Free The Midwives : Midwifery Care in California

(heart beats) – [Narrator] Nurse-midwives provide critical healthcare services
in hospitals, clinics, birth centers, and homes, and present a solution to the crisis in U.S. maternal healthcare outcomes. They have been shown to
create better outcomes for mother and child, while at the same time, reducing
overall healthcare costs. However, midwives in
California face obstacles to providing care, and
we want that to change. (dramatic music) – The word midwife means with woman. A Certified Nurse Midwife
is an advanced practiced registered nurse who goes through at least a masters level of education. We take care of people
through their pregnancy and their birth, and
their postpartum time. I think people think of midwives as really only being people
that attend for births, but we really take care of the person, and their whole family
through that process. Support on all levels, like on the emotional,
spiritual, physical levels. You know, gynecological care,
birth control, abortion, pregnancy, postpartum,
well-woman care, all of that. And works independently
as a medical provider. – That was kind of the
epitome of midwifery approach and training,
is to see the patient really in the context of
their life, their family, their social situation. They bring that to the table
in a much more broader way than I was trained as
a physician, certainly. (dramatic music) – Our high rate of
interventions is associated with and in part responsible for our high morbidity and
mortality rate in this country. Despite spending more money
per capita on health care than any other country in the world. We have the highest
morbidity and mortality rates of all of the developed world. Midwives and midwifery care actually improves outcomes
for birthing people, so you have a lower risk of having a major abdominal surgery or c-section by having midwifery care, and overall, interventions are used intentionally and with indication as
opposed to routinely, and the impact of that is significant. – [Narrator] A 2018 study found that increased access to midwifery care is correlated with improved
outcomes for families in the form of increase breastfeeding, reduced interventions,
increased vaginal birth, and vaginal birth after caesarian, and lower neonatal death. – Midwives are known to decrease
the number of epidurals, lower c-section rates, include
lower episiotomy rates, include fewer interventions such as artificially rupturing membranes, or putting internal
monitors on the patient. There are so many benefits that a patient derives
from midwifery care. – [Narrator] Despite the clear benefits, why are so few nurse midwives
practicing in California? Nurse midwives are prevented
from opening practices, obtaining hospital privileges, even treating critical issues,
like postpartum depression and substance use disorder, due to outdated laws requiring
physician supervision. – Unfortunately, in California, we’re very limited by our ability to have private practice. Physicians, some of them
their hands are also tied because of of medical legal reasons and their malpractice carriers
won’t allow them to cover as a supervising physician for somebody who’s working
outside of the hospital. – [Narrator] Physician supervision is not defined in statue. Supervision does not require the physician to ever be present, nor
examine the patient, review their charts, or
oversee the midwife’s care. The supervision requirement
does create a hierarchy where physicians have the power to refuse permission to practice, and restricts midwives
from providing care. It centralizes nurse-midwives
in areas of the state where physicians already practice, while restricting practice where midwives are needed the most. In short, physician supervision
does not enhance safety. It’s a discriminatory
rule that prevents women from accessing care. California is one of only
four states in the country that still imposes these restrictions. With maternal health care
shortages at a critical high, we need nurse midwives in
California, now more than ever. – I’ve worked in states where
midwifery was not supervised, but was independent practice, and I really see no
different in the quality of midwifery practice in places where supervisory
limitations don’t exist. – Midwives, they really
are very complementary to physicians, and they
really can free up physicians to have a division of labor where they do things that they
are specially trained for, and allow midwives to provide
what is often superior care to women for natural birth. – There’s a current crisis
in OB/GYN in America today. There are not enough OB/GYN doctors to provide the care that’s necessary for the women who need that care. – We have nine counties where there are no obstetric providers, and because physician
supervision is required in order for midwives to practice, midwives can’t go there either. And if the doctors don’t want to go, and the midwives aren’t allowed to go, who’s going to care for those women? – Midwives, by virtue of their ability to provide care for normal pregnancies, and also, they can do normal gynecology, can certainly help that particular crisis. And I think they are part of the solution for the decreasing number
of OB/GYN providers. (dramatic music) – We all know the statistics are horrid. African-American women and babies are at risk for three to
five to even higher times more morbidity and
mortality than white women, regardless of class and economic status, education, any of the other things. We’ve done so many studies around this, and basically, the studies
have shown that it’s racism. – Racism and toxic stress
have huge implications on women’s healthcare. When they impact your likelihood
of having a premature baby, your likelihood of developing preeclampsia during your pregnancy, the kind of care that you get, the amount of stress you
endure during your pregnancy, as well as in every day life can have a huge impact on your outcomes. – Midwives are at the
forefront of the work around inequities in
our healthcare system, both racial inequities,
socioeconomic inequities, sexual identification inequities. All across the board, I see midwives at the forefront of this battle. I see midwives as the leading edge in dealing with inequities in healthcare. – CNMA also co-sponsored a bill to bring implicit bias
training to all people who interact with people during pregnancy. – One of the things I really wish we had, and I know that we need
to work harder to achieve is to bring in more midwives of color, more women of color into midwifery. We especially need black women
to enter this profession. Black women already know the solution, they just need to be at the table, and in the drivers seat,
to steer us and direct us to a better destination. (dramatic music) – Midwives bring down overall health costs in a number of ways, one of which is decreasing the number of interventions around birth, decreasing the c-section rate, and the cost that’s inherent in that. They also, by providing
preventive health care decrease the number of hospitalizations, and procedures that need to be done. (dramatic music) – Women deserve
evidence-based, high-quality, women-centered care,
meaning midwifery care, in every part of this state. – We know our scope of practice, we know when we need to co-manage, and we know when we need to transfer care. Other than that, we’re fully capable of operating independently, and we have great outcomes. – Midwifery is a very important element of providing care for women. Midwifery is essential to
protecting normal birth, and their scope of practice
is clearly delineated, and I don’t see that there needs to be physician supervision. (dramatic music)

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