California Maternal Quality Care Collaborative (CMQCC)  ~ A Contemporary Ray of Hope in a Still Dark Sky

by faithgibson on April 15, 2024

A brief comment by the editor (that would be me!)

A Contemporary Ray of Hope
in a Still Dark Sky

I am happy to report one small ray of hope that things may getting a little better for women who choose non-medical childbirth services in their home or a free-standing birth center and the professional midwives who provide this form of community-based care.

One tiny step forward for mothers and midwives . . .

An amazing contemporary example that things may finally be moving in a positive direction is happening right now in my very own community. This week (11-30-2022) a non-profit organization called the California Maternal Quality Care Collaborative (CMQCC)  hosted an online educational presentation about a very controversial and formerly taboo subject of integrating midwives and doulas into mainstream maternity care.

Personally, I never thought I’d live to see the day when the words: “midwife“, “doula” and “mainstream” were all in the same positive sentence!

But first let tell you a little bit about the CMQCC. It was founded in 2006 at Stanford University School of Medicine as a response to rising maternal mortality and morbidity rates in our state. The CMQCCis a research and educational group:

committed to ending preventable morbidity, mortality and racial disparities in California maternity care through the use research, quality improvement toolkits, state-wide collaboratives and its innovative Maternal Data Center to improve outcomes for mothers and infants.”

Since CMQCC’s inception, California has seen maternal mortality decline by 65 percent between 2006 to 2016, while the national maternal mortality rate continued to rise!  

Let me say that again, as it is so important to those families whose wife or mother did NOT die in childbirth  — the coordinated activities of the CMQCC and the California Department of Health reduced maternal mortality by 65% in the last 10 years!

Why the CMQCC matters childbearing women who choose to receive care from midwives and doulas.

This bring us back to the historic and current conflict between doctors and midwives in the US. I describe this as a “Hundred Years War” waged by organized medicine against the profession of midwifery, its individual practitioners, and everything related to out-of-hospital childbirth services.

If and when the Hundred Years War were to actually end, it will be a truly historic occasion, one almost impossible for me to imagine. I was one of those midwives caught up in the “regulatory capture” of our state medical board. The majority of MDs appointed to its governing board are members of the state chapter of the AMA. Organized medicine has been fighting midwifery, and all efforts to licensed non-nurse midwives for decades, while also promoting the arrest and criminal prosecution of lay midwives.

I was one of those midwives. I was arrested in my home in Palo Alto on August of 1991 and criminally prosecuted for 20 months ($40,000 in legal expenses). The charges against me were finally dismissed in April of 1993. The unwillingness of the DA to pursue a criminal case against me, along with an editorial in the San Jose Mercury on Sunday, May 5th, 1993, finally convinced the California Medical Association (i.e. state chapter of the AMA) to stop blocking passage of the Licensed Midwifery Practice Act of 1993 (LMPA), which was signed into law October 11, 1993.

What “burying the hatchet” means to mothers and midwives

The recent presentation by the CMQCC staff also took exception to the historical prejudice by obstetricians against mothers and midwives who don’t choose or are not affiliated with obstetrics. The CMQCC established as a professional obligation that obstetricians and the obstetrical staff of hospitals respect the decision of childbearing women, without judgment or negative comments, who planned to give birth in a community setting.

This quality of respect also applies to the collegial relationship between the obstetrical profession and professionally-licensed community midwives. The CMQCC presentation strongly discourages the use of evocative, and often factually incorrect, vocabulary such as “failed home birth” when describing an appropriate hospital transfer, and the use of  “lay midwife” when the practitioner in question is state-licensed and/or nationally-certified midwife.

This would also means making peace with the choice by many healthy childbearing women to have a midwife-attended birth in a non-medical setting as long as things continue to progress normally and the mother and baby remain healthy. This always includes timely transfer to obstetrical services as needed.

Accepting midwives and doulas as respected members of the mainstream healthcare system would a truly historic occasion. To the surprise of many, this actually is a science-based response, as the outcomes for intrapartum care as provided by professionally-trained midwives in a non-medical setting (parents’ home or freestanding birth center) are equivalent to hospital-based obstetrics for a similar demographic of healthy childbearing women.

This is a real, but welcomed, turn-around compared to the last four decades. During most of that time, many hospital obstetrical departments in the San Francisco Bay area were very vocal and even punitive in their opposed to out-of-hospital childbirth services. Whenever a hospital transfer became necessary, the conversations between attending OBs and midwives were generally very negative or they froze us out altogether.

One way this played out was for the attending OBs, and sometimes the L&D nursing staff, to never look at or talk to the midwife while she was present in the room. In addition they nurse would often to refer to the intrapartum transfer as a “failed home birth”.

However, from the perspective of the midwife and mother-to-be, these transfers were actually well-timed since they preserved the welfare of the mother and unborn baby. This was obviously the case, as none of the hospital staff were rushing the mother off to the OR for an emergency C-section.

I’m sure midwives and obstetricians will always have various differences of opinion, but I can’t thank the staff of the CMQCC for publicly acknowledging the contribution of midwives and labor-support providers as part of the overall goal to reduce the maternal mortality rate. This makes you is a hero in my book!

So now you know about the CMQCC and can find out more by visiting their website.

A quick definition of  Modern Maternity Care for healthy women with normal pregnancies.