AUGUST 2020 | NEWSLETTER
For general information on the bill and its amendments, and a Q&A session, join us for the SB 1237 Townhall on Tuesday Aug 4 at 7:30-8:30pm. We will address some misinformation that has been circulating about what the bill does and does not do. Register for the Townhall here (note this is NOT lobby day registration, please do that separately).
Virtual Lobby Day
Please join the California Nurse-Midwives Association for Virtual Lobby Day on Thursday August 13th! Like in past years, Lobby Day is extremely important for your legislator to hear about our bill and (hopefully) vote “aye” on the Assembly Floor when the bill gets there toward the end of August!
As you probably know, SB 1237 (Dodd/Burke/Mitchell) The Equity & Justice in Maternity Care Act has passed the Senate and is making its way through the Assembly committees! The final lobby day push will be the Assembly Floor Vote expected the week of August 17th. We are so close!! Because we cannot lobby in person this year, we are instead focusing on a virtual event. Luckily this means Lobby Day is even easier than in previous years! We will give you instructions ahead of time, so don’t worry if you don’t have experience. Since this is a virtual event, there is no Lobby Day registration fee. Please consider donating to CNMA or CNMF.
Here’s how it works:
Register for Lobby Day here.
We will assign you to a lobby day visit with other people in your district between 9am-5pm on THURSDAY AUGUST 13th, and will notify you of that visit after it is confirmed.
This visit will be 30 minutes long via Zoom conferencing with others in your district. CNMA leadership will be available for many of these calls. Many of you have done lobby day in the past and are well prepared for this. Others who have not done a lobby day, or are “singles” (e.g. in the cases where we find out that no one else from your district is signing up), you will be paired with a CNMA leader. A Lobby Day Preparation Session will be held August 10th from 7:30 - 8:30pm, link will be included in your confirmation email for your individual visit.
Go to cnma.org/today for information on how to participate in the other virtual events happening on August13th, 14th, and the week after. These events include:
Calling your legislator and urging their support for SB 1237 when it gets to the Assembly floor
Lifting up SB 1237 on social media and tagging your legislator
Annual Meeting Announcement.
As you all know, our August annual meeting was canceled due to COVID, but according to our Bylaws, we must have a yearly meeting. Thus, we will be scheduling an abbreviated meeting that will contain important and pertinent information, including the introduction of our new Board members.
This is your official **SAVE THE DATE** for the 2020 Annual meeting on September 19th.
This will obviously be a virtual event. Time is yet to be determined. Stay tuned for more details to follow.
We hope to reschedule our in-person event in early 2021 if that is feasible given the world we all live in now.
Spotlight on Anti-Racism
CNMA is working towards becoming an antiracist organization. In 2019 new bylaws were approved that recognize CNMA’s responsibility to actively address racism and the resulting health inequalities suffered by communities of color. Importantly, we must actively support efforts to increase racial diversity in our profession while engaging actively in self-education. “Spotlight on Antiracism” is a new section of the newsletter where you will find a monthly educational offering. We encourage our membership to check it out and share widely in your workplaces.
This month we start with a classic, White Privilege: Unpacking the Invisible Knapsack, by Peggy McIntosh. In an excerpt from McIntosh’s 1988 paper "White Privilege and Male Privilege: A Personal Account of Coming To See Correspondences through Work in Women's Studies", the essay lays out clearly how white privilege manifests in the daily lives of white Americans. It’s a short read! We encourage our white membership to take a look and discuss it with your white colleagues. We challenge you to consider the following statement, just as McIntosh does in her essay: “Describing white privilege makes one newly accountable... having described it, what will I do to lessen or end it?" What will you do to lessen or end white privilege?
Welcome New Officers!
Maria Ramos Bracamontes Brittany Edwards Elizabeth Smith
CNMA is thrilled to announce our new BOD members!!
We are grateful to Elizabeth Smith who will be staying on as our Treasurer. The CNMA BOD would like to thank her for continuing in this role and for her service over the past two years.
We welcome Brittany Edwards (Fresno,CA); and Maria Ramos Bracamontes (Watsonville, CA). They will be starting in the Fall and we look forward to their voices and perspectives with open hearts and minds. We thank them for stepping up to serve on the CNMA Board and represent the CNMs and the birthing individuals in their communities. I wish to express my heartfelt gratitude to both of them.
As the out-going President, I also want to take this opportunity to thank all the incredible Board and committee members for their engagement and hard work over the last few years. We will continue to have important work to do, but we have collectively accomplished so much! This would not have been possible without the overwhelming degree of commitment of all our Board and committee members.
If you would like to get involved in CNMA, please reach out to me personally.
Kathleen Belzer, CNMA President.
Birthing People’s Bill of Rights
CNMA has been working with a coalition of advocacy groups to address equity issues in this time of Covid. The coalition is called the California Covid-19 Birth Justice Group. This group includes many partners who are working to create necessary change.This was started by the amazing Nourbese Flint from Black Women for Wellness. She is tireless and the vision that she laid out includes surveying and collecting the stories of individuals who are pregnant or have given birth during Covid, creating a Birthing People’s Bill of Rights to inform and educate birthing individuals and their families about their fundamental rights. Lastly, the group hopes to make recommendations to policy makers and those in governance. Please distribute the Birthing People’s Bill of Rights to your communities. https://www.bwwactionproject.org/pregnantbillofrights/
CHCF Health Care Leadership Program
Hello maternity colleagues in California---
Just reminding you all of this opportunity before the summer gets away from us! Please consider applying if you have not yet been a fellow and please pass along to others. The CHCF Health Care Leadership Program is a great opportunity for learning and networking! We are especially looking for providers of color and providers in the Central Valley and SoCal (notably LA and Inland Empire).
About the opportunity and eligibility to apply here.
And an update on deadlines and other program changes during COVID: Given the state of the world and the need for uplifting and visionary leaders, we
believe now may be the best time ever to participate in the CHCF Health Care Leadership Program. While we recognize that it’s an extraordinarily difficult time for clinicians to take on additional responsibilities, we truly believe this program will inspire, transform, and energize. Additionally, the program will provide a robust peer network to help overcome isolation and navigate change and progress. And if financial concerns are top of mind, this year we are able to offer significant tuition assistance. Please share this information. We appreciate your partnership!
Amendments to SB 1237
Most of you are aware that SB 1237 has gone through a few rounds of amendments. These amendments are reflections of our work to hear the concerns of our members, various stakeholders, committee recommendations, as well as making our own improvements to the bill. The bill language can be viewed here.
The following is a list of amendments by section of the bill:
Requires the BRN to name the Nurse-Midwifery Advisory Committee. This committee already exists and meets a couple times a year. This amendment would make the existence of the committee mandatory.
Increases the number of physicians to 2, and the number of CNMs to 4. Also one public member is required
The NMAC will make recommendations to the board on all matters related to midwifery practice, education, appropriate standard of care, and other matters as specified by the board
The NMAC will provide recommendations or guidance on care when the board is considering disciplinary action against a certified nurse-midwife.
Subsection (a) Creates a specific “low-risk” scope for CNMs that requires no written guidelines, policies, or even standardized procedures for furnishing medication
Adds “interconception care” to our scope of practice, which is not currently in statute.
For patients with conditions that arise from or before the pregnancy, the language gives the CNM autonomy to decide whether a patient’s condition falls within the core competencies of the ACNM in order to determine whether the CNM can address said condition or whether the patient should be transferred from their care, or co-managed with a physician.
A recent amendment was added to note that CNMs practicing solely within the scope delineated in subsection (a) of Section 4 are in no way required to have any
signed agreements, signed policies or protocols, or any other written document with a physician
Subsection (b) Gives all CNMs, regardless of practice location the ability, if they wish, to collaboratively manage and attend the birth of higher risk patients, or to give gyn care that falls out of the delineated scope in subsection (a). To do so, the CNM must have written/signed, mutually-developed policies and protocols with a physician that delineate the parameters for consultation, collaboration, referral, and transfer of a patient’s care (just as CNMs have now for the care of patients who require co-management).
Written guidelines for the collaborative care of clients is a standard of professional practice by the American College of Nurse-Midwives. You can find that standard here (see Standard V). These written guidelines are not the same as collaborative practice agreements, and should not be confused as such. The ACNM’s description of collaborative practice agreements can be found here (such a thing is not included in the bill!), and page 2 explains the difference between collaborative practice agreements and written, mutually-agreed upon guidelines with physicians for collaborative management
Intrapartum and birth care of patients with a previous cesarean falls under “collaborative management” with a physician, but can occur in any setting. Prenatal care of clients with a previous cesarean falls under the delineated low risk scope described in subsection (a).
In the community birth setting, the amendment in subsection (c)(2) allows for certain patients in very advanced labor (e.g., transitioning or pushing) to remain in the care of the CNM even though they may have crossed over the 42 week threshold, but have no other medical conditions that would require transfer to the hospital
A patient autonomy section has been added to subsection (e), stating: “This section shall not be interpreted to deny a patient’s right to self-determination or informed decision making with regard to choice of provider or birth setting.”
Allows for furnishing of medications for the scope of services delineated in Section 4 (a) without standardized procedures (!)
Allows for furnishing of medications outside of the scope delineated in Section 4 (a) with standardized procedures, as CNMs are currently have.
Standardized procedures are necessary for all scheduled medications (Schedule II-V), regardless of whether it falls within the scope of services in Section 4(a).
No changes here. Allows for episiotomy and repair of lacerations in all settings, including the home and without standardized procedures.
Includes the required patients disclosures for out of hospital birth
The current language for this Section is placeholder language only. This language is being updated to reflect a streamlined data collection for out of hospital birth that will rely heavily on what community CNMs already submit via vital records (birth certificates), and will add some supplemental information about patient transfers to the hospital setting.
Questions? News? Want to get involved?
Email us at email@example.com
That's all for this month's issue. Catch you next time!
-CNMA MEDIA TEAM
Visit us at cnma.org