UCSF Study Exposes California’s Obstacles for Medi-Cal-Related Midwifery Services

Midwife Madeleine Wisner made her dream of providing community midwife services a reality when she opened Welcome Home Community Birth Center in south Sacramento. However, after five years and 451 births, Wisner is relocating to New Zealand due to challenges in operating in California, particularly with Medi-Cal patients. She found it unsustainable to continue her birth center as insurance refused to pay the majority of her claims for services including prenatal visits, labor and delivery, postpartum check-ups, and lactation consultations.

According to a new UC San Francisco study, community midwives in California are facing significant obstacles, especially when it comes to serving patients with Medi-Cal insurance. The study warns that maternity care access in California could deteriorate if the number of community midwives who are Medi-Cal providers is not increased at a time when hospitals are closing labor and delivery wards and maternal mortality rates are on the rise.

Currently, there are 75 community midwives registered with Medi-Cal, but outdated licensing requirements, complex state regulations, and cumbersome insurance policies make it nearly impossible for these midwives to accept Medi-Cal patients. This is in spite of the fact that Medi-Cal covers 40% of all births statewide and midwife care is a guaranteed benefit for expecting mothers.

The findings of the study come at a time when California is attempting to address disparities in maternal and infant health, particularly among Black families. Black mothers have shown the most interest in alternative birth support provided by doulas and midwives.

The study also highlights the potential benefits of community midwife care, citing large studies that demonstrate lower rates of cesarean sections and preterm births, as well as higher rates of breastfeeding and satisfaction with birth experiences when low-risk patients are cared for by trained midwives.

Despite efforts to improve access to midwife care, both through legislative measures and collaborative initiatives, the challenges faced by community midwives in California persist, pushing many to the point of leaving the state altogether.

Wisner’s personal experience, coupled with the broader challenges faced by community midwives, sheds light on the need for reform in the healthcare system. The existing policies and regulations have largely supported physician-only maternity care, leading to a situation where hospitals are closing and offering limited options for expecting mothers, especially those with Medi-Cal insurance.

As Wisner prepares to depart California for New Zealand, her decision underscores the continued struggle of midwives to thrive in the state. The hope for policy and program improvements to create a sustainable environment for community midwives remains uncertain.

Overall, the challenges faced by community midwives in California, particularly in serving Medi-Cal patients, serve as a poignant reminder of the complex and seemingly unattainable barriers within the state’s healthcare system. Nonetheless, the resilience and dedication of midwives like Wisner continue to provide a glimmer of hope for improved maternal and infant health outcomes.