California Licensed Midwives

MBC Midwifery Advisory Council Info Page

Barbara Yaroslavsky, MBC,  Carrie Sparravohn, LM, Guillermo Valensuela, MD/OB,
Faith Gibson, LM, Karen Ehrlich, LM, Ruth Haskins, MD/OB

Faith Gibson, Chair; Ruth Haskins, V-Chair

Short Cut to April 17th 2007 meeting

                Welcome!       Short Cut to:  OSHPD Annual Stats Report for LMs

The is the place for written reports and pod-casts of the California medical board's Midwifery Advisory Council Meetings. The first meeting was held March 9th, 2007.

Click here for a report on the first Midwifery Advisory Council meeting (March 2007)

All meetings are open to the public --  midwives and consumers are both welcome and encouraged to attend.

The next Midwifery Council meeting is tentatively scheduled for April 17th @ the Medical Board facility in Sacramento o@ 1426 Howe Avenue. Be there or be square!

For more info, either go to Medical Board site or email me via:

Click here for PodCasts ~
July 29th 2005 Medical Board Meeting
Mfry Council Meeting held on March 9th 2006

This URL will take you to another web site especially for posting podcasts. To access the podcast, click on the word "blogs" at the very top of the page (easy to miss if your not looking for it!).

This brings up a page with links to the most recently posted daily blogs. Click at the bottom of March 19th, 2007 (the one with the purple "Pod Cast" graphic!), where it says: "Read More".

That will take you to the expanded blog for that date, which contains some information and the pod-cast itself. You can click at the bottom of the pod-cast icon to play it at your computer and/or "subscribe" to all new pod-casts. If you have an Apple, podcasts for the Mfry Council will appear in your iTunes program or whatever application you use for your Mp3 player (iPod, etc). That means you can listen in your car while driving (nice way to stay awake while going to births in middle of night!). 

In case you want to access that web site from other places, the actually name of the web site is

However, if you have a Windows-based (Microsoft) system, you must first download QuickTime. This is an Apple program that has both Apple and Windows versions. The easiest way is to click the PodCast URL above, then after following directions to the right page for the pod-cast, click on the weird distorted spot on the bottom of the purple pod-cast icon. This should prompt you to begin a free download of QuickTime.

After the Apple download window opens, choose the version "for Windows". Be sure to save it to disk (your hard drive) where you can find it easily (either "desktop" or "MyDownloads" is best).  After the download is finished, you must go to the "Start" menu and click on "Run". Use the "browse" feature to find the download on your desktop or your download file. Click on "QuickTimeInstaller.exe" icon, which will automatically download for you.

Go back to the my podcast web page and "Refresh". Only after doing this will you find a tiny blue "Q" at the bottom of the pod-cast icon. After clicking on this, a start button and little slider to listen will appear in about 5 seconds. Click the little triangle on the left to start, click again to stop.

The file is 1 hr, 6 minutes long. Listen at your computer while you do your email or surf the web, etc or download to Mp3 player and listen while washing dishes or weeding the garden.  

The audio of the July 2005 Medical Board meeting has two very different topics. The first part is an excellent presentation by an administrative law judge on the rights of a Medical Board licentiate (MD or LM) to practice, that is, a license is property and they can't take your "property" away without "due process". Please listen carefully, this is one of the most useful presentations that I have heard as a regular attender of MBC meetings

The second part is a midwifery regulatory hearing prior to the adoption of the Standard of Care. At the end, there are the most compelling oral testimonies by several mothers about their right to have control over the manner and circumstance of their normal births, including VBACs at home with midwives. Don't miss this!

While both of these Medical Board meeting topics are very interesting, their purpose here is also to help me learn how to use this technology to pod-cast audio CDs of the Midwifery Advisory Council meetings. You will be able to load them as a Mp3 files and listen to them on your I-pods or other Mp3 players.  
I have already ordered the audio record for the first MBC Midwifery Advisory Council, which was held March 09, 2007. I expect that I will be able to post it soon after it comes.
So Stay Tuned......                                    faith ^O^

Informational Binders distributed to Council Members @ March 9th meeting

printer-friendly copies of California Licensed Midwives Annual Report (LMAR)   
1) March '07  letter MBC    2) LMAR - Instructions   3) LMAR Statistical Form

Click Picture to Return to Home Page

Mfry Council Meeting April 17, 2007 - Report of the Chair

Shortcut to Proposed Complication Codes

I received NO feedback in the weeks before the Council meeting on the comprehensive list of complication codes posted March 30th on Medical Board web site. I can only assume that California midwives felt the list had not missed any important category nor did it contain anything objectionable.

The April 17th work group: Approximately 5 California LMs (plus Bruce Ackerman), 4 council members (3 LMs, 1 OB) and 4 MBC/OSHPD staff members worked from overhead transparencies of the master list & CAM's list, adding or lining out entries based on general consensus of the group.

As is the custom for all formally-noticed Medical Board meetings, an audio recording of the meeting was made and will be posted as a podcast as soon as the staff mails me the CD (usually about 3 weeks)

Per request of the staff, I transcribed the complications codes arrived at during the meeting to make a hard copy for the Board that is also posted further down this page for public review. Mr. Qualset asked that I also include a number for each entry. I organized the information logically / chronologically and had Karen Ehrlich review it for transcription accuracy, spelling and formatting errors.

I used a unique code for each category and each entry, so that LMs can tell from the coding number itself exactly what category is referred to. For example:
is Antepartum Elective transfer for maternal condition #1 -
Medical or mental health conditions unrelated to pregnancy.
is Intrapartum Urgent/emergent transport for fetal condition #1 - Prolapsed umbilical cord.

 is Complication  leading mortality for mother - condition #1  Blood loss  
is Outcome /maternal - category #1 - Vaginal birth with no complications

However, SB 1638 assigned the development of the reporting form and the protocols used for numbering the system to the Medical Board and the OSHPD, so this may (and probably will) change. 

There are a few additions in red text; they were (A) added per Dr Haskins' request, (B) obvious oversight or (c) indicates a problem, such as lack of definition of "intrapartum".

Our group failed to specify when intrapartum or "birth-related" care ended and when postpartum/neonatal began. Choices are (a) @ delivery of placenta [textbook definition]; (b) @ the end 1-2 hours [typical hospital L&D timing] (c) @ the end of first 6 hours [time frame used by free-standing birth centers, and therefore it is the closest to PHB category of care]. The two categories in blue text will probably need to be moved to different place in the list, depending on where we draw the bright line between the IP and PP/NN.

Request to LMs -- Must be done this week

First I encourage LMs to come to the Medical Board quarterly meetings in Sacramento for the midwifery committee meeting on April 26th and/or the DOL meeting on April 27th, where some "tweaking" will no doubt occur before the final vote.

Second, my request for California LMs is that they write down the reasons for their last 10+ transfers, then look over the list to see how many of them fit into easily identifiable categories on the list of complication codes. If you find a significant number of your transfers that did not fit in to any category or you would have to use "other" for frequently occurring transfers, please contact me or other Council members.

I did a version of this exercise by going thru a partial list of my clients (names on my cell phone directory). There were 161 PHB clients, with a total of  25 transfers of care (24 elective, 1 urgent, total transfer rate of 15.6%. This included 4 antepartum transfers (2 PTLs, 1 induction for PIH, 1 set of twins), 5 active 1st & 2nd labor for inadequate progress &/or pain relief request; and 15 latent-stage labor for dysfunctional or non-progressive patterns, &/or pain relief, including one freely ballotable head at 2 cms, polyhydramnois & painful, non-progressive labor and 1 urgent neonatal for a newborn who passed bloody meconium within 15 minutes of birth (Dx as maternal blood swallowed during delivery, no treatment required).

As it stands now, there is no distinct category for clients who never get into an active labor pattern or who are otherwise inappropriate candidates for labor at home, such as a ballotable head. Under proposed coding categories, these transfers would be be counted as:

IE-m 7 -- Lack of progress; maternal exhaustion; dehydration. 

As for the baby, the code category would be IU-f 3 -- Other life threatening conditions or symptoms.

Personally, I would like our codes to distinguish between early/prophylactic "just in case" transfers, including elective transfers in latent/very early (4 or less cms) labor and/or immediate transport of baby for evaluation.

This type of category reflects complex situations that, in the clinical judgment of the LM, called for precautionary or pre-emptive action. This is in contrast to the actual development of complications, such as someone in active labor that displays some form of dystocia or failure to progress that inevitably is accompanied by maternal-fetal stress, dehydration or other diminution of wellbeing. Ditto for babies -- transport for immediate evaluation based on being prudent.

I believe that more precautionary transfers will drop the number of urgent or emergent transports and subsequent adverse outcomes in the "Serious pregnancy/birth related medical complications persisting beyond 6 weeks" category.  What's not to like about that?

NOTE: It is possible that the DOL will vote on these categories next THURSDAY!, so please do this in the next few days and be sure the info gets to me, Karen Ehrlich or Carrie Sparravohn before the April 26-27th Medical Board meeting

Attendance at April 17th Council Meeting

Public members: Lucinda Johnson, LM; Claudia Breglia, LM; Diane Holtzer, PA, LM; Bruce Ackerman, Edana Hall, LM Alison Price, LM; visiting midwife from Uganda and two women in the back of the room that didn't enter into the dialogue.

Council members: Faith gibson, LM; Carrie Sparravohn, LM; Karen Ehrilch, LM, Ruth Haskins, MD

State Agency employees: Gary Qualset, Kati Burns, Pam Thomas, Mike McMulligan (new staff person assigned to the mfry program) and Robin Strong, OSHPD.

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Report on the First Mfry Council Meeting ~ March 9th, 2007

By Faith Gibson, LM

As most of you probably already know, in February 2007 I was appointed to the Midwifery Advisory Council of the California Medical Board at the Division of Licensing meeting, along with LM Carrie Sparravohn, Karen Ehrlich, Barbara Yaroslavsky (MBC consumer member), and obstetricians Ruth Haskins and Guillermo Valensuela. .

On Friday, March 9th, at the first Council meeting, I was elected Chair of the Council and Ruth Haskins elected Vice-Chair. I feel that she and I will be able to provide dynamic leadership and am very happy to have this unique opportunity. One of the responsibilities of all Council members is to speak only for the consensus of the Council, rather than any personal or professional opinion. Another is to follow the rules laid out in the Keene-Bagley Act, which govern public meetings.

As Chair, I am committed to fairly representing all licensed midwives, to presenting a unified face for the Council’s opinions, policies and activities and to do my best, in conjunction with the other 5 members, to make the work product of Midwifery Council be to the benefit of childbearing women, the midwives who serve them and the agency that regulates us. In that way, the Council will also serve the legislative mission of the Medical Board, in regard to consumer safety, and the goals of State of California, relative to improving access to cost-effective maternity care for all California residents.

In order to be sure that everyone on the Council, regardless of personal or professional background in the history and politics of midwifery and medicine, I compiled an 3-ring informational binder for each members of the Council, plus an archival copy for Kathi Burns, in the MBC office. Topics covered this time can be accessed by clicking on this link. Other topics and documents will be added at subsequent meetings of the Council.

Gary Qualset, director of the Division of Licensing, suggested that topics which are felt by LMs around the state to require the time and attention of the Midwifery Council should be sent as a brief (but informative) request to the DOL, to the attention of Kathi Burns. As time permits, they will include them in the agenda at one of the four Council meetings which will be scheduled each year.

The next Mfry Council meeting is tentatively scheduled for April 17th in Sacramento at the Medical Board’s Howe Ave facility. Starting time will be 11 am. The main agenda item will be implementation of SB 1638 through the development of a list of the reasons and complications for each stage of midwifery care relative to transfer of care for PHB clients. Preparatory information for this task will be on the MBC web site and also the public notice of the meeting time and agenda will be mailed out at least 10 days in advance of the date.   

Finally – A Midwifery Council!

It’s been a long legal journey for traditional midwifery since the 1976 Bowland Decision which ruled, for the first time, that the practice of midwifery without a state license was an illegal practice of medicine. That California Supreme Court decision offered only a ‘legislative remedy’ i.e., passage of a new law, either to exempt the practice of midwifery or to license it. It was the consensus of practicing midwives, home birth parents and California legislators that licensing was the preferred option.

Over the next 13 years (1977 to1993) there were six legislative attempts to pass a midwifery licensing law before the LMPA was signed into law in October of 1993. Since 1999, there have been three attempts – all unsuccessful -- to replace the legally impossible mandate of physician supervision with a consultation and collaboration relationship. However, Senator Figueroa and Linda Whitney at the Medical Board helped midwives legislatively amend the LMPA 5 times, to correct legal problems and make it work better for us, for midwifery students, and for the families we serve.

While the LMPA and its amendments have been hugely successful in many ways, there still was an additional problem, namely the Medical Board’s regulation of licensed midwifery, without having any representation by licensed midwives. In order to be appointed to the Medical Board’s governing body, one must either be an MD or a “public member” – defined as a person NOT licensed by the Medical Board. What that meant was that LMs could never serve on the very Board that regulated them.

Finally, ten years after the first midwife was licensed, we have a process for representing ourselves in the regulatory process. How did this wonderful thing come about?

I believe that mothers and midwives have been able to make a positive impact on the century-long culture of prejudice against normal birth and midwives, at least as those beliefs are reflected in our licensing law, because we relied on the same underlying principles in our political efforts that are successful in regard to the successful biology of spontaneous childbirth. In biology, this begins with a basic trust in the normal physiology of labor and birth, patience with nature, and the right use of gravity. In the political realm, that can best be described as a fundamental respect for and trust in the ‘system’ – the basic goodness of human nature and the justice inherent in our democratic process.

In addition a fundamental sense of trust, we also had the collective wisdom to accept the reality of the situation at each step along the way and to do the best where ever we found ourselves, with whatever we had at hand. Sometimes it was nothing more that just the hope that eventually things would get better.

Working with the “labor” you have, instead of the one you wanted

As every mother and midwife knows, you have to accept and work with the imperfect labor you get, not the perfect fantasy labor you imagined. For us as birth activists and advocates, this is an important concept. We are justifiably outraged over the fundamental injustice of our situation. However, whenever we let our sense of umbrage fuel our actions, our energy is dissipated in raging against an unfortunate past, rather than working for a better future. We have a really big job ahead of us, both in relation to the regulation of California licensed midwives and the core issue –the need to rehabilitate our national maternity care policy for health women with normal pregnancies. 

Luckily for midwives, we have chosen to work with the political “labor” handed to us by the Fates. This meant having ‘patience with nature’ (both human and political!), consistent persistence, a willingness to go with the flow and the wisdom to honor the hard work of all the parties who shared this journey with us, including consumer activist organizations, State Legislators, Medical Board appointees and the hard working staff of the State agency. A lot of people played a part -- some big, some small -- but all were crucial absolutely to achieving this worthy goal.

I believe that we have already righted many of the wrongs of history and are part of a fundamental shift in the nature of maternity care, to rehabilitating our national maternity care policy, to bring about science-based care for healthy childbearing women and to a harmonizing of the relationship between the obstetrical profession, normal birth and midwives. 

Our time has come. As with any human endeavor, we will lose our way from time to time, there will be missteps, misunderstandings and sometimes we will have to backtrack, we will get discouraged, but nonetheless, we will prevail.

Warmest Regards,

Faith Gibson, LM, CPM
Executive Director, ACCM/California College of Midwives
Midwifery Advisory Council Member/Chair