Karen Ehrlich comments on Clinical Training of Midwifery Students

Originally posted on the CAmidwives Yahoo group after much (confusing) cross-talk about what students are and are NOT allowed to do. Her email included pertinent parts of the LMPA and the text of our regulations.


This topic is confusing, and aggravating as well. Yes, we are hoping to convene a task force to hash this all out. Know that everything having to do with Medical Board moves ssss lllllll ooooooo wwwwwww llllllll yyyyyyy. We have no idea when it might happen. Yes, I will post to this list when we know anything about it.

The next Midwifery Advisory Council meeting is August 30 (Thursday) in Sacramento. It is possible that his issue will be on the agenda, but that won’t be known for sure until August 20. Carrie Sparrevohn, current chairwoman, might know that now.

All of what I am explaining here is correct TO THE BEST OF MY KNOWLEDGE. Unfortunately sometimes information changes or opinions change, and then we all have to run like mad to catch up.

If someone who comes to a birth does not do any clinical care at all, she should not have any legal liability or jeopardy. She is acting as a personal attendant to the mother or as an observer or as a potential care provider. She has no clinical responsibility at all. Faith speaks of this person as someone who might help the midwife carry her bags back and forth from the car, or hand things to the midwife, or perhaps help the mother get up and go to the bathroom. She may touch the laboring woman, but not act in any clinical capacity.

The mother has the right to have any number of people present — as long as they don’t do anything that might be considered midwifery tasks.

If the midwife needs to hear fetal hearts while she is gloved up so she can catch the baby, may the observer put a doppler, with audio speaker activated, on a woman’s belly at the request of the midwife? Probably. May she chart at the request of the midwife? Probably. These are among the grey zones that we really don’t know for sure.

If she takes orders from a midwife to do any kind of clinical care, she must be enrolled in a Medical Board approved school, and the midwife she is working with must be contracted as her preceptor. Think belly checks, vag exams, fetal heart checks, perineal support, informed consents, any kind of assessments or clinically-related education or decision making.

The legalese for this is partly in our law, but also appears in our regulations — which carry the force of law. Regulations can only be superseded by new laws or by changes in the regulations. The legislative process is way more difficult to accomplish than the regulatory process, but neither one is straightforward.

Here is from our regulations:

§ 1379.31. Evidence of Completion of Educational Requirements.For purposes of Section 2515.5 of the code, either of the following shall be deemed satisfactory evidence that an applicant has met the educational standards required for licensure as a midwife:(a) A diploma issued by a midwifery program approved by the division; or(b) A notice of successful completion of the challenge program (credit by examination) issued by a program approved by the division.

Note: Authority cited: Section 2514.5, Business and Professions Code. Reference: Section 2515.5, Business and Professions Code.

And the following are sections from our law. They clearly state that the educational programs must be approved by the board — meaning the Medical Board

2512.5.  A person is qualified for a license to practice midwifery when he or she satisfies one of the following requirements:

(a) (1) Successful completion of a three-year postsecondary midwifery education program accredited by an accrediting organization approved by the board. Upon successful completion of the education requirements of this article, the applicant shall successfully complete a comprehensive licensing examination adopted by the board which is equivalent, but not identical, to the examination given by the American College of Nurse Midwives. The examination for licensure as a midwife may be conducted by the Division of Licensing under a uniform examination system, and the division may contract with organizations to administer the examination in order to carry out this purpose. The Division of Licensing may, in its discretion, designate additional written examinations for midwifery licensure that the division determines are equivalent to the examination given by the American College of Nurse Midwives.

[education details are in the next section of this portion of the law]

(b) Successful completion of an educational program that the board has determined satisfies the criteria of subdivision (a) and current licensure as a midwife by a state with licensing standards that have been found by the board to be equivalent to those adopted by the board pursuant to this article.

If she is acting as primary, she must have the preceptor midwife present on site at all times that she is performing any midwifery tasks — prenatally, during labor and birth, and postpartum.

2514.  Nothing in this chapter shall be construed to prevent a bona fide student who is enrolled or participating in a midwifery education program or who is enrolled in a program of supervised clinical training from engaging in the practice of midwifery in this state, as part of his or her course of study, if both of the following conditions are met:
(a) The student is under the supervision of a licensed midwife, who holds a clear and unrestricted license in this state, who is present on the premises at all times client services are provided, and who is practicing pursuant to Section 2507, or a physician and surgeon.

(b) The client is informed of the student’s status.

If she does not yet have a license in California, she may not do any midwifery tasks and may not do any primary care unless her preceptor is present on site at all times.

If she wants to go through one of the approved schools that has had a challenge mechanism approved, she may not become clinically qualified within California or she runs the risk of being prosecuted in California. The only way she may become qualified via clinical training performed within California is if she is enrolled in a school that is approved by the Medical Board.

The NARM PEP process is not recognized by the Medical Board at all. Anyone who only has a CPM is not a legal midwife in California. In order to be a legal midwife, you must obtain a California license. The only way to get a California license is via a school that has been approved by the Medical Board. The two challenge programs that are possible are through schools that have been approved by the Medical Board, and then went on to apply to the Medical Board to additionally have their challenge approved.

As far as apprenticeship goes, that is such a sore point! When our law was written, there was intent all around (our legislative sponsor and all the midwives who were politically active during the legislative process) that apprenticeship would be supported. But as the laws got written and then the regulations got written, the interpretations by the legal staff of the Medical Board of the language that had been written made that a current impossibility. All three of the midwives who are on the Midwifery Advisory Council were apprentice trained. All three of us speak up frequently at the Council and with the staff (and at the Medical Board when we can) about our support of apprenticeship training. However at this time there is no recourse. The only ways to get licensed are through Medical Board approved schools. Right now, there is no other answer.

Know that the attitude of everyone I have heard discuss this on the Medical Board, including the lawyers and the analysts and the managers, is that apprentice training is substandard. Without an accredited program to rely on, it is their opinion that there can be no trust in the training process, so there can be no trust that the midwife knows what she is doing. The MedBrd wants verification through accreditation processes. That’s why it accepts MEAC — because its accreditation program is accepted by the federal Department of Education. MEAC jumped through tremendous hoops and cranked out mounds of paperwork (and donated countless hours of many women’s time) in order to create accreditation for direct entry midwifery. Without the unbelievably hard work of the MEAC activists, we might not have any educational programs accepted by the Medical Board at all.

I know there is a lot of this that is hard to swallow. Keep in mind that midwives in California decided to go for institutional acceptance and recognition in the 1990s. Since we wanted those perks, we have to accept the system as it is now — as well as keep on working to make it more what we had in mind.

There is obviously lots of work to be done. Please be a part of the process!

Karen Ehrlich, CPM, LM, MA
The views expressed in this email are those of the author and not of the Midwifery Advisory Council or the Medical Board of California.