Midwife: A Policy Overview

California faces Maternity Care Crisis: Can Expanding Midwifery Access Offer a Solution?

By A.I. Journalist

Published: [Current Date]

California’s maternity care system is facing significant challenges, including an OB/GYN shortage and the closure of labor and delivery units.Expanding the role and availability of midwives is gaining traction as a potential solution to improve access, address disparities, and enhance the overall quality of care for expectant parents.

The Vital Role of Midwives in Maternity Care

Midwives are specialized healthcare professionals focused on providing comprehensive care to birthing individuals throughout their reproductive journey, encompassing pregnancy, childbirth, and the postpartum period. In the United States, while often overshadowed, midwives, alongside OB/GYNs, are the only professionals specifically trained and authorized to deliver babies. A crucial aspect of midwifery practice involves collaborative consultation with OB/gyns and seamless transfer to physician care when necessary.

Contrastingly, in numerous industrialized nations with demonstrably superior maternal health outcomes compared to the U.S., midwives serve as the primary maternity care providers. This highlights a potential area for advancement within the American healthcare system,suggesting that greater integration and utilization of midwives could positively impact maternal health outcomes.

“Midwifery care is recognized by many health policy experts as an important model for improving maternity care outcomes and addressing racism-based disparities in maternal health care, especially when provided by culturally and racially concordant providers.”

–California Health Policy Experts

California’s Looming Maternity Care Crisis

California, like many states across the U.S., is grappling with a growing shortage of OB/GYNs, exacerbated by the closure of hospital labor and delivery units, notably in rural areas. This crisis has sparked increased interest in expanding the role and scope of practice for midwives among advocates and policymakers alike.

Currently, California recognizes two distinct types of midwives:

• Certified Nurse-Midwives (CNMs): These are registered nurses who have completed graduate-level training in nurse-midwifery programs. They typically practice in hospital settings.
• Licensed Midwives (LMs): These midwives receive training through approved programs, often lasting three years, and primarily practice in birth centers and home settings.

Data from 2021 reveals that out of 420,000 births in California, physicians attended 86%, while midwives attended 13%. Projections indicate that by 2030, California’s demand for OB/GYNs will exceed the available supply by an estimated 1,160 full-time equivalents. This looming deficit underscores the critical role midwives could play in alleviating workforce shortages and addressing broader challenges related to maternity care access. As a notable example, several rural counties in the U.S., particularly in states like Texas and Kansas, are already experiencing maternity care deserts, where expectant mothers must travel significant distances to access essential services. Integrating midwives into these underserved areas could provide a lifeline for these communities.

Furthermore,research consistently demonstrates that midwifery care is associated with positive health outcomes. These include lower rates of Cesarean sections, reduced interventions during childbirth, higher rates of spontaneous vaginal births, and improved patient satisfaction scores. These findings align with a growing movement toward patient-centered care, where the birthing person’s preferences and autonomy are prioritized.

“Robust research demonstrates that midwifery care results in positive health outcomes. These include lower rates of cesarean sections and fewer interventions during birth, and also higher rates of spontaneous vaginal birth and higher patient experience scores.”

–Maternity Care Research

A survey of California mothers revealed that a majority would consider or actively seek out a midwife for future pregnancies, suggesting growing acceptance and demand for this model of care.

Indicator	Midwifery Care	Physician-Led Care
Cesarean Section Rate	Lower	Higher
Intervention Rate During Birth	fewer	More
Spontaneous Vaginal Birth Rate	Higher	lower
Patient Experience Scores	Higher	Vary

Shrinking Training Options for Aspiring Midwives

Despite the growing need for midwives, California faces a concerning trend: shrinking training opportunities for aspiring professionals.

• Certified nurse-midwives (CNMs): California currently has approximately 1,200 CNMs. However, the state has only two educational programs for nurse-midwifery, and one of these programs is currently not admitting new students, further limiting access to training.
• Licensed Midwives (LMs): California has around 500 licensed midwives.Alarmingly, the state currently lacks any accredited midwifery training programs specifically for LMs, even though two programs are in development with funding from the California Department of health Care Access and Information.

Policy Recommendations for Expanding Midwifery Access

To address the maternity care crisis and fully leverage the potential of midwives, California policymakers should consider the following policy recommendations:

1. Expand Professional Autonomy: Current state statutes impose limitations on the scope of practice for both LMs and CNMs, restricting their autonomy and requiring physician oversight in certain situations. This restricts midwives from fully utilizing their training and expertise.

   “Nearly 9 in 10 licensed midwives identify government scope of practice restrictions as a “major” (39%) or “minor” (49%) problem in their practices.Among nurse-midwives, 10% consider this a “major” and 27% a “minor” problem in their practices.”

   –California Midwives Survey

2. Integrate Midwives into the Healthcare System: Truly integrating midwives involves respecting their expertise and including them as valued members of the healthcare team. This also entails ensuring broad insurance coverage for midwifery services in both hospital and community settings.This would align California with states like Washington and Oregon, which have successfully integrated midwives into their healthcare systems.
3. increase Funding to grow the Midwifery Workforce: Expanding access to midwifery care necessitates financial support for midwifery students, clinical training sites, and initiatives to diversify the midwifery workforce, particularly by supporting midwives of color. This mirrors efforts to increase diversity in othre healthcare professions, recognizing the importance of culturally competent care.
4. Streamline Licensing Requirements for Birth centers: Freestanding birth centers, which provide high-quality, midwife-led care, can achieve excellent outcomes for birthing individuals and their babies. However, California’s stringent licensing requirements have led to the closure of at least 19 birth centers since 2020, leaving only five licensed birth centers in the state. Streamlining these requirements,while maintaining safety standards,could encourage the growth of birth centers and expand access to midwifery care.

Policy Area	Current Challenge	Proposed Solution
Scope of Practice	Restrictive state statutes limiting autonomy	Expand professional autonomy for LMs and CNMs
system Integration	Limited integration and insurance coverage	Include midwives as healthcare team members; ensure broad insurance coverage
Workforce Development	Insufficient funding for training and diversity	Increase financial support for students, training sites, and midwives of color
Birth Center licensing	Onerous requirements leading to closures	Streamline requirements while maintaining safety

What are the key differences in the practices of Certified Nurse-Midwives (CNMs) and Licensed Midwives (LMs)?

Midwifery in California: An Interview with Dr.Evelyn Reed on Solving the Maternity Care Crisis

Introduction

Archyde: Welcome, Dr. Evelyn Reed, to Archyde News. Thank you for joining us today. California is facing a critical shortage of OB/GYNs and a concerning decrease in labor and delivery units. How important a threat is this to maternal health?

Dr. Reed: Thank you for having me. The situation is indeed alarming. The shortage of healthcare professionals, especially OB/GYNs, coupled with the closure of maternity wards, significantly jeopardizes the access and quality of maternal care. In certain areas, pregnant individuals must travel long distances for even basic services. This delay or lack of access can worsen complications for both mothers and babies.

The Role of Midwives

Archyde: As our article highlights, midwifery is gaining recognition as a viable solution. In your expert opinion, how can expanded midwifery access help mitigate these challenges?

Dr. Reed: Midwives are uniquely positioned to address several concerning aspects of this crisis. Firstly, midwives are explicitly trained to provide comprehensive care throughout the pregnancy, delivery, and post-partum periods. Their focus on a holistic approach, and ability to collaborate with other specialists, can improve maternal health outcomes. Secondly, midwives can bridge the gap by offering care to underserved populations. This makes maternity care accessible for those in rural or underserved areas, and can help alleviate the burden on existing OB/GYNs.

Expanding Midwifery and Addressing Challenges

Archyde: There are two types of midwives in california: Certified Nurse-Midwives (CNMs) and Licensed Midwives (LMs). What are the key differences in their practices and what challenges do they face?

dr. Reed: CNMs,being registered nurses with advanced training,typically operate within hospital settings. LMs, trained through different programs, often practice in birth centers and home settings. One significant challenge is the limited scope of practice, and lack of training programs to expand the field and educate the next generation of midwives. Another major challenge is the lack of integration of these providers into the health care system.

Policy Recommendations

Archyde: What specific policy changes could make a significant difference in expanding midwifery access in California?

Dr. Reed: Several key policy areas require attention. First, we need to increase midwife professional autonomy by expanding the scope of their practices. Also, we must integrate midwives into the broader healthcare landscape, improving support for midwives to obtain insurance coverage for their services. We also need to focus on growing the workforce. This includes investing in education and training programs, and addressing the diversity of healthcare providers by recruiting those of color. the state must make the licensing process easier for birth centers. simplifying the licensing requirements for birth centers, while maintaining safety standards, would increase access to midwife-led care.

Patient Experience

Archyde: Several stats show that midwifery care frequently enough leads to higher patient satisfaction. How does the patient-centered approach of midwives impact birthing experiences?

Dr. Reed: Midwives prioritize patient-centered care, giving emphasis on the birthing person’s preferences. Midwives tend to spend more time with their patients,building trust,and creating a sense of empowerment. This can lead to more satisfying birthing experiences, and improved patient overall outcomes. Midwives often encourage natural childbirth methods and reduce the need for interventions unless medically necessary, which aligns with giving the birthing person control in the experience.

Looking Ahead

Archyde: Considering the current trends and the potential benefits, what is the future of midwifery in california?

Dr.Reed: I remain hopeful. ThereS a growing recognition of the value of midwifery, and its critical need in communities that are underserved. By prioritizing workforce development, streamlining regulations, and expanding autonomy and integration, California can forge a path toward improved maternal health outcomes for all its residents.I believe there is a shining future for midwifery in California, provided that the current policy changes are adopted.

A call to Action

Archyde: Dr.Reed, thank you for your valuable insights. Our discussion has given the audience a better view of the importance of midwifery care in California. What message would you like to leave our readers with?

Dr. Reed: I encourage everyone to learn more about midwifery and consider it as a viable option for maternity care. I would also like to encourage readers to advocate for policies that support midwives.By expanding access, we are investing in a healthier future for our communities. Let us know in the comments: What are your biggest concerns about maternity care in your area, in the comments below?