AzDHS “training” on coercion

So today, AzDHS held a three hour “training”. Here are some of the more confusing or interesting gems AzDHS gave today:

Our goal is compliance.

Midwives are supposed to let you know in informed consent at start of care that we have to force you to do certain things.

Our goal is compliance.

You must periodically have a vaginal exam. Period. Every time your midwife assesses your labor, she has to do a vaginal exam. Required. All clients, not just VBAC and breech. You cannot refuse.

Our goal is compliance.

If you are in labor and refuse a vaginal exam, we have to force you. We cannot leave you during labor but we also have to terminate care if you decide not to have a vaginal exam. How to resolve this conflict was never answered.

Our goal is compliance.

The survey monkey report is not for regulation, it is just for ensuring compliance with the rules. (Re read that several times if you want, it will not become clear).

Our goal is compliance.

All clients must get a syphilis test before 28 weeks, citing ARS 36-693. If you do not, we cannot legally continue midwifery care.

Our goal is compliance.

All clients have NO right to decline weight, bp, pulse, urinalysis, edema assessment, measurement of fundal height, listening to fetal heart tones,  and palpation to find baby position AT EVERY PRENATAL VISIT.

Our goal is compliance.

All clients must attend prenatal visits every four weeks until 28 weeks, every 2 weeks between 28-36 weeks, and weekly from 36 weeks until birth. Get sick, go on vacation, don’t feel like seeing your midwife today – too bad.

Our goal is compliance.

The survey monkey reporting form is for “quality data collection”. Ha!

AzDHS says they are not trying to audit charts. Hmmmmm, they just enjoy browsing through hundreds of your records?

AzDHS is claiming that administrative staff and a couple RNs are better at reviewing your charts than the midwives on the midwifery advisory board established in the 2013 rules rewrite.

Midwives are required to notify the closest hospital that you are in labor, and when your baby arrives, if the hospital policy requires. How your midwife is to know hospital policy is still a mystery.

Any call to 911 requires us to terminate care. Any transfer to the hospital or physician, with few exceptions, requires us to terminate your care. Even if you are stable. Even if EMS or the hospital says return to care with your midwife.

Which of the rules clients can decline were decided according to what determines high versus low risk pregnancies. Diabetes screening is optional, weight is not. Explain that.

If you have ever been diagnosed with a mental illness, you cannot hire a midwife. Stability doesn’t matter, documented diagnoses does. (Ever try to lose a diagnosis?)

There was a very blatant threat that if we mess with the survey monkey, they will yank our licenses.

We (AzDHS) didn’t do our job before. 🙂

Let us get back to you on that.
Let us get back to you on that.
Let us get back to you on that.
Let us get back to you on that.
Let us get back to you on that.
Let us get back to you on that.
Let us get back to you on that.
Let us get back to you on that.
Let us get back to you on that.
Let us get back to you on that.
Let us get back to you on that.
Let us get back to you on that.
Let us get back to you on that.
Let us get back to you on that.
Let us get back to you on that.
Let us get back to you on that.

…………………………………………………………
Oh and just as a side note, the best summary of the midwives response to the department was made by Paula Matthews, LM when she said,  and this is my paraphrase…

I think you would clear up a lot of confusion if you simply stated that you are NOT interested in safey, but only whether or not we follow the rules.

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About One Arizona Midwife

I am a currently practicing, licensed midwife (LM) in Arizona.
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9 Responses to AzDHS “training” on coercion

  1. April Pak says:

    Coercion has no place in informed consent. Period! This is so asinine on so many levels. Time to put a bill on the ballot to strip these jerks of their so called jurisdiction if it can’t be proven that their actions are impairing public health and illegal.

  2. This is heartbreaking and scary! and if I didn’t trust this site I would be tempted to say it was made up, it is that unbelievable.

  3. melody fisher says:

    Those of us trying to listen in (,which was difficult and we missed most of what was said), were frustrated by the whole meeting. If they dont even know what they mean, how are we suppose to know what they mean? The survey monkey has been flawed from the start. To say that files are being requested to clarify is ridiculous, clarification could be a phone call to ask a question to clarify, not a whole chart to review..
    .

  4. Delilah says:

    Where is the patients rights to self determine care? It used to be battery if a health care provider forced anything on a patient or touched them without explicit consent, forcing them to consent under duress is actually the same thing. Has this law changed? It used to be abandonment if a midwife or caregiver left a woman alone in labor or didn’t show up at all. Will AZDHS represent the midwife if this presents a legal problem for her? Is AZDHS obligated to comply with federal laws that are already in place or can they make rules that may conflict with them? This seems to be the direction health care is traveling and its just one more way of taking away ones personal freedom. Doctors are dropping patients all the time for not complying with vaccines and procedures. Parents are loosing their children to CPS if they ask for a second opinion. It seems this is a human rights issue rather than a law to keep midwives in check. Informed consent on the medical side is almost non existent today as most doctors simply only represent their own opinions. Midwives have traditionally been known to be advocates of education, information and presenting choices to women. Is there a study in place that shows more vaginal exams in labor result in better outcomes that these violations/rules are based on? I just want to know what sound statistical information they are using to base these new rules on.

    • Delilah, AzDHS would claim that you still have the right to self-determined care, just that if you do not agree to these requirements, you cannot legally hire a midwife.

      It is still battery for a care provider to force any procedure, test, etc on you without your expressed non-coerced consent. It is still abandonment for a care provider to leave you simply because you decline to agree with the state demands. AzDHS would still like your midwife to coerce you or abandon you if you do not agree to every ‘required’ test or procedure on their list of rules.

      There is NO study that shows that vaginal exam improve outcomes. There are plenty that show routine vaginal exams increase risk and unnecessary intervention. Why this was left in the new version of rules when AzDHS had ample evidence it should have been removed is unknown. They are not basing their rules on any sound statistical information.

  5. Pingback: Birth Monopoly | Arizona Birth Monopoly: Mandatory Surgery or Forced Vaginal Exams

  6. Pingback: Midwifery, the law, and ethics | One Arizona Midwife Speaks

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