What can I do? I cannot tell you the number of times this question has been posed to me and other midwives by home birth clients. What can I do to help my midwife, the midwives, midwifery and home birth as the state of Arizona Department of Health Services (AzDHS) actively tries to eliminate legal midwifery under the guise of safety? To tell you the truth, beloved home birth families, we midwives may not know the answer. The number of midwives now under scrutiny by AzDHS now approaches half of the actively practicing midwives in the state, and we are scared. Daily, more and more midwives are receiving requests for charts. We are holding on by the seat of out pants. We need you home birth clients, midwifery consumers, to understand what battles AZ midwives are currently fighting, and we need you to fight for your rights to a safe, legal home birth in the ways in which you know (or can make up). Speak out, write letters, form groups, call AzDHS, support your midwife, protest. Demand a system that respects your choice to a midwifery model of care. This fight is about your rights to have the kind of care you want, it is not about our right to practice. We have no practice without you. Your midwives are tough women (midwives have to be tough) and we will continue fight for your right to have a legal option for a home birth with a midwife, and we are scared and we cannot fight this fight without you.
As we audit our own charts for compliance, we find again and again that it is impossible to be in compliance with AzDHS rules around midwifery. It is impossible because midwifery is being regulated as if there are not human midwifery clients on the other end, and as if the state’s method of “supervision” actually serves to make birth safer. We are being told to force you to comply with expectations of monitoring, testing, vaginal exams, vitals or to tell you that we cannot be your midwives. We are being told to walk away from you when you make a healthcare choice for yourself or your baby that is different than what is written in those rule. We are being told that we are never to see you again if you transfer to a hospital for a complication, or for pain relief, or just because someone has a gut feeling. We are finding that even in cases with no complications and clients who consent to all routine procedures and monitoring, our charts are still not “in compliance.”
As we fill out this ridiculous survey monkey form with information about your birth experience, we watch over each other’s shoulders trying desperately to determine how AzDHS will choose to interpret our answers. We make sure to remind each other to screen shot or print each page because that is the only way we have a record of what we typed. We anticipate the fines for a report that was filed after the 30 day deadline, knowing there is consistency and some midwives are being fined by the day, or by the incident, or an arbitrary number no one can puzzle out. We know with more and more certainty that this “data collection tool” is really just an attempt to nail us to the wall. We remind each other to refrain from snarky comments in comment boxes, even if we erase them because it turns out AzDHS sees all drafts as well as the final submitted form.
As we, one by one, or as a group try to communicate with AzDHS about this current climate of regulation and how it does not increase safety or promote midwifery, we are met with messages of ‘we will get you’ masked in nice statements about the health and safety of moms and babies. The department of special licensing in AzDHS regulates midwifery and has no idea what midwifery is, and that comes through in their responses. They assume we can and will bully you, dear midwifery clients, into complying. That if you want a home birth with a midwife bad enough, you will do whatever AzDHS tells us to tell you what is best. They assume that what you are looking for is the same kind of birth care you would get at the hospital, just without pains meds and at home. They assume you need them to protect you from the midwives (who they license as safe and knowledgeable health care providers and you hire because you trust).
Consider the sum of this situation. There is no way to provide good, safe, ethical midwifery care under current rule so all charts will reflect rules violations. AzDHS has created a convoluted reporting form for gaining access to your information so they can examine those charts and then hand out punishment for violations. AzDHS does not have staff providing this oversight who actually know what midwifery care is or make an attempt to assess judgements in clinical care. This combination is at best folly, and at worst a structured attempt at eliminating legal midwifery from the state of AZ.
Beloved home birth consumers, you are the reason we are midwives, and you must be the ones to decide what kind of midwifery care you want and demand that systems are put in place that support your choices. When clients ask me, “Dear midwife, what can I do for you?” my response is “No, dear client, what can I do for you?” What sort of midwifery system do you want, who do you want to be in charge of your birth, what can you do to build and support that system?