California College of Midwives

Legislative Fact Sheet with Citations
California Citizens for Health Freedom 888 / 557-8092

      Unworkability of Physician Supervision
of Community Midwives

Physician Supervision of professional midwives is unnecessary, inappropriate and an insurmountable barrier to practice ~

"There is overwhelming scientific evidence proving midwives are the safest and best birth attendants at the over 75% of all birth where there have been no serious medical complications during pregnancy. is as inappropriate and counter-productive to mandate that midwives be "supervised" by obstetricians as it would be to mandate that general practice physicians be "supervised" by cardiologists."

1999 Letter to the California Legislature re AB 1418 by Dr. Marsden Wagner, MD, MSPH, former C-Director, Bureau of Maternal Child Health, California State Department of Public Health, Regional Officer for Women’s and Children’s Health, WHO, Europe

Midwives should practice independently while interfacing collaboratively with medical care providers ~ Midwives should be recognized as independent and collaborative practitioners, with the rights and responsibilities regarding scope of practice authority and accountability that all independent professional share. Recommendations - Joint Report-Pew Health Professions Commission & the UCSF Center for the Health Professions- Charting a Course for the 21st Century: The Future of Midwifery, April, 1999

In the future liability insurance companies may even favor physicians who collaborate with midwives, because litigation is much less likely to occur when outcomes are good and client satisfaction is high. Editorial, Journal of Nurse Midwifery, Vol 40, no 6, Nov/Dec 1995

Statements by physician malpractice insurance carriers forbidding doctors from providing home-based birth care or supervising community midwives who do

"Given the potential risks involved and considering the possible unfavorable interpretation of the standard of care in the courts, NORCAL MUTUAL INSURANCE cannot countenance the practice of physicians attending home deliveries and will not continue the insurance of physicians engaged in the practice"  NORCAl Mutual News, 1979

Letter from physician malpractice carrier NORCAL, May 18th 1999 "Risk Management recommendations on the supervision of Midwives"

"Exclusion and limitations on coverage: a. Clinic physicians cannot supervise, consult with or back-up any midwife for home birth. The policy language specifically excludes, in II A.7 of the "Professional Liability Coverage Form section of the policy"

"d. The attendance at or supervision of labor and or delivery in any place other than a licensed acute care hospital or licensed alternative birth center, except in the case of a bona fide emergency which requires the immediate and unexpected intervention by the insured"

8. If a ... home birth midwife calls for advice of any kind, explain that you cannot give any advise (otherwise you are engaging in supervision, which is not covered under your policy as discussed above.) 9. If a .... home birth midwife call to report an emergency situation, tell him/her to call 911 in order to have the patient transported to the hospital. Do not give any other advise. Risk Management Specialist, NORCAL

Statements from  a physician-owned malpractice carrier and physician s describing their inability to provide supervision to community midwives or to provide care to maternity patients who are planning to give birth at home:

"With regards to [hospital] admission on behalf of the licensed midwife, your policy will only provide coverage to you if your involvement is necessary as part of your emergency room call schedule" (Letter July 30, 1998 to physician in Arroyo Grande, Ca]

I have decided not to offer back-up OB care for practicing midwives in the community because my [malpractice] insurance company has notified me that I have to pay more insurance for this liability. ... it is increased liability over the usual backup emergency room call.  [Letter July 26, 1999, from a physician in Oceanside, CA]

"This letter is to formally communicate to you that I will no longer be providing pre-natal care because you are planning a home birth. ... The malpractice insurance carriers in the State of California are fearful of backing home birth because of the legal requirement that midwives be supervised by an obstetrician and the obstetricians' fear (whether accurate or not) that they will be held liable for the care of a midwife that they knowingly back-up in a home birth situation.  I regret that we are unable to provide that service for you ... Emergency care is available to you through any emergency room at any hospital. "  [Letter firing a patient receiving concurrent care from an obstetrician, October 27, 1999, Redwood City, CA]

SB 1479 ~California Citizens for Health Freedom 888 / 557-8092