California Nurse-Midwives Association

We are excited to see you at 

CNMA Lobby Day 

on March 7th in Sacramento! 


CNMA Sponsored Legislation Introduced

On February 17, Assemblymember Autumn Burke introduced Assembly Bill 1612, sponsored by CNMA and the California Birth Center Association. As introduced, AB 1612 will make a minor change to the nurse-midwife statute in that it will eliminate the authority of the nurse-midwife committee of the BRN to develop ratios of supervising physicians to certified nurse-midwives. The bill will serve the purpose of continuing dialog about the removal of physician supervision of certified nurse-midwives, and may be amended as stakeholder conversations evolve. This bill requires CNMA member support : if you are interested in volunteering to make this bill more successful than the last, please email Kim Dau, kim.dau@gmail.com.

AB 1612 will be assigned the Assembly Business and Professions Committee and must be heard prior to April 28th deadline. In-district visits are critical to our success and the Health Policy committee will lead grassroots efforts to start these visits late March through mid-April. Stay tuned for more information about how to arrange a local visit. Members of the committee provided below:

Rudy Salas (D-Bakersfield) -- Chair
Bill Brough (R-Dana Point) -- Vice Chair
Joaquin Arambula (D-Fresno)
Catharine Baker (R-Walnut Creek)
Richard Bloom (D-Santa Monica)
David Chiu (D-San Francisco)
Jordan Cunningham (R-Templeton)
Brian Dahle (R-Bieber)
Susan Eggman (D-Stockton)
Mike Gipson (D-Carson)
Timothy Grayson (D-Concord)
Chris Holden (D-Pasadena)
Evan Low (D-Los Altos)
Kevin Mullin (D-South San Francisco)
Marc Steinorth (R-Rancho Cucamonga)
Phillip Ting (D-San Francisco)

Medical Community to Sponsor Out of Hospital Birth Legislation 

While no bill has yet been introduced directly on the issue, we have been informed that ACOG and the California Medical Association are likely to amend recently-introduced legislation this year that will do the following:

  1. Impose uniform standards, procedures, and disclosure requirements to all providers of non-hospital maternal care This would include physicians, certified nurse-midwives, and licensed midwives. 
  2. Clarify ongoing regulatory issues with the Board of Medicine regarding licensed midwives.
  3. Remove physician supervision from the practice of nurse-midwifery in out-of-hospital settings.

There may be additional items included, but this is the general intent of the legislation. This bill is being developed without the input of CNMA or the midwifery community at large. As reviewed in last month's newsletter, it is

against ACNM policy to create regulations that define CNM scope of practice based on setting, as opposed to education and preparation. The Clear Advocacy team monitors all amendments for all bills, and will advise if and when such amendments appear in print. 

Sunset Review Process to Commence

The Senate Business and Professions Committee will commence hearings on the Board of Registered Nursing on March 6th. Clear Advocacy will be monitoring these.




Equity.  
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.      

Visibility.  

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.



The Board of Registered Nursing regulates on education, practice, legislative and discipline issues for nurses in California, including nurse-midwives.

BRN Meeting Minutes:

http://www.rn.ca.gov/about_us/meetings.shtml#board

http://www.rn.ca.gov/about_us/pastmtgs.shtml

BRN Advisories on CNM Practice in California

http://www.rn.ca.gov/regulations/nmw.shtml


 




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The CNMA works to improve women's health through midwifery. Help us accomplish our maternal legislative goals by donating NOW! Click here to learn more about how we improve the health of women and their families.



Helpful Resources for In-District Advocacy

  1. How-to-Videos Re: Advocacy
  2. Legislative Visits – What to Expect
  3. Plan Your In-District Visit
  4. Talking Points for Legislators
  5. Materials for the In-District Visit
  6. Rainy Day Advocacy - Phone Prompt
  7. Find your CA Legislators HERE
  8. NEW: Customizable PowerPoint Presentation for In-District Visits




Health Policy Members:

Kim Q Dau, Chair

Kavita Noble, Vice Chair

Djina Ariel, Davis

Jenna Breton, Mendocino

Karen Ruby Brown, San Diego

Carol Bryan, Humboldt Co

Mary Croyle Farrell, San Diego

Roberta Frank, San Diego

Parie Lambert, Napa

Timmi Pereira, Santa Cruz
BJ Snell, Orange County

Health Policy Workgroup Members

Emily Beck (SF Bay Area Liaison)

Hannah Brodsky-Pena (San Francisco Bay Area)

Yelena Kolodji (Santa Cruz)

Sarah Levitan (Santa Cruz)

Cara Rasmussen (Santa Cruz)
Natalie Martina (East Bay)

Mari Oxenberg (Los Angeles)

Holly Smith (Sacramento)

Susan Stone (Sacramento)




 

Links to CNMA Coalitions:

California Action Coalition

California Coalition for Reproductive Freedom

Californians Allied for Patient Protection

Sacramento Women + Health Care Reform Coalition


 

Find Your Local Representative:

http://findyourrep.legislature.ca.gov/


 

Comparison of California Certified Nurse-Midwives (CNMs) and Licensed Midwives (LMs): PDF

State Fact Sheet - California: PDF

Certified Nurse-Midwives in California: PDF



Please Submit Your Comments and Issues on:

  • practice barriers
  • CNM practice in CA
  • openings and closings of CNM practices
  • BRN investigations
  • billing/reimbursement issues
  • women's health policy concerns
  • legislative suggestions

 

Email Kim at kim.dau@gmail.com.

 


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