Sweet Home Births in Alabama: Fighting to Legalize Midwives in the State

This essay will explore why consent and confidentiallity is important in midwifery practice. It will look into why it is needed and what can happen if these aspects are breeched in anyway. The National Health service was founded in 1948, this brought free healthcare to everyone. In 1902 the Midwives act becomes a law and midwifery became an established profession, fast forward to 2004 the midwives rules and standards are published and then amended in 2012 and in 2008 the code of conduct was brought into practice. These publications are legal documents in which all nurse and midwives must abide by. In these documents there are clear rules that surround both consent and confidentiality (NHS Choices 2014)

The Australian College of Midwives believes that it is the right of every pregnant woman to have access to continuity of care by a known midwife for her pregnancy, labour and early postnatal period. Midwives are the most appropriate primary care providers for healthy mothers and newborn babies and are able to refer to specialist medical care if the need arises (Hicks, Spurgeon & Barwell, 2003). Midwives must work within the competency standards enforced by The ANMC Australian Nursing & Midwifery Council (2006) in order to obtain and practice as a registered midwife in Australia. Competency 4 states Midwives should “promote safe and effective practice” (ANMC, 2006), this is achievable by providing Midwifery continuity of care to women and

“Texas’s new strict legislation is already forcing women to leave the state in order to receive medical services in neighboring states more sympathetic to their desires to obtain an abortion (Hagle).” This is causing many problems for expectant mothers, especially those who have preexisting genetic medical conditions. Many time a mother may have some type of illness that can be given to a fetus during pregnancy. Sometimes these issues are seen during a routine ultrasound and sometimes there are not noticed until the time of birth. This is causing woman who live in the state of Texas to have to cross state lines when they find out something is wrong with their baby and choose to terminate the pregnancy.

Provide full antenatal care including the screening tests in the hospital, community and at home.

The section of the law mandates that abortion doctors ought to have registration at a standing hospital in case of an emergency. However, organizations have filed suit against the enactment of the law before it came into action on October 29, 2013, including the Planned Parenthood Federation of America, the Center for Reproductive Rights, the American Civil Liberties Union and clinic owners (“American Civil Liberties”). Based on Erik Eckholm’s New York Times article “Judge in Texas Partly Rejects Abortion Law,” once the law was taken into court, Judge Lee Yeakel of United States District Court in Austin, Texas blocked part of the law based on "the act's admitting-privileges provision is without a rational basis and places a substantial obstacle in the path of a woman seeking an abortion of a nonviable fetus.” Although the majority of Texans stands against abortion they still ought to respect women’s reproductive rights.

While the fight to legalize abortion, for reasons other than a mothers health concerns, was won, states such as Texas are now reconsidering the regulations, which go along with such right. In 2004 the State of Texas introduced the Woman’s Right to Know Act, which “requires that all abortions at or after 16 weeks’ gestation be performed in an ambulatory surgical center (ASC)” (Colman, S., & Joyce, T. (2010), p. 775). Roe V Wade’s Supreme Court decision makes it federal law that abortion be legal, therefore the state of Texas cannot make a law specifically prohibiting abortions around this time. However, they can implement acts such as the one discussed above to hinder a women’s access to such rights. By implementing the Woman’s Right to Know Act, the state of Texas is allowing abortion, however it makes access to it within the state of Texas out of reach for the majority of women. In the time following the effect of this law “not one of Texas’s 54 nonhospital abortion providers met the requirements of a surgical center” (Colman, S., & Joyce, T. (2010), p. 775. Following that, a

This report will evaluate the roles and responsibilities of a midwife. “Midwifery encompasses care of women during pregnancy, labour, and the postpartum period, as well as care of the new-born.”(WHO, 2015) This is a recent definition and clearly points out that a midwife has many roles and responsibilities. The NMC Codes of Conduct will be evaluated with specific emphasis on recent changes within healthcare. These changes took place as a result of the tragedies at Mid-Staffordshire Hospital in 2005-2009 and are the outcome of the Francis report in order to improve care given to patients.

However, Ricki Lane, the producer of the film, “The Business of being Born,” hopes that viewers will see that economically, births out of hospitals and at home is cheaper with a midwife, who will charge their patients only $4,000 for everything, including post-natal care. Whilst, a normal vaginal birth can cost up to $13,000, and a birth with multiple drugs involved, which typically leads to C-Section costs up to $35,000. However, with the American Medical association’s relationships with the hospitals and insurances, they are actually discouraging home births and midwifery, when the truth is that, statistically, it is safer and cheaper with home births and midwifes. It kind of makes you wonder just what exactly is on their agenda when it is a common practice to give births at home in both, developing and under developing countries, and has been for hundreds of years.

Prosecutors said the midwife in Utah had reassured the parents that she could deliver premature twins safely at a birth center in 2012, but when one baby was born purple and unable to breath she tried to treat him with outdated techniques instead of going to the hospital right away. A Cedar City midwife convicted of manslaughter in connection with the 2012 death of a premature infant was sentenced to probation and 180 days in the Iron County Jail Tuesday. More than 30 friends, supporters, family members and past clients sobbed quietly and gasped as the clerk read the guilty verdict. Prosecutors argued she began the delivery of the first child, who was approximately two months early, at her birth center without the proper skills or equipment

As well as being notated as ‘eligible’, to work as a eligible midwife in private practice an eligible midwife must work in collaboration with a medical practitioner (Queensland Nurses Union, 2010). The Queensland Nurses Union (2010) explains that legislation specifies that eligible midwives working in private practice must operate under one of four collaborate models of care. These four collaborative models are as follows: Eligible midwives may be employed by an obstetric practitioner or an entity that employs an obstetric practitioner; eligible midwives may accept a written referral from a specified medical practitioner; eligible midwives may obtain a written agreement with a specified medical practitioner; or eligible midwives may have an arrangement with a specified medical practitioner (Queensland Nurses Union, 2010). The Queensland Nurses Union (2010) is concerned that this legislation will limit the ability for eligible midwives to work in private practice as unless eligible midwives are employed by medical practitioners, have women referred to them by a medical practitioner, or have an agreement with a medical practitioner, they will unable to work in private practice. Newnham (2010, p. 245) describes this as ‘creating a maternity service that is entirely within medical parameters, while seeming to advance midwifery models of care’

According to “Human Sexuality: Diversity in Contemporary America,” women and couples planning the birth of a child have decisions to make in variety of areas: place of birth, birth attendant(s), medication, preparedness classes, circumcision, breast feeding, etc. The “childbirth market” has responded to consumer concerns, so its’ important for prospective consumers to fully understand their options. With that being said, a woman has the choice to birth her child either at a hospital or at home. There are several differences when it comes to hospital births and non-hospital births.

Professional Ethics in midwifery practice is a book speaking about just that, professional ethics within the field of midwifery practice. This book addresses what ethics actually are and how they apply to the profession today. Ethics are not tied into religion rather are the moral way for professionals to interact with their clients regardless of background, religious beliefs or ethnicity. Ethics are relevant in field of the healthcare system. Ethics serve to protect both the midwife and the client by helping the profession of midwifery be a trustworthy one. If the profession is trustworthy it builds the client’s confidence of the profession. Within the topic of ethics there are four broad topics. The first being the respect of autonomy, which

NMC (2008) The Code: Standards of conduct, performance and ethics for nurses and midwives. London: Nursing and Midwifery Council

According to the American College of Nurse-Midwives (ACNMb) (2015), home births account for 1.4% of all births in the U.S. In eight years the number of home births in the US increased by 41% (ACNM, 2015b). Providing home births falls within the scope of practice of midwives and is supported by the American College of Nurse-Midwives (ACNM, 2015b). A mother can have the option of a home birth as long as the home birth follows regulations set in place by the state and can provide a favorable safe environment for both mother and newborn (ACNM, 2015b). Both the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) state that the ultimate decision of having a home birth is a patient’s right, especially if she is medically well informed (Declercq, & Stotland, 2016).

MD Marden Wagner said, “In every country where I have seen real progress in maternity care, it was woman’s groups working together with midwives that made the difference.” The Marriam Webster dictionary defines midwifery as “The art or act of assisting at childbirth”. The definition is a spot-on explanation. Midwifery is not very broad; it’s pinpointed as a specific job with detailed instructions that only deal with pregnancies. Many will argue to say that midwives only work with women who are having “normal-pregnancies”.(Goer, 2002). Normal pregnancies include a healthy mother and fetus, with no complications. “Approximately 10% - 30% of pregnant women will experience Bacterial Vaginosis (BV) during their pregnancy. An ectopic pregnancy happens in 1 out of 60 pregnancies. About 1% of all pregnant women will experience placental abruption, and most can be successfully treated depending on what type of separation occurs.” (Pregnancy Complications). Everyone is different, they handle pain in different ways, they have diverse fingerprints, they all have their own unique genetic material; evidently all pregnant women will experience each pregnancy they have differently from themselves and from other women. Many people will argue about the authenticity of a Certified Nurse Midwife’s education however, in reality “Certified Nurse-Midwives (CNM) are registered nurses, with a minimum of a