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MediCal for California Licensed Midwives?

On the California Association of Midwives website, it says:

Please support our efforts to make midwifery care accessible to all California families. Under our current legislation California Licensed Midwives are not eligible to be Medi-Cal providers unless we have physician supervision. This is something we have been unable to obtain since we got licensure in 1997. Although we function as primary care providers, not having physician supervision often impedes our ability to obtain important lab work, medications, oxygen, and ultrasounds for our clients. This year the California Association of Midwives is introducing new legislation to remove the “physician supervision”, which will better serve midwives, physicians, and most importantly - the families we care for. This will allow us to readily obtain everything our clients need as well as allow all families access to the highly personalized care and excellent outcomes that midwives provide.

Here are several things you personally can do:

If you've used midwifery care follow this link to have a postcard sent to your local legislators: http://form.jotform.us/form/30215615467148

Go visit your local legislators. To find out how contact Melissa Lang-Lytle at: camregion10@gmail.com

Let us know if you have any personal connections with your local legislators. Follow this link to find out who they are: http://www.californiamidwives.org/californialegislators

Forward this information to your families and anyone else willing support our cause.

On behalf of all California families, thank you for the difference your actions will make!

Constance Rock, LM, CPM

President, California Association of Midwives

I have several thoughts about this. First, remember I am a California Licensed Midwife, so my thoughts should have some weight in this subject, too.

First, there is no alternative to physician supervision given. For all the years I was practicing, we talked about moving the supervision to collaborative care, allowing midwives to go to OBs without the OB being responsible for the outcome, yet allowing for better care for the clients. I see none of that in this statement. What happened to that desire? Are midwives wanting complete autonomy? I don’t believe that’s appropriate. Here’s why.

Too many midwives take the women’s care lightly. They accept and do breeches and twins, VBAmC and women with the lower limits of high blood pressure. They accept and minimize the issues with LGA/macrosomic babies (including myself). They spread the length of pregnancy past the 42nd week. The LMs stretch the realm of normal until they are outside the parameters of normal and they justify it by using the “Trust Birth” mantra. I’ve seen how midwives allow women to push for far longer than 5-6 hours before transporting. I’ve seen how midwives hide bloody chux pads from EMS so they have an Estimated Blood Loss less than a hemorrhage. Even me, not transporting soon enough with a postpartum hemorrhage (and I know others who’ve done the same). 

(Know that I know better now and would never do the things I did when practicing.)

Perhaps it’s because midwives cannot stay within the limits of normal that they don’t get to do MediCal births? Or work without Supervision? If the midwives didn’t brag about their low transport rate as a medal of honor to try and get clients, the essence of safety might be in the forefront and doctors and legislators not so worried about loosening the tight regulations that bind us now.

There are alternative ways to be able to get the medications we need, the oxygen, the ultrasounds without eliminating physician supervision. Simply make a rule within each of the organizations that it’s legal for us to get the supplies. If that requires a law, then focus on that instead of the supervision aspect.

I do acknowledge that getting physician supervision isn’t ever going to happen in California, so I am for the movement toward physician collaboration in the language of the law. I know it would make things infinitely easier to take care of our clients. They would be able to get medications for STIs, urinary tract infections and GBS during the pregnancy. As it stands, the client has to find an OB, establish care, pay for it (making the choice between using her insurance for the doctor or midwife) and lie to the physician, not telling him she’s really having a midwife and home birth. That’s just unfair to the client to have to go through. Plus it doesn’t allow a discussion between midwife and doctor, the midwife asking questions before even sending a mom in… perhaps she doesn’t even need to go in at all. If there was collaboration, everybody wins: the doctor helping a client while not being the primary care provider and ultimately responsible for the outcome… the midwife being able to give higher quality care to her clients… and the clients who get the best of both worlds; midwifery and obstetric care.

Why can’t this be the request of the California Association of Midwives?

Then there’s the issue of the postcards being sent to legislators. Why aren’t women sending the forms themselves? I can see unscrupulous midwives taking their entire client list and sending a postcard for them even though the woman didn’t fill out the form herself. Why aren’t they having women send them themselves? I am very confused about this strategy and wonder if it’s even going to be accepted as a valid count of constituents or the postcards tossed into the garbage.

Lastly, I would love to see the statistics proving the “excellent outcomes that midwives provide.” What are the mortality rates of mothers and babies? California collects this information every year (for the last 4 years), so where are the numbers for the public to see? Is midwifery care as safe as CAM is claiming? I wonder.

I’d like to see this request changed to something more middle-of-the road, something that serves women more than the midwives. They say the changes will benefit the women, but I see it as taking much more care of the Licensed Midwives than the moms themselves. Our focus should be the women completely. If midwives stayed within the ranges of normal, it might be a totally different thing, but too many do not and it’s because of this I feel asking for what they are requesting is too much. Change it to collaborative and I am totally on board.