It’s a Thursday at Cal State Fullerton when a group of midwifery students each grab a model pelvis, to learn about how a baby’s head moves through the birth canal. Last week, students practiced catching babies with a mannequin in a birthing bed. Next week, they’ll learn how to suture, using foam and raw chicken for practice.
Student Janine Ruiz says it was this sort of hands-on experience that helped her choose this school’s program. “We got to practice, like ‘how do we position our hands?’ I just feel so supported,” Ruiz said. Cal State Fullerton only graduates about 10 to 12 midwives a year.
Now, it’s the only-masters level program left in the state training these health-care workers, in a time where advocates say more maternal care providers are needed. Certified nurse-midwives in California are registered nurses who have advanced degrees and care for people during pregnancy, including labor and delivery, and mostly work in hospitals. They make up the majority of the midwifery workforce.
(There’s another type of midwife in California, known as certified professional midwives or licensed midwives, who oversee home births and at birthing centers). The state’s only other program, UC San Francisco, has paused admissions as it switches to a doctoral program. The school says it’s seeking accreditation to open admissions in 2025.
“We have lots and lots of evidence that at the master's level, nurse midwives are performing very good care,” said Liz Donnelly, a UCSF alum and the vice chair of the health policy committee with the California Nurse-Midwives Association . “There's not an argument for why we need to add on this additional year and increase the cost — and at a time in which the state is facing an access crisis.” Studies have shown that being cared for by a midwife has been associated with fewer complications, like C-sections and preterm births.
And advocates say midwives can help address the shortage of maternal health care . But in 2021, nurse-midwives attended to just 13 percent of births in California. “There's a shortage of health-care providers, period,” said Angela Sojobi, assistant professor at CSU Fullerton’s School of Nursing and director of the nurse-midwifery program.
“We need more people providing care for women, and nurse midwives are very capable of providing this care.” A CalMatters investigation found that nearly 50 maternity wards have closed in the state over the last decade. Certified nurse-midwives in California are registered nurses who have advanced degrees and provide care during pregnancy, including labor and delivery, and mostly work in hospitals.
They care for low-risk pregnancies, and work alongside OB-GYNs. Certified professional midwives or licensed midwives are another category of midwives in California, who oversee births at home and at birthing centers. They are licensed by the Medical Board of California.
OB-GYNs are medical doctors that have a broader scope of practice and can manage high-risk pregnancies, and also perform surgeries. Doulas are professionals who provide support for birthing parents before, during and after labor and in the postpartum period. Sojobi said nurse midwives can play an important role in the Black maternal care crisis, as well as free up OB-GYNs so they can care for higher-risk patients.
Black birthing parents are three to four times more likely to die in California from pregnancy-related complications. Sojobi, who started practicing in Nigeria, works as a midwife at Martin Luther King Jr. Community Hospital in South L.
A., where the majority of her patients are people of color. She says when she walks into patients’ rooms, she often sees sighs of relief from patients who see a practitioner that looks like them.
“I've had patients look at me and say, ‘please, please don't let me die,’ you know, and all they're doing is having a baby, you know, so I've had to reassure them,” she said. The midwifery workforce is still more than 80% white. Sojobi and other maternal care advocates worry that the change at UCSF will mean it will be harder for people of color to enter the workforce, given the extra time and cost of tuition.
The American College of Nurse-Midwives has opposed a doctoral requirement to practice as a midwife. “It's the cost of education, the length of time ..
. thereby reducing the number of new midwives entering the field without any really strong evidence that that additional training will improve health outcomes of the people in the communities that we care for,” said Jessica Brumley, the group’s president. A spokesperson for UCSF said the school’s decision to move to a doctoral degree falls in line with a national movement to change advanced nursing programs to doctoral ones.
“The health challenges that California and the nation face are complex and ever-evolving, especially around reproductive health and in underserved communities. The new pathway will enable us to better prepare nurses to meet these complex needs and to fully serve as advocates for patients,” the spokesperson said. Ginger Breedlove, CEO of Grow Midwives and former president of the American College of Nurse-Midwives said the maternal care crisis is too pressing.
“The move that UCSF made is an absolute wrong move for not only our profession, but for the families trying to be served in California,” Breedlove said. For midwifery professor Sojobi, she worries the number of graduates her school produces is a drop in the bucket in a state like California. “And if that one school is only turning out two, three, maybe four minority midwives in a year, then we're really looking at an incredible shortage and a disservice to our women of color,” Sojobi said.
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