Creating a California Licensed Midwife Board Fact Sheet

One of CALM's primary policy goals is to pass legislation that transfers administrative authority of the existing Licensed Midwife Program and Licensed Midwife Fund from the Medical Board of California to a California Board of Licensed Midwives.

In 2022 the MBC agreed that regulation of the Licensed Midwife Program should be transferred to an independent LM board and went to the California legislature to ask for such legislation. AB 1767 Boerner Horvath – Midwifery introduced February 2, 2022 and died when its first committee hearing was cancelled.

The MBC first endorsed the formation of an independent licensed midwife board in its 2020 Sunset Review Report, an endorsement that was renewed in its 2022 Sunset report. However, MBC has declined to ask the legislature to take up the issue during the 2022-23 Sunset review process.

CALM and our allied organizations, including grassroots advocacy groups California Families for Access to Midwives and Californians for the Advancement of Midwifery, will continue our work with legislative offices and staff to build on the progress that has been made. Please be on the lookout for updates and calls for volunteers as the new legislative session gets underway.

Why do we need a California Board of Licensed Midwives?

When California’s licensed midwife practice act was reinstated in 1993, it followed the original 1914 midwifery law in placing regulation of the profession under the state’s physician-run medical board. Today, licensed midwives remain the only healthcare profession in California that is regulated by physicians and not by members of their own profession or by members of the public who use their services.

CALM, CFAM, CAM and other organizations have long advocated for a California Licensed Midwife Board for a number of reasons, including:

• California is one of only four states that continue to regulate midwives under the board of medicine. Other states have recognized the conflicts of interest and potential for regulatory capture inherent in this model, which creates unnecessary barriers to access and threatens public health and safety.
• An analysis of agency budget reports and projected revenue from fees, as well as the Licensed Midwife’ Fund’s existing reserves, demonstrates that transitioning the existing licensed midwifery program to a licensed midwife board is budget neutral, with the board well positioned to operate far more efficiently and cost-effectively than it would if it remains under the jurisdiction of the MBC.
• An independent licensed midwife board comprised of members who are educated, trained, and highly skilled and experienced in the provision of community-based midwifery care is necessary to protect the public from inappropriate or unsafe care when it does not meet professional standards of practice.
• The regulation of licensed midwives by physicians under the MBC creates an inherent conflict of interest that has needlessly obstructed the regulatory process, resulting in a regulatory stalemate that has remained unresolved for over seven years, leaving the public with no standards or guidelines by which to determine best practices.
• Midwifery is a long-established profession that is unique and distinct from obstetrics, nursing, and medicine. Despite this history, under the current regulatory structure licensed midwives are managed and disciplined as a lesser subspecialty of obstetrics and nursing, not as an independent profession that predates both.
• The medical profession’s control of midwifery through the current regulatory structure, as well as its on-going efforts to impose physician-permission requirements to limit access to midwifery care, are deeply rooted in paternalistic attitudes about the professionalism of midwives and the decision-making capacity of the women who seek their care.
• Licensed midwives are the only health care professionals in California that do not have their own board.
• By limiting its regulatory and disciplinary functions to the management of a small profession with an established fund that includes cost-recovery capacity, a California Licensed Midwife Board will be able to operate without the inflated costs and inefficiencies that have contributed to the Medical Board’s insolvency.
• A Licensed Midwife Board is necessary in order to achieve cost efficiencies by ensuring that the Licensed Midwife Fund is dedicated solely to the regulation, discipline, and professional development of Licensed Midwives and not to regulatory or disciplinary programs for other licensees.

What is a Licensed Midwife? Licensed Midwives undergo specialized clinical training to qualify as experts in community-based maternity care provided in private homes and freestanding birth centers. Since the start of the COVID19 pandemic, demand for licensed midwife services has nearly doubled, freeing up critical health-care personnel and resources in hospitals throughout the state.

There are 500 plus Licensed Midwives in California, serving approximately 6,000 families each year.

What is the difference between a Licensed Midwife and a Nurse-Midwife?

Licensed Midwives and Nurse-Midwives represent two separate professions with distinct but complementary training and skills. While Licensed Midwives are trained to provide maternity care in out-of-hospital settings, Nurse-Midwives are trained to provide hospital-based maternity care.

Nurse-Midwives are regulated by the California Board of Registered Nursing.