I am relieved and please that Assemblywoman Bonilla’ office kept their promise to do something really important to help midwives, mothers and eventually California taxpayers. Recognizing LMs as qualified to function as birth attendants in birth centers and for the facility to qualify for reimbursement through MediCal is monumental progress. This really is a BFD.
The California College of Midwives will be sending her flowers to honor Assemblywoman Bonilla (and Sonja’s) contribution to affordable maternity care in California and applaud the important birth-center authorization added to the bill.
Obviously AB 1308 isn’t perfect legislation and won’t solve all our problems. When dealing with any piece of legislation (state or federal) and whether it’s about mfry, healthcare reform or any other topic, we always worry about unforeseen or “unintended” consequences — language that seemed benign, but actually introduced a new type or level of problem.
Certainly the language requiring the MBC to hold regulatory hearings “revising” our Standard of Care and making yet another (useless) attempt to definite supervision in regulations is somewhat worrisome. But we will have other opportunities to influence AB 1308 before its passage. Should we be unable to modify it, there are strong safeguards in the regulatory process itself itself. This will protect LMs from having our Standard of Care deconstructed or otherwise modified in ways that would harm midwives or the families we serve.
All regulation have to adhere to 6 legal criteria that includes among others “authority” (i.e. regulations are restricted by specific language of the authorizing statue), “necessity” and “non-duplication”. The authority granted by in AB 1308 does not, for instance, allow ACOG or CMA to eliminate the California Licensed Midwives’ Standard of Care, or to push for changes where there is no clearly identified ‘necessity’.
The non-duplication criteria would prevent new regs that repeated requirement already in section 2508 that require midwives, in conjunction with each client, to identify and document a specific plan for medical interface/care during pregnancy, intrapartum, postpartum and the neonatal period.
My personal take on the phase in AB 1308 requiring a new regulation that would identify “criteria necessitating referral to a physician” is that any such additional regulation would be a duplication. Our current standard of care already lists criteria for each aspect of pregnancy, intrapartum, postpartum and the neonatal period that requires the LM to recommend medical evaluation or transfer of care for medical treatment.
It certainly would be splendid if somewhere in the legislative records and/or bill sets for versions of AB 1308, it noted that the specific reason for the regulatory process was relative to the drugs, devices, supplies and medical services. This would be very helpful if CMA or ACOG claimed that the intent of AB 1308 was to require that we rewrite our Standard of Care. But I am not personally worried about the regulatory issue.
However, I am extremely pleased that LMs were added to the birth center law. This is important for individual midwives both in running and getting compensated for birth center services.
But the biggest and most important impact of this amendment to the LMPA is normalizing the midwifery model of care for normal childbirth — physiologic care — as the science-based standard for all professional birth attendants and in all settings (medical as well as non-medical i.e. OOH). By mainstreaming birth centers, it helps us as birth activists to identify the real issue, which is neither midwives or PHB per se, but the ability of childbearing women to reliably access birth attendants and a childbirth setting that is able and eager to provide physiologic childbirth services. No healthy childbearing woman should ever have to choose between a midwife or a doctor, or between home and hospital in order to receive physiologically-based care for a normal labor and birth.
I see birth centers as playing a central role in the transformation of 21st century maternity care for healthy populations. They are part of the process that will move us from the standard hospital-based, highly-medicalized version of obstetrics, to a model that integrates the scientific principles of physiological management with the best advances in modern obstetrical medicine to create a single universal standard for healthy women with normal pregnancies. Obviously there is a lot more to say about the issue of midwives and independent birth centers as an opportunity for social change, but I will save those comments for another day.