sponsored by Assemblywoman

Autumn Burke

June 23, 2018

Friends and Colleagues,


It is with great sadness and disappointment that the California Nurse-Midwives Association has decided that we can no longer support A.B. 2682, the bill to remove physician supervision of nurse-midwives.


First, we want to thank our supporters. This time around we were so proud to boast a powerful and diverse coalition of supporters, including many women's health advocates, health plans, the California Hospital Association, many health professional organizations, countless consumers, and even Govern for California, a group of philanthropists working to bring common sense legislation to California ahead of party or political interests. This time around we also had organizations working behind the scenes, networking strongly on our behalf as well. The sheer amount of support we had this time is not just a reflection of the importance of independent nurse-midwifery practice, but also a reflection of the hard work each and everyone of you did this year and in past years. We galvanized a powerful force


Despite this, we were unable to reach an agreement with our primary bill opposition: the California Medical Association and American Congress of OB/GYNs District IX. After negotiations that have been ongoing for years, the most recent amendments to AB2682 make it clear that we are unable to find a place of compromise that still achieves our primary goal: improved access to women's health care.


The May 22 amendments that passed overwhelmingly in the Assembly, applied licensed midwifery statutes and licensed midwifery scope of practice to nurse-midwives. Current nurse-midwifery practice would be even further restricted - a failed outcome for CNMA members, as well as all the women we currently care for. Further, we had strong concerns that the amendments would prohibit patients from making informed decisions about their own health care, would force them to see a physician under the guise of informed consent even for the slightest deviation from "normal"


We worked in close negotiations with the bill author, Autumn Burke, who worked just as tirelessly on this bill and did everything she could to find common ground with the CMA. Protecting the practice of nurse-midwifery, and women's access to it, is and always has been our biggest concern. We simply could not allow ourselves to go backwards in our scope in the name of independent practice.


Make no mistake, many people worked tirelessly on this bill. The bill language was written and re-written countless times. Everything was supported with the evidence. We worked closely with the ACNM for insight into what other states have done/are doing. As described above, we had the most support we've ever had for our bill. We had hoped that the reams of research that show that nurse-midwifery care is not only safe, but also leads to improved health outcomes for women would help propel the negotiation process forward. We had also hoped that through bill negotiations the CMA and ACOG would support well defined evidence-based practices of team-based collaborative care, but it is clear that we still have far to go before seeing eye to eye.


Our charge to you is please do not give up hope! We are already exploring our next option. We won't stop until physician supervision is removed from our practice, access is improved, and every woman has the right to see the provider of her choice.


We look forward to future efforts in advancing and protecting women's health.


Yours truly,

Rebecca Garrett-Brown, CNMA President

Kathleen Belzer, CNMA President-Elect

Kim Dau, Co-Chair, Health Policy Committee

Holly Smith, Co-Chair Health Policy Committee.






Nurse-midwives will continue to practice in collaboration with physicians, but without the barriers imposed by supervisory language.  

The BRN will receive support on regulatory issues impacting CNMs via a nurse-midwifery advisory council. 


Home birth and birth center CNMs will have access to medications and resources necessary for safe care.


Clarify the inclusion of the home as a location for CNM services.


All newly licensed CNMs will have national AMCB certification, in line with national standards.




American College of Nurse-Midwives and the American Congress of Obstetrics and Gynecologists agree that to provide the highest quality of care, families need access to a system of care that fosters collaboration among licensed, independent providers. 

AB 2682 removes statutes requiring physician supervision and enables equal partnerships between nurse-midwives and obstetricians.



9 of 58 counties in California do not have access to an obstetrician. AB 2682 may solve the California maternity health care shortage. Releasing nurse midwives (CNM)s from physician supervision requirements will promote the expansion of midwifery care for thousands of women in urban and rural communities.



The safety of  CNM care includes fewer cesarean deliveries, fewer episiotomies, and higher rates of breastfeeding. AB 2682 supports the ability of midwives to access lifesaving medications, thus providing emergency care in the home or birth setting while awaiting transport to a hospital facility.



A hallmark of nurse-midwifery care supports avoiding unnecessary interventions. Cesareans are expensive to perform and result in longer hospital stays. Studies show that CNM-attended births are 25% more likely to avoid cesareans. Reducing cesareans would save the California medical system $80 million to $440 million per year.