Bill Legalizing Lay Midwifery Awaits Signing

In late summer of 1991, Faith Gibson was conducting a breast-feeding class for new mothers in Palo Alto when law enforcement agents burst through her front door, handcuffed her and carted her off to jail.

Hours later Gibson, a Mennonite lay midwife, discovered the crime she was supposed to have committed: delivering babies.

Now, however, the arrest and prosecution of lay midwives in California may be coming to an end. In the waning hours of its latest session, the California Legislature approved a landmark measure that, for the first time in decades, legalizes the practice of lay midwifery and places it under the jurisdiction of the state medical board.

If signed into law by Gov. Pete Wilson, the legislation would make California the 15th state to provide for licensing of non-nurse midwives.

Two years ago, agents of the medical board contended that Gibson was part of an underground movement, a network of non-nurse midwives who for years had been providing birthing services illegally to thousands of women in California who did not want to have their babies in a hospital setting.

She was accused of practicing medicine without a license, as other lay midwives have been. The charges against Gibson were dropped, but midwives have continued to be arrested.

The measure corrects a quirk in California law that had placed lay midwives in a legal quandary. Technically, the practice of lay midwifery is not outlawed in California, but to serve clients, a lay midwife is required to be licensed. Licenses, however, are not available because the state abandoned midwife licensing in 1949.

Because they deliver babies in a non-medical, family-oriented setting--usually the mother’s home--lay midwives are distinct from licensed nurse midwives. Some lay midwives have formal medical training, but most do not.

Although it is unclear whether the new measure will pave the way for midwives to legally assist in home births, supporters say the legislation gives pregnant women new alternatives for childbirth and adds impetus to the growing trend for natural deliveries.

Even opponents concede that it will provide a low-cost health care service for poor women, many of whom cannot afford prenatal care. Charges for prenatal care, deliveries and postnatal care from a lay midwife range from about $600 to $1,200; a doctor-assisted birth at a hospital often costs about $5,000.

“This is very, very significant,” said Kate Sproul, legislative director of the California chapter of the National Organization for Women. “We think it will provide more options for women when they’re pregnant and when they are about to give birth. And for some low-income women it will provide better care than they are currently getting.”

Sen. Lucy Killea (I-San Diego), the measure’s author, said the legislation’s greatest impact may be in minority communities, where language barriers and cultural differences often discourage pregnant women from seeking prenatal care from physicians.

Although Wilson has not disclosed his position on the bill, supporters are optimistic that he will sign it, especially since both the California Medical Assn. and the state medical board, which polices the medical professions, withdrew their opposition this year.

The change by the medical association, a professional organization for physicians that contributes heavily to political campaigns and is influential in the Legislature, was a key factor in the measure’s passage.

Steve Thompson, a lobbyist for the association, said the change came about because of Killea’s willingness to address the concern of physicians that lay midwives be properly educated and that their performance receive oversight from the medical community.

As a result of the agreement between Killea and Thompson, the final bill requires that each lay midwife work under the supervision of a physician--a provision that led midwives such as Gibson to oppose the measure--and complete a three-year accredited training program similar to that provided for nurse midwives.

Lay midwives who have received training and have been practicing would not have to complete the education program if they pass a series of examinations.

Thompson said the medical association believes that, as long as they are adequately trained and supervised, lay midwives could become an important part of the obstetrical team, providing prenatal care and birthing services to women who might not seek them from a physician.

“It will bring more hands to the process. We have over 600,000 births a year, yet we have fewer and fewer physicians willing to participate in that process because that’s the only area where malpractice rates are (prohibitively) high,” Thompson said.

It is particularly important, he said, to expand the number of practitioners providing prenatal care because “we know good prenatal care is probably the most significant aspect of a healthy birth.”

But, he said, the association’s position on the bill should not be interpreted as providing support for the notion of home birth.

He predicted that the bill would not make it easier for midwives to assist in home births because insurance companies currently will not provide coverage for any professional--whether it be a doctor, a nurse or a midwife--who practices in that setting.

Without the malpractice insurance coverage, Thompson said, most doctors will be unwilling to supervise a midwife who assists in home births. He said if the measure becomes law, he envisions lay midwives generally working in birthing centers.

Killea acknowledged that, initially, the lack of malpractice coverage will discourage home births, but she predicted that over time insurance companies will “go where there is a market.”

She said that if Wilson signs the bill, nurse midwives--who accept only low-risk cases--will gain more experience and visibility in the medical community. As a result, she said, insurance companies will come to recognize that they provide as safe a form of delivery as the medical professionals.