SF Chronicle: Opinion // Open Forum California bill would enhance the role of nurse-midwives

By Bill Dodd

Sep. 4, 2020

In California, nurse-midwives really deliver — to the tune of 50,000 babies a year. These unsung women’s health practitioners attend 10% of all births, providing mothers in mostly rural and typically poorer communities with excellent maternity care, all while saving millions on medical costs.

They fill an important role in a women’s health system struggling to keep up across the state. Despite population increases, the arrival of new obstetrician-gynecologists has remained flat since 1980, worsening “maternity deserts” and health provider shortage areas. Now, at least nine counties have no OB/GYN doctors at all and 19 other counties have five or fewer. A critical shortfall of obstetrical care is projected in less than five years.

Fortunately, our state’s cadre of well-trained midwives is ready to step up. A bill I co-wrote with my Los Angeles colleagues, Sen. Holly Mitchell and Assemblymember Autumn Burke, would allow midwives to practice with more independence, freeing them to attend routine cases now requiring the supervision of a sometimes-elusive doctor.

Physician supervision requirements currently force nurse-midwives to concentrate in geographic areas where physicians physically practice, thereby reducing access particularly in rural counties and lower income communities. That extra latitude will lead to greater access, especially for Black and Latino women, who are typically underserved and experience higher infant and maternal morbidity and mortality.

The promise of greater equity has won Senate Bill 1237 the support of many sponsors including the Black Women for Wellness Action Project, the California Nurse-Midwives Association, NARAL Pro-Choice California, United Nurses Association of California and The Women’s Foundation of California, Women’s Policy Institute. It has been approved by both houses of the Legislature with overwhelming, bipartisan support.

What’s clear is that states promoting and integrating midwives into their systems greatly improve women’s health, in part by cutting down on cesarean deliveries, preterm babies and underweight births. By one estimate, Black women are three to four times more likely to die from pregnancy-related causes than white women, and Black babies are four times more likely to die before their first birthday. That disparity is unacceptable, and greater access to midwives can help correct it.

Consistent with what 46 other states have already done, this bill will remove the “physician permission to practice” law for nurse-midwives. We need to increase access to care for expecting mothers and babies and create a collaborative model of care for certified nurse-midwifery in California. There is a direct link among race, access and maternity outcomes in minority communities. Improving access to nurse-midwifery care has been named by leading organizations, such as the March of Dimes and the World Health Organization, as one of the most important strategies in improving health outcomes and reducing racial disparities.

At the same time, midwives save money. A “Strong Start for Mothers and Newborns” study found the midwifery model resulted in a cost savings on average of $2,010 through the first year after birth. Another study supported by the California Health Care Foundation shows that increasing the percentage of low-risk pregnancies with midwife-led care from the current level of 9% to 20% over the next 10 years could result in a $4 billion savings — and 30,000 fewer preterm births.

All of this has proven persuasive in the Legislature. SB 1237 now sits on Gov. Gavin Newsom’s desk, awaiting his signature.

My hope is to increase access and equity of maternity care in our state through greater use of these dedicated and well-trained women’s health experts. Let’s support midwives as they continue to deliver for California.

Sen. Bill Dodd represents the 3rd Senate District, which includes all or portions of Napa, Yolo, Sonoma, Solano, Sacramento and Contra Costa counties. More information on Senator Bill Dodd can be found at www.senate.ca.gov/dodd.