Virginia Birth PAC

WEEKEND UPDATE - 2/14/09

Happy Valentine's Day!!!

HB 2163 with amendment passed unanimously on February 12th through the Senate Health Licensing Sub-Committee. The bill will be heard again next Thursday in the Senate Health Committee where it is expected to pass easily.

UPDATE - 2/10/09

Today HB 2163 was assigned to the Health Licensing Sub-Committee of the Senate Education and Health Committee.

In response to concerns voiced by many midwives and consumers, Delegate Lohr amended his bill. The language in this bill now reads as follows (updated wording is underlined):

require certified professional midwives to disclose to their patients, when appropriate, options for consultation and referral to a physician and evidence-based information on health risks associated with home deliveries including but not limited to special risks associated with vaginal births after a prior cesarean section, breech births, births by women experiencing high-risk pregnancies, and births involving multiple gestation.

Although this legislation remains redundant when compared to the professional requirements for CPMs, incorporating it into the Virginia statute may be helpful for a number of reasons. First, it will clarify the professional disclosure standards for consumers and birth professionals who may not otherwise be aware of them. Second, it sets an unprecedented legal disclosure standard that may benefit birth consumers. On behalf of birth consumers in Virginia, VA Birth PAC encourages all medical professionals to improve medical risk disclosures so consumers are better facilitated in making educated / informed choices.

As a result of the amended language and its potential for positive future implications, VABIRTHPAC is happy to support the amended bill.

NOW: Please take a moment to send Delegate Matthew Lohr a note in support of his amended bill ( delmlohr@house.state.va.us).

NEXT: Let the members of the Senate Education & Health Sub-committee on Health Licensing know that you support HB 2163 with the new amendment.

Chair:
Quayle, Frederick M. (R), District13@senate.virginia.gov
Members:
Lucas, L. Louise (D), District18@senate.state.va.us
Martin, Stephen H. (R), District11@senate.virginia.gov
Northam, Ralph S. (D), District6@senate.virginia.gov
Barker, George L. (D), District39@senate.virginia.gov

WEEKEND UPDATE - 2/7/09

HB 2163 passed the house on February 3rd with a vote of 95 yays and 3 nays.

On February 4th it was referred to the Senate Committe on Education and Health. Crossover is February 10th and members of the PAC Board and Advisory Board will be lobbying in support of HB 2163. After careful consideration and based on input from our Advisory Board we have changed our official position on this legislation. Although redundant, this legislation does not diminish consumer access to midwives or impact a midwife's ability to care for her client. Stay tuned for more information as the week progresses.

WEEKEND UPDATE - 1/29/09

HB 2163 & HB 2167 were unexpectedly on the docket this morning for the full committee. Becky Bowers-Lanier did an excellent job representing CMA and VABIRTHPAC with almost no notice!

HB 2163 passed with only one vote opposing. HB 2167 was laid on the table and killed. Great job everyone with contacting these members!!

Our friends were Rob Bell, Bobby Orrock, Joe Morrissey, Lionel Spruill (very surprising!), Kris Amundsen, David Englin. Robert Orrock moved to lay the bill on the table. Phil Hamilton was also excellent- a true friend to midwifery!

URGENT: Please email/call and thank these delegates for killing HB 2167. (Contact info below)

NEXT: The first reading of HB 2163 will be tomorrow- Jan 30th. If all goes as anticipated, the third and final reading will be Tuesday of next week, Feb 3rd.

Calls to the legislative hotline should continue:

1-(800)-889- 0229 (outside Richmond) or 698-1990 (Richmond area) 9am-5pm M-F. Ask that your delegates vote NO on HB 2163!!

STAY TUNED: We are strategizing on how to deal with HB 2163, the redundant informed consent bill, the hallmark of midwifery care. We will update you soon with the next steps for this bill and what we need from consumers.

HWI Committee:

Chair: Hamilton, Phillip A., - DelPHamilton@house.virginia.gov - R - 93rd District, County of James City (part); City of Newport News (part)
Members: Orrock, Robert D., - DelBOrrock@house.state.va.us - R - 54th District, Counties of Caroline (part) and Spotsylvania (part)
Bell, Robert B. - DelRBell@house.virginia.gov - R - 58th District - Counties of Albemarle (part), Fluvanna (part), Greene, and Orange (part)
Spruill Sr., Lionell - DelLSpruill@house.virginia.gov - D - 77th District Cities of Chesapeake (part) and Suffolk (part) Minority Caucus Vice Chair
Ebbin, Adam P. - DelAHowell@house.virginia.gov - D - 49th District Counties of Arlington (part) and Fairfax (part); City of Alexandria (part)
Englin, David L. - DelDEnglin@house.virginia.gov - D - 45th District Counties of Arlington (part) and Fairfax (part); City of Alexandria (part)
Amundson, Kristen J. - DelKAmundson@house.virginia.gov - D - 44th District County of Fairfax (part) Minority Caucus Vice Chair for Operations
Morrissey, Joseph D. - DelJMorrissey@house.virginia.gov - D - 74th District Counties of Charles City, Henrico (part), and Prince George (part); Cities of Hopewell (part) and Richmond (part)

UPDATE - 1/26/09

Hello Midwifery Supporters! Delegate Lohr is moving forward with HB 2163 & HB 2167. CMA lobbyist, Becky Bowers-Lanier, hopes to have more information on this Thursday. Regardless, it looks like we will have to be ready for some committee hearings next week. If it goes to sub-committee the earliest they would be heard is Monday February 2 at 5:00 PM (if they end up in sub).

THIS IS WHAT VABIRTHPAC NEEDS:

URGENT: Calls and letters, visits from constituents to subcommittee members. Make sure you let them know you are a midwifery consumer!!

Some of the legislators are confused thinking all these calls and emails are coming from the midwives. Remind them that consumers care deeply about this issue!!

The subcommittee members are:

If anyone has or knows of people who have relationships with these members we need to use them now.

O'Bannon III, John M. - DelJOBannon@house.state. va.us - R - 73rd District, County of Henrico (part); City of Richmond (part)

Nutter, David A. - DelDNutter@house. virginia. gov - R - 7th District Counties of Montgomery (part) and Pulaski (part); City of Radford

Frederick, Jeffrey M. - DelJFrederick@house.virginia. gov - R - 52nd District - District includes County of Prince William (part)

Peace, Christopher Kilian - DelCPeace@house.virginia.gov - R - 97th District Counties of Caroline (part), Hanover (part), Henrico (part), King and Queen (part), King William (part), New Kent, and Spotsylvania (part)

Spruill Sr., Lionell - DelLSpruill@house.virginia.gov - D - 77th District Cities of Chesapeake (part) and Suffolk (part) Minority Caucus Vice Chair

Howell Jr., Algie T. - DelAHowell@house.virginia.gov - D - 90th District

Armstrong, Ward L. - DelWArmstrong@house.virginia.gov - D - 10th District Counties of Carroll (part), Henry (part), and Patrick; City of Martinsville (part) Minority Leader

NEXT: Calls to the legislative hotline should continue:

1-(800)-889- 0229 (outside Richmond) or 698-1990 (Richmond area) 9am-5pm M-F. They have been coming in at a steady rate but over the next week we really need it to continue.

Still More: We have a group of HBAC moms on standby for these hearings. Be prepared to discuss what the informed consent process was like with your midwife compared to previous experiences with OBs. Also, your personal reasoning for choosing HBAC vs. OB care or repeat cesarean based on the research that you had.

Stay Tuned: The VA BIRTHPAC will be sure to keep you updated on the daily progress of these bills and what we need from consumers. Thanks again for your efforts!

WEEKEND UPDATE - 1/24/09

What is needed right now, as a follow-up to a meeting with Delegate Lohr on Friday, is outlined below. Delegate Lohr appears to want to keep HB 2163 (the informed consent for "special risk"/"high risk" which includes VBAC, twins, breech, however one may interpret "high" or "special" risk). He holds to this bill despite being informed that Licensed CPMs already are required to give Informed Consent, and so such situations are already covered; he has received no complaints from his constituents that LMs are not giving adequate informed consent, only the complaints of a few OBs whose opinion is that LMs are attending high risk mothers. Delegate Lohr is going to think about what to do about HB 2167 over the weekend (the Medicaid bill that bans payment to LM Medicaid providers for attending VBAC Medicaid moms)

This is what VABirthPACneeds:

HBACers ready to speak to the Health, Welfare, and Institutions (HWI) committee (could be as early as Thursday - date is unknown at this time) (Email Sara doulabelly@yahoo.com)
Consumers need to target their email and calls to members of the HWI committee (districts listed, below) in opposition to HB 2163 and HB 2167, sticking to the fact that midwifery clients engage in a series of discussions over their pregnancies with their midwives on the risks associated with pre-existing conditions and that they make their decisions based on evidence presented to them of the risks and benefits. Therefore, additional requirements on informed consent are not required.
Women who have had an HBAC should email HWI members with their reasons for choosing HBAC, if they were told about the risks associated with HBACs versus C-section and why they made the decision for HBAC. If they talked with obstetricians about having a HBAC in hospital, why they chose a midwife instead of an obstetrician, and so forth.
A doc to speak up on behalf of killing the VBAC bill (HB 2167). Dr. Marsden Wagner was suggested. Anyone else who would possibly do so?

HWI Committee:

Chair: Hamilton, Phillip A., - DelPHamilton@house.virginia.gov - R - 93rd District, County of James City (part); City of Newport News (part)
Vice Chair: Nixon, Samuel A., Jr.
Members: Orrock, Robert D., - DelBOrrock@house.state.va.us - R - 54th District, Counties of Caroline (part) and Spotsylvania (part)
Nixon, Samuel A., Jr. - DelSNixon@house.state.va.us - R - 27th District, County of Chesterfield (part)
O'Bannon, John M., III - DelJOBannon@house.state.va.us - R - 73rd District, County of Henrico (part); City of Richmond (part)
Bell, Robert B. - DelRBell@house.virginia.gov - R - 58th District - Counties of Albemarle (part), Fluvanna (part), Greene, and Orange (part)
Athey, Clifford L., Jr. - DelCAthey@house.state.va.us - R - 18th District, District includes Counties of Fauquier (part), Frederick (part), and Warren
Nutter, David A. - DelDNutter@house.virginia.gov - R - 7th District Counties of Montgomery (part) and Pulaski (part); City of Radford
Frederick, Jeffrey M. - DelJFrederick@house.virginia.gov - R - 52nd District - District includes County of Prince William (part)
Peace, Christopher Kilian - DelCPeace@house.virginia.gov - R - 97th District Counties of Caroline (part), Hanover (part), Henrico (part), King and Queen (part), King William (part), New Kent, and Spotsylvania (part)
Crockett-Stark, Anne B. - DelACrockett-Stark@house.virginia.gov - R - 6th District Counties of Bland, Giles (part), Pulaski (part), Tazewell (part), and Wythe (part)
Pogge, Brenda L. - DelBPogge@house.virginia.gov - R - 96th District Counties of James City (part) and York (part); City of Newport News (part)
Massie III, James P. - DelJMassie@house.virginia.gov - R - 72nd District County of Henrico (part)
Merricks, Donald W. - DelDMerricks@house.virginia.gov - R - 16th District Counties of Henry (part) and Pittsylvania (part); City of Martinsville (part)
Spruill Sr., Lionell - DelLSpruill@house.virginia.gov - D - 77th District Cities of Chesapeake (part) and Suffolk (part) Minority Caucus Vice Chair
Sickles, Mark D. - DelMSickles@house.virginia.gov - D - 43rd District County of Fairfax (part) Minority Caucus Secretary
Ebbin, Adam P. - DelAEbbin@house.virginia.gov - D - 49th District Counties of Arlington (part) and Fairfax (part); City of Alexandria (part)
Howell Jr., Algie T. - DelAHowell@house.virginia.gov - D - 90th District
BaCote, Mamye E. - DelMBaCote@house.virginia.gov - D - 95th District Cities of Hampton (part) and Newport News (part)
Englin, David L. - DelDEnglin@house.virginia.gov - D - 45th District Counties of Arlington (part) and Fairfax (part); City of Alexandria (part)
Armstrong, Ward L. - DelWArmstrong@house.virginia.gov - D - 10th District Counties of Carroll (part), Henry (part), and Patrick; City of Martinsville (part) Minority Leader
Amundson, Kristen J. - DelKAmundson@house.virginia.gov - D - 44th District County of Fairfax (part) Minority Caucus Vice Chair for Operations
Morrissey, Joseph D. - DelJMorrissey@house.virginia.gov - D - 74th District Counties of Charles City, Henrico (part), and Prince George (part); Cities of Hopewell (part) and Richmond (part)

ACTION REQUIRED NOW!! - 1/18/09

Delegate Lohr informed Brynne Potter, CPM that he intends to pull HB 2163 from the docket and amend HB 2167 to specify restriction of Medicaid reimbursement for VBAC as opposed to "high-risk" deliveries. Read Brynne Potter's letter to Delegate Lohr concerning concerning this legislation and then write your own!

ACTION ALERT and UPDATE: Oppose HB 2167 in the Virginia House of Delegates

UPDATE: Delegate Lohr agrees to pull HB 2163 and plans to amend HB 2167

Thanks to all who called and wrote Delegate Lohr on Friday educating him about midwifery care and asking him to pull these bills from the docket, Delegate Lohr has pledged to pull HB 2163, a bill that would have amended the CPM statute. In his response to CMA Policy Coordinator Brynne Potter, Delegate Lohr indicated that he plans to amend HB 2167 to specify the restriction for Medicaid reimbursement to women who seek VBAC deliveries at home with CPMs. You can read Brynne’s response to Delegate Lohr here.

ALERT: Now is the time to email Del. Matt Lohr delmlohr@house.virginia.gov to ask him to reconsider pursuing HB 2167, which would restrict Medicaid VBAC reimbursement to CPMs.

If you are Del. Lohr's constituent, you can also call his office Monday at 804-698-1026 asking him to withdraw the bill. If you're unsure about whether Del. Lohr is your delegate, find out who your delegate by clicking here.

What is wrong with HB 2167? You can use any of these arguments in your email. Select the ones that work for you.

Facts on VBAC

Policies are not based on evidence but in the context of liability concerns, financial benefit and time management issues.

Women have the right to informed consent and informed refusal of care. VBAC is not a procedure but a physiological end of a pregnancy. A cesarean section is a procedure.

Creating strict regulations on whom CPMs can attend could potentially increase transport rates to hospitals and threaten the safety of families who choose home birth in Virginia because a trained professional is not in attendance.

normal VBAC birth.

Women in midwifery care have a VBAC rate of 80-90% compared to obstetrical rates of 40-50%. This is because midwifery care is based on evidence and supports birth to proceed normally.

The safety of VBAC has been well documented. The British Medical Journal in 2004 stated a uterine rupture rate of 0.2% for a spontaneous VBAC. The rupture rate more than doubles when obstetricians induce and augment mothers in the hospital.

Facts on the CPM licensing statute

The General Assembly passed the CPM licensing statute in 2005 because women were already choosing to birth at home with or without qualified providers to attend them. Licensing midwives was one mechanism by which the State could protect the public from unqualified midwives.

Facts on consumer choice of midwives

Consumers make informed decisions to birth at home and have created the mandate for midwives to attend them.

Women want access to their choice of birthplace and provider. When you take away the option of birthplace, you are forcing women to choose between no care and an unassisted VBAC. Many women admit to choosing unassisted birth when a provider is not available.

Facts on the midwifery model of care

do not induce or augment labors.

Facts on the medical model of care related to cesarean section

31.6% are giving birth

via cesarean section

World Health Organization

15% cesarean rate.

Risks are accepted without questions in other pregnancy situations. Amniocentesis for example, has a 1-1.5% miscarriage rate and a 1% rate for complications that include infection, premature labor, and injury to the fetus, cord or placenta. Yet obstetricians advocate for this test for all women over 35.

risks of cesarean for both mother and baby

5 to 7 times the risk of death with cesarean section compared with vaginal birth

The March of Dimes released its Premature Birth Report Card for Virginia and the nation in November 2008 and gave Virginia a “D”.

repeat cesarean.

ectopic pregnancy, placenta previa

Facts on Medicaid Access

This legislation discriminates against low-income women.

This is a bill intended to discourage VBAC, thereby mandating surgical deliveries to women with prior c-sections in Virginia communities.

Thanks for your attention to this matter! You are preserving the rights of consumers to birth where and with whom they choose by making their own evidence-based decisions!!

ACTION ALERT - 1/15/09

Anti-Midwifery Bills in the Virginia House of Delegates: HB 2163 and HB 2167

Please take action now to stop two bills introduced into the House to limit the practice of Certified Professional Midwives. These bills have been introduced by Delegate Matthew Lohr - Harrisonburg.

URGENT: Please send him an email TODAY telling him that you would like him to pull these bills from the docket and to work to help increase access to midwives, rather than restrict it. You can also call his office: (804) 698-1026.

NEXT: Contact your legislators and tell them that you oppose HB 2163 and HB 2167. You can visit the VA Birth PAC to find out who your legislators are and register to receive updates on this important issue.

STILL MORE: Contact everyone you know who lives in the Harrisonburg area. Ask them to contact Del Lohr TODAY to express their concerns about these bills. He filed these bills for a single constituent, he needs to hear from 50 who oppose them.

STAY TUNED: We will be sending updates through all available channels. If you are not registered with the VA BirthPAC , please do so NOW! We need all of our voices united! More info about these bills:

HB 2163, is a bill to amend § 54.1-2957.9 (the CPM statute).

What is wrong with it:

The proposed legislation would add an amendment requiring midwives to give informed disclosure to their clients about the risks associated with home deliveries and with some specific pregnancy conditions. This legislation is redundant to the existing statute that already requires that licensed midwives in Virginia hold the designation of Certified Professional Midwife (CPM) and practice according to the standards of the National Association of Certified Professional Midwives.

CPMs are required by their certification to give a written informed disclosure regarding their experience, training, and the risks and benefits of home birth to every client at the beginning of care.

The NARM Job Analysis (cited in the VA statute) specifies the principles of informed consent and the conditions that may require additional education and informed decision making. The conditions cited in HB 2163 are included in this list.

The NACPM standards of practice (also cited in the VA statute) refer to informed consent and requirements for education and information of CPM clients.

The Virginia Licensed Midwife regulations already require that informed consent be obtained before any invasive procedure is performed.

Our biggest concern is that by opening the CPM statute, we will be vulnerable to other amendments that will not be redundant.

HB 2167 is a bill to require the Board of Medicine and the Department of Medical Assistance Services to review regulations and policies to ensure that no reimbursement is made to certified professional midwives providing services in high-risk situations, including high-risk home deliveries.

What is wrong with it:

This legislation is discriminatory to low-income women. Any woman who qualifies for Medicaid is designated "high-risk" based on her socio-economic status. Midwifery care, by way of its hallmarks of increased education, support, and respect, has been proven to benefit women who are at risk for pregnancy complications. Evidenced-Based Care does not support restricting access to home birth to women based on perceived risk. This is a bill intended to discourage VBAC, thereby mandating surgical deliveries to women with prior c-sections in some Virginia communities.

Thank you for your time and attention to this important issue. We have accomplished so much together, let's not let anyone take away what we fought so hard to obtain!

2008 Action Alerts

Dear Mothers, Midwives, and Birth Choice Advocates-you may already be aware that there is a critical threat to access to home birth in Virginia. After a mere 3 years of licensure, the scope of practice of Certified Professional Midwives is in jeopardy.

On Thursday, February 21, the Virginia Board of Medicine voted to initiate a review of regulations for Licensed CPMs with a focus on adding specific restrictions on which women/babies will be "allowed" to have a CPM attended home birth. This decision was not based on any evidence of a problem, but on two letters sent to the Board by maternity care providers with no experience in home birth, or knowledge about the CPM credential.

In restricting access to home birth for women who make informed decisions concerning their own health care, the Board of Medicine is supporting a process of eliminating choice for women.

There are many critical points along the way where the voice of the public not only must be heard, but can actually stop this threat in its tracks! Please take action right now and then forward this request to everyone you know who cares about autonomous decision making in health care.

Urgent Action:

The first step in a NOIRA (Notice Of Intention for Regulatory Action) is for the Board of Medicine to send it to the Governor for approval. Therefore, the Governor needs to hear from the public RIGHT NOW. Please let him know that, as a citizen of the Commonwealth, you support the practice of midwifery by CPMs and that you are satisfied with the current regulations that allow for autonomous discretion by the midwife and her client regarding acceptance into care.

Address your letter to:

Office of the Governor Timothy M. Kaine

Commonwealth of Virginia

Patrick Henry Building, 3rd Floor

1111 E. Broad St.

Richmond, VA 23219

Points to make in your letter (please choose one or two of these and then add your own to make it personal):

The General Assembly passed the CPM licensing statute in 2005 because women were already choosing to birth at home with or without qualified providers to attend them.
The CPM statute specifically states that no women can be forced to see a physician during their care.
The current C-section rate in Virginia is 32.91%, as compared to the WHO recommendation of 10-15% and a national average of 31.1%.
Forcing women to have a baby in the hospital cannot be done. By restricting the practice of CPMs, the BOM will be re-creating an unsafe situation. Women who want to resist the threat of unnecessary, non evidence-based care will likely once again choose to birth at home without skilled attendants to monitor them and their baby. Restrictions such as those proposed will essentially be a requirement for CPMs to abandon their clients in specific situations.

You can view the CPM statute and regulations here:

CPM Statute

Regulations

Please send your letter to the Governor right away. We suggest you also send a copy of your letter to each of your legislators. You can find out who your legislators are by visiting the Virginia Birth PAC website, or visit the Virginia General Assembly website.

Thank you for your continued support of midwifery and access to care. In three short years some have forgotten what VA families are willing to do to maintain their rights and freedoms.

For more information on this issue, please join our mailing list or visit the Background Summary.

Thank you for your continued support and attention-

Brynne Potter, CPM

Julia Martin, CPM

Policy Coordinators - Commonwealth Midwives Alliance

VA Birth PAC

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