The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA
An interactive resource for moms on easy steps they can take to reduce exposure to chemical toxins during pregnancy.
Other excellent resources about avoiding toxins during pregnancy
These are easy to read and understand and are beautifully presented.
It has been my impression that, in theory, a "primary care case manager" should be able to care for normal cases independently and recognize/refer high risk to the appropriate specialist. Under that definition, CNMs would make excellent case managers for OB/Gyn clients.
I'm afraid, though, the reality would be that the HMO's would object
to nearly every referral to a more highly trained (read more expensive)
specialist and the CNM-case manager would be faced with the choice of continuing
care for high risk cases without referral or consultation or jeopardizing
We already ARE primary care case managers in WA state, and practice
independently. We do primary care women's health care. I think/hope the
AMA is a dollar short on implementing this, as the mechanisms are already
in place in some states, and ARNPs aren't about to lose ground. I provide
lots of primary care type things. I also know when to refer, either back
to a PCP, or to a specialist. In our area, we refer to specialists. Remember,
they like the business too, and if you refer them clients because you like
their care, they'll accept your referrals. Its the inappropriate referrals
that gets one into trouble. I think the important thing is knowing your
limits and not overstepping your bounds. Some plans call for the PCP to
make the referral. It's touchy, however, under some contracts.
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