California has a child birth crisis. On Feb. 15, California State Auditor Grant Parks released a review of the state’s Comprehensive Perinatal Services Program, which helps reduce the percentage of babies born with low birth weights. Weights under 5 pounds 8 ounces are considered too low. The audit found the percentage of such births jumped from 6.7% in 2014 to 7.3% in 2021, affecting about 30,000 infants.
It found neither the departments of Health Care Services nor Public Health provided “the perinatal program with sufficient oversight.” Both departments — these are large bureaucracies — are in the Health and Human Services Agency, whose secretary, Mark Ghaly, was appointed by Gov. Gavin Newsom.
Specifically, in 2022 just 45 of the 2,600 reviews of providers even ran assessments of perinatal programs — 1.7%. Of 61 state health jurisdictions, 22 didn’t even complete reviews. The audit recommended the Legislature pass a law giving primary responsibility entirely to Health Care Services and direct it to “develop a system of oversight.” This seems essential to us.
Also this week, CalMatters reported on a midwife, Madeleine Wisner, who got so fed up with the red tape and expense of helping mothers give birth outside hospitals she moved to New Zealand. Of her price of $8,500 for a birth, only $1,451 was reimbursed by Medi-Cal, which funds about 40% of all births. By contrast, according to the data firm Fair Health, the full cost of a regular birth in California can be up to $36,000. (A C-section can be $50,000, but of course is performed in a hospital.) Thus, enabling more midwife births would reduce overall costs for both Medi-Cal and for private insurance companies.
A Feb. 12 report from the UCSF Osher Center for Integrative Health pointed out certified nurse-midwives are the only type who can work in hospital maternity wards; while both they and licensed midwives can help at free-standing birth centers or home births. The study cited seven main barriers to midwives signing up to be Medi-Cal providers and getting reimbursement. These included malpractice insurance costing at least $11,000 a year for midwives and up to $80,000 for centers. And the Medi-Cal application process doesn’t align with California licensing guidelines.
There is some good news. Last year the Legislature unanimously passed in both houses Senate Bill 667 by state Sen. Bill Dodd, D-Napa. At the time the bill was introduced, he explained, “This bill removes unnecessary barriers and supervision rules for nurse-midwifery practice.” Dodd’s office told us it’s too early to assess the bill’s effectiveness, but it is being monitored.
We urge Newsom to take charge of this by pushing through the Legislature the auditor’s reform consolidation and monitoring suggestions, while working to remove the seven barriers to midwives listed by the Osher Center. Enabling more midwives also would save Medi-Cal money during this time of budget deficits. Having a baby ought to be a joyous time, not one spent worrying about finding a midwife or paying a large co-payment. The system needs a sharp slap on the bottom.
