New update 9/7/13 - Proposed Bill Language Now Publicly Available
The proposed amendments are now publicly available! Read them here. Want to learn more about the implications of the proposed legislation? Read below for CFAM's analysis.
Update! New analysis of AB1308 available.
The proposed changes to AB1308 are not publicly available. To help families, midwives, and others concerned with midwifery law in California, CFAM has drafted an analysis of the proposed legislation. Please note these changes are not law! To learn more about how to take action, click here.
Top findings from our analysis of the proposed changes to AB1308:
CFAM is supporting AB1308, because it is a first step in increasing access to licensed midwifery care, and it lifts the looming threat of enforcement of physician supervision.
You can find full details in the complete analysis (Download the analysis here.).
Here’s some of the most impactful changes:
Removes physician supervision. Licensed midwives will for the first time in California history, be recognized as autonomous providers.
Plus: removal of physician supervision will inevitably lead to a greater degree of visibility and respect for what midwives do, and will make midwifery care a viable possibility for women of all income levels. It also limits licensed midwives’ scope of practice to “normal” birth.
Changes the educational requirements for students. After January 1, 2015, new licensees shall not substitute clinical experience for formal didactic education.
CFAM has consulted with California Association of Midwives, and they endorse this legislative change because the overwhelming majority of new midwives meet this requirement.
Adds physician liability limitations – and states that physicians are not responsible for midwives or their clients, and that no legal relationship is created as a result of a licensed midwife’s consultation with a physician. It also outlines liability limitations in regards to hospital transports.
These limitations of liability are unlikely to have a significant practical impact, except to the extent that they make physicians more comfortable accepting referrals and transfers. As such, the net outcome is likely to be positive.
Restates and adds informed consent and disclosures. Because the midwifery model of care is based on large part on informed consent, CFAM has no problem with the additional disclosures.
Authorizes state licensure for birth centers operated by licensed midwives.
This will result in increased access to care. CFAM does not anticipate any negative impact of this provision.
Increases access to drugs, tests, and medical devices used in midwifery practice.
This will increase convenience for licensed midwives and increase safety for women in their care. We do not anticipate any negative impact of this provision.
I don’t like every part of this bill - why is CFAM supporting it?
Like all legislative efforts, this bill is the result of compromise and give-and-take. We’re not happy with every aspect of the bill, either.*
*(This is why we are committed to continuing to grow as an organization, so that we can continue to have an impact long-term on legislation that impacts women and their babies).
Unfortunately, status quo is no longer an option.
As the law is currently written, licensed midwives must secure supervision from a physician in order to legally practice. However,physicians are unwilling or, because of insurance limitations, unable to provide the required supervision. The result? Licensed midwives providing home and birth center births are currently acting outside of California law.
This has been the case for 20 years. Until now this law has remained unenforced. But many changes this year mean that we cannot count the ongoing willingness of authorities to not enforce the law.
A new bill (SB 304) would move enforcement of licensees from the California Medical Board to the Department of Justice. As we understand it, this bill was designed to tighten enforcement of dangerous prescription writing by a tiny minority of physicians. However, this legislation could have the unintended consequence of opening up midwives to enforcement of the existing physician supervision regulations.
Even if SB 304 does not pass, one of our key allies - the executive director of the CA Medical Board - has mysteriously taken early retirement. Some have suggested she was forced out in part because of her support for home birth. A new executive director could quickly call for enforcement of physician supervision - which would criminalize most homebirth in CA.
This is why we support AB1308 - which, as currently amended, removes physician supervision. We are committed to staying a part of the process and doing everything we can to ensure maternal autonomy.