This article is Part 3 in a series on Oppressive Midwifery Regulation.
The situation in the state of California is complicated. It has taken me hours of pouring over the legislation and commentary, and in phone conversations with those in the throes of the battle to come to a semblance of understanding the circumstances.
A little history:
In 1993, California obtained licensure, and under the licensure guidelines, a stipulation of physician oversight was included. Like Delaware, midwives are required by law to have physician supervision in order to practice, legally. And like Delaware, this stipulation has, essentially, made all homebirth midwifery illegal, as physician malpractice insurance does not allow for any sort of collaborative working arrangement between physician and midwife.
So, for twenty years the Medical Board of California (MBC), who oversees and enforces the regulation of midwifery (breathe, we’ll go there in a moment), has chosen to turn a blind eye and not actively prosecute midwives for operating outside of this scope of the regulation. Concurrently, midwives have gotten around this caveat by providing clients with informed consent documents that expressly state that they have no physician oversight.
The Medical Board
Here’s where it gets complicated. Midwifery licensure falls under the Business and Professional Department, which oversees all licensing – from plumbers and barbers to physicians. The licenses within that department are then enforced by specific boards. Anything that is health-related is enforced by the The Medical Board of California (MBC). Midwifery falls under that category.
Now, recently the MBC has come under scrutiny due to a large number of pharmaceutical drug abuses and drug overdoses that have resulted in death. As a result, the legislature intervened with SB304. This bill specifies timely attainment of patient records during an investigation and it has appointed the Department of Justice (DOJ) to step into the MBC’s place in enforcing health-related regulation.
The latter is unfortunate because the DOJ has no history of friendly standoff with California midwives, like the MBC does. The DOJ’s job is to enforce the law. And California midwifery law requires physician supervision.
So this is all happening in the midst of what is known as the “Sunset Review,” which is simply a revisit to the current law for evaluation and potential adjustment. The proposed legislation that has come out of this review is AB1308.
AB1308 retains the language of physician oversight for midwives, and also throws in loose language to revisit the issue in 2015, which is incredibly dangerous because in the meantime midwives will be held to the physician oversight standard by the DOJ.
Interestingly, ACOG has, from California’s licensure inception twenty years ago, held a strong voice in this conversation. At the onset, ACOG rep’s wooed midwifery representation into believing that they wanted to work together to collectively construct the law in a way that was workable for all parties.
Obviously, that’s not what happened. ACOG underhandedly had their own conversations and crafted their own draft policies that were subsequently put into place – namely, the language that insists on physician oversight.
And they’re at it again. ACOG lobbyists and members have been meeting with legislators with an agenda to not only maintain the physician oversight language, but additionally, to convince legislators of the inherent “danger” of homebirth.
The MBC is comprised entirely of physicians and several public members. There is no midwifery representation. Instead, there is a Midwifery Advisory Council (MAC), who act separately to advise the medical board on issues regarding midwifery. However, they are not part of the regulating board and they do not hold decision making power.
I continue to be baffled at how states with regulation routinely end up with legislation that involves women and their chosen providers handing their rights and decision making powers over like subservient little plebeians to the lords in white coats.
Let’s just get real here about the blatant paternalism that exists a system where a profession comprised of those who are predominately white, male, and wealthy oversee a another profession comprised entirely of women who exclusively serve other women. And let’s not forget that a primary and overt historical goal of these same power lords was to eliminate from its competition, the midwifery profession, altogether. (You can read more about that history, here.)
Midwifery and medicine are NOT synonyms! Suggesting that midwives be overseen by physicians is not only insulting, it is illogical. Midwifery is the age-old profession; not obstetrics. Women have been the experts in attending other women since the beginning of time. Midwives are the experts when it comes to normal birth.
So who should be overseeing whom?!
The U.S. ranks FIFTIETH in maternal mortality. And only less than 2% of births take place at home, so it’s pretty clear where the trouble lies . Leaving birth in the hands of those who operate on the philosophy that birth is pathological in nature has led to a maternity care epidemic, which fouls the air with lack of access to evidence based care. This sharp deviation from normal physiology has resulted in the high intervention, induction and C-section rates, and the corollary high infant and maternal mortality rates.
Considering all of this, it seems to me we have it backward.
What you can do:
- Connect with California Families for Access to Midwives, a consumer group working to protect the rights of women and families’ access to midwifery care.
- Contact your legislators and let them know that you oppose AB1308 in its present form. Tell them how physician oversight hurts the midwifery profession, and hurts birthing women. (See CFAM for legislative links and talking points.)
- Follow CFAM on facebook to stay current on updates and calls to action.
An update on California can be found here.