informed consent homebirth & women s health

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1 informed consent Informed Consent for Homebirth with Karen Webster, CPM, LM In choosing home birth, I,, understand that I am taking primary responsibility for all decisions, procedures and outcomes regarding my prenatal, birth and postpartum care. I acknowledge that I am contracting for the services of Karen Webster, CPM. I understand that my midwife provides care for women who have normal, uncomplicated pregnancies and expect a normal delivery of a healthy child. I understand it is the policy of my midwife to attend home births between 37 and 42 weeks of pregnancy. Births occurring within this gestation period are normally considered low-risk. I understand that even with the most attentive care during the prenatal period, unpredictable medical problems may arise during pregnancy or childbirth. Because some of these problems may place myself or my child at risk, transfer to a physician and/or hospital may be necessary. The following situations are considered high risk. If they occur during my pregnancy I will need to reconsider my decision to have a home birth. They include but are not limited to the following: Q diabetes Q hypertension (high blood pressure) Q preterm labor Q twins Q breech presentation Q active genital herpes Q preeclampsia Q Rh negative mom with a Q Preterm premature rupture positive antibody screen of membranes The following complications may occur during the labor and birth process. They include but are not limited to: Q fetal distress Q retained placenta Q placenta previa Q stillbirth Q prolapsed cord Q uterine rupture Q placental abruption Q excessive blood loss Q severe lacerations Q congenital anomalies I understand that any of these situations could lead to permanent injury and/or death to myself or my child. I understand that Karen Webster, CPM, carries the following equipment, supplies, and medication with her during a homebirth: Q Oxygen Q Bag and Mask for Neonatal Resuscitation Q IV Therapy Equipment Q Basic Anti-Hemorrhagic Medication Q Fetoscope and hand-held Doppler Q Urinary Catheters Q Vitamin K for newborn blood clotting Q Erythromycin ointment for newborn infection prophylaxis Q Suturing Supplies (suture and lidocaine) Q DeLee catheter for deep suction of the newborn if necessary as in the case with passage of meconium

2 informed consent I understand that Karen Webster, CPM does NOT have the following equipment, supplies and medication with her at a homebirth: Q Pain Medication including epidurals or narcotics Q Surgical equipment beyond that needed for basic suturing Q Forceps or Vacuum Q Continuous Fetal Monitoring Equipment Q Blood for transfusions I understand that Karen Webster, CPM is NOT licensed in the states of PA, MD, DE or NJ and DOES NOT carry medical malpractice insurance. Karen Webster is licensed in the state of Virginia. I understand that Karen Webster, CPM does NOT have formal physician back up and that it is my responsibility to make specific arrangements for back up medical care and/or consultation in the case of complications arising during my pregnancy, labor, or in the postpartum period. Karen Webster, CPM will discuss the range of options for making these arrangements, and assist me if I request it in developing my plan, but I understand that it is my responsibility to establish a care relationship within the medical system by the 30th week of pregnancy. These arrangements will be documented in my chart. I consider myself healthy and to be a good candidate for a home birth and agree to inform the midwife of any changes in my health status over the course of my pregnancy. I agree to choose a health care provider for my baby (e.g. family practice doc, pediatrician, nurse practitioner, naturopath) by the 36th week of pregnancy. I hereby release Karen Webster, CPM and her assistants from all liability for complications which may arise during the course of my pregnancy, birth, or postpartum as a result of my decisions and my choice to birth my child at home. I acknowledge that I have thoroughly read and understood this document. I further acknowledge that I have had an opportunity to have any questions answered regarding the benefi ts and risks specific to homebirth. I HAVE READ AND UNDERSTAND THE ABOVE STATED MATERIAL. Client name: Signature: Date: Partner name: Signature: Date:

3 Karen Webster, CPM, LM I, Karen Webster, CPM, LM offer you a statement of my philosophy of midwifery care, and a summary of my education and experience as it relates to midwifery. What is a midwife? Midwife means with woman. A midwife provides comprehensive care and education for women and their newborns, encompassing their physical and emotional needs and fostering self-determination throughout the childbearing year. Midwives practice in home, birth center and hospital settings. Midwives worldwide have an excellent record of safety with numerous studies associating midwifery care with excellent outcomes. In the five nations with the world s lowest infant mortality and lowest rates of technological intervention, midwives attend 70% of all births without a physician in attendance. The Midwifery Model of Care The Midwifery Model of Care is based on the fact that pregnancy and birth are normal life processes. The Midwifery Model of Care includes: Monitoring the physical, psychological, and social well-being of the mother throughout the childbearing cycle; providing the mother with individualized education, counseling, and prenatal care; continuous hands-on assistance during labor and delivery, and postpartum support; minimizing technological interventions; and identifying and referring women who require obstetrical attention. The application of this woman-centered model of care has been proven to reduce the incidence of birth injury, trauma, and caesarean section. A Direct-Entry Midwife (DEM), also often referred to as a lay or traditional midwife, is a midwife who enters the profession directly, getting her education/training through an apprenticeship or by attending a formal midwifery education program. The North American Registry of Midwives (NARM) has developed a certification process which provides an International Credential that promotes the Midwifery Model of Care. A midwife who has been certified through this process is a Certified Professional Midwife (CPM). This is the only midwifery credential that requires experience in an out-of-hospital setting. There is also a new direct-entry credential created by the American College of Nurse Midwives, called the Certified Midwife (CM) which involves a course of study similiar to that of nurse midwives but without the requirement to first become an RN. A Certified Nurse Midwife (CNM) is a midwife who has obtained his/her education & certification by first becoming a Registered Nurse, and then completing a formal course of study approved by the American College of Nurse Midwives, usually a one two year course, after which one can earn certification as a Nurse Midwife, often by obtaining a Master s Degree in Nursing. I am a Direct-Entry Certified Professional Midwive. I have completed the North American Registry of Midwives certification process. As a midwive who attends homebirths, I assist in natural childbirth only. I am not a doctor and I am not a nurse. I have chosen to practice independently because I do not accept the definition of Midwifery as the practice of Medicine or Nursing. I believe that Midwifery, Nursing & Medicine are separate disciplines, and that the laws and health care system need to be corrected to reflect midwifery s unique role in providing high quality, cost-effective care for mothers and families. I believe that midwifery services, in every practice Initial

4 ...continued setting, should be promoted and protected as the Standard of Care for every woman. A parent may choose any place to give birth; to give birth at home is not illegal. However, the autonomy of parents in making a decision for their care as it relates to pregnancy and childbearing is being challenged in a number of court cases around the country. In addition, the legal status of practicing as a Direct-Entry Midwife varies from state-to-state ranging from being designated as illegal and a felony offense, to being legal, licensed and eliglible for Medicaid reimbursement. We will discuss the legal and political climate for the state you are in, how to refer to and/or describe your birthing plans and midwifery care with friends and other interested parties, and answer any questions or address concerns that you may have regarding these issues. I also believe that the laws and political and cultural environment, as well as policies for insurance coverage, will only change to be more supportive of midwifery and birthing rights if parents demand it. We encourage you to get involved with promoting the Midwifery Model of Care and homebirth as a vital and central part of the health care system for mothers and babies. My Philosophy I am committed to compassionate, women-centered care in which both midwife and mother are actively engaged in the decision-making process. I believe that pregnancy and birth are healthy and normal events in a woman s life. As a midwive I offer my skills, experience and loving attention as well as my deep trust in and respect for the birth process. I feel that it is my honor and responsibility to nurture and create a safe space for the women I serve during the journey to motherhood. I recognize that in pregnancy, many women experience great physical, emotional, social and spiritual changes, and it is my intention to support women and families in this time of transformation. I expect that mothers choosing homebirth are willing to take responsibility for their own health and well-being and that of their baby. It is my hope that in doing so, women will discover the power and potential that birth holds, and carry it with them throughout their lives. I also believe that we need more midwives in this country and are committed to the apprenticeship model of midwifery training and to working with students in my practice. With your permission and under supervision, a student will participate in your care throughout your pregnancy, birth, and postpartum period. Education, Training and Experience Karen Webster, CPM I have been involved in birth as an attendant since I was drawn to midwifery through the births of my own children. I am the mother of 8 children, 6 of whom were born at home, and Nana to 5 homeborn grandchildren. I have received training from both Certified Nurse Midwives and Traditional, Direct-Entry Midwives, and attended homebirths with a CNM and several direct-entry Midwives for nine years. During that time I also taught Bradley Childbirth classes and was able to provide labor support in all practice settings for many of the couples I taught. I have been practicing as a homebirth midwife since 1987 serving women and families in Pennsylvania, New Jersey, Delaware and Maryland. In September of 1993, I was charged by the State of MD, with practicing nursing without a license and misrepresentation as a nurse. I was the fifth midwife to be charged in two years in the state of Maryland. I opted for a Initial

5 ...continued jury trial and prepared for my trial for a year. Two weeks before the trial date, charges were dropped. The reason given was that the prosecutor could not find anyone to testify against me. This experience resulted in a complete change of consciousness, and inspired me to become politically active in efforts to make midwifery care in the homebirth setting available to all women & their families. In July, 1995, I completed the certification process of the North American Registry of Midwives (NARM) and became a Certified Professional Midwife. At this time this does not certify or license me to practice in PA, DE, MD, or NJ, but the CPM credential has aided midwives in other parts of the country in establishing themselves as recognized practitioners and is the focus of efforts to do so in this region. I have been involved in efforts to establish midwifery legislation in New Jersey, Pennsylvania, Delaware and Maryland. In Delaware, I served on a Governor appointed Committee to Study Midwifery that concluded in 2002 with a Rules & Regulation change to recognize the CPM credential if the midwife has a supervising physician. In 2007, I became licensed in the State of Virginia. I am or have been a member of several professional and consumer groups: MANA, ICEA, AAHCC, NAPSAC, Pennsylvania Midwives Association, Fellowship of Christian Midwives Intl., Citizens for Midwifery (CFM) MD and DE Friends of Midwives and Chesapeake Midwifery Guild (CMG). I have served as Treasurer and President for CMG, as well as a member of CMG s legislative committee. From I served on the MANA Board of Directors as the Regional Representative for the North Atlantic region. I currently serve as the Committee Chair for the MANA Regional Conference Committee. I am a Board member of the Foundation for the Advancement of Midwifery, F.A.M. I have attended conferences, seminars, and continuing education workshops sponsored by the Midwives Alliance of North America (MANA), Alternative Birth Crisis Coalition, International Childbirth Education Foundation (ICEA), Informed Birth & Parenting, American Academy of Husband Coached Childbirth (AAHCC), and Chesapeake Midwifery Guild, and others relating to the practice of midwifery. I have supplemented my midwifery education by self-study of midwifery & obstetric texts and other books related to midwifery. I participated in a study group course offered by the Midwifery Education Foundation. I was a certified Bradley childbirth Educator for 11 years. I am currently certified in CPR & Neonatal Resuscitation. I am a Certified Phlebotomist. I have my Reiki I certificate. As a CPM I must continue my education yearly. I strongly believe in the need to help grow more midwives, therefore I have always worked with students and apprentices. In September 2003 I became a preceptor for the National College of Midwifery (NCM) and a member of the NCM faculty. I also serve as a Qualified Evaluator with the North American Registry of Midwives (NARM) for other midwives and apprentices who are completing the CPM process. In Conclusion Regardless of where you choose to give birth, and whom you choose to attend you, you must realize that ultimately you, as parents, are responsible for creating a safe environment for your baby to be born. You must live with the results of any decisions you make regarding your care and your birth. You owe it to yourselves and your baby to make truly informed decisions. Whatever choices you make, it is my prayer and my purpose that your pregnancy and birth be healthy and joyous. Initial

6 WE HAVE READ AND UNDERSTAND THE ABOVE INFORMATION ABOUT MIDWIFERY CARE, AND THE EDUCATION AND EXPERIENCE OF KAREN WEBSTER AND HAVE HAD THE OPPORTUNITY TO HAVE OUR QUESTIONS AND CONCERNS ADDRESSED. Client name: Signature: Date: Partner name: Signature: Date:

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