Message from the chair: Changes to legal status of home birth
Laurie C. Gregg, MD
Since 1993, California has licensed midwives to deliver at home under the supervision of a physician. The Medical Board of California requires submission of statistics by midwives to renew licensure. From those statistics, we know that in 2012, 2,316 women delivered at home under the care of a licensed midwife. There were 118 vaginal births after cesarean delivery, 13 breeches, and four sets of twins delivered at home. According to the report submitted to the state, even one set of triplets came into this world at home. Of those women who started labor at home, 16% required intrapartum transfer. Forty-four women required urgent or emergency transfer to the hospital.
Home births in California do not always go smoothly when a transfer of care is necessary. ACOG consistently hears this from members at its meetings. One challenge is how difficult it is for a midwife to obtain a physician supervisor. Most physicians do not have liability coverage that will allow them to act in this capacity. In 1999, an administrative law judge recognized this difficulty and allowed midwives to go without supervision in a precedent-making ruling. In 2012, only 7% of home births had physician supervision.
This year, it appeared likely that the California Medical Board’s sunset review would remove the physician supervision requirement from the law, considering the clause had not been enforced since 1999. On October 9, Gov. Jerry Brown signed Assembly Bill 1308, which encourages better selection of home birth candidates. The law requires a verbal handoff of care and prenatal records when a woman is transferred to the hospital. It encourages women to preregister at a hospital given the 16% chance they will need to go to one while in labor.
The law also removes the requirement for physician supervision and replaces it with face-to-face physician consultation whenever a pregnancy falls outside of the bill’s definition of “normal.” It better delineates who truly is responsible for care and includes a clearer definition of legal boundaries should such a case result in medical liability litigation. Finally, the law mandates transfer of care reporting so better data can be collected and trends can be recognized.
ACOG believes that the safest place for a birth is in the hospital or a birthing center, but it respects the patient’s right to make an informed decision about where she would like to give birth. We believe this new law will allow patients to make better informed choices and enable a smoother transfer of care should “home sweet home” become “not so ideal.”