Friday, May 23, 2008

Here comes the bus...

For a while now, there's been a big push to legalize CPMs (certified professional midwives) in Illinois, a state with a nasty reputation for persecuting midwives to the utmost extent possible. The women of ICAN have always had an uneasy relationship with "legalization" and licensure of CPMs....because unless the people pushing for legalization are very careful (and sometimes even when they are), usually the state requires a sacrifice to the gods of the medical association before agreeing to legalization. The big three sacrificial lambs are VBAC, breech and twins -- and sure enough, VBAC moms once again find themselves laid out on that altar, under the bus of licensure, hung out to dry while preserving homebirth for "low risk women". I think what really stings this time around is that the ICAN chapters in Illinois have been very active in supporting the efforts to get a licensure bill in front of the state legislature, writing letters, raising money and really getting out there for this cause. And now we find that for our efforts we get a pat on the back, a sympathetic "sorry about that" and a trip back to the surgical suite, since not only are homebirths after cesarean forbidden but we can't find a hospital to "let us" VBAC even if we want to go back into the lion's den. I'm sure the midwives are upset about this and I'm sure they feel like they had no choice. And maybe they didn't or maybe they did. After talking to a few people who know more about Illinois politics than I do, I realize that the situation isn't simple or even logical...so the story isn't nearly done, even if it might look like it. But I've got to say, I'm am SO tired of always being the one who gets locked out, when the women I represent need what a CPM can offer more than any other group out there. Still, while the International Cesarean Awareness Network can't support The Midwifery Licensure Act (Senate Bill 385, House Bill 385) as it is currently written, we are going to keep very close track of its progress, should it make any. Keep watching to see what you can do if the opportunity presents itself.

17 comments:

WarriorMoM said...

Please get your facts straight. It's first-time vbacs, not all. Subsequent vbacs were not negotiated out. And, yes, the CPM advocates are painfully aware (some of them from first-hand experience) that it's hard, or even impossible in some areas. This is better than many states.

Your feelings are understandable, but the way you pain things just isn't accurate.

What do you propose people trying to legalize midwives do? Sacrifice the entire endeavor after 30 years of battling? Do you not understand that this is a first step? You can't climb the mountain in one giant leap.

I wonder if this comment will pass moderation....

Gretchen said...

Of course it will pass moderation :-)

You are right, in this case, it is primary VBACs that are disallowed. And its nice that they fought for the secondary VBACs. But let's be honest. How many secondary VBACs are there going to be to make it to a homebirth, if the woman trying for that all important primary VBAC have to figure out how to do it in an increasingly hostile hospital culture? I'm going to bet not very many at all.

I'm comfortable that I have a pretty good grasp of the facts, after having spent several hours on the phone yesterday talking to people who are much more intimately involved with the situation than I am. I did say that I'm sure the midwives weren't happy about having to give up primary VBACs. And I hold out hope that we can get this changed, either after it leaves committee or in a future session....but nevertheless, once again, it is the scarred women who pay the price -- like it or not, that's how it came out, whether or not its "better" than in many other states or not (ICAN gets to field the calls from desperate women in IL who literally have NO options, short of a midwifery attended homebirth or an unassisted birth. It is heart wrenching and now is going to be even more so). This is why many women who want a HBAC prefer states with no formal licensure....because at least then, they haven't been officially risked out of homebirth. So in that state, its actually "better" for us. Selfish? Well, we have just as much desire for self-preservation (quite literally) as do the midwives who pursue legalization to be safe in their practice. It is unreasonable to expect women to reconcile to unwanted, unnecessary surgeries because it furthers someone else's "safety" -- that's exactly the same as what the OBs are asking for when they put their liability concerns ahead of our health and refuse to attend VBACs.

As far as it being a first step...there aren't too many cases where restrictions on midwife practice have been reversed (2 states total). Its hard to depend on that, when we have to wonder if we would be left alone to fight that fight, even though we joined with people to fight this one. Is working hard to make this better for scarred women a promise that the CPMs are willing to make? And is it one that they will keep?

WarriorMoM said...

It's sucks for everyone. We can agree on that. That's why I acknowledged in my first response that "CPM advocates are painfully aware (some of them from first-hand experienct) that it's hard, or even impossibly in some areas" [although I wasn't clear that I mean getting primary vbac in some/most areas of Illinois.]

I assume you're entirely correct about moms with previous cesarean preferring no licensure. But how fair is it to ask someone to risk jail and all their personal assets to attend your birth? We know Illinois is the most punitive state in the nation.

I think it's hard to say how restrictions will be effected in the future, since the majority of states with midwifery licensure have only had it, at most, for 10 years, mostly less, That means the majority of midwifery licensure laws haven't even sunsetted/been renewed.

Getting midwives on the books in all states, and therefore proving in the public eye their wonderful safety, will go further in easing restrictions than anything else. But it's sadly a pendulum swing. First restrictions, then easing.

Also, it's my understanding that there was really no choice in the matter for the midwifery advocates. It was this or continued illegality. And I intimately know that women in Illinois have deteriorating choices. All the experienced midwives have been under the gun in Illinois. So they stop practicing or leave and are replaced with much less experienced midwives.

That is not ideal, nor is it fair to the majority of home birth moms to sacrifice their safety by having to rely on less experienced midwives.

(In this post by "midwife" or "midwives" I mean direct entry. The number of home birth nurse-midwives in Illinois is so small, that most women have no access to them whatsoever.)

Thanks for your willingness to engage! I admit I was *lucky* to stay at home for my first. I'm sure my asynclytic posterior baby that took 48 hours of labor to arrive, would have been cut out of me, had I not fired the ob and hired a DEM. I think that's the most important birth to have at home -- the first birth.

Gretchen said...

I wrote a response but it doesn't seem to be appearing....so if it does appear twice, don't laugh too hard (until I realize it and delete one :-)

It is probably not fruitful to use the language of "fairness" and "sacrifice" when discussing this. If you turn it around, is it fair to ask a woman to risk her health and well-being because someone else might suffer financially if she plans a VBAC? I suppose if the repeat c/s goes smoothly and the woman and her baby are "healthy" (a slippery term that gets slipperier the farther out one gets from the c/s) then it was "fair"? But how do we determine worth? Is losing a uterus worth more than jail time? Is permanent brain damage worth less than financial ruin? What if the woman or her baby dies? See, its just not that helpful. After all, from the point of view of the scarred woman, she is being asked to sacrifice her short- and long-term health and well-being (and that of her child) unnecessarily for the financial security of someone else. Isn't this exactly what the OBs are requiring of us when they refuse to attend VBACs?

It is tragic when a midwife is persecuted for attending births. It is tragic when a woman throws a blood clot and dies after an unnecessary cesarean (well, its tragic even if the cesarean was necessary but particularly bitter if it was for no good reason). Fortunately both of these events are relatively rare, and both of these events are on the increase (persecutions varying by state, c/s complications are rising nationwide, obviously).

Now mind you, I know perfectly well that the CPMs in IL didn't decide themselves to not do primary VBACs. And I have a good understanding of the choices they felt they had (it isn't really accurate to say they had no choice -- they did, they just didn't choose to wait and fight again another day. Just because the choices are unpleasant doesn't mean they aren't real choices) And I also understand that historically VBACs (and primips, for that matter) have represented a small percentage of most CPMs practices. But if what I am hearing from the midwives in Michigan is any reflection of the Midwest overall, the percentage of VBACs is rising, and it is rising rapidly. It may be that someday, that "majority of homebirth moms" won't be quite the demographic CPMs count on. And then, they will be fighting to attend VBACs after multiple cesareans, because women had no option for that primary VBAC.

WarriorMoM said...
This comment has been removed by a blog administrator.
Gretchen said...

Actually, my sources work for the coalition that came together on this issue, so I don't think there's bias against the midwives at work. My opinion on the facts are just that, my opinion. Your opinion on the facts is a different one -- the facts are likely the same. If your life experience was more like mine, you might have a different opinion. What is a valid choice? A choice is invalid because someone really doesn't want to make it? An extremely distasteful choice is still a choice. It is almost never true that someone has "no choice" (I have to point this out to women who's only choices are another c/s or stay at home unattended or travel very far to find an attendant. They often say "they have no choice" as they sign up for the repeat c/s but in fact they do. Just choices they don't want to make.) It might seem a picky point but I'd rather someone admitted "I made this choice, which hurts you, because I preferred it to this other choice, which hurts me" or "I made this choice, which will hurt you because I'm afraid of what might happen if I made this other choice", rather than claiming "I had no choice".

We understand the pressures. We understand the issues. We understand that in the end, most people look out for themselves (as do we!). Somehow "we had no choice" relieves the not-choosing chooser of any moral obligation to address the consequences of that not-choice. It allows the not-choosing chooser to be righteously indignant when the consequences of that not-choice are brought into the public forum and to discount those who were hurt by the not-choice as ignorant or selfish or petty or mistaken or insignificant or whatever dismissive descriptor you want to use.

What would make a difference? How about a public statement from IFM and associated members of the coalition that as soon as licensure is finalized, they will turn their efforts to overturning VBAC bans in Illinois hospitals, so that women at least have another choice, if the HBAC choice is taken away from them? That they will spend as much time and effort supporting that effort as the women of ICAN in IL put into pushing this legislation forward? So far we've heard nothing except a statement about how disappointed the midwives are and then explanations about how it really isn't that bad in the big picture because there just aren't that many women who would want a CPM attended primary VBAC anyway, coupled with "we had no choice" anyway.

Actions talk a lot louder than words. Why should any of us scarred women believe that they really are "sad" about this, sad in a way that makes a difference? Why should we expect that it will do anything other than fade away? "I'm sorry" really only means anything if there is action attached to it -- some sort of effort to address the wrong. The only way anything will be done is if we keep the pressure on and even then, who knows. The first to go, the last back on...

Gretchen said...

Just so people don't think I'm awful, I removed the comment at the request of the author, not because I had a problem with the content. It does make my response kind of odd, but hey, I'll leave it up because I rather enjoyed exploring the idea of choice and what it means to be sorry....

Ruthie said...

WarriorMom,
I would understand the exclusion of hbac if there were studies showing that hbac is unsafe. Breech and twins take special skills and training......hbac does not.

WarriorMoM said...

This is to verify that my comment was removed at my request. Thank you, Gretchen.

birthbeautifully said...

I'd like to comment on this issue if I may...

As a 3 time VBAC mom (pregnant with VBAC #4) in a state where ANY homebirths attended by ANY midwives other than CNM's is a felony (yeah, you read that right) I find my choices pretty slim. As I follow the workings toward legislation that would legalize CPM's I understand the "give and take" that goes into getting legislation passed at all, let aone favorable legislation.

I'll go on the record here as saying the midwives here would rather keep practicing under the table and at incredible risk rather than accept unfavorable legislation. The midwives organization here has been fighting to legalize midwifery in my state for more than 25 years. We've been felons that entire time.
While we had a major victory this year, CPM's are still illegal.

While you're right, legislation can be changed later and some give and take is necessary, to sacrifice the well-being of a mother and unborn child in the name "fairness" is absurd. Like Gretchen said, it's little different than the excuse OB's use to justify the bans in the first place.

Though I have a hard time with it as well, twins and breeches can be seen to take more skill to deliver vaginally. I can get (I guess) why those had to be precluded from legalized homebirth.

But to include 1st time VBAC's in that is like saying to the medical powers that be, "You're right... VBAC's are dangerous and risky."

Let me ask this question: If no one gives that mom her first VBAC attempt, how will she ever get to be a REPEAT VBAC? She won't. And I don't believe for one minute that the political powers that agreed to "repeat VBAC's only" didn't figure that into their decision. They are almost entirely banned in hospitals, and now are banned at home with a CPM, so how is that "repeat VBAC" ever going to happen in a "legal" setting? It ain't.

As to the question, "What do you propose people trying to legalize midwives do? Sacrifice the entire endeavor after 30 years of battling?"

Yes. I propose just that. There is always next year. :) This choice has nothing to do with women, it has to do with financial power, risk and personal gain. Sad. Very sad indeed.

heather said...

I'm one of those who is reluctant to support licensure. I'm all for the idea of protecting midwives by eliminating the illegality but I do think that licensure instills a false sense of security. I hate to see childbirth choices being limited. And as a HBAC mom of twins, there is a great chance that I could end up with a twin/breech/HBAC. Good thing I"m in a state where licensure is unavailable. One of our neighboring states started licensing midwives and of course VBAC moms were thrown under the bus. There has to be a better way...

WarriorMoM said...

birthbeautifully -- how many of your Missouri midwives have actually been charged with anything in the past 10 years? 20 years? How many have stopped practicing in those same time periods? How many practicing well-experienced midwives do you have vs. how many home births? How many CPMs practice in Missouir? Home birth CNMs or doctors? How many under-experienced midwives do you have? Do you have legal free-standing birth centers (I know you do)?

I'm certain Illinois has had far, far more charges actually brought upon midwives than Missouri. And guess what? Sometimes they're felony charges! Because, while it's great spin that MO is the only state that categorically lists it as a felony, many midwives have been charged as felons in other states. In Ilinois, at least one midwife is charged, on average, every year -- usually even in the absence of any bad outcome. It's not a question of *if* in Illinois, but more a question of *when* a midwife will face charges, sometimes criminal (e.g. manslaughter).

And even one FSBS is more than Ilinois currently has.

Illinois is known to be the toughest state in the country when it comes to regulating health care professions. To expect perfect regs from Illinois is so unrealistic, that one has to wonder what you expect to accomplish by this smearing of midwifery advocates.

It's outrageous to expect or try to force someone to risk jail for you. If someone volunteers to risk jail, that's one thing, but that's not what's being proposed here. (Please spare me the flipping my statement around. It grows old quickly; of course the opposite is true.)

Arguing semantics about "choice" doesn't change the fact that outsiders are speculating and making sweeping assumptions about a state that they clearly don't understand. (And I question whether you really talked directly with anyone actually involved in the legislative negotiations, gretchen since I know all six of them in real life and none of them is aware of having had any contact with you.)

Why should Illinois advocates issue a statement promising to do work toward changing VBAC policy (although I actually know that many of them are committed to the final goal of full access<-- I expect this will be ignored but I'm still putting it here), when all indications are that ICAN's likely response would be public condemnation anway?

To wit: Just three months ago, ICAN lumped the American Assoc. of Birthing Centers together with the truly evil (and our real enemy) the American College of Obstetricians and Gynecologists and ICAN publicly condenmed AABC in response to an AABC statement that stated, in part:

>>"AABC has given priority to launching a National Study of Optimal Birth; and .... Whereas: The AABC Board has struggled with how this small organization can respond to the very large VBAC issue; therefore ....Be it resolved that: After long and extensive review of the feasibility of AABC conducting another study on VBAC in birth centers, the AABC Board of Directors has determined it is not possible for the Association conduct such a study at this time and VBAC. and will instead continue to advocate to policymakers for access to
VBAC. "<<

That's almost exactly what you requested here, gretchen, from Illinois midwifery advocates. But the only evidence available of how ICAN would react to such a statement is this recent condemnation. That hardly seems like it would engender a desire to engage with your group. (Note: This is my own extrapolation; I'm not speaking directly for the Coalition for Illinois Midwifery board here.)

What legislative-specific materials has ICAN created to help states avoid these bans? After a fairly lengthy search of your website, I mostly see consumer support that would take many, perhaps dozens, of hours to convert to something appropriate for negotiations or for legislators. Consumer support is great and necessary but not helpful to the advocates in the political arena who I KNOW are doing their best and working their arses off in the process.

Working on legislation isn't about writing emotion-laden comments on the internet. It's very sadly about compromise. I find it fascinating that you expect .5% of the women of Illinois to successfully advocate for all VBACs with thus far no help compiling a succinct listing of statistical evidence regarding the lack of availability of vbacs in hospitals (I don't mean your clickable map but something neat and complete that could be be distributed electronically or on paper), or supporting primary VBAC to the satisfaction of the professional groups which hold waaay more clout than the home birth moms/midwives.

I know the hours the current group of Illinois advocates have poured into this in the past seven years. There's literally no free time for them to add another research project to all they're already doing on top of their personal, unpaid, more than full-time efforts.

It's true that local ICAN groups have been extremely supportive in Ilinois, and I've observed that some individual ICAN members have volunteered a LOT. But this post and the comments are just plain wrong about the motivations or feelings of Illinois midwifery advocates and the political realities they face. I think you owe them an apology.

If your goal is to be truly divisive, spend more time attacking your allies. You're doing such a great job fostering unfounded doubt and blind assumptions, that ACOG/AMA can just sit back and watch us implode.

Way. To. Go.

Gretchen said...

ah, where to start.

Let's go back to the original post. This part seems to get missed "I'm sure the midwives are upset about this and I'm sure they feel like they had no choice. And maybe they didn't or maybe they did. After talking to a few people who know more about Illinois politics than I do, I realize that the situation isn't simple or even logical...so the story isn't nearly done, even if it might look like it." plus "...because unless the people pushing for legalization are very careful (and sometimes even when they are), usually the state requires a sacrifice to the gods of the medical association before agreeing to legalization." which says that sometimes even being very careful isn't enough.

Throughout my comments I have acknowledged that the situation is a difficult one and not one with simple explanations or answers. I have responded strongly to statements that it is somehow unreasonable for ICAN (and its members) to be very upset about this, and that it is unreasonable (or worse) for us to express this publicly. Silence can and will be interpreted as acceptance or support. I've pointed out that history does not support the idea that this will change after the fact, while acknowledging that the system in IL is different enough that it may be possible to change things. What you have not seen (and what we have directly counseled women in IL against) is any direct opposition to the bill, because we don't feel that that would be beneficial to anyone at this time.

I do not mean to imply that I've been in contact with anyone directly involved with legislative negotiations -- what I said was that I talked to people who worked with the coalition -- similar but not the same. And I did talk with people who have much more familiarity and experience with IL politics than I do and who are strong and active supporters of midwifery. Those discussions certainly informed my perspective on the situation, hence the reason I continue to say that it isn't over and we need to to watch carefully, because change can still happen but those conversations did not change the fundamental fact that if things stay as they are proposed, women who want a VBAC in IL now have even fewer options than before, yes, even considering the trials that midwives faced being illegal in IL.

No one has ever contacted me for more information about VBAC policy in IL (contrary to statements to the effect that ICAN was "non-responsive to inquiries", there is no evidence that anyone on the Board was ever contacted about any of this -- had I been contacted for information, I could have fairly easily provided it. There is nothing "neat and complete" right now because we are in the middle of updating and expanding the data on VBAC policies -- it takes awhile to call over 3000 hospitals. Nevertheless, I can get narrower, state specific information if asked, and plan to have such information ready should the time come when the VBAC issue in IL might be revisited. This isn't because someone from IFL (or other organization) requested it or even mentioned that it could be helpful, it is because we decided we needed to do it, when the situation in IL was revealed to us.

I'm not going to speak in detail to the AABC situation other than to point out two things: the statement "will instead continue to advocate to policymakers for access to VBAC." is disingenuous at best, because there really hasn't been any advocation to policymakers for access to VBAC on the part of the AABC that I know of, so there isn't anything to continue with and in fact, our statement opened up a dialog with AABC that they were not willing to have prior to our response. It is hard for me to see our statement as a mistake or even as divisive when it provoked communication that didn't exist before.

I'm not sure why anyone would assume that ICAN hasn't or isn't exploring how VBACbans can be countered. Certainly one possible interpretation for why we haven't provided materials for negotiations (with hospital administrations?) or legislators is that we aren't actually doing anything, but rather prefer to sit around and complain about no one doing anything. Another interpretation might be that we are actively seeking ways to combat VBACbans and have found, as we explore the issues that while sometimes individual hospitals can be influenced to reverse bans through consumer pressure (it has yet to be done through any other means, and the only times it has been done, it has been done with ICAN's support. There are several active campaigns right now, led by local ICAN Chapters), it is unlikely that the remedy to VBACbans lies with legislation but rather, with the courts. Perhaps the remedy that we seek would not be best served by preparing materials for legislators who can not do what we want, but rather in finding and preparing the cases which will bring the issue to the courts and by providing material support for the women who are willing to directly challenge VBACbans in the hopes of making a successful legal challenge. ICAN is in fact doing all of those things, and has been for some time. All it takes is asking.

Talk of choice isn't just semantics. I think it is intellectually dishonest and a cop out to claim "I had no choice" when in fact, one made one choice over another. I'm not arguing that midwives must see things the same way as consumers. But to say that the midwives had no choice, just because the alternative was not something they would consider simply isn't true. It dodges the issue of taking responsibility for a choice and acknowledging the repercussions of a choice. The announcement I received regarding the licensure bill used the term "thrilled" to describe IFM's stance. Perhaps that was a politically naive mis-statement, I don't know. I do know its hard to reconcile "thrilled" with "we wish we could have done differently but this was the only choice we had".

The common thread here, with the situation in IL and AABC is that decisions were made that were not in the best interest of women who seek VBACs and no one considered what ICAN's response to those decisions might be. No one thought to contact ICAN and at a minimum open a discussion before a public announcement was made. Then when ICAN makes a strong response, there is a defensive backlash and we are accused of being divisive or worse. There is no inclusion to break if we are not included to begin with. Certainly, I don't see being silent as a rational response to being ignored. The fact that anyone is surprised at our responses to these sorts of things really just illustrates how little anyone thinks about us at all, until after the fact.

WarriorMoM said...

>>"The announcement I received regarding the licensure bill used the term "thrilled" to describe IFM's stance."<<

Really? That's not what was actually written. What that announcement really said was they were thrilled that the nurses agreed to no written agreement for CPMs. That was followed almost immediately by a statement that they were "extremely disappointed" that the nurses insisted that primary vbac not be in the scope of CPMs. Two different reactions to two separate issues.

Talk about intellectual dishonesty. You are clearly misrepresenting what the announcement said, and pretending to know how someone else felt.

I never suggested you shouldn't say anything, just that it's outrageous to insist someone else break the law for you.

Unreal.

SC HBAC mama said...

I believe the implosion began when the VBAC mothers, who work tirelessly on a local and national level to help others avoid the difficult lesson they learned the hard way, were thrown under the bus. Disallowing primary VBACs gives the medical profession affirmation that VBAC is unsafe (it's not), ensures that MANY more women will go under the knife unnecessarily because of lack of access to midwifery care, and guarantees that many VBAC moms who are unwilling to be a part of a machine that doesn't treat women holistically will birth alone, not out of choice, but out of fear and because of their abandonment.

The notion that women who want a VBAC should necessarily stick up for themselves in a hospital setting, when they do not want a hospital birth, consider it sub-par when compared to homebirth, and do not want a combative atmosphere at their births, and when HBAC has not been proven unsafe, is insulting.

Plus, living in a state that has a midwifery VBAC ban, I can assure you that it will most likely NOT be addressed later. Once you allow the medical boards to have a stranglehold on the midwives, they do not let go, and the midwives lose their nerve to fight.

SC HBAC mama said...

By the way, the amount of venom, condescension, and sarcasm from warriormom makes me uncomfortable, and less inclined to support the push in IL in any way at all. I hope she doesn't speak for the IL push in any official capacity, but if she does, it reflects poorly on their cause.

Gretchen said...

I'm not going to respond in a line by line manner, picking apart what may or may not have been meant, conveyed or otherwise communicated by a particular word or phrase. I've never found that sort of argument to be fruitful in the end and typically it just leads to a lot of "last wordism". So I'll concede the last word on reading emotional content into written statements and leave it at that. All the involved parties need to find our common ground and learn from the various failures of communication how to use that common ground together.

I have never stated that I would prefer midwives to remain illegal in IL. Never have I said that, in private or public as I do not hold that opinion. In fact, I have said repeatedly that I absolutely sympathize with the desire to be legal. I have also talked about the dilemma that women wanting an HBAC have when it comes to licensure simply because we are painfully aware that when compromises have to be made, VBAC is generally high on the list. It just isn't reasonable to expect women to suck it up and take it for the team, time after time after time without saying something about it. That's the reality on the ground, whether its a comfortable one or not.

Are there individuals who have publicly stated that they'd prefer IL scrap the whole thing? Yes, there are. But let's not confuse what individuals say with what ICAN says (I haven't come across a statement from anyone speaking in an official ICAN capacity calling for midwives in IL to remain illegal. If there is one, the Board needs to know about it, because that is contradictory to what we've told leaders our stance is). We are not opposing the bill. We are simply not supporting it as it is currently likely to be written (knowing that in IL, things change up until the last minute). How could anyone expect us to support it as an organization? Our constituency would never allow it, even if the Board wanted to continue to actively support it. We are more than willing to provide whatever support we can to any efforts to change the likely VBAC restriction, now or in the future.

Somehow it gets lost that I have also tried to explain to people that as it was described to me, the political situation in IL is unique and there may be a chance for this to change, unlike the situation in other states (such as SC) where the prospect of changing the regulations is so daunting as to appear impossible. The reason I make sure that I mention this is because I want women to still be willing to work toward a change in the VBAC restrictions if that opportunity presents itself. I want our members to be ready to work on VBAC issues, not feeling hopeless after they are done feeling betrayed (neither rightly or wrongly -- as a good friend says, feelings are feelings, they are neither right nor wrong).

I'll state things very clearly.
-I do not want midwives in IL to remain illegal.
-I believe that a lot of this contention could have been avoided with clearer communication about the situation, including the urgency and last minute nature of some of the negotiations. (it isn't like ICAN doesn't understand that last minute politicking is par for the course, especially with well-funded opponents like the medical associations who will take any chance possible to derail something like a midwifery bill)
-ICAN can not officially support legislation that restricts access to VBAC, even while acknowledging that hopefully, legal status will impact the primary c/s rate.
-ICAN can and will support efforts to change VBAC restrictions, even if they are associated with a bill we don't support. (I sincerely doubt that the lack of an official ICAN stamp of approval on the bill will impact its status in any way at all.)

If any of what I've stated above becomes an inaccurate reflection of ICAN, I'll correct it immediately.