Important changes you should know about home birth VBAC (HBAC) options in California.
As you may have heard, an earlier version of AB1308 had the potential to significantly limit VBAC options in California. However, California Families for Access to Midwives, along with California Midwives Association, worked hard to make the following changes:
AB1308 does not have any language limiting access to VBAC. California’s new midwifery legislation does not have any express limitations on out-of-hospital VBAC. As a direct result of advocacy efforts of California Association of Midwives and California Families for Access to Midwives, AB1308 does not include absence of prior uterine surgery in the definition of normal pregnancy and childbirth. AB1308 defines normal pregnancy and birth as follows:
There is an absence of both of the following:
Any preexisting maternal disease or condition likely to affect the pregnancy.
Significant disease arising from the pregnancy.
There is a singleton fetus.
There is a cephalic presentation.
The gestational age of the fetus is greater than 37 0/7 weeks and less than 42 0/7 completed weeks of pregnancy.
Labor is spontaneous or induced in an outpatient setting.
If a client has a preexisting disease or condition as defined in the regulations created by the medical board, the midwife must refer the client for an examination by an obstetrician/gynecologist for a determination that “the risk factors presented by her disease or condition are not likely to significantly affect the course of pregnancy and childbirth.”
We need active engagement and public pressure on the California Medical Board as they draft regulations to define what constitutes a preexisting disease or condition that is likely to affect pregnancy. The medical board’s legal mandate is to implement the law regulating medical licensees, and they have no legal authority to craft regulations beyond the scope of their legislative mandate. Thus, it is our job, collectively, to provide the medical board with relevant information regarding VBAC safety, and to remain vigilant and engaged so the medical board does not miscategorize prior cesarean as a preexisting condition that is likely to affect pregnancy and childbirth.
VBAC access is virtually nonexistent in many counties, and low-income women are disproportionately impacted. Under current law, Medi-Cal does not recognize LMs as independent providers and does not cover out of hospital birth. Accordingly, women on Medi-Cal are often denied access to VBAC because their health care providers do not “permit” them to attempt VBAC. This unjust system contributes to income-based and racial disparities in birth outcomes. AB1308 removes the primary legal impediment to Medi-Cal coverage of out-of-hospital maternity care.
Getting Governor Brown to sign AB1308 is a critical next-step to preserve midwifery access in California. We are at a time in California when two Certified Nurse Midwives, who have nearly identical scope of practice and supervisory requirements as LMs, are being investigated by the Board of Registered Nursing for no other reason than attending home births without physician supervision. Self-report statistics indicate that over 90% of LMs in California are practicing without supervision, and are therefore violating the law. It is a realistic possibility that the State of California will not relent its efforts to enforce physician supervision of midwives, and LMs are next on the list if AB1308 is not signed into law.
For additional analysis of the bill, please visit here. The final bill is available at: www.legiscan.com/CA. Type in AB1308 under bill number. To review current law, search California Business and Professions Code section 2507