Why Changes To California Midwifery Legislation Are Critical
With the exception of California, Louisiana, and Arkansas, the laws governing the relationship between licensed midwives and physicians in the rest of the nation conform to the Standards of Practice of the National Association of Certified Professional Midwives, which are based on the following principles:
Licensed midwives are trained to work as autonomous providers.
Licensed midwives recognize that optimal care of women and babies during pregnancy, birth, and postpartum takes place within a network of consulting relationships with physicians and other providers who can provide care outside the scope of midwifery practice when needed.
Licensed midwives are trained to recognize abnormal or emergent conditions needing expert help outside their scope.
Licensed midwives have a plan for consultation and referral when such conditions arise.
California Families for Access to Midwives supports modernizing California’s licensed midwife practice act to conform to the NACPM Standards of Practice for the following reasons:
Physician supervision of licensed midwives is unworkable and unenforceable in practice, imposing liability burdens and other disincentives for physicians to enter into formal or contractual agreements with licensed midwives.
Because this unenforceable and unworkable provision in California law remains on the books, licensed midwives are unable to care for Medi-Cal recipients, creating discriminatory barriers to access and costing the state millions of dollars in unrealized savings each year.
Licensed midwives already consult with physicians as needed. Physician supervision requirements are therefore unnecessary and burdensome.
Imposing a supervisory relationship between a licensed midwife and a physician interferes with the midwife-client relationship for women who specifically choose alternatives to physician-led care.
The Removal of Physician Supervision?
Didn’t We Do That Already?
We know you thought we already removed physician supervision from midwifery law right? And yes you are right. We removed physician supervision from Licensed Midwives, and now are seeking the same thing for Nurse Midwives!
California is blessed to have many types of maternity care providers, Licensed Midwives, Nurse Midwives, Obstetricians, Family Practice Doctors, and Doctors of Naturopathy. Our Midwives practice under two different laws, Nurse Midwives are licensed by the Board of Registered Nursing and Licensed Midwives by the Medical Board of California.
California Families for Access to Midwives supports modernizing California’s Nurse Midwifery Practice Act, bringing CNM law into alignment with California Licensed Midwifery Practice Act and national recommendations.
We are calling for the removal of physician supervision from the Nurse Midwifery Practice Act because:
Physician supervision of nurse midwives is unworkable and unenforceable in the home and birth center setting, decreasing safety and imposing liability burdens and other disincentives for physicians to enter into formal or contractual agreements with nurse midwives.
Currently nurse midwives are limited in their ability to offer care to families in out of hospital settings and performing life saving emergency procedures may be considered illegal. Removal of physician supervision will allow nurse midwives to practice fully within the scope of their practice, in ways already practiced by Licensed Midwives in California.
Nurse midwives consult with physicians as needed. Physician supervision requirements are poorly defined, burdensome, and fail to increase safety.
Imposing a supervisory relationship between a nurse midwife and a physician decrease options in childbirth and limit access to the midwifery model of care in all settings.
Removing physician supervision will allow nurse midwives to work in underserved areas of our state, some communities have no maternity care providers at all!
California is lagging behind most other states, we are only one of nine states that require physician supervision of nurse midwives. Let’s move the midwives of California forward!