Medical Board of California Declines to Pursue Legislation that would Limit Licensed Midwives’ Scope of Practice after Significant Pressure from Midwife Community

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By Angela O’Hara

At its November 7, 2019 meeting, the Medical Board of California (MBC) considered whether to pursue a legislative proposal that would amend section 2507 of the Business and Professions Code to, among other things, prohibit licensed midwives under MBC’s jurisdiction from attending home births if the mother had a prior cesarean delivery (commonly known as a “VBAC” (vaginal birth after cesarean).

In presenting the item, staff explained that the proposal is the result of nearly six years of debate after AB 1308 (Bonilla) (Chapter 665, Statutes of 2013) became effective in January 2014. That bill generally eliminated the requirement for a physician to supervise a licensed midwife but provided that if a potential patient failed to meet the standards for a “normal pregnancy or childbirth,” the licensed midwife must refer the patient to a physician.  To implement the bill, the Board established a task force consisting of physicians, representatives from the California Association of Midwives, the California Association of Licensed Midwives, and the American College of Obstetricians and Gynecologists (ACOG), to develop regulations defining “normal birth” among other things. The taskforce held interested parties meetings to discuss the current status of regulations defining the pre-existing maternal disease or conditions likely to affect the pregnancy.

While the task force ultimately reached a consensus as to most issues, they disagreed as to whether to allow licensed midwives to attend home births for women with prior cesarean deliveries. Midwives argued that there is very low risk with VBAC performed at home, while physicians (ACOG and CMA) contended that, while rare, the complications that could arise are severe enough that a lack of immediate, full range of emergency hospital services could be dire. The task force members agreed the matter could not be entirely resolved through regulations because the changes would exceed the Board’s scope of authority. Accordingly, staff proposed the statutory change to resolve the issue at the Board’s November 7 meeting, presenting language that the Board had voted to approve at its April 2017 meeting [Agenda Item 22].

The meeting was overwhelmed by members of the public opposing this statutory proposal.  32 speakers and 11 callers gave public comment on this item, providing opinions, personal stories, and citing evidence, all of whom urged Board members to vote against narrowing licensed midwife scope of practice. Many more were present in the audience with buttons and signs.  After a lengthy discussion in which Board members weighed the risks of VBAC procedures and the possible consequences of prohibiting midwives from performing them at home, the motion to further pursue this legislative proposal failed, and the Board thus declined to move forward with this legislative proposal.

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