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Birth Is Political PDF Print E-mail
Written by Laura Maxson LM   

Birth is political. Every woman should be concerned about the possible loss of options when it comes to giving birth. A thriving homebirth practice in your community positively affects hospital practices. The presence of tubs, rooming-in, partners present at birth, and reduced rates of episiotomy, just to name a few, all stemmed from consumer pressure and hospital marketing to make birth more “home-like”.



In 1993 the Licensed Midwife Practice Act was signed into California law, finally providing licensure for most of California’s then illegal homebirth midwives. Unfortunately, as part of the last-minute scramble that is part and parcel of our legislative system, a requirement for physician supervision was added to the bill, against the wishes of midwives and midwife supporters.


As the newly licensed midwives (LM) began to practice, the reality of the supervision requirement set in as a Catch-22. Obstetricians (OB) are not required by the law to supervise licensed midwives, and virtually all OBs are forbidden from doing so by their medical malpractice policies. In the 1990s the California Supreme Court upheld that physician supervision was essentially unattainable, noting that the LM being prosecuted had attempted every possible avenue to obtain supervision and had been denied. This ruling supports that LMs cannot be prosecuted for being out-of-compliance with their licenses due to lack of physician supervision.


Although LMs aren’t currently being prosecuted for lack of physician supervision, California is a large and diverse state, and midwives feel the repercussions from this unattainable requirement in different ways. In some communities, LMs are unable to open lab accounts because they cannot provide a supervising physician’s signature. Referrals for follow-up to prenatal testing can become complicated for the same reason. Midwives have been harassed with threats of legal action when appropriately transferring to the hospital, as though what they are doing is illegal.


While the American Congress of Obstetrics and Gynecologists (ACOG) and California’s LMs don’t always see eye-to-eye, they both agree that birth without a trained professional is the least safe option. Unattainable physician supervision is not currently prohibiting California’s LMs from practicing, however midwives in other states have had to give up their licenses when the supervision requirement was suddenly enforced. With no midwives able to help at homebirth some women in these states still opt to stay home to birth unattended. Of course, it is it always legal to give birth at home; in this case it would only be illegal with a trained midwife in attendance. It places a low-risk woman into a much higher-risk situation if she chooses to birth at home without a midwife.


Licensed Midwives in California almost exclusively attend women giving birth at home and have been doing so without the required physician supervision for 20 years, accessing OB care for their clients informally, as needed. It is clear that most OBs don’t want to deliver babies at home, and ACOG doesn’t have any desire to encourage OBs to assist women in a homebirth. The debate about whether to give birth at home or not will go on. But the fact is, women who want to give birth at home will do so, whether it is legal or not, and whether they are attended or not, just as they did in the 60s and 70s and just as it is now in states without legally practicing homebirth midwives. 


There is an opportunity right now in California to try to fix the physician supervision issues contained in the Licensed Midwifery Practice Act through AB 1308. California Association of Midwives (CAM) is working with bill sponsor, Assembly member Susan Bonilla, and ACOG to try to find language that will best serve women seeking homebirth in California. A new consumer-based organization, California Families for Access to Midwives (CFAM), is working to give consumers a voice in the legislative process and can use support.


It is possible that by the time you read this, language favorable to homebirth families has already been adopted and all you’ll need to do is call Assembly member Bonilla to thank her for her help. Or, more likely, the bill is still in development and it will be vital to act. Because the summer break for legislators takes place a few days after the deadline for this article, the exact language in the bill can’t be reported here. Follow the links below to see the current status of AB 1308 and the current calls-to-action if you want to get involved.


Laura Maxson, LM, CPM, the mother of three grown children, has been working with pregnant and breastfeeding women for over 20 years. Currently she is the executive director of Birth Network of Santa Cruz County and has a homebirth midwifery practice. Contact her at This e-mail address is being protected from spambots. You need JavaScript enabled to view it or This e-mail address is being protected from spambots. You need JavaScript enabled to view it .


Side Bar

CAM – californiamidwives.org

CFAM – cafamiliesformidwives.org

AB 1308 – Links to official language at CFAM

Find Your State Representatives – findyourrep.legislature.ca.gov

Birth Network of Santa Cruz County – birthnet.org

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