California licensed midwives will have increased independence and authority in attending births, potentially giving more pregnant women access to their services under a new law that goes into effect in January.
Assembly Bill 1308 removes an unworkable clause that required all licensed midwives to be supervised by a physician. Licensed midwives had been unable to fulfill that requirement since it went into effect 20 years ago because physicians’ malpractice insurance prohibited them from filling that role.
In addition, licensed midwives will now be authorized to operate birth centers without physician supervision and will have increased access to drugs, tests and medical devices used in their practice.
“It’s huge,” said Modesto midwife Lucinda Chiszar of the new law. “It’s a sea change.”
The law puts California in line with most other states, which consider midwives independent practitioners.
AB 1308 also clarifies the scope of practice for licensed midwives, allowing them to attend cases of normal birth (no twins, only births between 37 and 42 weeks) and requires them to provide medical records and inform doctors on the status of labor if a woman has to be transferred to the hospital.
It limits physician liability, making it easier for physicians to consult with midwives without fear of being sued. The law clarifies that physicians aren’t responsible for midwives’ practice.
The law could open the door for Medi-Cal to cover licensed midwives, said Jessica Johnson, a Modesto midwife and regional representative for the California Association of Midwives.
“It would give a safe home birth option for low-income women,” Johnson said.
A small percentage of mothers use licensed midwives now. Last year, about 2,300 births were attended by the state’s 300 licensed midwives. California has about 500,000 births annually.
Natalie Hackett, 25, of Modesto, hired Johnson to attend the home birth of her son a year ago. She was influenced by two documentaries – “Pregnant in America” and “The Business of Being Born,” which criticize a perceived over-use of medication and interventions like Cesarean sections at hospital births.
Hackett loved giving birth at her own home. She was able to walk around during labor in familiar surroundings, she didn’t take any drugs and her recovery was fine. “It was the greatest experience of my life,” she said. “My dream would be now to be an advocate of home births and have everybody understand how amazing that experience is.”
Jennifer Silva, 29, of Manteca, had a hospital birth for her first child two-and-a-half years ago but turned to Johnson for a home birth of her new baby. While her first birth in the hospital wasn’t traumatic, she had a strong desire to be out of a medical setting for her second delivery.
“I feel natural birth is empowering and it’s good for the mom and baby,” she said.
Silva also liked the idea of using a midwife because she knew the same person who gave her prenatal care would also attend the birth.
“A lot of times that doesn’t happen at a hospital,” she said. “There’s a loss of relationship. You don’t have that comfort and relationship”
Like Hackett, Silva also appreciated laboring in her own space rather than in a hospital room.
“It was so stress free,” she said. “I feel like all women should give birth this way. It was relaxing. Jessica said ‘When you feel like you need to push, push.’ She wasn’t coaching the pushing. She trusted that my body knew what to do and I did too.”
Johnson said midwives offer mother-centered care. “It’s about what the mother wants, her choices and how she wants to do it,” she said.
Other reasons why women choose midwives include religious beliefs and value of modesty and the expense. Johnson, as an example, charges $3,700 for prenatal care through birth. Hospital costs in the area for a birth can be $25,000-$30,000.
“Not everyone is willing to go to a hospital, not everyone can afford to go to a hospital,” Chiszar said. “Sometimes it’s cultural, sometimes it’s their mental health. People have all kinds of reasons why they’re going to refuse to go to a hospital. If you don’t have a skilled attendant, it’s dangerous.”
Chiszar said that when mothers haven’t been able to access midwives, they have had unassisted home child births, which have led to tragic deaths of both moms and babies. “Once there were licensed midwives, the losses went down,” Chiszar said.
AB 1308 was supported by the American Congress of Obstetricians and Gynecologists. “ACOG believes that hospital and birthing centers are the safest settings for birth, but we respect the right of a woman to make an informed decision about place of delivery,” said a statement by Dr. Laurie Gregg, a representative of the organization. “The intent of all our efforts with this bill was to make the home birth choice a little safer and with a better transition from the midwifery home setting to medical care if the need arises.”
Assemblywoman Susan Bonilla, D-Concord, who sponsored the bill, said in a statement that she believes midwives offer excellent care. “This is a historic new law because it finally ensures that women who choose to have midwives deliver their babies will have the peace-of-mind knowing that proper safeguards are in place to provide them with physician care if necessary,” she said.