California Nurse-Midwives Association

October 2018 Health Policy Update

Dear CNMA Midwives,

We are recruiting for the 2018-2019 Health Policy Committee and Working Group. If you are interested in joining a group of midwives committed to working to improve the laws, policies and structures that impact our profession and the communities we care for please join us!

We are hosting a webinar Oct 30th from 8p-9p,  where we will update current and new members on where we stand with next year's legislative cycle as well as give everyone an overview of what we are working on in the committee. If you are interested in joining the group please read the rest of this email and then fill out this google form.

Both working group and committee members meets by webinar/phone calls once a month, sometimes twice per month (possibly more only when in the middle of very busy negotiations, e.g. if we are running a bill during the legislative cycle and committee votes are pending). The meetings happen on Tuesday nights from 8p-9p (occasionally going later as needed). We obviously understand the typical midwife schedule and student schedule, so you do not need to commit to each call, but committee members are expected to join for most calls.

Committee members must be active CNMA members, and must be able to participate regular Tuesday night phone meetings. These members have the ability to vote in the rare occasions in which we need to vote to make decisions. Most of our decision making is done by consensus.

Those interested in participating on health policy issues who are not able to attend the majority of the calls but would like to keep up to date through the list-serve and will attend meetings when they are able can join as "working-group" members.

We plan to host a HP Committee phone call on Oct 30th from 8p-9p,  where we will update current and new members on where we stand with next year's legislative cycle as well as give everyone an overview of what we are working on in the committee.

Please fill out this google form, if you are interested in joining the working group or committee.

We look forward to connecting with you all and getting to work together!


Holly Smith

Health Policy Chair

Liz Donnelly

Health Policy Vice-Chair

Worth a Listen!

We applaud Freakonomics for their astute podcast of “Nurses to the Rescue.” This podcast is worth the listen!!! Like Nurse Practitioners (NPs), Certified Nurse-Midwives (CNMs) are Advanced Practice Nurses with graduate level education and rigorous training. In California, our current Bill (AB1612) to remove physician supervision for CNMs has been met with similar opposition from CMA. This is our third attempt to remove physician supervision for CNMs in order to meet the growing demand for women’s health and maternity care services throughout the State. Nine California counties do not have an OBGYN! This podcast explains why full practice authority for Advanced Practice Nurses is so important.

Current regulations make it difficult for nurse-midwives to practice equitable, team-based care. In effective team-based care, each provider is integral to the team and each is able to offer the full scope of what they have to offer, which ultimately provides better health care overall. The “supervision” concept creates a sense of hierarchy that is antithetical to effective team-based care. As providers tethered to physicians, CNMs are unable to promote midwifery care without supervisory permission. Physician supervision also fosters interprofessional tension because of the erroneous idea that the physician is legally responsible for the CNM’s actions.      


Midwives are often invisible within the healthcare system by not being counted/included as providers by insurance companies or hospitals. Currently, Medi-Cal and private health plans do not track where CNMs work and what we do. That means our impact is often invisible to policy makers, insurance companies, and the general public—but not to budget administrators, who may well eliminate a CNM “line item” because our worth is not known.                                                                                    

Economic Stability.  

Removal of the word “supervision” would expand market opportunities for CNMs and the physicians with whom we collaborate. It will also make it easier for a CNM to obtain hospital privileges and become a full hospital staff member; to work with physicians who are no longer fearful of liability issues; to start a midwife-owned private practice; and to contract with health plans. Likewise, it will be easier for hospitals to hire the appropriate number of CNMs and physicians required for optimal patient care rather than basing hiring decisions on supervision ratios. Removal of supervisory requirements does not, of course, preclude a CNM from working within a physician or hospital group if she or he so chooses.  

The Health Policy Committee is responsible for assisting in the fulfillment of these specific purposes of the California Nurse-Midwives Association (CNMA):

  •       Represent the membership regarding issues impacting the practice of midwifery in the state of California in accordance with the bylaws and policy guidelines of the American College of Nurse-Midwives.
  •       Promote the health and well-being of women and families in the state of California by furthering the profession of midwifery.
  •       Establish a mechanism for cooperation with other groups and organizations in promoting the health and well-being of California families.
  •       Achieve legislation and regulation that is favorable to midwifery practice.
  •       Support and foster appropriate professional licensure regulations and legislation related to midwifery and women’s health issues in California.

Wondering how to get involved?

Join fellow CNMA members that are active proponents of our health policy goals, in either the Health Policy Committee (3 yr commitment) or the Health Policy Workgroup for smaller projects:

  1. Engage locally: Determine what is going on in your local chapter. Does your chapter have a Health Policy liaison? What issues face your local CNM community?; Where do CNMs work in your community? Can you identify local supporters? Build a relationship with your local representatives.
  2. Attend CNMA Lobby Day! Volunteer to help organize!
  3. Make in-district lobbying visits with your legislator, closer to home!
  4. Help CNMA fundraise!
  5. Represent CNMA at coalition, BRN, or other meetings!

Contact the Chair or Vice Chair of the CNMA Health Policy Committee to find out how you can help.