Update on AB 1308 ~ California Families for Access to Midwives

by faithgibson on August 27, 2013

in AB1308, new regs & new legislative efforts

The following update on AB 1308  was written by: Adeola Adeseun, Treesa Mclean, Jennifer Heystek, Tanya Smith-Johnson and Louis Heystek

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This it to update you on the status of our efforts to remove physician supervision of licensed midwives from California law, and to urge you to actively support AB1308, which, despite its limitations, represents a historic victory for families that want and deserve access to midwifery care.

Earlier this year, CFAM launched a statewide, grassroots effort to make one critical change to California law: remove the unobtainable and discriminatory provision that requires licensed midwives to work under the supervision of a physician.

As you are likely aware, physicians are unable to supervise midwives due to restrictions placed on them by their malpractice insurance carriers.  Thus, virtually all licensed midwives in the state of California are practicing illegally, and are in constant and unrelenting danger of prosecution for breaking the law.  They are also prohibited from serving Medi-Cal families because Medi-Cal does not recognize them as independent providers.

Your Efforts Made A Difference: Physician Supervision Removed
However, after several months of advocacy, activism, and rallying, your voices have made a difference, and AB1308 has gone from restating and mandating implementation of physician supervision, to removing it from law altogether.  This is no small feat.

Stay Tuned: We’re Watching For Last Minute Shenanigans
Assemblywoman Bonilla’s office confirmed yesterday that AB1308 will be amended on the Senate floor next week, and removal of physician supervision is one of the amendments.CFAM is taking a strong position in support of this bill, and  Assemblywoman is well aware that our support is contingent on this key amendment.  We will be watching the bill closely to ensure that there are no unanticipated last-minute changes, and we need you to be ready to pull your support if there are any shenanigans.  It’s critical, however, that we all begin contacting legislators right away and letting them know that we support AB1308 with Assemblywoman Bonilla’s proposed amendments.

AB1308 Wins: Increased Access Through Birth Centers and Medi-Cal
The fundamental benefits of passing AB1308 are that it will make licensed midwives legal in California for the first time in two decades, and will authorize state licensure for freestanding birth centers run by licensed midwives.

This means that our midwives will be able to continue providing care for families without fear of losing their licensure and/or being prosecuted, and Medi-Cal will have no choice but to cover out-of-hospital maternity care (both at home and in freestanding birth centers) for the 48% of California moms whose income qualifies them for Medi-Cal.

That is a huge win given the tremendous benefits of midwifery care, and the importance of making this care available to all families regardless of income level.

New Limits On Home Birth Require Our Undivided Attention
Make no mistake, however; this bill is far from perfect.

ACOG has taken full advantage of the fact that the physician supervision requirement leaves midwives vulnerable, and that we need to get a bill passed this year much more than they do.  They know that the midwife-friendly director of the medical board was fired earlier this year.  They know that separate legislation is working its way through the legislature that will shift enforcement of physician supervision to either the Department of Justice or the Division of Investigation.

And their well-funded lobbyists have successfully negotiated for a new provision that narrows midwives’ scope of practice to “normal pregnancy and normal birth,” which they define as:

  • Absence of any preexisting maternal disease or condition that is likely to affect the pregnancy
  • Absence of significant disease arising from the pregnancy
  • Singleton fetus
  • Cephalic presentation
  • Gestational age between 37 and 42 weeks
  • Labor is spontaneous or induced in an outpatient setting

Notably, this definition of normal pregnancy and birth excludes mothers carrying more than one baby and mothers whose babies are in a breech position at birth.  This is not something we take lightly.  Also, for women with “preexisting maternal disease[s] or condition[s],” and women who experience “significant disease” during pregnancy, midwives will be required to refer them to an obstetrician for a determination that their condition is not likely to affect their current pregnancy.

This provision is likely to impact moms having a vaginal birth after a prior cesarean, but we were successful in including language that leaves this door open.  The bill will direct the medical board to craft regulations defining what constitutes a “preexisting maternal disease that is likely to affect the pregnancy,” and that will be the next battleground for preserving access to midwife-supported VBACs.

Our Work Is Not Done Until We Secure A Woman’s Right To Make Her Own Health Care Decisions
Ultimately, however, we cannot create a maternity care system that is responsive to and respectful of the needs of mothers and babies, without addressing the fundamental problem: California has yet to recognize that pregnant women have the same rights as everyone else to make their own decisions regarding their health care.

All of us at CFAM believe that a woman’s human right to self-determination in making health care decisions is basic and self-evident, and is not mitigated by “risk” factors.  No one—not the government, not our doctors, not even our midwives—has the right to force us into a particular course of action, or to prevent us from accessing the maternity care that we decide is best for ourselves and our babies.

We hope that you will join us as we continue to move forward with this movement of mothers and families.  From where we stand, passing AB1308 is a big step forward.  By removing the threat of physician supervision, we can focus the next leg of this journey on the underlying issue: human rights in pregnancy and childbirth.

Here is what you can do now to support this effort:

  • Contact your state senator and assemblymember, and urge them to support AB1308 with Bonilla’s amendments only.  Ask your family and friends to do the same
  • While you’re at it, tell them how you feel about women’s human rights in childbirth, and let them know it’s an issue that needs to be addressed urgently
  • Help us build our numbers. Spread the word while earning a chance to win some #freeourmidwives swag. Learn more here.
  • Visit our website and make a donation to CFAM so we don’t have to drag our unpaid bills from this campaign into the next one.

As you can see, our work is not done.  We’re counting on you to move this movement forward because we now know—from experience—that our voices really do make a difference.

All the best,

Adeola Adeseun
Treesa Mclean
Jennifer Heystek
Tanya Smith-Johnson
Louis Heystek

P.S. Please consider a donation TODAY – it will make a huge difference in our work.

Our mailing address is:

California Families for Access to Midwives

161 Georgia Way

San Leandro, CA 94577

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