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Legislature should end antiquated regulation for certified nurse-midwives

California is facing intersecting crises that place a heavy, dangerous burden on pregnant people. 

The COVID-19 pandemic has robbed many patients and families of the nurturing birth experiences they deserve with drastic changes in hospital policies. That’s layered on top of a preexisting care shortage, with nine California counties having no OB-GYN available and many more counties expected to face critical shortages in the next five years. 

Most important of all, the extreme racial disparities in many birth outcomes throughout the state, such as black patients being three to four times more likely to die of pregnancy-related causes compared to white patients, are undoubtedly exacerbated by this pandemic. 

We’ve always had a way to help lessen these serious consequences for patients, and now more than ever it’s time to recognize, honor and employ that solution: certified nurse-midwives. They are trained in nursing and midwifery and already attend more than 50,000 births in our state every year. They are highly-skilled pregnancy and women’s health care providers, and many patients prefer and choose their model of care. But they are constrained by an outdated law requiring physician supervision to practice. 

It’s irresponsible and detrimental to deny unrestricted access to the high-quality care that certified nurse-midwives provide. California should be ashamed of perpetuating this unnecessary requirement and catch up to the rest of the country by passing the Justice and Equity in Maternity Care Act, Senate Bill 1237, introduced by state Sen. Bill Dodd, a Democrat from Napa.

Some of the most formative parts of my training as an OB-GYN are because of certified nurse-midwives, who continue to teach me and future generations of physicians how to deliver human-centered, high-quality, equitable pregnancy and birthing care. Not only have I learned core technical and clinical principles of delivering care from certified nurse-midwives, but more importantly I learned how to approach patients as humans and individuals, not as a medical chart. 

Certified nurse-midwives have taught me their mastery of the art of being a pregnancy and women’s health care provider: prioritizing patients’ human and birthing rights, minimizing and avoiding obstetrical trauma through practice that uplifts healing, and centering the patient and their support structures in care delivery.

This isn’t about providing care that’s just as good as what pregnant people get now. It’s about elevating the standard of care we provide and giving patients across the state what they need and deserve. The only way to do this is through allowing certified nurse-midwives to autonomously practice. 

Studies show that people have better birth outcomes when certified nurse-midwives are allowed to practice autonomously and use a collaborative, team-based model of care with physicians. There are much lower rates of cesarean sections, preterm birth and low birthweight infants. But with certified nurse-midwives only able to practice where physicians are practicing, it cuts off access to parts of the state that need the same high-quality care. These restrictions in turn are harmful to patients, without any evidence to support them.

Before the COVID-19 pandemic, the public health urgency of addressing racism and racial disparities in pregnancy care was a growing – and delayed – conversation within the OB-GYN community. Certified nurse-midwives have been actively working on this for much longer than physicians have, and the March of Dimes and the World Health Organization highlight certified nurse-midwives care access as one of the key actions to tackle disparities. 

In my experience, certified nurse-midwives have led the charge in identifying ways to reduce harm to communities of color and serve as leaders in providing equitable, racially just care. By increasing access to certified nurse-midwives care statewide, we can surely stop perpetuating the cycle of racial disparities pregnant patients of color face from the moment they start their pregnancy and reproductive health care. 

California has been a national leader in health access and quality in many dimensions, including the COVID-19 pandemic. Not allowing for autonomous certified nurse-midwives practice seriously undermines that leadership. 

There’s no excuse for us to lag behind 46 other states by clinging to this antiquated and unnecessary regulation. Certified nurse-midwives do not need permission from me or any other physician to practice. Our Legislature, in accordance with its duty to ensure high-quality equitable care, unrestricted access and healthy lives for California’s parents and babies, must pass SB 1237.


Dr. Biftu Mengesha is the medical director of Inpatient Obstetrics at Zuckerberg San Francisco General Hospital, She wrote this commentary for CalMatters.

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