SB 1479 was signed into law by Gov. Davis on September 1, 2000. It amends the Licensed Midwifery Practice Act of 1993 in way that are ultimately favorable to community-based midwives and women who choose home-based birth care.

The "intent" language, found in section 4 of the new amendment, should be of particular interest to childbearing women (click here for a stand-alone copy to print as a hand-out). It represents a reversal of that part of the Bowland Decision which noted that the legislature had never recognized the right of childbearing women to have control over "the manner and circumstances" of childbirth. In the 1974 criminal case against former lay midwife Kate Bowland (Kate is now a CNM with a home birth practice in Santa Cruz) the court used this notion, in conjunction with a legal theory taken from the US Supreme Court's 1973 abortion decision (Roe v. Wade), to declare that unregulated midwifery was illegal. It proposed that unlicensed midwifery was in opposition to the state's obligation (compelling interest) to protect the viable fetus as determined by Roe v. Wade.

This represents the biased thinking promoted by organized medicine for the last 100 years -- i.e., that home-based midwifery care kills babies, therefore the Court does not have to make any qualitative distinction between abortion and midwifery. Since the 1976 Bowland decision, states all over the US (Indiana, Illinois and New York) have been reiterating this fallacious California interpretation of Roe v Wade to criminalize direct-entry midwives and prevent mothers from having the lawful choice of a professionally-attended home labor and birth. 

Our newly amended midwifery licensing law acknowledges that pregnancy and birth are a normal process and not a disease and acknowledges the woman's right to choose community-based midwifery care -- i.e., granting legislative recognition that a woman is in control over her pregnancy and has the right (absent life-threatening medical complications) to choose the manner and circumstances of her birth.  It is a "must read"  -- follow the above hyperlink to SB 1479.

Section 1 of SB 1479 repeals the the original wording of section 2508 which required a licensed midwife to inform the client that a specific physician was being regularly briefed and would be available to provide care in the hospital should a complication arise. It replaces this language (amended 2508) with a requirement that licensed midwives have specifically identified arrangements for the transfer of care during the prenatal period, hospital transfer during the intrapartum and postpartum periods, and access to appropriate emergency medical services for mother and baby if necessary. This does not refer to a relationship with specific "supervising" physician but rather acknowledges a wide range of possible methods to meet any sub-acute or acute medical needs relative to childbearing while under the primary care of a community midwife. Examples of possible "arrangement" for these categories are :

"Contact Kaiser (or other clinic or a specific midwife-friendly physician);  Elective intrapartum/immediate PP transfer to ___________ Hospital under the care of ________physician (on-call obstetrician, teaching staff, etc); 
Emergency services accessed by contacting EMTs or paramedics through 911"

Information on medical interface needs to be verbally disclosed to the client and memorialized in writing through a form signed by the midwife and client and maintained in the client's chart.

SB 1479 also requires that LMs reveal the lawful scope of licensed midwifery practice as defined in Section 2507. If the LM does not carry malpractice insurance she must communicate that fact. Lastly, a LM must provide the phone number/web site URL for contacting the Medical Board of California should the client have a complaint regarding her care.

SB 1479 also authorizes the Medical Board to develop an official form to be used by all licensed midwives. Please note -- this section does NOT require the Medical Board to do this -- it merely says they "may" develop a form. My recommendation is that we voluntarily adopt the following sample form which uses the language from SB 1479 as its text. I will provide a copy of it to the Medical Board and they may choose to simply let us utilize our own rather than attempt to develop an "official" version. 

If or when the Medical Board does choose to proceed with regulation, it would include one or more public hearing(s), testimony by midwives and other interested parties and require the final approval of the Office of Administrative Law.  By law they must choose the least burdensome method that satisfies the intent of the law, so our written and oral testimony is very important. If a regulatory process is implemented by the Board, our best opportunity to have a positive impact on the process is to provide them with a completed sample form (or an improved version of it) that is already in use. We will petition the Medical Board to adopt this wording for the final version of the official regulation. Passage of a regulation takes from 6 to 24 months (or longer) so there is plenty of time to work out the bugs.

Please be aware that this version is "work in progress" -- suggestions for improved clarity, brevity and grammar are welcomed.

Hyperlink to read and/or print the CCM sample form for Medical Interface

Birth Registration:

The information in Senator Figueroa's letter (future hyperlink here) about birth registration is technically correct for the moment (i.e. that we would have to appear in person at the country registrar’s office). Excellent legal advise assures us that the policies currently used by the OVR are "underground regulations" and, as such, are illegal (i.e. an authorized use of governmental powers). So don't panic. We are planning to require the State Office of Vital Records to either voluntarily work with midwives and home birth parents to develop a mutually acceptable policy that does not require the physical present of the midwife OR we will use legal means to require the OVR to hold regulatory hearing.

An official regulatory hearing by the OVR would provide the opportunity for home birth parents, midwives and other "interested parties" (for example citizens groups like California Citizens for Health) to submit written testimony or to testify in person. The agency would then have to maintain a "rule making file" containing all these documents to be submitted to the State Office of Administrative Law. There are 6 "standards" that any regulation must meet (authority, necessity, non-duplication, etc) in addition to the assurance that any regulation passed is the "least burdensome" solution available that will fulfill the intent of the statute. If the agency’s recommended regulation does not meet this criteria the OAL has a legal duty to deny its passage. While this all sounds like a lot of work, it is mainly a letter writing project and the burden of its implementation will fall on me most specifically.

hyperlink to print California College of Midwives' Medical Interface form

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