Update: Midwifery bill moves on to governor’s desk

After months of negotiations, including major amendments added just a week ago, a bill aiming to improve care for women giving birth outside the hospital passed unanimously Thursday night.

The bill, AB 1308, addresses long-standing issues that made it nearly impossible for licensed midwives to operate legally. As I reported for KALW Public Radio, licensed midwives were legally obligated to be supervised by physicians. If a doctor supervised a licensed midwife, however, the doctor ran the risk of losing liability insurance. So, collaboration was unattainable and advocates said this put women and babies at risk.

The bill removes the requirement for licensed midwives to be supervised by a physician.

“Because physician supervision was required but not available, the midwives often had to operate in the shadows,” said Shannon Smith-Crowley, a lobbyist for the American Congress of Obstetricians and Gynecologists (ACOG), a group representing OB/GYNs and the bill’s sponsor. “Midwives can be out in the open, helping them develop better relationships, warmer reception and protocols for transfer, ideally leading to earlier transfers in less dire circumstances.”

Under the bill, a doctor who sees a midwife’s client will get more information at the point that responsibility is transferred, or even along the way, which should lead to better care for mother and baby.

The new amendments better define the licensed midwife’s scope of practice, which includes making it illegal to attend to high risk pregnancies and births, such as twins, breech (when the baby’s head is up rather than down) and pregnant women with diseases that put the pregnancies at risk. Licensed midwives can only assist women who have “normal” pregnancies and who give birth between 37 and 42 weeks of pregnancy.

The bill further clarifies that licensed midwives are able to order medication and supplies.

Ultimately, advocates, say, these changes will lead to improved care for the women of California.

“Women won't feel they have to lie to the doctor or hospital that they are a client of a licensed midwife and planning a home birth,” Smith-Crowley said. “Open communication should lead to better care.”

The bill does not add any liability protections for doctors who choose to collaborate with licensed midwives. It does require that licensed midwives tell their clients that many physicians “do not have liability insurance coverage for services provided to someone having a planned out-of-hospital birth.”

Last year, California's licensed midwives helped deliver 2,300 babies.

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Lauren M. Whaley

Freelance journalist Lauren M. Whaley is a photographer, radio producer and print reporter specializing in topics related to mental illness, reproductive health care and health disparities. She is also a childbirth photographer.This year, She is working on a series about how low-income parents access care for perinatal mental illnesses. The project is funded in part by the Rosalynn Carter Fellowships for Mental Health Journalism.She was a 2016-17 Knight Science Journalism Fellow at the Massachusetts Institute for Technology.Her work has been recognized by the Association of Health Care Journalists, the Scripps Howard Foundation and the Public Radio Exchange (PRX) STEM story project. She has contributed radio, video, photography and written stories to KQED Public Radio, Southern California Public Radio, the San Jose Mercury News, the New York Times and other media outlets. For six years, she worked as the Center for Health Reporting's multimedia journalist. She is a past president of the national organizationJournalism and Women Symposium (JAWS) and spent her early 20s leading canoe expeditions for young women, including a solo-led 45-trip in the Canadian Arctic. She is based in Los Angeles.

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