The role of The Midwifery Advisory Council (MAC) and California Association of Midwives (CAM) in the legalization of Midwifery in California
Click to view the members of the Advisory Council under Governor Jerry Brown, 1980
Summary:
In 1977 Gary Hart introduced Assembly Bill 1896 (the Midwifery Practice Act of 1978) which would allow the training and licensing of non-nurse midwives. Department of Consumer Affairs (DCA) supported this bill, however the California Medical Association (CMA) and California Nursing Association (CNA) opposed it. The bill troubled the CNA because of the joining of nurse midwives and lay midwives into a single ‘certified nurse-midwife’ category which would mean that nurses would now be under the jurisdiction of the Medical licensing Board instead of the Board of Registered Nursing. This caused for some disagreement among nurse midwives and lay midwives within CAM. Lay midwives wanted the protection of licensing, however nurses feared the possibility of medical dominance over their practices. The bill was killed in the Assembly Subcommittee on Health Personnel in Jan. 1978.
A second attempt to license lay midwives came in April of 1980 when Senator Barry Keene introduced Senate Bill 1829 (the Professional Midwifery Practice Act of 1980). This time no mention was made of Nurse Midwives, thus leaving their jurisdiction under the Board of Register Nursing. This time nurse midwives and lay midwives joined forces and were on board together in a big way. CAM sponsored a ‘Rally for the Midwifery Practice act of 1980’ outside the capitol on the day the bill was heard. Governor Brown supported this bill, and the midwives whole heartedly. He endorsed the bill and personally lobbied for it. The California Medical Association (CMA) and American College of Obstetricians and Gynecologists (ACOG) opposed it – harshly. The bill was defeated. On the day the bill went down, Governor Brown met with the supporters of the bill, included CAM, to organize and pledge support for similar legislation in the following year.
The Department of Consumer Affairs and Governor Brown were strong supports of legalization and they realized there were steps needed to counteract the powerful medical lobby if a midwife licensing bill were pass. They decided to create the Midwifery Advisory Council (MAC) whose purpose was to advise the California state government on midwifery and childbearing issues. I was honored to serve on this council and add my voice and energy to the effort. Steering committees were formed and events such as the ‘Labor Day Picnic and Homebirth Reunion’ were organized to attract media attention.
The Midwifery Advisory Council helped to redraft the bill for submission in the next year, setting the stage for the 3rd attempt to license lay midwives. In March 1981, Senator Keen introduced Senate Bill 670 (the Midwifery Practice Act of 1981). This time jurisdiction of midwives would fall under the Board of Registered Nursing, not the Medical Licensing Board. California Association of Midwives (CAM) had several members who sat on the Advisory Council of which I was one.
Finally the day came for a hearing on the bill. 500+ people showed and hours of testimony were heard. When it came to a vote, there were 5 votes needed to pass but some members of the committee withheld their votes resulting in a 2-2 vote. The bill was denied, again. It would be another 10 years before another bill was introduced, this time under Governor Pete Wilson.
In March 1991, Senator Lucy Killea introduced bill 1180 (An Act to License Midwives), it was co-authored by Dee Dee Alpert, Barbara Lee and John Vasconcellos. The bill went through several revisions until, finally, AB 1308 was passed in 1993 and licenses became available in 1997. It took 17 years of CAM, and others lobbying and legislative efforts to pass legalization of lay midwifery, and now because of their efforts hundreds of licensed midwives are practicing in the state of California.
For a full account of the legalization effort, the creation of the Midwifery Advisory Council and California Association of Midwives role in the effort, click here.