Midwifery

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Great Midwife Center

noreply@blogger.com (Editor) — Sun, 21 Jun 2009 22:40:00 +0000

Midwifery only birth center - licensed, accredited, and freestanding are great establishments. You will be pleased to have your baby there and the staff and care is excellent.

A Midwifery Center provides a full range of midwifery services for clients in every stage of the birthing process.

Services offered include:
- Well-woman care for women of all ages,
- For birth, the center provides prenatal care, natural birth, water birth in Aqua Doula tubs, nutritional counseling and more,
- Educational services that complement birth, such as classes on childbirth, newborn care and breastfeeding, and Lactation consulting.

These centers are expert for Midwives, doulas, massage therapists, yoga instructors, childbirth educators, lactation educators, nurses, OB's or anyone else involved in caring for women and their babies.

Midwife Jobs

noreply@blogger.com (Editor) — Thu, 28 May 2009 21:04:00 +0000

Here is a good description of what to expect from Midwife Jobs.

Midwife Clinics are a good place to work your profession. They are a fast-paced, friendly and fun environment where you will work with a staff of a number of midwives and a large number of families as they move through their pregnancies, births, and postnatal periods under the care of the midwives. If you become a clinic manager you will be responsible for creating the experience of being in a clinic for our clients and for the midwives who work here. As the "face" of the clinic to the public, the clinic manager provides information and services to your clients in a professional and caring way, and assists the midwives with the administrative aspects of providing midwifery care. Clinics are seeking a highly-motivated person who enjoys working in a fast-paced health care environment, and is competent with computers and bookkeeping.

This position will entail:

• Cultivating good working relationships with clients, midwives, other clinics and other health care providers
• Answering the phone, taking intakes for new clients, relaying messages to the midwife on call, answering questions about midwifery care
• Booking appointments in our clinic and with other health care providers
• Administrative work: photocopying, monitoring and reordering supplies, preparing charts, filing paperwork
• Managing our computer charting and office management system, OSCAR
• MSP Billing, bookkeeping and managing financial accounts

The successful candidate will:

• Be personable, friendly, and able to make clients feel well-taken care of
• Have a high level of computer skills, and be fluent with Microsoft Office and able to learn OSCAR
• Have an exceptional ability to multitask and prioritize in a faced-pace and demanding environment
• Have superior communication skills
• Have relevant experience
• Be knowledgeable about the midwifery model in British Columbia
• Training as a medical office assistant an asset
• Be self-motivated and able to work independently
• Agree to a Criminal Record and Child Abuse Registry check

Become a Mid Wife

noreply@blogger.com (Editor) — Mon, 30 Mar 2009 20:56:00 +0000

Learn Prenatal, Birth, and Postpartum support and the midwife model of care!
Interactive and culturally diverse learning experience!

International Center for Traditional Childbearing (ICTC) presents the
Full Circle Doula Training Intensive

The 3.5-day training includes:
~ infant mortality prevention
~ medical terminology
~ prenatal support
~ labor and birth management
~ postpartum and breastfeeding support
~ prenatal nutrition
~ relaxation techniques
~ lead prevention awareness
~ cultural awareness and sensitivity
~ professional business development
~ traditional and spiritual birthing practices
~ a provisional certificate and ongoing support for full certification
~ and much more

Training dates:
Thu April 23, 2009: Orientation 4pm-8:30p
Fri April 24, 2009: Training 10am-5pm
Sat April 25, 2009: Training 10am-5pm
Sun April 26, 2009: Training 10am-4pm

Tuition:
$425 (a few partial scholarships still available)
Includes training manual , doula bag and continued support for full certification

Location:
International Center for Traditional Childbearing
2823 N. Rosa Parks Way, Portland OR 97217

The Full Circle Doula is a well-rounded professional trained to offer prenatal, birth and postpartum services to women and families. Enroll and start a new career!

Download the registration packet at www.ictcmidwives.org or contact:
Aqiylah Collins
Training Coordinator
503.460.9324
aqiylah@ictcmidwives.org

noreply@blogger.com (Editor) — Wed, 04 Mar 2009 22:02:00 +0000

HARLESTON, W.Va. -- Nurse midwife Angie Nixon hugged her way around a recent meeting of home-birth advocates and moms. She admired the healthy babies held by their beaming mothers and exclaimed over how much they'd changed since she last saw them at their birth.

She shares an intimate bond with these women, who trusted her with their pregnancies and the deliveries of their babies, most of them in their own homes. Since 2003, Angie Nixon's midwifery practice has been mostly home deliveries. She spent her first five years as a midwife delivering babies in a birth center.

"Women choose home births for a variety of reasons. Some want to save money. They expect the birth to be normal and are not afraid. They appreciate the privacy of their own homes."

Trebor’s close friend Michelle Moore holds Stephen while talking with Teresa Stire, who delivered her fourth child vaginally after three Caesarean births, inspired Trebor to give birth at home.

Midwives also deliver in hospitals, but Nixon, who is a certified nurse midwife, prefers a home delivery unless hospitalization is medically necessary. She's delivered about 600 babies, 100 of them home deliveries. About 10 percent to 15 percent of her patients transfer to a hospital for delivery, most often because their labor is not progressing. Only one of her patients has had a Caesarean.

She enjoyed her work at WomenCare Birth Center in Teays Valley and follows most of its strict guidelines in her practice. She left there, however, because she enjoyed the personal relationship she develops with an expectant couple as she sees them throughout the pregnancy and delivery. The birth center employs numerous midwives and patients see whoever is on call.

Nixon, who lives in Scott Depot, makes her own rules. For example, the birth center will not accept patients who have had Caesarean deliveries, but Nixon will work with viable candidates, such as Trebor Sutler.

The number of Caesarean deliveries in the U.S. is on the rise, and West Virginia has the fifth-highest rate of Caesarean deliveries. In 1996, 21 percent of deliveries were Caesarean compared to 31 percent in 2006, according to the U.S. National Center for Health Statistics. West Virginia's rate in 2007 was 35 percent. The World Health Organization recommends a 5 percent to 15 percent Caesarean rate.

"Women need to understand the trade-offs of surgical birth," Nixon said. "They risk future childbearing, infection, surgical mistakes and will have two times as much blood loss. It also impairs breastfeeding.

"This is my opinion, but it's also hard to recover from the sadness and disappointment that a woman might feel from not succeeding with a vaginal birth, if that's what she wanted."

At the home birth meeting, women, several wearing T-shirts proclaiming their support of natural deliveries after Caesareans, added to Nixon's comments.

Midwife

noreply@blogger.com (Editor) — Fri, 30 Jan 2009 15:00:00 +0000

Midwife Services and Training should look something like this ad below:

I am a trained midwife, birth doula, childbirth educator and baby nurse. I have over 8 years experience serving Prenatal & Postpartum families. I am Trustline registered, CPR certified, and have a recent (-) TB test. I work primarily in the evenings (12 hr shifts) doing such duties as:

Staying in the baby's room and managing their care while you get much needed rest. When the baby wakes up I feed by bottle or bring the baby to Mom for nursing. After feeding, I burp, change and settle the baby back to sleep. (A nursing Mother can hand the baby over immediately after nursing and can get right back to sleep.) As a daytime Baby Nurse I provided similar care and also strive to create a nurturing, stimulating environment for your baby during waking hours. As a baby nurse working day or night I document your baby's patterns and keep a log of sleeping, feeding and changing times. Typically one of my key objectives is to help transition the baby to a regular feeding and sleeping schedule.

List of Great Books on Midwifery

noreply@blogger.com (Editor) — Tue, 16 Dec 2008 03:53:00 +0000

Here is some great books on midwifery and their authors. Most are available on Amazon.com or on eBay.com.

Title - Author

A Midwife's Tale - Ulrich
A New Life - Queenan
Alternative Birth - Jones
American Academy of Pediatrics Neonatal Resuscitation - AAP
An Easier Childbirth - Peterson
Aquatic Readiness - Bruya
Attachment Parenting - Granju
Bestfeeding - Arms
Birth Traditions & Modern Pregnancy Care - Priya
Birthing From Within - England
Breast Cancer, Breast Health - Weed
Breastfeeding Naturally - Lothrop
Breastfeeding Your Premature or Special Care Baby - Walker
Building Medical Vocabulary Study Guide
Child of Mine: Feeding with Love and Good Sense - Satter
Childbirth at Home - Sousa
Children's Health - Rodriguez
Chromium Picolinate - Passwater
Circumcision: The Rest of the Story Mothering Special Edition
Complete Book of Pregnancy and Baby's First Year - Mayo Clinic
Cord Blood Banking Handbook
Creating a Joyful Birth Experience - Bardsley
Dictionary of Medical Terms, 3rd ed. - Chapman
Dr. Miriam Stoppard's Pregnancy and Birth Book - Stoppard
Dry All Night: The Picture Book Technique that Stops Bedwetting - Wilensky
Dubious Conceptions: The Politics of Teenage Pregnancy - Luker
Ears, an Owner's Manual - Moser
Eight Weeks to Optimum Health - Weil
Encyclopedia of Natural Health & Healing for Children - Weber
Encyclopedia of Natural Medicine - Murray
Enhancing Fertility Naturally - Wesson
Entering the World - Odent
Essential Exercises for the Childbearing Year - Noble
Goddess in the Kitchen - Lapanja
Guide to Baby Products - Consumer Reports
Guide to Clinical Thinking - Bates
Having Twins - Noble
Healing Childhood Ear Infections - Schmidt
Heart & Hands, 2nd ed. - Davis
Helping Hands: The Apprentice Workbook - Hartley
Helping Your Child Sleep Through the Night - Schevill
Herbal Healing for Women - Gladstar
Home Medical Dictionary, new rev. ed.
Homeopathic Self-Care - Ullman
Homeopathy for Pregnancy, Birth and Your Baby's First Year - Castro
How Was I Born? - Nilsson
Human Embryology Study Guide and Review Manual Moore & - Persaud
Human Labor & Birth, 5th ed. - Oxorn
Husband Coached Childbirth - Bradley
Immaculate Deception II - Arms
In Labor: Women & Power in the Birthplace - Rothman
Infant Massage - McClure
International Midwife, Issues 1-7 Midwifery Today
Into the Mouthes of Babes - Firkaly
Kangaroo Care - Golant
La Leche League International Pamphlets - La Leche League Int'l
M.D. Doctors Talk About Themselves - Pekkanen
Maternal Newborn Nursing Workbook
Maternal Newborn Nursing, 5th ed. - Olds
Mayes' Midwifery
Merck Manual of Medical Information, Home Edition
Midwifery and the Law Mothering Special Edition
Midwives: A Novel - Bohjalian
Milk, Money, and Madness - Baumslag
MMA Basic Course in Midwifery Studies Journal Articles 1996-1997
MMA Basic Course in Midwifery Studies Yearlong Study Packet - MMA
MMA Practice Guidelines
Modern Obstetrics for Student Midwives - Towler
Mother and Child: Visions of Parenting from Indigenous Cultures Reynolds
Mother Nature - Hrdy
Mothering: Special Issue on Vaccination
Natural Baby Care: Non-toxic and environmentally friendly ways to take care of you and your child - Pennybacker & Ikramuddin
Natural Childbirth the Bradley Way - McCutchen
Natural Mothering - Wesson
Natural Pregnancy - Balaskas
Natural Progesterone - Bond
Natural Ways to Relieve Common Discomforts of Pregnancy Jones
Newborn Screening Video Tape Program - NCCLS
Nighttime Parenting - Sears
No More Morning Sickness - Erick
Nurse's Clinical Guide to Neonatal Care - Kenner
Nursing for Two, Is it for You? - Berke
Nursing Your Adopted Baby - Anderson
Nutrition Almanac, 3rd ed. - Dunne
Nutrition Almanac, 4th ed. Kirschnann
Obstetric Myths Versus Research Realities - Goer
Open Season Wainer - Cohen
Optimal Foetal Positioning - Scott
Our Babies, Ourselves - Small
Our of Night, Our Share of Morning: Parenting as a Spiritual Journey - Fuchs
Ourselves as Mothers - Kitzinger
Pediatric Clinical Skills - Goldbloom
Postpartum Survival Guide - Dunnewold
Potty Training Your Baby - Van Pelt
Pregnancy & Dreams - Maybruck
Pregnancy Feelings - Baldwin
Pregnancy, Children and the Vegan Diet - Klaper
Pregnant and Chic - Sutherland
Prescriptions for Nutritional Healing, 2nd ed. - Balch
Quick & Easy Medical Terminology, 2nd ed. - Leonard
Quickening Magazine Vol. 29 No. 6
Raising Children Toxic Free - Brazelton
Seasons of Change: Growing Through Pregnancy & Birth - Arms
Shots in the Dark The Next City
Silent Knife Wainer - Cohen
Sleep Child Magazine
Smart Medicine for a Healthier Child - Avery
Special Breastfeeding Supplement - Midwifery Today
Special Delivery - Baldwin
Spiritual Midwifery, 3rd ed. - Gaskin
Stepping Stones to Midwifery Basic Course Workbook
Stranger Danger - Cope
Successful Homebirth & Midwifery: The Dutch Model - Abraham-VanDerMark
Swim Baby Swim - Hawley
Taber's Cyclopedic Medical Dictionary, 17th ed.
Taking Care of Your New Baby - Walker
The Alexander Technique Birth Book - Drake
The Bantam Medical Dictionary, rev. ed.
The Birth Tree - Doula Magazine
The Borning Room - Fleischman
The Breastfeeding Sourcebook - Rosenthal
The Childbirth Picture Book - Hosken
The Complete Book of Pregnancy and Childbirth (old ed.) - Kitzinger
The Complete Book of Pregnancy and Childbirth, New ed. - Kitzinger
The Complete Family Guide to Alternative Medicine -Shealy
The Complete Medicinal Herbal - Ody
The Complete Woman's Herbal - McIntyre
The Emotional Life of the Toddler - Lieberman
The Encyclopedia of Childbearing - Katz Rothman
The Encyclopedia of Medicinal Plants
The Family Bed - Thevenin
The Girlfriends' Guide to Pregnancy - Iovine
The Holistic Herbal - Hoffman
The Holistic Pediatrician - Kemper
The Midwife's Challenge - Kitzinger
The Midwife's Pregnancy & Childbirth Book - McCartney
The Natural Pregnancy Book - Romm
The Natural Treatment of Carpal Tunnel Syndrome - Wunderlich
The New Well Pregnancy Book - Samuels
The Next Nine Months - Sigel
The Nursing Mother's Companion, 3rd rev. ed. - Huggins
The Nursing Mother's Companion, rev. ed. - Huggins
The Nursing Mother's Guide to Weaning - Huggins
The Nutrition Bible - Anderson
The Patient's Guide to Homeopathic Medicine - Ulman
The Potential of the Traditional Birth Attendant - WHO
The Premature Baby Book - Harrison
The Tentative Pregnancy - Rothman
The Waterbirth Handbook - Herzberg
The Whole Person's Fertility Program - Payne
The Womanly Art of Breastfeeding - La Leche League Int'l
The Womanly Art of Breastfeeding, 6th ed. - La Leche League Int'l
The Worst Loss - Rosof
The Year After Childbirth - Kitzinger
Toilet Training Without Tears - Schaefer
Tough Questions: Talking Straight with your Kids About the Real World - Kitzinger
Treating Menstrual Cramps Naturally - Lark
Tricks of the Trade - Midwifery Today
Tricks of the Trade Vol. 2: Wisdom of the Midwives - Midwifery Today
Understanding Diagnostic Tests in the Childbearing Year: A Holistic Approach, 5th ed. - Frye
Vaccinations: The Rest of the Story, 2nd ed. - Mothering
Varney's Midwifery, 3rd ed.
Vegetarian Pregnancy - Yntema
Water and Sexuality - Odent
Water Babies - Sidenbladh
Water Birth - Napierala
What to Expect the First Year - Hathaway
What You Can Do About Asthma - Altman
What Your Doctor May Not Tell You About Pre-Menopause - Lee
When a Child is Born - Linden
Whose Body, Whose Rights: Examining the Ethics and Human Rights Issues of Infant
Male Circumcision - Money
Wise Woman Herbal Childbearing Year - Weed
Women's Bodies Women's Wisdom - Northrup
You Can Cook After the Baby Comes National Association of Post Partum Care Services
Your Baby & Child: From Birth to Age 5 - Leach
Your Baby Your Way - Kitzinger
Your Child in the Hospital - Keene
Your Child's Food Allergies - McNicol
Your Fertility Signals - Winstein
Your Pregnancy Week by Week - Curtis
Your Premature Baby - Manginello

Midwife Care and Services

noreply@blogger.com (Editor) — Mon, 24 Nov 2008 14:37:00 +0000

If you are looking for affordable midwifery care see if the offer some of the below services.

Our passion is taking care of pregnant moms, caring for you through out your pregnancy, birth, postpartum and beyond. Nuturing and providing skilled newborn care. We visit you in your home so you can save your gas money and childcare worries. You get to deliver in the comfort and conveniance of your own home. We offer a free in-home consultation. We accept most insurances and take ohp. Between the two of us we have delivered over a thousand babies.

We do
VBACS
Water Births
Nutritional Counseling
Herbal Remedies
Family Planning Counseling

Doula searching for Midwife

noreply@blogger.com (Editor) — Thu, 30 Oct 2008 14:21:00 +0000

Found this on Craigslist and wanted to share with others to see if anyone can match.

Aspiring Doula in search of practicing midwife to work/attend births with.

Doula living in New Westminster, age 29, very energetic, looking for experience &/or a mentor. Attended DONA Workshop for Birth Doulas in July & working on certification. Very knowlegable, but needs hands on pratice!

Required to attend at least 3 births for certification purposes, but may be interested to work as a team for an extended period. Looking for a good fit and an amiable co-worker, as well as knowlegable and experienced.

Lives within walking distance of Royal Columbian Hospital. No drivers licence/vehicle at present, but transit proficient.

To contact please email: DavinaSimms@gmail.com

Homebirth Witness

noreply@blogger.com (Editor) — Wed, 02 Jul 2008 15:27:00 +0000

Found this on Craigslist. A good place to search for this type of event.

I will be applying to Birthingway Midwifery School this fall with the intention of becoming a Homebirth Midwife. As part of my own personal due diligence I am looking for a woman that would feel comfortable with me witnessing her home or water birth.

I would be honored to be a part of your birth at any level you choose. I can stay in the shadows, take photos, or be a working part of your birthing team.

In trade I would love to offer my services as a post-partum Doula (non-certified) and assist you with anything from running household errands, to assisting with breastfeeding (I will be acquiring my Labor Doula Certification in late September).

If you're curious or have any questions, please contact me. All my life I've searched for my passion and I believe I've found it, and just to be sure I would like to witness a homebirth. Thanks you so much for even considering providing me with this opportunity. Happy Birthing.

Childbirth Organizations and Resources

noreply@blogger.com (Editor) — Fri, 28 Sep 2007 14:04:00 +0000

Organizations and groups involved in womens health, natural childbirth, and the care of babies and moms.

Academy of Certified Birth Educators

American Academy of Husband-Coached Childbirth

American College of Nurse-Midwives

College of Domiciliary Midwives

Association of Labor Assistants & Childbirth Educators

Association for Pre- & Perinatal Psychology & Health

Association of Women's Health, Obstetrics, and Neonatal Nursing

Attachment Parenting International

Birthworks, Inc

Center for Perinatal Research & Family Support

Childbirth Solutions

Doulas of North America

The Farm

Global Maternal/Child Health Association

International Cesarean Awareness Network

International Childbirth Education Association

International Lactation Consultant Association

La Leche League International

Lamaze International

Midwifery Today

Midwives Alliance of North America

Ministry of Midwifery

National Association of Childbearing Centers

National Association of Postpartum Care Services

North American Registry of Midwives

Virginia Friends of Midwives

What is a midwife

noreply@blogger.com (Editor) — Wed, 12 Sep 2007 13:47:00 +0000

A midwife is a person who, having been regularly admitted to a midwifery educational program that is duly recognised in the country in which it is located, has successfully completed the prescribed course of studies in midwifery and has acquired the requisite qualifications to be registered and/or legally licensed to practice midwifery. The educational program may be an apprenticeship, a formal university program, or a combination.

The midwife is recognised as a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labour and the postpartum period, to conduct births on the midwife's own responsibility and to provide care for the infant. This care includes preventive measures, the promotion of normal birth, the detection of complications in mother and child, accessing of medical or other appropriate assistance and the carrying out of emergency measures.

The midwife has an important task in health counselling and education, not only for the woman, but also within the family and community. This work should involve antenatal education and preparation for parenthood and may extend to women's health, sexual or reproductive health and childcare.

A midwife may practice in any setting including in the home, the community, hospitals, clinics or health units

Source: According to the International Confederation of Midwives (a definition that has also been adopted by the World Health Organization and the International Federation of Gynecology and Obstetrics), Wikipedia

Motherhood day was a success!

noreply@blogger.com (Editor) — Sat, 01 Sep 2007 13:43:00 +0000

Despite the drizzling rain and cold wind, Motherhood Day turned out well. Our classes had decent attendance and the moms, dads and nurses who participated learned about breastfeeding, childbirth issues, midwifery, the legislative process of midwifery in our state, the Bradley childbirth method, as well as the new CIMS initiative in which Ina May Gaskin is leading our nation.

We learned about Ina May's quilt being the first attempt on the part of a concerned midwife to alert the public to the unfortunate and highly preventable problem of maternal mortality in our country. The quilt stretched from one side of the large classroom to almost the other end. Sadly, this quilt will continue to grow and we will support Ina May in walking with this quilt through the nation's capital some day.

We had many pioneering vendors who braved the cold for the morning outside and ended up cozy and warm with other vendors inside by the afternoon. We owe everyone a big thanks for their participation and effort and we look forward to seeing the same faces again next year.

Dr. Warren Johnson, Dr. Dallas Cooley and Deborah Snarr, R.N., M.S.N, N.P. were honored at our first annual award ceremony that evening. We were pleased to offer them hand-tossed and glazed pottery from a local potter with the MOM emblem on the front. A local Irish dance school put on a fabulous show for the evenings light entertainment and we were blessed to hear Ina May speak once again of the importance of autonomous midwifery and how our group CAN change the laws in our state.

(We have to mention the *delicious* Indian food that a Stephens City restaurant made for us that evening --- if you are ever in Stephens City, stop by the convenience shop on Main St. and be prepared for a mouth-watering treat!)

Motherhood Day has given the MOM group more inspirational energy to tackle the upcoming year and we will take with us the memory of this first, special event to inspire our next event. Thank you to everyone who made it possible! All of the hard work was appreciated.

Previous information for those looking for Midwifery information from VirginiaMom.org

Midwifery Information

noreply@blogger.com (Editor) — Wed, 22 Aug 2007 13:39:00 +0000

This information if from the previous VirginiaMom.org site:

Virginia MOMs is a group of midwives, mothers and childbirth activists that formed out of concern over the lack of birth options and the barriers to midwife practice in our state. When we first began our dialogue in early 2001, we identified a few problems.

The mothers of Virginia noted that it was extremely difficult to find any alternative to a routine, medically-managed birth with a doctor in a hospital. Finding a doctor who would support a natural, low-intervention approach to birth in the hospital was hard enough. Finding a midwife who could legally attend a home birth, finding a birth center not attached to a hospital, or even finding a midwife with her own practice were nearly impossible in most areas of the state.

The midwives gave their perspective as well. There were Certified Professional Midwives (CPM's), who are not able to legally practice under Virginia law, despite their documented experience, safety, and credentialing by independent national midwives' groups. These midwives have the ability and skills to meet many of the homebirth needs of Virginia families, yet every time they attend a birth, they must do so illegally. These midwives have difficulty in obtaining support or help from doctors and hospitals when it is needed, such a lab work, emergency medicines, or medical advice when questions arise with a pregnancy or labor.

Certified Nurse Midwives (CNM's), who are legally licensed in Virginia, reported a different set of problems. Virginia is one of only 12 states with a law requiring “physician supervision” of CNM practice. Thus, a CNM with a legal home birth practice, a birth center, or even a hospital practice, is dependent upon having an OB-GYN "supervisor". Lack of satisfactory "physician supervision" has caused a number of birth centers and home birth services to close, and remains an ongoing concern for the CNM's who do remain in practice. CNM's with hospital practices are dependent upon the OB-GYN as well, since hospitals refuse the midwife privileges unless she is employed by or contracted with a doctor, and the midwife may not admit her own patients under this arrangement. Midwives fully recognize the need to cooperate and consult with doctors for problems outside the normal scope of midwifery practice; but requiring this type of supervision only limits the practice of normal birth and decreases safety.

The answer to the problems, as we identified them, became clear: to improve birth options, to increase safety, to improve midwife practice in our state, we need to:
1.) Legalize Certified Professional Midwives… and
2.) Remove Physician Supervision from Virginia midwifery law.