks, she can’t pee in a cup? The midwife is in violation.
- Run syphilis screening, period. Your clients cannot refuse. Technically they can refuse because individuals must consent to all medical procedures, but then the midwife is in violation.
- Do diabetes screening. Technically in rule this is an optional test, however the state is actively harassing midwives whose clients have opted out of the test and then go on to having large babies (babies as little as 8.5 lbs are creating red flags).
This list could go on and on, and others have written here, here, here, and here about the absurdity of the state of Arizona AzDHS’ current interpretation of midwifery rule, but the point is that even the day to day practice of midwifery is threatened by legality. For decades, midwives in Arizona have been artful in balancing an ethical midwifery practice with what is required by the state to maintain a license. In recent years that balance has become more and more difficult if not impossible. Which brings us back to the Survey Monkey Protest. If midwives and midwifery consumers are concerned about a small action of civil disobedience like this being unethical because it is illegal or might cause the midwives some trouble… I worry greatly about the future of licensed midwifery care in Arizona.
Midwifery consumers, your midwife likely breaks the rules for you all the time or she wouldn’t be able to practice. Please educate your self about the and rules (here) and statutes (here and here) that govern out of hospital birth in AZ and then thank her for giving you good care in spite of these laws and their black and white interpretation.
Midwives, the state is unreasonably interpreting rules in black and white fashion with no concerns for safety and ethics. They have not listened to our quiet, nice, professional requests for change. Maybe it is okay to shake things up a little to prove a point. We have to be willing to acknowledge that not everything that is legal is ethical and not everything that is ethical is legal. Remember that the International Confederation of Midwives established this code of ethics for midwifery practice which does not ever mention bowing to legal requirements at the expense of our clients.