Update from the States: California
California midwives are going to the legislature with three midwifery bills this session. California Association of Midwives (CAM) and California Nurse Midwives Association (CNMA) have each sponsored legislation that will increase access to midwifery care for the families of California.
New California Legislation: Expanding Access To Midwifery Care Through Medi-Cal
California Senate Bill 407 will, if passed, authorize California Department of Health Care Services to recognize licensed midwives as providers in the Comprehensive Perinatal Services Program (CPSP). This is a critical step towards Medi-Cal coverage for licensed midwives in California. SB 407, sponsored by CAM, will add licensed midwives to the list of qualified Comprehensive Perinatal Service Program providers under Medi-Cal, further expanding access to community-based midwifery care in all settings for all women and families in California. The Comprehensive Perinatal Services Program (CPSP) provides educational, nutritional, and psychosocial support to pregnant women, as well as childbirth and breastfeeding education, services already provided within the scope of LM practice and fully in line with the midwifery model of care.
The Comprehensive Perinatal Services Program became a Medi-Cal benefit in 1987. Licensed midwives are not currently, but should be, recognized as eligible providers of these benefits, which fall squarely within their scope of practice. The passage of this bill would allow licensed midwives who work in clinics providing CPSP services to bill Medi- Cal.
This bill is a part of a larger legislative strategy spearheaded by the California Association of Midwives (CAM). “All women in California deserve to be able to choose midwifery care,” said Sarah Davis, LM “Our goal is to expand the option of midwifery care to all women in California by making care with licensed midwives Medi-Cal eligible.”
If passed SB 408 will expand midwifery care – particularly in rural and other underserved areas – by allowing ‘midwife assistants’ to legally assist licensed midwives at out-of-hospital births. Typically, two providers attend each birth, but licensed midwives are scarce in some areas of the state. This bill would allow a specially trained ‘midwife assistant’ to legally assist a licensed midwife, expanding the reach of existing providers.
California Assembly Bill 1306 removes physician supervision from the law governing CNM practice. It also authorizes a certified nurse-midwife to manage a full range of primary health care services for women from adolescence beyond menopause in all settings, including, but not limited to, a home, without direct supervision of a physician. The bill, sponsored by CNMA, would provide for consultation, collaboration, or referral as indicated by the health status of the client and the resources of the medical personnel available in the setting of care, and would provide that the practice of nurse-midwifery emphasizes informed consent, preventive care and early detection and referral of complications to a physician and surgeon. This bill would authorize a certified nurse-midwife to provide peripartum care in an out-of-hospital setting to low-risk women with uncomplicated singleton-term pregnancies who are expected to have uncomplicated birth. It would also allow nurse- midwives to furnish medications and devices within the scope of her practice, and to make repairs of the perineum for 1st and 2 degree lacerations.
Regulatory Process Still Underway
Physician supervision is no longer required for licensed midwives, thanks to the passage of California bill AB1308 in 2013. That bill also called for a number of changes to be determined through regulation (as opposed to legislation). CAM, alongside the consumer group California Families for Access to Midwifery (CFAM) have been participating in the regulatory process.
The new regulations dictate a physician referral for preexisting maternal diseases or conditions likely to affect a pregnancy and significant diseases arising from pregnancy. At issue is the complete list of those conditions. The regulation has been the source of some confusion (it calls for exams, not a required transfer of care to a physician). It has also sparked concern, particularly from consumers concerned that a physician may be unwilling to address their desire for a home birth with a licensed midwife.
“Consumers of California want the option of using a midwife, either at home for birth or in clinics, birth centers and hospitals. California Families for Access to Midwifery is very excited to support the three midwifery bills introduced to our legislators! We were a part of the process from the passage of AB1308 (the removal of physician supervison for LMs), to the regulatory process, and now we are supporting SB 407 and 408 and again supporting the removal of physician supervision from the nurse midwives of California AB 1306. ” -Tanya Smith-Johnson President CFAM