It is with great sadness and disappointment that the California Nurse-Midwives Association has decided that we can no longer support A.B. 2682, the bill to remove physician supervision of nurse-midwives.
First, we want to thank our supporters. This time around we were so proud to boast a powerful and diverse coalition of supporters, including many women's health advocates, health plans, the California Hospital Association, many health professional organizations, countless consumers, and even Govern for California, a group of philanthropists working to bring common sense legislation to California ahead of party or political interests. This time around we also had organizations working behind the scenes, networking strongly on our behalf as well. The sheer amount of support we had this time is not just a reflection of the importance of independent nurse-midwifery practice, but also a reflection of the hard work each and everyone of you did this year and in past years. We galvanized a powerful forc.e
Despite this, we were unable to reach an agreement with our primary bill opposition: the California Medical Association and American Congress of OB/GYNs District IX. After negotiations that have been ongoing for years, the most recent amendments to AB2682 make it clear that we are unable to find a place of compromise that still achieves our primary goal: improved access to women's health care.
The May 22 amendments that passed overwhelmingly in the Assembly, applied licensed midwifery statutes and licensed midwifery scope of practice to nurse-midwives. Current nurse-midwifery practice would be even further restricted - a failed outcome for CNMA members, as well as all the women we currently care for. Further, we had strong concerns that the amendments would prohibit patients from making informed decisions about their own health care, would force them to see a physician under the guise of informed consent even for the slightest deviation from "normal"
We worked in close negotiations with the bill author, Autumn Burke, who worked just as tirelessly on this bill and did everything she could to find common ground with the CMA. Protecting the practice of nurse-midwifery, and women's access to it, is and always has been our biggest concern. We simply could not allow ourselves to go backwards in our scope in the name of independent practice.
Make no mistake, many people worked tirelessly on this bill. The bill language was written and re-written countless times. Everything was supported with the evidence. We worked closely with the ACNM for insight into what other states have done/are doing. As described above, we had the most support we've ever had for our bill. We had hoped that the reams of research that show that nurse-midwifery care is not only safe, but also leads to improved health outcomes for women would help propel the negotiation process forward. We had also hoped that through bill negotiations the CMA and ACOG would support well defined evidence-based practices of team-based collaborative care, but it is clear that we still have far to go before seeing eye to eye.
Our charge to you is please do not give up hope! We are already exploring our next option. We won't stop until physician supervision is removed from our practice, access is improved, and every woman has the right to see the provider of her choice.
We look forward to future efforts in advancing and protecting women's health.
Rebecca Garrett-Brown, CNMA President
Kathleen Belzer, CNMA President-Elect
Kim Dau, Co-Chair, Health Policy Committee
Holly Smith, Co-Chair Health Policy Committee
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.
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:
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.
Attend CNMA Lobby Day! Volunteer to help organize!
Make in-district lobbying visits with your legislator, closer to home!
Help CNMA fundraise!
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 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.