California bills to address midwife shortage

Amber Evans probably won’t give birth like she envisioned.

At seven months pregnant, Evans is one of the thousands of California women who wants a home birth. But she’s had trouble finding a licensed midwife in the Sacramento area who will accept Medi-Cal. She can’t afford the $3,500-$4,500 a midwife charges, so Evans is stuck delivering in a hospital.

Sarah Davis, a licensed midwife and policy chair for California Association of Midwives, said the demand for out-of-hospital birth services is more than midwives can meet right now. According to the California Medical Board’s 2013-14 annual report, there were only about 300 licensed midwives to handle more than 5,000 requested out-of-hospital births. But two proposed state bills may help women like Evans exercise their personal or religious preference and gain greater access to midwifery care.

Senate Bill 407 would allow licensed midwives to work as eligible providers of the Medi-Cal Comprehensive Perinatal Services Program, which offers a broad range of prenatal and postpartum support, including nutrition, childbirth and breastfeeding education, as well as mental-health services. That means more low-income women could choose to deliver in a birthing center with a midwife.

Typically, two licensed midwives attend a home birth, a challenge when birth rates are high and midwives are in short supply, especially in underserved or rural communities. If passed, SB 408 would allow midwife assistants to perform basic procedures like administering medications, drawing blood or assisting in neonatal resuscitation, under direct supervision of a licensed midwife, allowing midwives to spread out and serve more women.

The midwife assistant bill passed its first committee hurdle Monday.