Date
The Honorable Susan Bonilla
Chair, Assembly Business and Professions Committee
State Capitol, Box 942849
Sacramento, CA 95814
RE: AB 1306 (Burke)- SUPPORT
Dear Assemblymember Bonilla:
[Organization name] supports AB 1306, 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 1306 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 1306
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 1306 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 1306 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 1306 and urges your “aye” vote.
Sincerely,
cc: Assemblymember Autumn Burke