We have been asked several times to consider offering a monitrice program. After prayer, consideration, meeting with board members, and consult from an attorney, we have determined to move in this direction. The program will be more expensive, but it will require quite a bit more paperwork and supervision, and some significant more responsibility to take care of legal liability. Cost of the program will be an additional $75 over and above the cost of the labor support training for the certification year and $30 per year to maintain certification above and beyond the annual Titus 2 dues of $24.

The Titus 2 Birthing Labor Support training will suffice for training for both the CCD and the new CCM program. There will be some new forms to include: Informed Consent, required Certification of Skill Level, Practice Guidelines, and a Titus 2 Release of Liability Form.

Understand that we will not be providing training in clinical skills! Your training must be acquired elsewhere and must be verified by a qualified, certified instructor (CPM, CNM, RN, doctor, or college medical skills instructor) who can sign off on your verification forms. (Some Titus 2 workshops sponsored by other organizations may choose to offer clinical skills training under their own skills credentialling for the convenience of Titus 2 attendees.)Each and every Skills form will be verified! (This covers our legal liability.) You cannot use clinical skills in this program without skill verification. If you do so, your certification will be revoked. Certification in this program does not guarantee that all skills are legal in your state - you must know what those guidelines are and respond accordingly.

I hope this new program offers a good option for caregivers providing labor support with the use of clinical skills. I also hope it offers a good option for consumers looking for certified professionals with clinical skills who are willing to provide labor support out of hospital. This could be a good option for midwifery students working towards certification but not there yet and those who have let certification lapse for whatever reason.

This certification does not give our birth professionals the ability, responsibility, or authorization to deliver babies, to make diagnoses, or to determine a course of treatment. The purpose of clinical skills is to assist families to remain at home as long as possible before moving to the hospital or birth center or to allow the monitrice to monitor the mom and baby until the midwife or other medical personnel hired to assist delivery arrive.

Circumstances under which these skills might be used include:

• assisting a mom who has exhibited an elevated blood pressure in prior appointments, but is not pre-eclamptic, by monitoring blood pressure in cooperation with the primary birth attendant.
• helping to monitor a woman who's waters are broken by monitoring temperature and pulse rates for signs of infection
• monitoring fetal heart rate during a VBAC or broken waters
• Dilation/effacement checks done in cooperation and communication with the birth professional. (There are other ways to assess dilation than vaginal examination.)

Definitions:

• Monitrice: a person who provides labor support with limited clinical monitoring skills, in cooperation with a licensed birth attendant (midwife or doctor)
• Limited Clinical skills: blood pressure, temperature, pulse, vaginal checks, fetal heart tones
• Cooperation: the birth professional in charge of the birth (midwife or doctor) knows you are there, what you are doing, why, the results of your findings and is comfortable with your skill level. This should be done whenever possible, but we do understand is not always an option.
• Verification of skills: a signed affidavit from a certified or licensed medical professional (midwife, doctor, nurse, EMT/Paramedic) attesting to your competency to perform the listed skill
• Informed Consent: a signed document indicating that you and the client are both clear about your skill level, under what circumstances you will perform a skill, under whose authority you practice and how you received your training, and who is liable for your work
• Release of Liability form: a signed release from the client making it clear that Titus 2 did not provide your skills training, does not certify your ability to provide clinical skills and cannot be held liable for your competency or lack thereof
• Practice Guidelines: a document signed by the birth professional outlining conditions under which clinical skills are acceptable in this program and the responsibilities and requirements for birth professionals practicing under this umbrella.
• Birth Skill Report: a document completed for every birth where the monitrice provides limited clinical monitoring skills - includes why the skills were performed, a copy of the Informed Consent and Release of Liability forms, report of the birth outcome and the client evaluation form

Required Paperwork:

• Verification of Skills Training and Competency
• Informed Consent and Practice Guidelines
• Release of Liability
• Birth Outcome and Skills Report
• Client Evaluation Form
• Titus 2 Statement of Faith, Mission Statement, Birth Philosophy and Code of Ethics

Required Training:

• Titus 2 Birthing Labor Support Workshop
• Training provided by a licensed health care worker or a post-high school certification class in clinical skills that will be utilized during labor

Program Costs:

• Certification packet fee of $25
• Titus 2 Birthing Labor Support Workshop fee
• Outside training (Some workshops may offer clinical skills training with workshops. Check each workshop offering to see if labled as a Labor Support Workshop or as a Labor Support/Monitrice Workshop. Those designated for monitrice's will contain an extra day of clinical skills training. This skill training day is not a Titus 2 offering, but rather one offered to Titus 2 attendees through the sponsoring group and under that provider's licensing credentials.)
• Administrative fee in the first year - $75
• Annual membership fee of $24
• Annual recertification fee of $30

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