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  • Peggy Garland Spindel CNM, MPH,

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    • Peggy Garland Spindel began attending home births in 1975 as a lay midwife. She co-authored a textbook on home birth with family physicians in 1984. She completed her MPH and nurse-midwifery education at the Boston University School of Public Health in 1993. She has a particular interest in health law as it relates to midwives. She works as a CNM at Planned Parenthood of Brookline, Massachusetts, Urban Midwife Associates of Boston, Partners in Women's Health in Maiden, Massachusetts; she holds a faculty adjunct appointment at the Boston University School of Public Health and attends an occasional home birth.

  • Suzanne Hope Suarez BAN, JD

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    • Suzanne Hope Suarez is an attorney, registered nurse, and midwifery activist. Her article “Midwifery is not the Practice of Medicine,” was published in the Yale Journal of Law and Feminism in 1993. Since then, she has served as consultant to midwives and attorneys around the country. Presently, she serves as legal advisor for the North American Registry of Midwives and is working as senior analyst for Florida's Agency for Health Care Administration in the Division of Health Policy and Cost Control. Suzanne had her daughter at home in 1980 with a traditional (non-nurse) midwife. Her subsequent training in nursing (ASN 1984, BSN 1986) led to further interest in midwifery.

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The history and purpose of informed consent are explored and its legal components are detailed. Recommendations are given to meet the criteria for informed decision-making at home, including discussion of unusual circumstances. The nature of assistance at childbirth, especially at home, is explored in relation to legal obligations. The article includes some observations on cultural dissonance regarding informed consent. Finally, the authors recommend a focus on a therapeutic alliance with the client as the best outcome of effective informed consent and as the second best preventive measure against malpractice, the first being competent care.