Thriving Midwifery At Risk

Thriving Midwifery At Risk

Midwives need medical collaboration not supervision. 

Midwifery is a birth specialty.  Midwives are specially trained through years of schooling, mentoring, and peer review, in the art of vaginal birth.  They are trained in suturing, medication, anatomy, physiology, psychology, prenatal care, and post-partum care.  They are trained to diagnose the difference between the vast variations of natural birth and when a safe hospital transfer is in the best interest of the mother and child.  They are medical professionals who chart, file insurance, use sanitary measures, and supervise birth in the home, birth center or hospital.   

Can you imagine any other professional modality requiring "supervision" of a doctor to preform basic functions of the job?  Acupuncturists  needing to get approval from a hospital administrator to see patients in a home office?  Massage therapists being hauled into court for giving backrubs without medical approval?  Chiropractors seeking to open a practice needing to have oversight from a spine surgeon?   Dermatologists needing a surgical oversight to extract a mole.


Once Upon A time: 
Midwives are currently overseen by the Board of Licensing of the Medical Board of California.  Until recently, midwives were able to get the required "supervision" -which was basically just a sign off on charts if the birth went as planned or the initial contact if a hospital transfer was needed.   Holdovers from when family doctors attended births, and multi-day labors were normal, these doctors worked with the midwives as consultants for tricky situations, and as the point of contact should hospital care become necessary.  It was a partnership that benefitted everyone:  Midwives attended natural births, and when additional medical support or surgery was necessary, a surgeon was available.


Then the money got big. Hospitals turned to cesareans as a HUGE source of funding.  Hospitals -- including Cedars, St. Johns, and UCLA Santa Monica have c-section rates between 30% and 45%.  After spending only a few minutes with their doctors at each visit (to save money, tests and assessments are usually done by nurses or technicians), women felt their care was wanting.  In response to these surgical assaults on our bodies, and attracted to the hour long appointments and extra personal care, homebirth and midwifery began to emerge from the hippy hillsides and enter into affluent and influential homes.   ACOG took notice.

Doctors began to be unable to offer their support to local midwives.  They were told by their insurance carriers that if they chose to back up midwives, their rates would skyrocket.  They were told by their hospitals, that they would lose hospital privileges at their hospital.  Interesting, since only 10-20% of homebirths transfer to hospital care, and usually (anecdotal discussions with LA midwives say they see a real emergency transport once every few years) the transfer is because the mom is tired and wants to rest with an epidural.  Midwives have nearly non-existent rates of epidural, decreased occurrence of severe tearing, and sky-rocketing approval rates from clients.  


Communication is Part of the Problem:
Most of the people making these decisions have very little knowledge of how midwifery works.  It's always been women's work -- therefore less worthy of respect and interest.  Midwives thrived for decades in poor, rural, and minority community decades after middle class communities moved their births into the hospitals.  Mainstreaming Midwives, by Robbie Davis-Floyd and Christine Johnson is an excellent read if you're a political wonk.  Midwives, even at their loudest and most passionate, are lightweights in the political realm.  There is no well-funded midwifery association (the Big Push For Midwives begs for pennies) that balances out ACOG.  All their communications is grass roots.


A Plea From A LA Midwife:
"It saddens me to think that the tradition of serving the community as a homebirth (and birth center) midwife would end when I have so much more work to do! My great-great grandmother, my grandmother, my aunt and cousin were/are all midwives who helped make a difference in not only the births, but lives of the families they served. I most certainly don't need physician supervision for the normal healthy mamas that are seeking midwifery care. It would be awesome to have their support and collaboration when they their pregnancies & labors no longer fall within my scope." -Racha Tahani Lawler, CPM, LM.  She recently opened up the LA Community Birth Center between South Los Angeles and Inglewood.  Midwifery is thriving throughout Los Angeles.


Why You Should Care:
Because you, or your loved one, may be interested in exploring your homebirth options.  Because you want midwifery care to be available to women of ALL income levels.  Because you don't want to be interviewed by the police if you end up birthing at home.  Because even if you decide that a hospital birth is the right way to go for you, it must be your choice, not a corporate edict.  Because freedom to birth at home is a human birthright.  Because you have every right to bring whomever you want into your bedroom, and the midwife you choose to support you should be threatened with jail time.  It is a women's right's issue.  It is a religious freedom issue.  It is your issue.  Please take a moment to make a difference.


What you should do:

Call your legislators know that the physician supervision requirement in California's licensed midwife law must go. 

  • Join the facebook page working to support midwives in California.
  • Find out who your representatives are by clicking this link and inputting your address.
  • Then CALL YOUR REPRESENTITIVE and encourage them to remove the physician supervision requirement in California's licensed midwife law.


Educate Yourself: 
More information can be found at the following sites:

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Chelsea (Shure) Lientz More Articles By This Author

Chelsea (Shure) Lientz, CD(DONA) is birth writer and doula. Her musings can be found at  

She is an activist with the International Cesarean Awareness Network of Los Angeles (  She believe that a doula supported birth can enhance and empower a birth experience.  If you are looking for a doula to attend your birth or support you postpartum, contact


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