My name is Fadwah Halaby and I am a certified nurse midwife serving families in Palm Beach and Broward counties. I offer well-woman care with a holistic touch as well as pregnancy and birth services with birth in the clients home. This is a choice that any woman can make and a viable option for all low risk, healthy clients and even with some that have a more complex physiologic pregnancy – such as previous cesarean, twins, or breech.
Pregnant people have human rights too!
The bottom line is that we all agree that everyone should have certain rights by virtue of being human – we call them human rights. And these rights are repeatedly denied to many pregnant women because her care provider has decided:
- that he or she is not comfortable with a given situation
- has decided on a particular course of action
- is determined to force the client to comply
This has gone so far in some cases as getting a judge to order a forced cesarean surgery by deeming the client incompetent to make decisions for her own body and that of her baby. It is ludicrous to imagine that a person who has conceived and grown a baby in their womb for 40 weeks does not have the best interests of that baby in mind when making decisions regarding the birth of the baby. No one has more of a vested interest in that baby than that pregnant person. And no one has more of a vested interest in the woman’s body than the woman herself. We have a right to choose to birth at home, in a birth center, in the hospital or anywhere else a person would choose to birth. This is a basic human right and is upheld in the laws and rules of our state.
What is not supported by our laws and rules is the right of that pregnant person to have the trained and licensed provider of their choice attend to them in any of these settings.
Nurse Midwives are trained to practice independently
As a certified nurse midwife (CNM), I am trained and licensed to attend to women in any of these settings. I have maintained hospital privileges without any negative incidents for more than 8 years and over 1600 births. Yet now that I am attending to women in their homes, I am not allowed to continue to care for them should they require a transfer to the hospital either before or during labor. ACOG (American Congress of Obstetricians and Gynecologists, the OB/GYN national organization) recognizes women’s right to choose their place of birth and makes a recommendation that if a woman wants to birth at home she should be a healthy, low-risk candidate, choose a CNM to attend her, and birth in an integrated environment. [ACOG Committee Opinion on Home Birth] And this, my friends, is the missing piece of the puzzle. The lack of integration makes out of hospital birth less safe for everyone.
Transferring from home to hospital is fraught with anxiety for both clients and home birth care providers
How many times have you heard stories of “train wrecks” – home birth transfers to the hospital when things have gone far past the point of being OK? Midwives dropping clients off at the door or not participating in the transfer at all are tales that are told by hospital personnel about home birth transfers. It is true that the out of hospital provider is bound by duty to shift location to the hospital once they feel that it is no longer safe to be at home and if it is for an emergent reason, then the 911 system should be employed to make the transfer. If it is for a non-emergent reason (as 90% of home to hospital transfers are), then the transfer can happen by private vehicle. In both cases, the hospital should be alerted and records sent ahead to facilitate care for the client and to give the receiving provider as much advance information as possible. The provider should accompany the client and be prepared to give a concise report of the relevant details and reasons for the transfer. This is considered a hand-off and according to JCHAO [Joint Commission for Hospital Accreditation] is where most critical incidents happen.
One solution
Giving APRNs (Advanced Practice RNs or Nurse Practitioners) the ability to practice to the extent of their training (why are we being restricted from that in the first place?!) would make this situation much safer. By allowing the clients chosen provider to be a member of the team once the transfer to the hospital becomes necessary. I have not been able to maintain hospital privileges, not due to any malpractice or incidents. This is purely due to not having an obstetrician who doesn’t have a financial stake in me or my practice being willing to “take responsibility” for my actions. Really, why should anyone else take responsibility for my actions?
I am trained to work to the extent of my scope of practice like any other healthcare provider. To make decisions, prescribe medications and tests and to interpret those results and determine when consultation, co-management, or referral is necessary. LIKE ANY OTHER HEALTHCARE PROVIDER. There is no worry that OBs will start trying to treat people for heart failure – they would refer to a cardiologist. If they try to work outside their scope of practice, then they are appropriately reprimanded or relieved of their license to practice. We understand that we would be held to the same standards. However, to require me to find a doctor willing to take responsibility for my work and to require that they sign my application for hospital privileges places an undue burden on me and is effectively restraint of trade. This has to stop now.
Please support Senate Bill 972 and HB 871 to increase the number of health care providers and contribute to reducing the costs of health care. Reach out to your Senator and Legislator with a postcard, email, and/or phone call today! Click here or below to find your elected official now.
