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, email@example.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:
- 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.
- Clarify ongoing regulatory issues with the Board of Medicine regarding licensed midwives.
- 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.
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.
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.