Editorials

Calling the midwife for Medi-Cal moms

A midwife in rural Alpine County conducts a prenatal examination. New bills in California would make it easier for families to access midwives and nurse practitioners, which are often more available than doctors in some areas.
A midwife in rural Alpine County conducts a prenatal examination. New bills in California would make it easier for families to access midwives and nurse practitioners, which are often more available than doctors in some areas. Associated Press file

California women who want to give birth at home or in another non-hospital setting often rely on midwives to help keep them and their babies safe and healthy. But low-income women who get their care through the Medi-Cal program don’t have all the same options as women with private insurance.

Two bills pending in the Legislature would help change that. Lawmakers should approve both.

One proposal would allow licensed midwives to provide prenatal care to women on Medi-Cal. These women are already eligible for pregnancy counseling and childbirth and breastfeeding education.

But Medi-Cal does not currently reimburse for those services when they are provided by midwives, even though the program a year ago started paying for midwives to attend to the birth itself. Giving low-income women access to midwives during pregnancy would make them more likely to retain a midwife for childbirth, as well.

The bill to allow Medi-Cal reimbursement for prenatal care, Senate Bill 407, has bipartisan sponsors, a rarity in this day of political polarization.

The other bill, SB 408, would allow midwife assistants to legally assist licensed midwives at births. This is important because two midwives typically attend a birth, but in rural areas and in many low-income communities there is a shortage of licensed midwives. Allowing assistants to help would make midwife services a better option for women in these areas.

Encouraging the use of midwives is part of a broader and necessary trend to supplement California’s short supply of primary care doctors with other health providers who can offer services that don’t require full medical training. Along those lines, legislation to allow nurse practitioners to work independently, without a doctor’s supervision, also deserves another look in the Legislature. That bill, SB 323, is scheduled for its first hearing on Monday.

Surveys have shown that many women, especially those who have already given birth in a hospital, are open to the idea of having their next baby in a birthing center or at home. It’s a less invasive option and usually far less expensive, so it makes sense for the state to do all it can to make the services available to all.

Most women still prefer to have their babies in a hospital, and hospitals have been changing to make the experience less intrusive and medically oriented.

But women who want alternatives to hospital births should have them available. And women whose births are paid for by Medi-Cal should have the same choices as women with private insurance.

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