Sunset Review Committee makes “relationship btw midwives & physicians” one of its top 4 priorities

by faithgibson on March 12, 2013

in AB1308, new regs & new legislative efforts, Physician Supervision Issues

Good news for CaLMs — we had a great (and unexpected!) outcome at yesterday’s hearing.

We’d been lead to believe that the Senate B&P Committee was not willing to take on any “controversial” issues, which altogether eliminated addressing the midwife-physician supervision problem. For the first 5 1/2 hours of the hearing there was not a single mention of midwifery or any of the issues. Naming midwifery as a top priority when the Chair of the B&P Committee made his closing statement was a complete surprise to all of us.

Just prior to that, Carrie Sparrevohn, LM (chair-MAC) and Constance Rock, LM (president-CAM) both spoke on behalf of midwifery, as did Shannon Smith-Crowley (lobbyist-ACOG). Each of them added an informative perspective that was very helpful.  I don’t know if these comments made  the critical difference but always assume that being visible and having our voice heard is better than not speaking up.

During Senator Rich Gordon’s closing statement, he listed 4 areas of action for the Committee’s review. We were #4 — addressing the relationship between midwives and physicians.  As soon as the webcast is available, I will post video footage of the public comments about midwifery and Sen. Gordon’s final words on the Ca LMs website.

Senator Rich Gordon’s reframing of the ‘physician supervision problem’ as a relationship issue is brilliant! That is a much more successful way to talk about this topic when compared to remarks about ‘getting rid of physician supervision’.

The words “removing physician supervision” shall never again cross my lips!

Instead I’ll talk to Legislators about changing the legally-defined relationship between midwives and physicians, how the legal definition of that relationship impacts affordable maternity care and why improving the nature of the relationship btw midwives and physicians is in the interest of taxpayers and the State’s ability to meet its financial obligations.

This new language, which so nicely re-frames such a complex and loaded topic, is a real gift to midwifery. I hope everyone who speakers on behalf of our legislative efforts will take advantage of this improved way to discuss a topic that has been off-putting for Legislators in the past. Proof of that statement is our legislative record. This is the 5th legislative attempt to (a) replace physician supervision OR (b) change the relationship between midwives and physicians.

Plan A — counting all our legislative and regulatory attempts, ‘getting rid of supervision’ language has failed us 5 times in a row

Plan B — we’ll soon see, but I think focusing the conversation on:

  • affordable, cost-effective maternity care
  • the economic advantages of physiological childbirth practices
  • eligibility by midwives to serve low-income women
  • changing the relation btw midwives and physicians

This is our ticket to ride and this time, we ARE going to do it!

Gender-specific vs. gender-neutral talking points

In 1982, I and other members of the San Francisco Valencia Women’s Center flew on the same plane as Gloria Steinem to Chicago to participate in a day-long rally and march to get the Equal Right Amendment passed. Its been 31 years and still no ERA.

I’m suggesting that we re-think our strategies, particularly our perspective on who midwives need to reach. Speaking to women, mom, dads, birth educators, breastfeeding groups, etc. to generate support is very different than ‘speaking legislator’. Conversations about ‘access to care’ and the ability of childbearing women to choose midwifery are both important topics. But unfortunately, women’s issues don’t do particularly when measured by legislative success.

However the communication problem doesn’t stop with the Legislature, which means our outreach can’t be restricted by age, gender, economic status or interest in childbirth per se. Everybody is the answer to the query “who should we appeal to?”

So when I talk of the ‘affordability’ issue in affordable maternity care, I’m particularly referring to those who pay the bills. Except for the statistically rare woman who pays out-of-pocket for a midwife-attended home birth, over 90% of the money that goes for maternity care in the United States does NOT come from the bank account of the pregnant woman or her family. In California 40% is paid by AIM and the State’s MediCal program and most of the rest comes from employee health insurance plans or flexible (medical) spending accounts.

By providing less medicalized and a more supportive and personalized kind of maternity care to healthy women, the number of premature births is greatly reduced and the Cesarean rate drops from over 30% to under 10%. Legislators should care about that and if they don’t already, its our job to educate them.

The California Legislature is still facing a huge budget deficit. In regard to affordable maternity care, its members need to appreciate some really simple math:

every dollar of unnecessary and unproductive expense paid out by MediCal is a dollar NOT available to pay for road repairs, support our community college system, fund pre-K education or provide substance-abuse treatment programs for teens and young adults (those who attended the March 11th hearing will appreciate the urgency of this last category)

The contrast between spending money on the complications of surgical deliveries (including necrotizing faciitis) and hiring more teachers and firefighters and putting ‘dirty doctors’ who run prescription pill mills out of business is quite powerful.

A perspective that is less gender-centric and less age-related takes a topic that otherwise interests only a small segment of society – midwives and families interested in ‘alternative’ childbirth practices — and makes it an issue of great importance to every man, woman and child in the state of California, as well as the environment and our wildlife. Even our animal shelters benefit when the tax base is sufficient to meet our public needs.

When it comes to the money, everybody has a dog in this fight, which means everyone benefits by changing the relationship between midwives and physicians.

By changing the legal definition of that relationship to one that is more appropriate for the 21st century, midwives who wish to can qualify as MediCal providers for low-income woman. Families with health insurance can get reimbursed for services received from their midwife. Affordable maternity care means that taxpayers will get library services, school buses, crossing-guards and be much happier with their legislators.

My request is the same as always ~ do a little something everyday to further the political action.

  • Contribute $$
  • Volunteer to help CAM
  • Become better informed
  • Write, call or visit legislators
  • Create a unique action-plan in your peer-review or regional group
  • Read & share the info in March 4th TIME Magazine article “BITTER PILL”
  • Post your thoughts, ideas, news or video about our legislative efforts on Facebook
  • Interview/video a midwife, mother or other person who has compelling story or a good idea
  • Volunteer to read the information posted on this website about the background of these political issues
  • Send an article about any of these “affordable maternity care” topics to your company newsletter or local newspaper
  • Write a script for a documentary about history, politics, legal, & legislative issues pertinent to our current legislative efforts

Material posted about our current legislative efforts begin on February 17th, 2013. If you go to “New Posts”, then scroll to the very bottom of the webpage, there are short excerpts and links to earlier posts and back-arrows to access older dates.

Readers vs. Activists:

If you are more of a reader than a writer, trying reading the new material I post on the website every day of two . When you see something you think is important or interesting, copy it into an an email and send it to other midwives or the CAmidwives Yahoo group. You could buddy up with one of CAM’s busy officers, who are in a chronic state overwhelm. Constance is the current CAM president and is tying to maintain a mfry practice in addition to becoming a nearly full-time lobbyist. Sara Davis is in addition nursing a 7-month out baby. I’m sure other CAM Board members are working just as hard and are just as busy. Consider contributing your time as read and personally alert your identified person if you see something — an idea or information — that you believe she should know about.

If you read enough of this stuff, you will join me in being an Idiot Savant on midwifery politics in California!

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