21st Century Healthcare ~ Community Midwives join as “up-streamists” in the new approach to preventative healthcare

This link takes you to a new and dynamic organization called HealthBegins.org.

This topic is crucially important to Ca LMs in many ways, including our ability to ‘fix’ the ‘unintended consequences’ (i.e. problems) created by the AB 1308 amendment to the LMPA.

The HealthBegings movement was started by a general practice physician from South LA (a very low-income area) whose clinic treats the veterans, the unhoused, and the chronically ill.

His name is Dr. Rishi Manchanda and his TED talk presentation is called “What makes us get sick? Look upstream“.

I encourage every community-based California LM & CNM to go to this site and watch the two videos posted on its homepage. Dr. Manchanda’s TED Talk is on the left side.

The ideas expressed and being implemented by the HealthBegins organization are the core of a dynamic and cost-effective 21st century “health” care system that is truly organized around protecting, preserving and promoting health. This is where midwives fit into the system.

Interestingly enough, the traditional purpose and goal of maternity care is to protect, preserve and promote the health of already healthy pregnant women. That’s why maternity care is a fundamental aspect of any good “health” care system.

These concepts allows us all to see and publicly acknowledge the big blue elephant in the middle of the room — the fact our so-called “health” care system is really a sickness-care system organized around providing expensive medical, surgical and pharmaceutical treatments to the already seriously ill or injured.

As a new 20th century expression of ‘modern’ (i.e. scientific) medicine, the allopathic medical system was never designed or intended to preserve the health of the already healthy. Doctors don’t go to school for 8 to 13 years so they can spend their very expensive time discussing issues such as housing, employment, relationships, sex, money, and/or the eating habits of ordinary healthy people.

These same 21st century “health” care principles are also vitally important in regard to maternity care for healthy women with normal pregnancies. The current obstetrical system, as a hospital-based surgical speciality, is not now and never was organized around preserving the biological normalcy of childbirth.

As you know, our licensing law — LMPA — states that Ca LMs are “not authorized to practice medicine or surgery”. That means midwives are quintessential HEALTHCARE providers in the purest sense of the word.

AB 1308, for all its faults, legally promoted us from a medicalized discipline under the control of the medical profession (i.e. physician supervision) into the independent category of a true “healthcare provider”. For this we must thank Assemblywoman Susan Bonita and Sonja Paladino, as well as Constance Rock and Sarah Davis, and ACOG reps Shannon Smith-Crowley and Lori Gregg.

The true or ‘traditional’ practice of midwifery always a function of public health. Unfortunately the midwifery profession in California suffered a “hostile take-over” that began in 1974 when the CMA wrote the licensing laws for CNM.  ACOG and the CMA insisted that nurse midwifery be a medicalized discipline under the control and that CNM practice only under the supervision of an MD trained in obstetrics (i.e. an obstetrician).

For the hospital-based practice of nurse-midwifery, an argument can be made that it is a medicalized form of midwifery and therefore co-management with an obstetrician is logical. However, things didn’t stop there. IN 1993  the CMA and ACOG once again insisted that the direct-entry (i.e. non-nurse) midwifery also be licensed as a medical disciple under control of the medical profession, again requiring supervision of a obstetrician in order for the practice of licensed midwifery to be legal in California.

Thank G*D, AB 1308 finally end the hostile take-over of midwifery and now recognizes Ca LMs as members of an independent healthcare profession.

Being legally recognized as an independent healthcare profession is very important to our efforts to correct the two major problems with AB 1308.

I really urge every California licensed midwife to become familiar with these principles and start thinking and talking about yourselves as a healthcare provider.


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