American College Of Domiciliary Midwives
May 13th 1994
Medical Board of California
1426 Howe Avenue, Suite 54
Sacramento, CA 95825-3236
RE: Publication of a survey in Action Report soliciting information from California physicians about their interest in and ability to enter into a supervisory relationship with licensed midwives
Dear Ms. Cohen,
As you may of may not be aware, the issue of physician supervision for licensed midwives is a controversial one. It has been the experience of both nurse and non-nurse (direct-entry) midwives that physicians are increasingly unwilling, for a variety of reasons, to enter into any kind of formalized arrangements between themselves and midwives who provide maternity care in a domiciliary setting. However, the Licensed Midwifery Practice Act of 1993 mandates that licensed midwives practice only under physician supervision. The obvious question is the availability of physicians to provide the mandate supervision to these midwives. If a substantial pool of potential supervisors is identified, the survey would provide the opportunity to connect up willing physicians with midwives in their geographical area. If there is a great disparity between the number of physicians and the number of licensed and practicing midwives, this may indicate the necessity for the Board to seek “clean-up” legislative to remedy the situation. However, there are 76,000 practicing physicians in California and only 45 currently licensed midwives, so sheer volumn alone would suggest that a less drastic solution should be possible. Surely such a survey would be of great value in sorting this out.
When the midwifery implementation committee meetings first convened (March of 1994), I asked at that time for a notice to be published in at least two issues of the Action Report, soliciting information on the number of physicians willing (by temperament and interest) and able (by virtue of malpractice contracts and policies governing their hospital privileges) to provide the mandated supervision to midwives. Somehow this fell through the cracks and has never been carried out. I am hoping that you can rectify that oversight with a survey in the next couple of issues of the Action Report so that some hard data will exist to assist us in the decision-making process.
I look forward to hearing from you on this matter.
faith gibson, community midwife
NARM Certified Professional Midwife #96050001
Executive Director, ACDM
cc: California Association of Midwives