The Honorable Susan Bonilla

Chair, Assembly Business and Professions Committee

State Capitol, Box 942849

Sacramento, CA 95814

RE: AB 1612 (Burke)- SUPPORT

Dear Assemblymember Bonilla:

[Organization name] supports AB 1612, which would promote greater access to women’s health care and foster true collaboration across health care disciplines by removing physician supervision of nurse-midwives. AB 1612 economically un-tethers nurse-midwives from physicians, creating an opportunity for expansion of women’s health care services within their current scope of practice. Removing state-mandated supervision would allow the nurse-midwife to partner collaboratively with physicians, expanding options beyond working as a physician’s employee. It would also eliminate barriers that physicians encounter from malpractice carriers that prohibit them from supervising nurse-midwives due to fears of vicarious liability.

The current supervision language is in contradiction to national and international standards. In 2011, the American Congress of Obstetricians and Gynecologists (ACOG) and the American College of Nurse-Midwives (ACNM) released a joint statement declaring, “Ob-gyns and CNMs/CMs are...licensed, independent providers who may collaborate with each other based on the needs of their patients.” In 2014, the Board of Registered Nursing reported that it “is not aware of any research or evidence that supervision improves patient safety.” California is one of six remaining states to include physician supervision language.

Physician collaboration is and has always been a hallmark of nurse-midwifery care and AB 1612 will not change that. In 2012, ACOG and ACNM jointly published over fifteen articles describing successful physician and nurse-midwife collaborative practices, noting themes of mutual respect and trust. An ACNM and ACOG review of the essential components of successful collaborative care models concluded, “regulation allowing the full scope of midwifery practice…was essential to successful collaborative practice”

According to ACOG, California is facing a workforce shortage of women’s health care providers and their primary initiative to help alleviate provider shortages includes, “promot[ing] sustainable collaborative practice models with certified nurse-midwives…” Results from a recent Duke University study, demonstrate the feasibility of nurse-midwives filling the workforce shortage upon removal of supervision language. Additionally, the dramatic health care savings related to removal of supervision language have been well documented.

AB 1612 will not change the way that nurse-midwives currently practice and will not change the high quality of care provided by nurse-midwives. They provide women’s primary health care across the state of California, including care during pregnancy and at birth. Ninety-five percent of the births attended by nurse-midwives take place in a hospital and research demonstrates that the midwifery model of care reduces the risk of cesarean birth by as much as 25%, thereby improving maternal and infant health outcomes in California.

More and more women are seeking nurse-midwifery care because of the strong research supporting their outcomes and their strong educational preparation. All three nurse-midwifery education programs in California are Masters degree programs within Schools of Nursing at University of California at San Francisco, California State University- Fullerton, and San Diego State University.

AB 1612 would directly and positively affect the California health care system by providing for improved physician and nurse-midwife collaboration, improved access to health services, lower health care costs, improved quality of care, and greater innovation in health care delivery.

For these reasons, [Organization name] supports AB 1612 and urges your “aye” vote.


cc: Assemblymember Autumn Burke