Hi Reader,

More good news... on June 1, 2023, the Governor of Iowa signed HF 265 which makes certified professional midwives (CPMs) legal and regulated... all while protecting VBAC.

You can read the press release ​for more details, but I wanted to draw your attention to four aspects of this bill.

First, it doesn't mention prior cesarean or prior uterine surgery. This is good because often when these histories are highlighted, it is to limit the scope of practice for CPMs. No call out equals no limit on scope.

Second, here is the only text referencing high-risk pregnancies:

While consultation with a licensed physician or certified nurse midwife is required for high-risk pregnancies, no definition of high-risk is supplied in the bill.

This is good because means the midwife can use their clinical knowledge and skills to determine what is high-risk and when a consultation would be prudent rather than policymakers dictating when consultation should be required.

Third, do you see how patient autonomy is upheld when the bill clarifies "a licensee [can] maintain care of a client according to the client's wishes?"

In other words, consultation doesn't mean that the midwife or birthing person must follow the recommendations made by a physician or CNM including, birthing in a hospital.

Finally, while the Board of Nursing will regulate CPMs, the bill is clear that the Board "shall not adopt rules" that require physician supervision or collaboration.

So important to spell this out because while physician supervision or collaboration might seem like a good idea, what it really does is limit the ability of midwives to practice.

When the existence of midwives is tied to the power and approval of physicians, all it does is reduce access to care.

Midwifery care should not be contingent on whether there are physicians in their state that are willing to collaborate with them.

VBAC access with a community midwife is critical given how many hospitals maintain VBAC bans and how many physicians do not attend VBAC.

With 86% of people having repeat cesareans in the US, and most births occurring in the hospital, it's important for birthing people to have access to community midwives.

For many people, community VBAC (meaning in their home or at a freestanding birth center) is the only way that they can access VBAC in their community.

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In solidarity,

Jen Kamel
VBAC Facts® Founder

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