Bill would give new rights to California midwives and the families they serve
The Affordable Care Act has opened up health care to millions of new patients, but it has also made it more difficult to find doctors, particularly those specializing in delivering babies.
Because of high insurance rates and inconvenient hours, nine California counties don’t have an obstetrician, and more than a dozen others have fewer than two for every 10,000 women. Bridging that gap is one of the motives behind a bill going to the California Senate next week. The other is helping to make childbirth more natural.
The bill, AB 1306, would allow the state’s 1,200 certified nurse midwives to continue to collaborate with doctors, but doesn’t require doctors to supervise them. It frees more of them to practice in birthing centers or homes. California is one of only six states in the country that hasn’t already done this.
Local midwives are thrilled with the proposal. Santa Cruz County has 12 midwives, one for each practicing obstetrician in town. Monterey County has only one.
“For me, it’s not about saving money. It’s about saving lives,” says Santa Cruz midwife Timmi Pereira, who has delivered more than 3,000 babies in 39 years of practice at Dominican and Sutter hospitals.
While doctors are needed in the most complicated births, 90 percent of women don’t need surgical help, she says. The new legislation would also allow midwives to handle the basic drugs and sutures that are part of their training, without a doctor being there overseeing.
Midwives are also trained in preparing women for birth and labor with prenatal and preventive health care, and can work with women’s needs from adolescence to menopause. Until the early 1900s, births were assisted predominantly by women working as midwives. After the turn of the 20th century, doctors and hospitals took over the birthing industry, but over the past 40 years, midwives have again become a valued part of the process, helping women deliver babies naturally instead of with more risky Caesarean sections.
Nationally, 34 percent of women have babies delivered surgically. In Santa Cruz, the number is 25 percent. In most cases, Cesareans, like any surgery, are more risky for the mother and can damage their ability to have natural childbirth later. In New Mexico, 33 percent of babies are delivered by a midwife, the highest percentage in the country. It’s 11 percent in California.
“Our doctors here have a philosophy of not intervening unless needed,” says Santa Cruz’s Pereira, 62, whose own two children were delivered by midwives. “Their specialty is in intervening when something goes wrong. But when you have a birth and everything is going right, what you really want to do is not intervene.”
That can mean a more active role for the mother in the birthing process.
“If she’s out of bed, or in the Jacuzzi, or maybe walking up and down stairs, she has a lot more chance of the baby moving down into her pelvis than if she’s stuck in bed with monitors on,” says Pereira.
But in cases where the baby is breech, or the mother or baby are having health issues, then surgery is the way to go, she says. Midwives, who make a third of what an obstetrician is paid (the Bureau of Labor statistics lists $70,000 annually for midwives versus $290,000 for obstetricians), are more available to more people, particularly in lower-income communities.
Greater access is one of the motivations behind the bill drafted by Assemblywoman Autumn Burke (D-Inglewood), whose daughter was delivered a year ago by a midwife.
“This is a commonsense measure that removes an onerous restriction on women’s access to health care,” Burke says. The bill passed the Assembly with a 78-1 vote in June and heads to the Senate’s Business, Professions and Economic Development Committee next week, where there is expected to be more debate about provisions that forbid nurse midwifes from sending patients to businesses they have an economic interest in.
“So much of the discussion isn’t even related to this practice,” says Allison Ruff, Burke’s capitol director. “We are cautiously optimistic that we can work it out. We are trying to open up access to health care for women who need it.”
Local midwives are showing the film The Mama Sherpas at 6:30 p.m. on Friday, July 10, with a talk about midwifery at the Pacific Cultural Center. Donations for the movie, which was produced by Ricki Lake and Abby Epstein, will go to the California Nurse-Midwives Association.
The movie takes on some of the misconceptions about surgical birth and the pressures some doctors put on mothers to choose that instead of a natural path. For example, a woman in the documentary is told that her vagina will be more attractive if she has surgery.
“You won’t care how you had this baby once she’s in your arms,” the woman says she was told by the same doctor trying to convince her to have a Cesarean. “He couldn’t have been more wrong,” she explains later.
Showtime is 6:30 p.m. Friday at the Pacific Cultural Center, 1307 Seabright Ave., Santa Cruz. Suggested donation $10-$25. PHOTO: Theresa and Andrew Bergdahl had never heard of midwives until one delivered their baby, Quincy, on April 22. Now they are big supporters. THERESA BERGDAHL