Existing law requires the Department of Health Care Access and Information, formerly known as the Office of Statewide Health Planning and Development, to establish a program to contract with programs that train certified nurse-midwives and programs that train licensed midwives in accordance with the global standards for midwifery education and the international definition of midwife as established by the International Confederation of Midwives in order to increase the number of students receiving quality education and training as a certified nurse-midwife or as a licensed midwife. Existing law requires these provisions to be implemented only upon an appropriation by the Legislature for these purposes in the annual Budget Act or another act.

This bill would require the Department of Health Care Access and Information, upon appropriation from the Legislature for this purpose, to administer funding for a statewide study on midwifery education. The bill would require the study to be conducted by an outside consultant familiar with the health care and midwifery landscapes and workforce in California that would, among other things, identify viable education programs that can serve both rural and urban geographic areas. The bill would require the department to submit a report from the studys findings to the Legislature, to post the report on the departments internet website, and to notify all persons in the departments reproductive health and maternity care electronic mailing list, as specified. The bill would define reproductive health care professionals as, among others, medical doctors and licensed midwives.

Existing law requires the Department of Health Care Access and Information, formerly known as the Office of Statewide Health Planning and Development, to establish a program to contract with programs that train certified nurse-midwives and programs that train licensed midwives in accordance with the global standards for midwifery education and the international definition of midwife as established by the International Confederation of Midwives in order to increase the number of students receiving quality education and training as a certified nurse-midwife or as a licensed midwife. Existing law requires these provisions to be implemented only upon an appropriation by the Legislature for these purposes in the annual Budget Act or another act.

This bill would require the Department of Health Care Access and Information, upon appropriation from the Legislature for this purpose, to administer funding for a statewide study on midwifery education. The bill would require the study to be conducted by an outside consultant familiar with the health care and midwifery landscapes and workforce in California that would, among other things, identify viable education programs that can serve both rural and urban geographic areas. The bill would require the department to submit a report from the studys findings to the Legislature, to post the report on the departments internet website, and to notify all persons in the departments reproductive health and maternity care electronic mailing list, as specified. The bill would define reproductive health care professionals as, among others, medical doctors and licensed midwives.

Existing law requires the Office of Statewide Health Planning and Development to establish a program to contract with programs that train certified nurse-midwives and programs that train licensed midwives in accordance with the global standards for midwifery education and the international definition of midwife as established by the International Confederation of Midwives in order to increase the number of students receiving quality education and training as a certified nurse-midwife or as a licensed midwife. Existing law requires these provisions to be implemented only upon an appropriation by the Legislature for these purposes in the annual Budget Act or another act.

This bill would require the Department of Health Care Access and Information, upon appropriation from the Legislature for this purpose, to administer funding for a statewide study on midwifery education. The bill would require the study to be conducted by an outside consultant familiar with the health care and midwifery landscapes and workforce in California that would, among other things, identify viable education programs that can serve both rural and urban geographic areas. The bill would require the department to submit a report from the studys findings to the Legislature, to post the report on the departments internet website, and to notify all persons in the departments reproductive health and maternity care electronic mailing list, as specified. The bill would define reproductive health care professionals as, among others, medical doctors and licensed midwives.

Existing law requires the Office of Statewide Health Planning and Development to establish a program to contract with programs that train certified nurse-midwives and programs that train licensed midwives in accordance with the global standards for midwifery education and the international definition of midwife as established by the International Confederation of Midwives in order to increase the number of students receiving quality education and training as a certified nurse-midwife or as a licensed midwife. Existing law requires these provisions to be implemented only upon an appropriation by the Legislature for these purposes in the annual Budget Act or another act.

This bill would require the Department of Health Care Access and Information, upon appropriation from the Legislature for this purpose, to administer funding for a statewide study on midwifery education. The bill would require the study to be conducted by an outside consultant familiar with the health care and midwifery landscapes and workforce in California that would, among other things, identify viable education programs that can serve both rural and urban geographic areas. The bill would require the department to submit a report from the studys findings to the Legislature, to post the report on the departments internet website, and to notify all persons in the departments reproductive health and maternity care electronic mailing list, as specified. The bill would define reproductive health care professionals as, among others, medical doctors and licensed midwives.

Existing law requires the Office of Statewide Health Planning and Development to establish a program to contract with programs that train certified nurse-midwives and programs that train licensed midwives in accordance with the global standards for midwifery education and the international definition of midwife as established by the International Confederation of Midwives in order to increase the number of students receiving quality education and training as a certified nurse-midwife or as a licensed midwife. Existing law requires these provisions to be implemented only upon an appropriation by the Legislature for these purposes in the annual Budget Act or another act.

This bill would require the Department of Health Care Access and Information, upon appropriation from the Legislature for this purpose, to administer funding for a statewide study on midwifery education. The bill would require the study to be conducted by an outside consultant familiar with the health care and midwifery landscapes and workforce in California that would, among other things, identify viable education programs that can serve both rural and urban geographic areas. The bill would require the department to submit a report from the studys findings to the Legislature, to post the report on the departments internet website, and to notify all persons in the departments reproductive health and maternity care electronic mailing list, as specified. The bill would define reproductive health care professionals as, among others, medical doctors and licensed midwives.

Existing law requires the Office of Statewide Health Planning and Development to establish a program to contract with programs that train certified nurse-midwives and programs that train licensed midwives in accordance with the global standards for midwifery education and the international definition of midwife as established by the International Confederation of Midwives in order to increase the number of students receiving quality education and training as a certified nurse-midwife or as a licensed midwife. Existing law requires these provisions to be implemented only upon an appropriation by the Legislature for these purposes in the annual Budget Act or another act.

This bill would require the Department of Health Care Access and Information, upon appropriation from the Legislature for this purpose, to administer funding for a statewide study on midwifery education. The bill would require the study to be conducted by an outside consultant familiar with the health care and midwifery landscapes and workforce in California that would, among other things, identify viable education programs that can serve both rural and urban geographic areas. The bill would require the department to submit a report from the studys findings to the Legislature, to post the report on the departments internet website, and to notify all persons in the departments reproductive health and maternity care electronic mailing list, as specified.

CONCURRENCE IN SENATE AMENDMENTS

CSA1 Bill Id:AB 836

Author:(Stefani)

As Amended Ver:September 3, 2025

Majority vote

SUMMARY

Requires the Department of Health Care Access and Information (HCAI), upon appropriation from the Legislature, to administer funding for a statewide study on midwifery education. Requires the study to be conducted by an outside consultant familiar with the health care and midwifery landscapes and workforce in California that would, among other things, identify viable education programs that can serve both rural and urban geographic areas.

Senate Amendments

Are technical and clarifying, and add coauthors.

COMMENTS

Communities around California face a severe lack of access to reproductive health and maternity care. The California Hospital Association reports that between 2014 to 2024, more than 50 maternity units closed throughout the state. The maternity workforce shortage is one of three key drivers, with a projected shortage of 1,100 OB/GYNs in California by 2030.

Midwives. Midwives are licensed clinicians who play a key role in the maternity care workforce. California credentials two types of midwives: licensed midwives (LMs) and nurse-midwives (NMs). Both types of midwives provide care during pregnancy, childbirth, and postpartum, although they have different clinical training and licensure. According to the California Health Care Foundation October 2024 report, ″California′s Midwife Workforce: Practice Settings, Work Environments, and Future Practice Plans,″ the number of NMs licensed in California was stable between 2017 and 2023, fluctuating between a low of 1,157 and a high of 1,175 NMs. Over the same period, the number of LMs increased 22%, from 376 in 2017 to 458 in 2023. Not all licensed NMs and LMs practice as midwives.

California births. There were 419,104 births in California in 2022. The majority of these births had a physician as the primary attendant, although midwife attendants have increased over the last decade. Midwives serving as a primary attendant increased from 9% of births in 2012 to 14% of births in 2022, with the majority of these being NMs. California NMs and LMs collectively attend approximately 14% of births in California, but could provide greater health care access with workforce expansion. Nurse-midwifery is a mandated Medi-Cal benefit, but access to midwifery care across the state is highly variable.

Positive health outcomes. According to a 2014 study, ″Improvement of Maternal and Newborn Health Through Midwifery," published in The Lancet, when midwives are integrated into health systems, we find more positive health outcomes, including spontaneous vaginal birth, labor after Cesarean, vaginal birth after Cesarean, breastfeeding, patient confidence and control, patient centered care, and lower costs. We also see fewer undesirable health outcomes: cesarean birth, operative vaginal delivery, induction of labor, episiotomy, perineal lacerations, use of pain medicine, epidural anesthesia, continuous fetal monitoring, neonatal intensive care unit (NICU) admissions, preterm birth and low birth weight infants, infant emergency department visits and hospitalizations, and neonatal deaths. As noted above, the number of births attended by California NMs and LMs has increased over time and in 2022, they attended approximately 14% of total births in the state.

With increased access to midwifery care, this proportion would increase and thereby improve maternal and newborn outcomes associated with midwifery care.

California Reproductive Health Service Corps. AB 1918 (Petrie-Norris), Chapter 561, Statutes of 2022, establishes the California Reproductive Health Service Corps program within HCAI to reduce the debt burden of current and future health care professionals dedicated to providing reproductive health care in underserved areas of California. HCAI entered into agreements with two leading reproductive health training organizations, Training in Early Abortion for Comprehensive Healthcare (TEACH) and Empower RX, who are leading a collaborative effort with multiple partners to implement and expand curricula/training opportunities in abortion and abortion related care for health workers ranging from allied health professionals to advanced practitioners. These efforts are ongoing through 2028. HCAI awarded 343 individuals loan repayment and scholarships through the clinical infrastructure funds. These awardees committed to providing reproductive health services. HCAI has multiple existing loan repayment and scholarship programs that cover the full array of health professionals who provide reproductive health services. HCAI augmented existing programs to award individuals providing those services or currently in training to provide those services in the future. All of the funds from the Reproductive Health Service Corps have been obligated.

According to the Author

California is facing a maternity and reproductive health care crisis. Communities across California face severe lack of access to reproductive health and maternity care. The author states that midwifery care has demonstrated excellent clinical outcomes but is underutilized, and this bill advances the future of midwifery care in California by requiring a landscape analysis of the state to consider truly innovative and financially sustainable educational options, with a focus on the communities who need midwifery care the most. This study will evaluate opportunities to diversify the midwife pipeline, assessing barriers to educational pathways, and identifying potential solutions to expand the number of programs preparing high-quality, culturally responsive, maternal healthcare providers. This analysis will inform future strategies to develop a robust and well-trained midwife workforce to fill California′s maternity and reproductive health provider shortages across the state. The author concludes that California has an opportunity to strategically invest in midwifery education programs and the landscape analysis required under this bill will help ensure that strategic investment in midwifery education builds sustainable cost-effective programs for a robust and reliable workforce.

Arguments in Support

The California Nurse Midwives Association (CNMA) is the sponsor of this bill and states that communities around California face a severe lack of access to reproductive health and maternity care. Between 2014 to 2024, more than 50 maternity units closed throughout the state. Midwifery care has demonstrated excellent clinical outcomes, but they are underutilized and can be mobilized to help address provider shortages. California currently only has one nurse-midwifery program accepting students: the California State University Fullerton master′s degree in nurse-midwifery. There are currently no licensed midwife programs in California. To fill the state′s needs, midwifery education should aim to serve parts of the state with the most significant provider shortages and maternity care needs. Midwifery education programs are required to meet high quality standards and can successfully prepare the midwife workforce in California. CNMA concludes that this bill will ultimately increase access to clinical placement sites appropriate to midwifery scope of practice.

Arguments in Opposition

None.

FISCAL COMMENTS

According to the Senate Appropriations Committee HCAI estimates General Fund costs of approximately $1 million in 2026-27 to contract with a consultant to develop the workforce study.

VOTES:

ASM HEALTH: 15-0-0

YES: Bonta, Chen, Addis, Aguiar-Curry, Arambula, Carrillo, Flora, Mark González, Krell, Patel, Celeste Rodriguez, Sanchez, Schiavo, Sharp-Collins, Stefani

ASM APPROPRIATIONS: 13-0-2

YES: Wicks, Arambula, Calderon, Caloza, Dixon, Elhawary, Fong, Mark González, Hart, Pacheco, Pellerin, Solache, Ta

ABS, ABST OR NV: Sanchez, Tangipa

ASSEMBLY FLOOR: 73-2-4

YES: Addis, Aguiar-Curry, Ahrens, Alanis, Alvarez, Arambula, Ávila Farías, Bains, Bauer‑Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Calderon, Caloza, Carrillo, Castillo, Connolly, Davies, Dixon, Elhawary, Ellis, Flora, Fong, Gabriel, Garcia, Gipson, Jeff Gonzalez, Mark González, Hadwick, Haney, Harabedian, Hart, Irwin, Jackson, Kalra, Krell, Lackey, Lee, Lowenthal, Macedo, McKinnor, Muratsuchi, Nguyen, Ortega, Pacheco, Papan, Patel, Patterson, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Ransom, Celeste Rodriguez, Michelle Rodriguez, Rogers, Blanca Rubio, Schiavo, Schultz, Sharp-Collins, Solache, Soria, Stefani, Ta, Valencia, Wallis, Ward, Wicks, Wilson, Zbur, Rivas

NO: DeMaio, Sanchez

ABS, ABST OR NV: Chen, Gallagher, Hoover, Tangipa

UPDATED

VERSION: September 3, 2025

CONSULTANT: Lara Flynn / HEALTH / (916) 319-2097 FN: 0001644

 THIRD READING  

Bill No: AB 836

Author: Stefani (D), et al.

Amended: 9/3/25 in Senate

Vote: 21

SENATE HEALTH COMMITTEE: 10-0, 7/16/25

AYES: Menjivar, Valladares, Durazo, Gonzalez, Limón, Padilla, Richardson, Rubio, Weber Pierson, Wiener

NO VOTE RECORDED: Grove

SENATE APPROPRIATIONS COMMITTEE: 7-0, 8/29/25

AYES: Caballero, Seyarto, Cabaldon, Dahle, Grayson, Richardson, Wahab

ASSEMBLY FLOOR: 73-2, 6/2/25 - See last page for vote

SUBJECT: Midwifery Workforce Training Act

SOURCE: California Nurse-Midwives Association

DIGEST:

This bill requires the Department of Health Care Access and Information, upon appropriation from the Legislature, to administer funding for a statewide study on midwifery education conducted by an outside consultant familiar with the health care and midwifery landscapes and workforce in California.

Senate Floor Amendments of 9/3/25 add Senators Blakespear, Richardson, and Wiener as coauthors, and make various other technical changes.

ANALYSIS:

Existing law:

1. Establishes the Department of Health Care Access and Information (HCAI), and requires HCAI to collect, analyze, and publish data about health care workforce and health professional training; identify areas of health workforce shortages; and provide scholarships, loan repayments, and grants to students, graduates, and institutions providing direct patient care in areas of unmet need. Establishes the Health Professions Education Foundation within HCAI to, among other functions, develop criteria for evaluating applicants for various scholarships and loans. [Health and Safety Code (HSC) §127000, et seq. and §127750, et seq.]
2. Requires HCAI, as part of the Midwifery Workforce Training Act, to establish a program for training certified nurse-midwives (CNMs) and licensed midwives (LMs) in accordance with the global standards for midwifery education and the international definition of “midwife” as established by the International Confederation of Midwives, in order to increase the number of students receiving quality education and training as a CNM or as a LM. [HSC §128298(b)(1)]
3. Requires HCAI to only contract with programs that train CNMs and programs that train LMs that, at minimum, include, or that intend to create, a component of training designed for medically underserved multicultural communities, lower socioeconomic neighborhoods, or rural communities, and that are organized to prepare program graduates for service in those neighborhoods and communities, or that seek to recruit and retain racially and ethnically diverse students, underrepresented groups, or people from underserved or historically marginalized communities. [HSC §128298(b)(2)]

This bill:

1. Requires HCAI, upon appropriation from the Legislature, to administer funding for a statewide study on midwifery education conducted by an outside consultant familiar with the health care and midwifery landscapes and workforce in California.
2. Requires the study to include such things as:
3. An evaluation of status and trends in midwifery education in California and the U.S.;
4. A financial sustainability plan, including long-term education program financing, cost of educating midwives in California, and the options for financial stability of midwifery education—including assessing available state and federal funding resources to cover specified students’ costs;
5. Identifying and proposing pathways to diversify the midwifery student pipeline, including assessing the opportunities, challenges, and support needs of prospective students, current students, and preceptors;
6. Identifying institutions and programs of study that are equipped to house midwifery education programs, as well as viable education programs that can serve both rural and urban geographic areas;
7. Identifying sites for interprofessional education between resident obstetricians and midwives, as well as considering ways to allow CNMs and LMs to train together, with separate exit requirements specific to their path;
8. Ensuring proposed solutions for midwifery education meet the needs of California birthing families and future midwives; and,
9. An assessment of jobs available for new graduates, and projected growth.
10. Requires HCAI to post the report on its website, and to notify all persons in their reproductive health and maternity care electronic mailing list, no later than 36 months after the appropriation of funds to HCAI.

Comments

According to the author of this bill:

California is facing a maternity and reproductive health care crisis. Communities across California face severe lack of access to reproductive health and maternity care. Midwifery care has demonstrated excellent clinical outcomes but is underutilized. This bill advances the future of midwifery care in California by requiring a landscape analysis of the state to consider truly innovative and financially sustainable educational options, with a focus on the communities who need midwifery care the most. This study will evaluate opportunities to diversify the midwife pipeline, assess barriers to educational pathways, and identify potential solutions to expand the number of programs preparing high-quality, culturally responsive, maternal health care providers. This analysis will inform future strategies to develop a robust and well-trained midwife workforce to fill California’s maternity and reproductive health provider shortages across the state. California has an opportunity to strategically invest in midwifery education programs and the landscape analysis required under this bill will help ensure that strategic investment in midwifery education builds sustainable, cost-effective programs for a robust and reliable workforce.

Background

Midwifery in California. According to a February 2025 California Health Care Foundation (CHCF) Issue Brief, midwives play a crucial role in the maternity care workforce, providing comprehensive health services during pregnancy, labor, and postpartum, including as the primary birth attendant. In many countries that have better birth outcomes than California and the U.S., midwives provide the majority of care for uncomplicated pregnancies and births. The midwifery model of care emphasizes respectful, relationship-based, and person-centered care, supporting the progress of labor and birth with minimal intervention unless necessary. An element of successful midwifery care is appropriate consultation with obstetrician/gynecologists and transfer to physician care if the need arises (e.g., if a patient develops medical complications outside the scope of midwifery care or requires surgery). California has two types of midwives: LMs and CNMs. LMs, regulated by the Medical Board of California, primarily practice in community-based settings, including birth centers and home births. Nationally certified LMs are credentialed as certified professional midwives and are legally recognized in 38 states. CNMs are also registered nurses and are regulated by the California Board of Registered Nursing, primarily practicing in clinics and hospitals. Nationally, CNMs are legally recognized in all 50 states. Both LMs and CNMs meet international midwifery education standards and provide high-quality care focused on pregnancy, childbirth, and postpartum, including family planning and newborn care, with CNMs also offering broader gynecologic services.

An October 22, 2024 CHCF publication on California’s midwife workforce notes:

1. Only 12% of LMs and 10% of CNMs were Latina/x, while 45% of the state’s population of women/birthing people age 15 to 44 (considered reproductive age by the U.S. Centers for Disease Control and Prevention) was Latina/x;
2. Two percent of LMs and 4% of CNMs were Black, compared to 6% of the Black women/birthing people of reproductive age;
3. Many LMs (25%) and CNMs (33%) said they spoke a non-English language fluently; and,
4. LMs estimated that 6% of their patients preferred to receive services in a non-English language, and CNMs reported that 33% of their patients preferred to receive services in a non-English language.

Doctor of Nursing Practice (DNP) programs result in some closures of masters-level midwifery programs; others reopen. In 2004, the American Association of Colleges of Nursing (AACN) called for all nursing schools to phase out master's-level preparation for advanced practice registered nurses (APRNs: clinical nurse specialists, nurse practitioners, nurse midwives, and nurse anesthetists) and transition to DNP preparation only by 2015, based on some Institute of Medicine (IOM) reports on medical errors, quality of care, and safety. Given the growing complexity of care, and strong recommendations by the IOM, many believed health care would benefit from doctorate-educated practitioners—this was at a time during which other disciplines, such as pharmacy and physical therapy, also moved their disciplines to a doctoral level. Yet, when it released the Future of Nursing report in 2010, IOM did not explicitly state a need for a practice doctorate as a universal requirement for APRN entry. However, the number of DNP programs and graduates continued to grow steadily over the next decade: the national DNP program count rose from 92 in 2008 to 354 in 2018, while master’s-level programs remained stagnant, or even decreased. And in 2025, UCSF, one of only two California master’s-level programs for midwifery, stopped admitting students while it revamped its curriculum to offer only DNPs through the Bachelor of Science in Nursing Entry to DNP model. But a large number of schools actually retained their Master of Science in Nursing (MSN) option while instituting a nonclinical version of the DNP. Many nursing schools kept up robust MSN enrollment and only added the post-MSN-DNP, which did not require extensive investment in clinical sites and could be delivered to large numbers of students online. Further, a September 6, 2024 CHCF blog notes that the national transition to DNPs has not caught on the way AACN envisioned, and an acute need for maternal health practitioners has had some universities moving in the other direction. CHCF notes that in 2024, Rutgers University reinstated the nurse-midwifery master’s training it had eliminated in 2016. The University of Alabama-Birmingham also restarted its master’s in nurse-midwifery program in 2022 after a 25-year hiatus. In addition, George Washington University in Washington, DC; Loyola University in New Orleans; and, the University of Nevada-Las Vegas added master’s training in nurse-midwifery.

CHCF states that UCSF estimates tuition and fees will cost $152,000 for a three-year doctoral degree in midwifery, compared with $65,000 for a two-year MSN. Studies show that 71% of nursing master’s students and 74% of nursing doctoral students rely on student loans, and nurses with doctorates earn negligibly or no more than those with master’s degrees. A 2020 article in Nursing Outlook argued that the financial implication of requiring the DNP degree is the largest barrier to adoption, both for students and organizations, as a universal DNP requirement would have financial ramifications on three levels: a) cost to individual students; b) cost to institutions that financially support advanced nursing practice education; and, c) cost to schools. The article cites a 2019 study that revealed the average 2014 salary for DNP-educated CNMs to be $105,968; the average salary for master's-prepared CNMs was $102,576 in 2014. This annual differential of $3,392 in mean salary dollars pales in comparison to the differences in time, effort, and tuition dollars required of DNP students, compared to CNM students, the article notes.

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No

According to the Senate Appropriations Committee:

The HCAI estimates General Fund costs of approximately $1 million in 2026-27 to contract with a consultant to develop the workforce study.

SUPPORT: (Verified 9/2/2025)

California Nurse-Midwives Association (source)

American College of Nurse-Midwives
American Nurses Association\California
Black Women for Wellness Action Project
California Latinas for Reproductive Justice

California Legislative Women’s Caucus
California Women’s Law Center
Citizens for Choice

City of Glendale
Essential Access Health
If/When/How: Lawyering for Reproductive Justice
March of Dimes
National Health Law Program
Planned Parenthood Affiliates of California
Reproductive Freedom for All California
Rural County Representatives of California

San Francisco Bay Area Black & Jewish Unity Coalition
United Nurses Associations of California/Union of Health Care Professionals
Urban Counties of California
Western Center on Law and Poverty

OPPOSITION: (Verified 9/2/2025)

None received

ARGUMENTS IN SUPPORT: The California Nurse-Midwives Association, as sponsor, and other supporters of this bill state that communities around California face a severe lack of access to reproductive health and maternity care. Between 2014 and 2024, more than 50 maternity units closed throughout the state. Midwifery care has demonstrated excellent clinical outcomes, but they are underutilized and can be mobilized to help address provider shortages. Supporters state when midwives are integrated into health systems, they find more positive health outcomes, including spontaneous vaginal birth, labor after Cesarean, vaginal birth after Cesarean, breastfeeding, patient confidence and control, patient-centered care, and lower costs. There are also fewer undesirable health outcomes: cesarean birth, operative vaginal delivery, induction of labor, episiotomy, perineal lacerations, use of pain medicine, epidural anesthesia, continuous fetal monitoring, NICU admissions, preterm birth and low birth weight infants, infant emergency department visits and hospitalizations, and neonatal deaths. Supporters further argue California currently only has one nurse-midwifery program accepting students: the California State University Fullerton master’s degree in nurse-midwifery. There are currently no LM programs in California. To fill the state’s needs, midwifery education should aim to serve parts of the state with the most significant provider shortages and maternity care needs. Midwifery education programs are required to meet high quality standards and can successfully prepare the midwife workforce in California. This bill proposes a landscape analysis to assess barriers to education program growth and identify possible solutions.

ASSEMBLY FLOOR: 73-2, 6/2/25

AYES: Addis, Aguiar-Curry, Ahrens, Alanis, Alvarez, Arambula, Ávila Farías, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Calderon, Caloza, Carrillo, Castillo, Connolly, Davies, Dixon, Elhawary, Ellis, Flora, Fong, Gabriel, Garcia, Gipson, Jeff Gonzalez, Mark González, Hadwick, Haney, Harabedian, Hart, Irwin, Jackson, Kalra, Krell, Lackey, Lee, Lowenthal, Macedo, McKinnor, Muratsuchi, Nguyen, Ortega, Pacheco, Papan, Patel, Patterson, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Ransom, Celeste Rodriguez, Michelle Rodriguez, Rogers, Blanca Rubio, Schiavo, Schultz, Sharp-Collins, Solache, Soria, Stefani, Ta, Valencia, Wallis, Ward, Wicks, Wilson, Zbur, Rivas

NOES: DeMaio, Sanchez

NO VOTE RECORDED: Chen, Gallagher, Hoover, Tangipa

Prepared by: Reyes Diaz / HEALTH / (916) 651-4111

9/6/25 10:30:13

**** END ****

 THIRD READING  

Bill No: AB 836

Author: Stefani (D), et al.

Amended: 6/23/25 in Senate

Vote: 21

SENATE HEALTH COMMITTEE: 10-0, 7/16/25

AYES: Menjivar, Valladares, Durazo, Gonzalez, Limón, Padilla, Richardson, Rubio, Weber Pierson, Wiener

NO VOTE RECORDED: Grove

SENATE APPROPRIATIONS COMMITTEE: 7-0, 8/29/25

AYES: Caballero, Seyarto, Cabaldon, Dahle, Grayson, Richardson, Wahab

ASSEMBLY FLOOR: 73-2, 6/2/25 - See last page for vote

SUBJECT: Midwifery Workforce Training Act

SOURCE: California Nurse-Midwives Association

DIGEST:

This bill requires the Department of Health Care Access and Information, upon appropriation from the Legislature, to administer funding for a statewide study on midwifery education conducted by an outside consultant familiar with the health care and midwifery landscapes and workforce in California.

ANALYSIS:

Existing law:

1. Establishes the Department of Health Care Access and Information (HCAI), and requires HCAI to collect, analyze, and publish data about health care workforce and health professional training; identify areas of health workforce shortages; and provide scholarships, loan repayments, and grants to students, graduates, and institutions providing direct patient care in areas of unmet need. Establishes the Health Professions Education Foundation within HCAI to, among other functions, develop criteria for evaluating applicants for various scholarships and loans. [Health and Safety Code (HSC) §127000, et seq. and §127750, et seq.]
2. Requires HCAI, as part of the Midwifery Workforce Training Act, to establish a program for training certified nurse-midwives (CNMs) and licensed midwives (LMs) in accordance with the global standards for midwifery education and the international definition of “midwife” as established by the International Confederation of Midwives, in order to increase the number of students receiving quality education and training as a CNM or as a LM. [HSC §128298(b)(1)]
3. Requires HCAI to only contract with programs that train CNMs and programs that train LMs that, at minimum, include, or that intend to create, a component of training designed for medically underserved multicultural communities, lower socioeconomic neighborhoods, or rural communities, and that are organized to prepare program graduates for service in those neighborhoods and communities, or that seek to recruit and retain racially and ethnically diverse students, underrepresented groups, or people from underserved or historically marginalized communities. [HSC §128298(b)(2)]

This bill:

1. Requires HCAI, upon appropriation from the Legislature, to administer funding for a statewide study on midwifery education conducted by an outside consultant familiar with the health care and midwifery landscapes and workforce in California.
2. Requires the study to include such things as:
3. An evaluation of status and trends in midwifery education in California and the U.S.;
4. A financial sustainability plan, including long-term education program financing, cost of educating midwives in California, and the options for financial stability of midwifery education—including assessing available state and federal funding resources to cover specified students’ costs;
5. Identifying and proposing pathways to diversify the midwifery student pipeline, including assessing the opportunities, challenges, and support needs of prospective students, current students, and preceptors;
6. Identifying institutions and programs of study that are equipped to house midwifery education programs, as well as viable education programs that can serve both rural and urban geographic areas;
7. Identifying sites for interprofessional education between resident obstetricians and midwives, as well as considering ways to allow CNMs and LMs to train together, with separate exit requirements specific to their path;
8. Ensuring proposed solutions for midwifery education meet the needs of California birthing families and future midwives; and,
9. An assessment of jobs available for new graduates, and projected growth.
10. Requires HCAI to post the report on its website, and to notify all persons in their reproductive health and maternity care electronic mailing list, no later than 36 months after the appropriation of funds to HCAI.

Comments

According to the author of this bill:

California is facing a maternity and reproductive health care crisis. Communities across California face severe lack of access to reproductive health and maternity care. Midwifery care has demonstrated excellent clinical outcomes but is underutilized. This bill advances the future of midwifery care in California by requiring a landscape analysis of the state to consider truly innovative and financially sustainable educational options, with a focus on the communities who need midwifery care the most. This study will evaluate opportunities to diversify the midwife pipeline, assess barriers to educational pathways, and identify potential solutions to expand the number of programs preparing high-quality, culturally responsive, maternal health care providers. This analysis will inform future strategies to develop a robust and well-trained midwife workforce to fill California’s maternity and reproductive health provider shortages across the state. California has an opportunity to strategically invest in midwifery education programs and the landscape analysis required under this bill will help ensure that strategic investment in midwifery education builds sustainable, cost-effective programs for a robust and reliable workforce.

Background

Midwifery in California. According to a February 2025 California Health Care Foundation (CHCF) Issue Brief, midwives play a crucial role in the maternity care workforce, providing comprehensive health services during pregnancy, labor, and postpartum, including as the primary birth attendant. In many countries that have better birth outcomes than California and the U.S., midwives provide the majority of care for uncomplicated pregnancies and births. The midwifery model of care emphasizes respectful, relationship-based, and person-centered care, supporting the progress of labor and birth with minimal intervention unless necessary. An element of successful midwifery care is appropriate consultation with obstetrician/gynecologists and transfer to physician care if the need arises (e.g., if a patient develops medical complications outside the scope of midwifery care or requires surgery). California has two types of midwives: LMs and CNMs. LMs, regulated by the Medical Board of California, primarily practice in community-based settings, including birth centers and home births. Nationally certified LMs are credentialed as certified professional midwives and are legally recognized in 38 states. CNMs are also registered nurses and are regulated by the California Board of Registered Nursing, primarily practicing in clinics and hospitals. Nationally, CNMs are legally recognized in all 50 states. Both LMs and CNMs meet international midwifery education standards and provide high-quality care focused on pregnancy, childbirth, and postpartum, including family planning and newborn care, with CNMs also offering broader gynecologic services.

An October 22, 2024 CHCF publication on California’s midwife workforce notes:

1. Only 12% of LMs and 10% of CNMs were Latina/x, while 45% of the state’s population of women/birthing people age 15 to 44 (considered reproductive age by the U.S. Centers for Disease Control and Prevention) was Latina/x;
2. Two percent of LMs and 4% of CNMs were Black, compared to 6% of the Black women/birthing people of reproductive age;
3. Many LMs (25%) and CNMs (33%) said they spoke a non-English language fluently; and,
4. LMs estimated that 6% of their patients preferred to receive services in a non-English language, and CNMs reported that 33% of their patients preferred to receive services in a non-English language.

Doctor of Nursing Practice (DNP) programs result in some closures of masters-level midwifery programs; others reopen. In 2004, the American Association of Colleges of Nursing (AACN) called for all nursing schools to phase out master's-level preparation for advanced practice registered nurses (APRNs: clinical nurse specialists, nurse practitioners, nurse midwives, and nurse anesthetists) and transition to DNP preparation only by 2015, based on some Institute of Medicine (IOM) reports on medical errors, quality of care, and safety. Given the growing complexity of care, and strong recommendations by the IOM, many believed health care would benefit from doctorate-educated practitioners—this was at a time during which other disciplines, such as pharmacy and physical therapy, also moved their disciplines to a doctoral level. Yet, when it released the Future of Nursing report in 2010, IOM did not explicitly state a need for a practice doctorate as a universal requirement for APRN entry. However, the number of DNP programs and graduates continued to grow steadily over the next decade: the national DNP program count rose from 92 in 2008 to 354 in 2018, while master’s-level programs remained stagnant, or even decreased. And in 2025, UCSF, one of only two California master’s-level programs for midwifery, stopped admitting students while it revamped its curriculum to offer only DNPs through the Bachelor of Science in Nursing Entry to DNP model. But a large number of schools actually retained their Master of Science in Nursing (MSN) option while instituting a nonclinical version of the DNP. Many nursing schools kept up robust MSN enrollment and only added the post-MSN-DNP, which did not require extensive investment in clinical sites and could be delivered to large numbers of students online. Further, a September 6, 2024 CHCF blog notes that the national transition to DNPs has not caught on the way AACN envisioned, and an acute need for maternal health practitioners has had some universities moving in the other direction. CHCF notes that in 2024, Rutgers University reinstated the nurse-midwifery master’s training it had eliminated in 2016. The University of Alabama-Birmingham also restarted its master’s in nurse-midwifery program in 2022 after a 25-year hiatus. In addition, George Washington University in Washington, DC; Loyola University in New Orleans; and, the University of Nevada-Las Vegas added master’s training in nurse-midwifery.

CHCF states that UCSF estimates tuition and fees will cost $152,000 for a three-year doctoral degree in midwifery, compared with $65,000 for a two-year MSN. Studies show that 71% of nursing master’s students and 74% of nursing doctoral students rely on student loans, and nurses with doctorates earn negligibly or no more than those with master’s degrees. A 2020 article in Nursing Outlook argued that the financial implication of requiring the DNP degree is the largest barrier to adoption, both for students and organizations, as a universal DNP requirement would have financial ramifications on three levels: a) cost to individual students; b) cost to institutions that financially support advanced nursing practice education; and, c) cost to schools. The article cites a 2019 study that revealed the average 2014 salary for DNP-educated CNMs to be $105,968; the average salary for master's-prepared CNMs was $102,576 in 2014. This annual differential of $3,392 in mean salary dollars pales in comparison to the differences in time, effort, and tuition dollars required of DNP students, compared to CNM students, the article notes.

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No

According to the Senate Appropriations Committee:

The HCAI estimates General Fund costs of approximately $1 million in 2026-27 to contract with a consultant to develop the workforce study.

SUPPORT: (Verified 8/27/25)

California Nurse-Midwives Association (source)

American College of Nurse-Midwives
American Nurses Association\California
Black Women for Wellness Action Project
California Latinas for Reproductive Justice

California Legislative Women’s Caucus
California Women’s Law Center
Citizens for Choice

City of Glendale
Essential Access Health
If/When/How: Lawyering for Reproductive Justice
March of Dimes
National Health Law Program
Planned Parenthood Affiliates of California
Reproductive Freedom for All California
Rural County Representatives of California

San Francisco Bay Area Black & Jewish Unity Coalition
United Nurses Associations of California/Union of Health Care Professionals
Urban Counties of California
Western Center on Law and Poverty

OPPOSITION: (Verified 8/27/25)

None received

ARGUMENTS IN SUPPORT: The California Nurse-Midwives Association, as sponsor, and other supporters of this bill state that communities around California face a severe lack of access to reproductive health and maternity care. Between 2014 and 2024, more than 50 maternity units closed throughout the state. Midwifery care has demonstrated excellent clinical outcomes, but they are underutilized and can be mobilized to help address provider shortages. Supporters state when midwives are integrated into health systems, they find more positive health outcomes, including spontaneous vaginal birth, labor after Cesarean, vaginal birth after Cesarean, breastfeeding, patient confidence and control, patient-centered care, and lower costs. There are also fewer undesirable health outcomes: cesarean birth, operative vaginal delivery, induction of labor, episiotomy, perineal lacerations, use of pain medicine, epidural anesthesia, continuous fetal monitoring, NICU admissions, preterm birth and low birth weight infants, infant emergency department visits and hospitalizations, and neonatal deaths. Supporters further argue California currently only has one nurse-midwifery program accepting students: the California State University Fullerton master’s degree in nurse-midwifery. There are currently no LM programs in California. To fill the state’s needs, midwifery education should aim to serve parts of the state with the most significant provider shortages and maternity care needs. Midwifery education programs are required to meet high quality standards and can successfully prepare the midwife workforce in California. This bill proposes a landscape analysis to assess barriers to education program growth and identify possible solutions.

ASSEMBLY FLOOR: 73-2, 6/2/25

AYES: Addis, Aguiar-Curry, Ahrens, Alanis, Alvarez, Arambula, Ávila Farías, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Calderon, Caloza, Carrillo, Castillo, Connolly, Davies, Dixon, Elhawary, Ellis, Flora, Fong, Gabriel, Garcia, Gipson, Jeff Gonzalez, Mark González, Hadwick, Haney, Harabedian, Hart, Irwin, Jackson, Kalra, Krell, Lackey, Lee, Lowenthal, Macedo, McKinnor, Muratsuchi, Nguyen, Ortega, Pacheco, Papan, Patel, Patterson, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Ransom, Celeste Rodriguez, Michelle Rodriguez, Rogers, Blanca Rubio, Schiavo, Schultz, Sharp-Collins, Solache, Soria, Stefani, Ta, Valencia, Wallis, Ward, Wicks, Wilson, Zbur, Rivas

NOES: DeMaio, Sanchez

NO VOTE RECORDED: Chen, Gallagher, Hoover, Tangipa

Prepared by: Reyes Diaz / HEALTH / (916) 651-4111

8/29/25 20:57:13

**** END ****

SENATE COMMITTEE ON

Senator Anna Caballero, Chair

2025 - 2026 Regular Session

AB 836 (Stefani) - Midwifery Workforce Training Act

Bill Summary:

AB 836 would require the Department of Health Care Access and Information (HCAI) to administer funding for a statewide study on midwifery education, as specified.

Fiscal Impact:

The HCAI estimates General Fund costs of approximately $1 million in 2026-27 to contract with a consultant to develop the workforce study.

Background:

Current law requires HCAI, as part of the Midwifery Workforce Training Act, to establish a program to contract with programs that train certified nurse-midwives (CNMs) and licensed midwives in accordance with the global standards for midwifery education and the international definition of “midwife” as established by the International Confederation of Midwives, in order to increase the number of students receiving quality education and training as a CNM or as a licensed midwife. Current law requires HCAI to only contract with programs that train CNMs and programs that train licensed midwives that, at a minimum, include, or that intend to create, a component of training designed for medically underserved multicultural communities, lower socioeconomic neighborhoods, or rural communities, and that are organized to prepare program graduates for service in those neighborhoods and communities, or that seek to recruit and retain racially and ethnically diverse students, underrepresented groups, or people from underserved or historically marginalized communities.

In California, licensed midwives (LMs) are regulated by the Medical Board of California, and primarily practice in community-based settings, including birth centers and home births. Certified nurse-midwives (CNMs) are registered nurses and are regulated by the California Board of Registered Nursing, primarily practicing in clinics and hospitals. Both LMs and CNMs meet international midwifery education standards and provide high-quality care focused on pregnancy, childbirth, and postpartum, including family planning and newborn care, with CNMs also offering broader gynecologic services.

Proposed Law:

Specific provisions of the bill would:

• Require, upon appropriation from the Legislature, the HCAI to administer funding for a statewide study on midwifery education and require the study to be conducted by an outside consultant familiar with the health care and midwifery landscapes and workforce in California.
• Require the HCAI to submit a report from the study’s findings to the Legislature and to post the report on the department’s internet website.

Related Legislation:

SB 520 (Caballero) would create the California Nurse-Midwifery Education Fund within the HCAI for the purpose of establishing California-based, master’s level, nurse-midwifery education programs within the California State University, the University of California, or both. The bill is currently in the Assembly Appropriations Committee.

-- END --

SENATE COMMITTEE ON HEALTH

Senator Caroline Menjivar, Chair

BILL NO: AB 836

SUBJECT: Midwifery Workforce Training Act

SUMMARY:

Requires the Department of Health Care Access and Information, upon appropriation from the Legislature, to administer funding for a statewide study on midwifery education conducted by an outside consultant familiar with the health care and midwifery landscapes and workforce in California.

Existing law:

1. Establishes the Department of Health Care Access and Information (HCAI), and requires HCAI to collect, analyze, and publish data about health care workforce and health professional training; identify areas of health workforce shortages; and provide scholarships, loan repayments, and grants to students, graduates, and institutions providing direct patient care in areas of unmet need. Establishes the Health Professions Education Foundation (HPEF) within HCAI to, among other functions, develop criteria for evaluating applicants for various scholarships and loans. [HSC §127000, et seq. and §127750, et seq.]
2. Requires HCAI, as part of the Midwifery Workforce Training Act, to establish a program for training certified nurse-midwives (CNMs) and licensed midwives (LMs) in accordance with the global standards for midwifery education and the international definition of “midwife” as established by the International Confederation of Midwives, in order to increase the number of students receiving quality education and training as a CNM or as a LM. [HSC §128298(b)(1)]
3. Requires HCAI to only contract with programs that train CNMs and programs that train LMs that, at minimum, include, or that intend to create, a component of training designed for medically underserved multicultural communities, lower socioeconomic neighborhoods, or rural communities, and that are organized to prepare program graduates for service in those neighborhoods and communities, or that seek to recruit and retain racially and ethnically diverse students, underrepresented groups, or people from underserved or historically marginalized communities. [HSC §128298(b)(2)]

This bill:

1. Requires HCAI, upon appropriation from the Legislature, to administer funding for a statewide study on midwifery education conducted by an outside consultant familiar with the health care and midwifery landscapes and workforce in California.
2. Requires the study to include such things as:
3. An evaluation of status and trends in midwifery education in California and the U.S.;
4. A financial sustainability plan, including long-term education program financing, cost of educating midwives in California, and the options for financial stability of midwifery education—including assessing available state and federal funding resources to cover specified students’ costs;
5. Identifying and proposing pathways to diversify the midwifery student pipeline, including assessing the opportunities, challenges, and support needs of prospective students, current students, and preceptors;
6. Identifying institutions and programs of study that are equipped to house midwifery education programs, as well as viable education programs that can serve both rural and urban geographic areas;
7. Identifying sites for interprofessional education between resident obstetricians and midwives, as well as considering ways to allow CNMs and LMs to train together, with separate exit requirements specific to their path;
8. Ensuring proposed solutions for midwifery education meet the needs of California birthing families and future midwives; and,
9. An assessment of jobs available for new graduates, and projected growth.
10. Requires HCAI to post the report on its website, and to notify all persons in their reproductive health and maternity care electronic mailing list, no later than 36 months after the appropriation of funds to HCAI.

FISCAL EFFECT:

According to the Assembly Appropriations Committee, HCAI estimates costs of approximately $1 million in fiscal year 2026-27 to contract with a consultant to develop the workforce study (General Fund).

PRIOR VOTES:

COMMENTS:

1. Author’s statement. According to the author, California is facing a maternity and reproductive health care crisis. Communities across California face severe lack of access to reproductive health and maternity care. Midwifery care has demonstrated excellent clinical outcomes but is underutilized. This bill advances the future of midwifery care in California by requiring a landscape analysis of the state to consider truly innovative and financially sustainable educational options, with a focus on the communities who need midwifery care the most. This study will evaluate opportunities to diversify the midwife pipeline, assess barriers to educational pathways, and identify potential solutions to expand the number of programs preparing high-quality, culturally responsive, maternal health care providers. This analysis will inform future strategies to develop a robust and well-trained midwife workforce to fill California’s maternity and reproductive health provider shortages across the state. California has an opportunity to strategically invest in midwifery education programs and the landscape analysis required under this bill will help ensure that strategic investment in midwifery education builds sustainable, cost-effective programs for a robust and reliable workforce.
2. Midwifery in California. According to a February 2025 California Health Care Foundation (CHCF) Issue Brief, midwives play a crucial role in the maternity care workforce, providing comprehensive health services during pregnancy, labor, and postpartum, including as the primary birth attendant. In many countries that have better birth outcomes than California and the U.S., midwives provide the majority of care for uncomplicated pregnancies and births. The midwifery model of care emphasizes respectful, relationship-based, and person-centered care, supporting the progress of labor and birth with minimal intervention unless necessary. An element of successful midwifery care is appropriate consultation with obstetrician/gynecologists and transfer to physician care if the need arises (e.g., if a patient develops medical complications outside the scope of midwifery care or requires surgery). California has two types of midwives: LMs and CNMs. LMs, regulated by the Medical Board of California, primarily practice in community-based settings, including birth centers and home births. Nationally certified LMs are credentialed as certified professional midwives and are legally recognized in 38 states. CNMs are also registered nurses and are regulated by the California Board of Registered Nursing, primarily practicing in clinics and hospitals. Nationally, CNMs are legally recognized in all 50 states. Both LMs and CNMs meet international midwifery education standards and provide high-quality care focused on pregnancy, childbirth, and postpartum, including family planning and newborn care, with CNMs also offering broader gynecologic services.

An October 22, 2024 CHCF publication on California’s midwife workforce notes:

1. Only 12% of LMs and 10% of CNMs were Latina/x, while 45% of the state’s population of women/birthing people age 15 to 44 (considered reproductive age by the U.S. Centers for Disease Control and Prevention) was Latina/x;
2. Two percent of LMs and 4% of CNMs were Black, compared to 6% of the Black women/birthing people of reproductive age;
3. Many LMs (25%) and CNMs (33%) said they spoke a non-English language fluently; and,
4. LMs estimated that 6% of their patients preferred to receive services in a non-English language, and CNMs reported that 33% of their patients preferred to receive services in a non-English language.
5. Doctor of Nursing Practice (DNP) programs result in some closures of masters-level midwifery programs; others reopen. In 2004, the American Association of Colleges of Nursing (AACN) called for all nursing schools to phase out master's-level preparation for advanced practice registered nurses (APRNs: clinical nurse specialists, nurse practitioners, nurse midwives, and nurse anesthetists) and transition to DNP preparation only by 2015, based on some Institute of Medicine (IOM) reports on medical errors, quality of care, and safety. Given the growing complexity of care, and strong recommendations by the IOM, many believed health care would benefit from doctorate-educated practitioners—this was at a time during which other disciplines, such as pharmacy and physical therapy, also moved their disciplines to a doctoral level. Yet, when it released the Future of Nursing report in 2010, IOM did not explicitly state a need for a practice doctorate as a universal requirement for APRN entry. However, the number of DNP programs and graduates continued to grow steadily over the next decade: the national DNP program count rose from 92 in 2008 to 354 in 2018, while master’s-level programs remained stagnant, or even decreased. And in 2025, UCSF, one of only two California master’s-level programs for midwifery, stopped admitting students while it revamped its curriculum to offer only DNPs through the Bachelor of Science in Nursing Entry to DNP (BSN-DNP) model. But a large number of schools actually retained their Master of Science in Nursing (MSN) option while instituting a nonclinical version of the DNP. Many nursing schools kept up robust MSN enrollment and only added the post-MSN-DNP, which did not require extensive investment in clinical sites and could be delivered to large numbers of students online. Further, a September 6, 2024 CHCF blog notes that the national transition to DNPs has not caught on the way AACN envisioned, and an acute need for maternal health practitioners has had some universities moving in the other direction. CHCF notes that in 2024, Rutgers University reinstated the nurse-midwifery master’s training it had eliminated in 2016. The University of Alabama-Birmingham also restarted its master’s in nurse-midwifery program in 2022 after a 25-year hiatus. In addition, George Washington University in Washington, DC; Loyola University in New Orleans; and, the University of Nevada-Las Vegas added master’s training in nurse-midwifery.

CHCF states that UCSF estimates tuition and fees will cost $152,000 for a three-year doctoral degree in midwifery, compared with $65,000 for a two-year MSN. Studies show that 71% of nursing master’s students and 74% of nursing doctoral students rely on student loans, and nurses with doctorates earn negligibly or no more than those with master’s degrees. A 2020 article in Nursing Outlook argued that the financial implication of requiring the DNP degree is the largest barrier to adoption, both for students and organizations, as a universal DNP requirement would have financial ramifications on three levels: a) cost to individual students; b) cost to institutions that financially support advanced nursing practice education; and, c) cost to schools. The article cites a 2019 study that revealed the average 2014 salary for DNP-educated CNMs to be $105,968; the average salary for master's-prepared CNMs was $102,576 in 2014. This annual differential of $3,392 in mean salary dollars pales in comparison to the differences in time, effort, and tuition dollars required of DNP students, compared to CNM students, the article notes.

1. Related legislation. SB 520 (Caballero) creates the California Nurse-Midwifery Education Fund, with $2 million upon appropriation by the Legislature, administered by HCAI to establish master’s level nurse-midwifery education programs within the California State University, the University of California, or both. SB 520 passed the Assembly Higher Education Committee by a vote of 9-0 on July 8, 2025.
2. Prior legislation. AB 1918 (Petrie-Norris, Chapter 561, Statutes of 2022) establishes the California Reproductive Health Service Corps program within HCAI to reduce the debt burden of current and future health care professionals dedicated to providing reproductive health care in underserved areas of California.

SB 65 (Skinner, Chapter 449, Statutes of 2021) establishes the California Momnibus Act, which, among other provisions, requires HCAI to work to increase the number of students receiving training as CNMs or LMs.

SB 1237 (Dodd, Chapter 88, Statutes of 2020) authorizes a CNM to attend to low-risk pregnancies and perform related incidental functions without physician supervision; replaces the supervision requirement for higher-risk pregnancies with mutually agreed-upon policies and protocols; requires the Board of Registered Nursing to establish a Nurse-Midwifery Advisory Committee; establishes a disclosure and informed consent requirement; and, establishes new reporting and data collection requirements.

1. Support. The California Nurse-Midwives Association, as sponsor, and other supporters of this bill state that communities around California face a severe lack of access to reproductive health and maternity care. Between 2014 and 2024, more than 50 maternity units closed throughout the state. Midwifery care has demonstrated excellent clinical outcomes, but they are underutilized and can be mobilized to help address provider shortages. Supporters state when midwives are integrated into health systems, they find more positive health outcomes, including spontaneous vaginal birth, labor after Cesarean, vaginal birth after Cesarean, breastfeeding, patient confidence and control, patient-centered care, and lower costs. There are also fewer undesirable health outcomes: cesarean birth, operative vaginal delivery, induction of labor, episiotomy, perineal lacerations, use of pain medicine, epidural anesthesia, continuous fetal monitoring, NICU admissions, preterm birth and low birth weight infants, infant emergency department visits and hospitalizations, and neonatal deaths. Supporters further argue California currently only has one nurse-midwifery program accepting students: the California State University Fullerton master’s degree in nurse-midwifery. There are currently no LM programs in California. To fill the state’s needs, midwifery education should aim to serve parts of the state with the most significant provider shortages and maternity care needs. Midwifery education programs are required to meet high quality standards and can successfully prepare the midwife workforce in California. This bill proposes a landscape analysis to assess barriers to education program growth and identify possible solutions.
2. Unclear need. There appear to be various outside entities that have produced recent studies and reports on midwives and the status of the profession—including many of the components required in the study specified in this bill—in at least the past several years. As this bill requires an appropriation from the Legislature, it is unclear the immediate effect this study will have in informing the research and recommendations that have been made to date.

SUPPORT AND OPPOSITION:

Support: California Nurse-Midwives Association (sponsor)

American College of Nurse-Midwives
American Nurses Association\California
Black Women for Wellness Action Project
California Latinas for Reproductive Justice

California Legislative Women’s Caucus
California Women’s Law Center
Citizens for Choice
Essential Access Health
If/When/How: Lawyering for Reproductive Justice
March of Dimes
National Health Law Program
Planned Parenthood Affiliates of California
Reproductive Freedom for All California
Rural County Representatives of California

San Francisco Bay Area Black & Jewish Unity Coalition
United Nurses Associations of California/Union of Health Care Professionals
Urban Counties of California
Western Center on Law and Poverty

Oppose: None received

-- END --

ASSEMBLY THIRD READING

ATR Bill Id:AB 836

Author:(Stefani)

As Amended Ver:March 24, 2025

Majority vote

SUMMARY

Requires the Department of Health Care Access and Information (HCAI), upon appropriation from the Legislature, to administer funding for a statewide study on midwifery education. Requires the study to be conducted by an outside consultant familiar with the health care and midwifery landscapes and workforce in California that would, among other things, identify viable education programs that can serve both rural and urban geographic areas.

Major Provisions

COMMENTS

Communities around California face a severe lack of access to reproductive health and maternity care. The California Hospital Association reports that between 2014 to 2024, more than 50 maternity units closed throughout the state. The maternity workforce shortage is one of three key drivers, with a projected shortage of 1,100 OB/GYNs in California by 2030.

Midwives. Midwives are licensed clinicians who play a key role in the maternity care workforce. California credentials two types of midwives: licensed midwives (LMs) and nurse-midwives (NMs). Both types of midwives provide care during pregnancy, childbirth, and postpartum, although they have different clinical training and licensure. According to the California Health Care Foundation October 2024 report, ″California′s Midwife Workforce: Practice Settings, Work Environments, and Future Practice Plans,″ the number of NMs licensed in California was stable between 2017 and 2023, fluctuating between a low of 1,157 and a high of 1,175 NMs. Over the same period, the number of LMs increased 22%, from 376 in 2017 to 458 in 2023. Not all licensed NMs and LMs practice as midwives.

California births. There were 419,104 births in California in 2022. The majority of these births had a physician as the primary attendant, although midwife attendants have increased over the last decade. Midwives serving as a primary attendant increased from nine% of births in 2012 to 14% of births in 2022, with the majority of these being NMs. California NMs and LMs collectively attend approximately 14% of births in California, but could provide greater health care access with workforce expansion. Nurse-midwifery is a mandated Medi-Cal benefit, but access to midwifery care across the state is highly variable.

Positive health outcomes. According to a 2014 study, ″Improvement of Maternal and Newborn Health Through Midwifery,″ published in The Lancet, when midwives are integrated into health systems, we find more positive health outcomes, including spontaneous vaginal birth, labor after Cesarean, vaginal birth after Cesarean, breastfeeding, patient confidence and control, patient centered care, and lower costs. We also see fewer undesirable health outcomes: cesarean birth, operative vaginal delivery, induction of labor, episiotomy, perineal lacerations, use of pain medicine, epidural anesthesia, continuous fetal monitoring, neonatal intensive care unit (NICU) admissions, preterm birth and low birth weight infants, infant emergency department visits and hospitalizations, and neonatal deaths. As noted above, the number of births attended by California NMs and LMs has increased over time and in 2022, they attended approximately 14% of total births in the state.

With increased access to midwifery care, this proportion would increase and thereby improve maternal and newborn outcomes associated with midwifery care.

California Reproductive Health Service Corps. AB 1918 (Petrie-Norris), Chapter 561, Statutes of 2022, establishes the California Reproductive Health Service Corps program within HCAI to reduce the debt burden of current and future health care professionals dedicated to providing reproductive health care in underserved areas of California. HCAI entered into agreements with two leading reproductive health training organizations, Training in Early Abortion for Comprehensive Healthcare (TEACH) and Empower RX, who are leading a collaborative effort with multiple partners to implement and expand curricula/training opportunities in abortion and abortion related care for health workers ranging from allied health professionals to advanced practitioners. These efforts are ongoing through 2028. HCAI awarded 343 individuals loan repayment and scholarships through the clinical infrastructure funds. These awardees committed to providing reproductive health services. HCAI has multiple existing loan repayment and scholarship programs that cover the full array of health professionals who provide reproductive health services. HCAI augmented existing programs to award individuals providing those services or currently in training to provide those services in the future. All of the funds from the Reproductive Health Service Corps have been obligated.

According to the Author

California is facing a maternity and reproductive health care crisis. Communities across California face severe lack of access to reproductive health and maternity care. The author states that midwifery care has demonstrated excellent clinical outcomes but is underutilized, and this bill advances the future of midwifery care in California by requiring a landscape analysis of the state to consider truly innovative and financially sustainable educational options, with a focus on the communities who need midwifery care the most. This study will evaluate opportunities to diversify the midwife pipeline, assessing barriers to educational pathways, and identifying potential solutions to expand the number of programs preparing high-quality, culturally responsive, maternal healthcare providers. This analysis will inform future strategies to develop a robust and well-trained midwife workforce to fill California′s maternity and reproductive health provider shortages across the state. The author concludes that California has an opportunity to strategically invest in midwifery education programs and the landscape analysis required under this bill will help ensure that strategic investment in midwifery education builds sustainable cost-effective programs for a robust and reliable workforce.

Arguments in Support

The California Nurse Midwives Association (CNMA) is the sponsor of this bill and states that communities around California face a severe lack of access to reproductive health and maternity care. Between 2014 to 2024, more than 50 maternity units closed throughout the state. Midwifery care has demonstrated excellent clinical outcomes, but they are underutilized and can be mobilized to help address provider shortages. California currently only has one nurse-midwifery program accepting students: the California State University Fullerton master′s degree in nurse-midwifery. There are currently no licensed midwife programs in California. To fill the state′s needs, midwifery education should aim to serve parts of the state with the most significant provider shortages and maternity care needs. Midwifery education programs are required to meet high quality standards and can successfully prepare the midwife workforce in California. CNMA concludes that this bill will ultimately increase access to clinical placement sites appropriate to midwifery scope of practice.

Arguments in Opposition

None.

FISCAL COMMENTS

According to the Assembly Appropriations Committee, HCAI estimates costs of approximately $1 million in fiscal year 2026-27 to contract with a consultant to develop the workforce study (General Fund).

VOTES

ASM HEALTH: 15-0-0

YES: Bonta, Chen, Addis, Aguiar-Curry, Arambula, Carrillo, Flora, Mark González, Krell, Patel, Celeste Rodriguez, Sanchez, Schiavo, Sharp-Collins, Stefani

ASM APPROPRIATIONS: 13-0-2

YES: Wicks, Arambula, Calderon, Caloza, Dixon, Elhawary, Fong, Mark González, Hart, Pacheco, Pellerin, Solache, Ta

ABS, ABST OR NV: Sanchez, Tangipa

UPDATED

VERSION: March 24, 2025

CONSULTANT: Lara Flynn / HEALTH / (916) 319-2097 FN: 0000836

Date of Hearing: April 23, 2025

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Buffy Wicks, Chair

ABPCA Bill Id:AB 836

Author:(Stefani) – As Amended Ver:March 24, 2025

Urgency: No State Mandated Local Program: No Reimbursable: No

SUMMARY:

This bill requires the Department of Health Care Access and Information (HCAI), upon appropriation, to administer funding for a statewide study on midwifery education.

The bill specifies the questions and issues the study is to address, including education financing, diversifying the midwife workforce, the shortage of preceptors, additional education pathways, and programs to serve urban and rural areas, among other things. Requires HCAI to submit the report to the Legislature and to disseminate it as specified.

FISCAL EFFECT:

HCAI estimates costs of approximately $1 million in fiscal year 2026-27 to contract with a consultant to develop the workforce study (General Fund).

COMMENTS:

1. Purpose. This bill is sponsored by the California Nurse-Midwives Association. According to the author:

California is facing a maternity and reproductive health care crisis. Communities across California face severe lack of access to reproductive health and maternity care. Midwifery care has demonstrated excellent clinical outcomes but is underutilized. AB 836 advances the future of midwifery care in California by requiring a landscape analysis of the state to consider truly innovative and financially sustainable educational options, with a focus on the communities who need midwifery care the most…This analysis will inform future strategies to develop a robust and well-trained midwife workforce to fill California’s maternity and reproductive health provider shortages across the state. California has an opportunity to strategically invest in midwifery education programs and the landscape analysis required under this bill will help ensure that strategic investment in midwifery education builds sustainable cost-effective programs for a robust and reliable workforce.

1. Background. The California Hospital Association reports between 2014 and 2024, more than 50 maternity units closed in the state; the maternity workforce shortage is one of the key drivers of closures, with a projected shortage of 1,100 obstetrician-gynecologists in California by 2030. Midwives are licensed clinicians. California credentials two types of midwives: licensed midwives (LMs) and nurse-midwives (NMs). Both types of midwives provide care during pregnancy, childbirth, and postpartum, although they have different clinical training and licensure.
   
   According to a 2024 report from the California Health Care Foundation, the number of NMs licensed in California between 2017 and 2023 fluctuated between 1,157 and 1,175. Over the same period, the number of LMs increased from 376 in 2017 to 458 in 2023. However, not all licensed NMs and LMs practice as midwives. NMs and LMs collectively attend approximately 14% of births in California, but could provide greater health care access with workforce expansion. Nurse-midwifery is a mandated Medi-Cal benefit, but access to midwifery care across the state is highly variable. The sponsor of this bill states California has only one NM program accepting students, and there are no LM programs in California.
2. Related Legislation. AB 55 (Bonta) removes the requirement that an alternative birth center (ABC) be a comprehensive perinatal services provider as a condition of licensure and Medi-Cal reimbursement. The bill would also remove the requirement that an ABC be 30 minutes from a hospital. AB 55 is pending in this committee.
3. Prior Legislation.

SB 65 (Skinner), Chapter 449, Statutes of 2021, establishes the California Momnibus Act, which, among other provisions, requires HCAI to work to increase the number of students receiving training as certified NMs or LMs.

AB 1918 (Petrie-Norris), Chapter 561, Statutes of 2022, establishes the California Reproductive Health Service Corps program within HCAI to reduce the debt burden of current and future health care professionals dedicated to providing reproductive health care in underserved areas of California.

Analysis Prepared by: Allegra Kim / APPR. / (916) 319-2081

Date of Hearing: April 8, 2025

ASSEMBLY COMMITTEE ON HEALTH

Mia Bonta, Chair

ABPCA Bill Id:AB 836

Author:(Stefani) – As Amended Ver:March 24, 2025

SUBJECT: Midwifery Workforce Training Act.

SUMMARY: Requires the Department of Health Care Access and Information (HCAI), upon appropriation from the Legislature, to administer funding for a statewide study on midwifery education. Requires the study to be conducted by an outside consultant familiar with the health care and midwifery landscapes and workforce in California that would, among other things, identify viable education programs that can serve both rural and urban geographic areas. 

Specifically, this bill:

1. Requires, upon appropriation from the Legislature, HCAI to administer funding for a statewide study on midwifery education. Requires the study to be conducted by an outside consultant familiar with the health care and midwifery landscapes and workforce in California. Requires the study to include, but not be limited to, all of the following:
   1. An evaluation of status and trends in midwifery education in California and the United States;
   2. A financial sustainability plan, including long-term education program financing, cost of educating midwives in California, and the options for financial stability of midwifery education;
   3. Assess available state and federal funding resources to cover student tuition and fees, and report on average student debt per program upon program completion;
   4. Identify and propose pathways to diversify the midwifery student pipeline;
   5. Identify institutions and programs of study that are equipped to house midwifery education programs, including those outside of schools of nursing;
   6. Identify viable education programs that can serve both rural and urban geographic areas;
   7. Consider education consortium models that pool resources to support student didactic education and allow them to stay in their communities while completing their education;
   8. Identify and propose solutions to address the shortage of clinical preceptors and precepting sites;
   9. Identify sites for inter-professional education between resident obstetricians and midwives;
   10. Consider innovations in education and training that allow nurse-midwives and licensed midwives to train together, with separate exit requirements specific to their path;
   11. Ensure that proposed solutions for midwifery education meet the needs of California birthing families and future midwives;
   12. Current and projected needs for midwifery and reproductive health care professionals; and,
   13. Assessment of jobs available for new graduates and projected growth.
2. Requires HCAI to submit a report from the study’s findings to the Legislature, to post the report on HCAI’s internet website, and to notify all persons in HCAI’s reproductive health and maternity care electronic mailing list no later than 36 months after actual appropriation of funds to HCAI.
3. States that it is the Legislature’s intent to study the existing and projected opportunities and barriers to establishing, operating, and attending accessible, high-quality midwifery education programs that will serve the maternity and reproductive health needs of Californians.

EXISTING LAW:

1. Requires HCAI to establish a program to contract with programs that train certified nurse-midwives and programs that train licensed midwives in accordance with the global standards for midwifery education and the international definition of “midwife” as established by the International Confederation of Midwives in order to increase the number of students receiving quality education and training as a certified nurse-midwife or as a licensed midwife. [Health and Safety Code § 128298]
2. Requires HCAI to only contract with programs that train certified nurse-midwives and programs that train licensed midwives that, at minimum, include, or that intend to create, a component of training designed for medically underserved multicultural communities, lower socioeconomic neighborhoods, or rural communities, and that are organized to prepare program graduates for service in those neighborhoods and communities, or that seek to recruit and retain racially and ethnically diverse students, underrepresented groups, or people from underserved or historically marginalized communities. [Ibid.]
3. Authorizes HCAI to adopt standards and regulations necessary to carry out the provisions of 2) above. Authorizes HCAI, in adopting eligibility standards for programs that train certified nurse-midwives and licensed midwives in accordance with the standards set forth, to accept those educational standards and competencies established by the respective state licensing and regulatory bodies for certified nurse-midwives and for licensed midwives. Requires HCAI to take care not to implement education or competency standards beyond what is required for the training programs by their respective state licensing and regulatory bodies that could inadvertently create an unnecessary barrier for training programs to obtain funding for the training of midwives in California. [Ibid.]
4. Requires HCAI to develop alternative strategies to provide long-term stability for, or expansion of, the provisions above, such as through funding provided by private foundations and administered by HCAI for the purposes of carrying out this article. [Ibid.]

FISCAL EFFECT: Unknown. This bill has not yet been analyzed by a fiscal committee.

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, California is facing a maternity and reproductive health care crisis. Communities across California face severe lack of access to reproductive health and maternity care. The author states that midwifery care has demonstrated excellent clinical outcomes but is underutilized, and this bill advances the future of midwifery care in California by requiring a landscape analysis of the state to consider truly innovative and financially sustainable educational options, with a focus on the communities who need midwifery care the most. This study will evaluate opportunities to diversify the midwife pipeline, assessing barriers to educational pathways, and identifying potential solutions to expand the number of programs preparing high-quality, culturally responsive, maternal healthcare providers. This analysis will inform future strategies to develop a robust and well-trained midwife workforce to fill California’s maternity and reproductive health provider shortages across the state. The author concludes that California has an opportunity to strategically invest in midwifery education programs and the landscape analysis required under this bill will help ensure that strategic investment in midwifery education builds sustainable cost-effective programs for a robust and reliable workforce.
2. BACKGROUND. Communities around California face a severe lack of access to reproductive health and maternity care. The California Hospital Association reports that between 2014 to 2024, more than 50 maternity units closed throughout the state. The maternity workforce shortage is one of three key drivers, with a projected shortage of 1,100 OB/GYNs in California by 2030.
   1. Midwives. Midwives are licensed clinicians who play a key role in the maternity care workforce. California credentials two types of midwives: licensed midwives (LMs) and nurse-midwives (NMs). Both types of midwives provide care during pregnancy, childbirth, and postpartum, although they have different clinical training and licensure. According to the California Health Care Foundation October 2024 report, “California’s Midwife Workforce: Practice Settings, Work Environments, and Future Practice Plans,” the number of NMs licensed in California was stable between 2017 and 2023, fluctuating between a low of 1,157 and a high of 1,175 NMs. Over the same period, the number of LMs increased 22%, from 376 in 2017 to 458 in 2023. Not all licensed NMs and LMs practice as midwives.
   2. California births. There were 419,104 births in California in 2022. The majority of these births had a physician as the primary attendant, although midwife attendants have increased over the last decade. Midwives serving as a primary attendant increased from 9% of births in 2012 to 14% of births in 2022, with the majority of these being NMs.

California NMs and LMs collectively attend approximately 14% of births in California, but could provide greater health care access with workforce expansion. Nurse-midwifery is a mandated Medi-Cal benefit, but access to midwifery care across the state is highly variable.

• 1. Positive health outcomes. According to a 2014 study, “Improvement of Maternal and Newborn Health Through Midwifery,” published in The Lancet, when midwives are integrated into health systems, we find more positive health outcomes, including spontaneous vaginal birth, labor after Cesarean, vaginal birth after Cesarean, breastfeeding, patient confidence and control, patient centered care, and lower costs. We also see fewer undesirable health outcomes: cesarean birth, operative vaginal delivery, induction of labor, episiotomy, perineal lacerations, use of pain medicine, epidural anesthesia, continuous fetal monitoring, neonatal intensive care unit (NICU) admissions, preterm birth and low birth weight infants, infant emergency department visits and hospitalizations, and neonatal deaths. As noted above, the number of births attended by California NMs and LMs has increased over time and in 2022, they attended approximately 14% of total births in the state.

With increased access to midwifery care, this proportion would increase and thereby improve maternal and newborn outcomes associated with midwifery care.

• 1. California Reproductive Health Service Corps. AB 1918 (Petrie-Norris), Chapter 561, Statutes of 2022, establishes the California Reproductive Health Service Corps program within HCAI to reduce the debt burden of current and future health care professionals dedicated to providing reproductive health care in underserved areas of California. HCAI entered into agreements with two leading reproductive health training organizations, Training in Early Abortion for Comprehensive Healthcare (TEACH) and Empower RX, who are leading a collaborative effort with multiple partners to implement and expand curricula/training opportunities in abortion and abortion related care for health workers ranging from allied health professionals to advanced practitioners. These efforts are ongoing through 2028. HCAI awarded 343 individuals loan repayment and scholarships through the clinical infrastructure funds. These awardees committed to providing reproductive health services. HCAI has multiple existing loan repayment and scholarship programs that cover the full array of health professionals who provide reproductive health services. HCAI augmented existing programs to award individuals providing those services or currently in training to provide those services in the future. All of the funds from the Reproductive Health Service Corps have been obligated.

1. SUPPORT. The California Nurse Midwives Association (CNMA) is the sponsor of this bill and states that communities around California face a severe lack of access to reproductive health and maternity care. Between 2014 to 2024, more than 50 maternity units closed throughout the state. Midwifery care has demonstrated excellent clinical outcomes, but they are underutilized and can be mobilized to help address provider shortages. California currently only has one nurse-midwifery program accepting students: the California State University Fullerton master’s degree in nurse-midwifery. There are currently no licensed midwife programs in California. To fill the state’s needs, midwifery education should aim to serve parts of the state with the most significant provider shortages and maternity care needs. Midwifery education programs are required to meet high quality standards and can successfully prepare the midwife workforce in California. CNMA concludes that this bill will ultimately increase access to clinical placement sites appropriate to midwifery scope of practice.
2. RELATED LEGISLATION.
   1. AB 55 (Bonta) would remove the requirement that an alternative birth center (ABC) be a comprehensive perinatal services provider (CPSP) as a condition of licensure, and a condition for Medi-Cal reimbursement. The bill would also remove the requirement that an ABC be 30 minutes from a hospital. AB 55 is pending in the Assembly Health Committee.
   2. SB 669 (McGuire) would require the Department of Public Health, in consultation with specified stakeholders, to establish a 5-year pilot project to allow critical access and individual and small system rural hospitals to establish standby perinatal medical services, as defined. SB 669 is currently pending in the Senate Health Committee.
3. PREVIOUS LEGISLATION.
   1. SB 65 (Skinner), Chapter 449, Statutes of 2021, establishes the California Momnibus Act, which, among other provisions, requires HCAI to work to increase the number of students receiving training as certified NMs or LMs.
   2. AB 1918 (Petrie-Norris), Chapter 561, Statutes of 2022, establishes the California Reproductive Health Service Corps program within HCAI to reduce the debt burden of current and future health care professionals dedicated to providing reproductive health care in underserved areas of California.

REGISTERED SUPPORT / OPPOSITION:

Support

California Nurse Midwives Association (sponsor)

American College of Nurse-Midwives
Citizens for Choice
Essential Access Health
Planned Parenthood Affiliates of California
San Francisco Bay Area Black & Jewish Unity Coalition
United Nurses Associations of California/Union of Health Care Professionals
Western Center on Law & Poverty, Inc.

Opposition

None on file

Analysis Prepared by: Lara Flynn / HEALTH / (916) 319-2097

Date of Hearing: April 8, 2025

ASSEMBLY COMMITTEE ON HEALTH

Mia Bonta, Chair

ABPCA Bill Id:AB 836

Author:(Stefani) – As Amended Ver:March 24, 2025

SUBJECT: Midwifery Workforce Training Act.

SUMMARY: Requires the Department of Health Care Access and Information (HCAI), upon appropriation from the Legislature, to administer funding for a statewide study on midwifery education. Requires the study to be conducted by an outside consultant familiar with the health care and midwifery landscapes and workforce in California that would, among other things, identify viable education programs that can serve both rural and urban geographic areas. 

Specifically, this bill:

1. Requires, upon appropriation from the Legislature, HCAI to administer funding for a statewide study on midwifery education. Requires the study to be conducted by an outside consultant familiar with the health care and midwifery landscapes and workforce in California. Requires the study to include, but not be limited to, all of the following:
   1. An evaluation of status and trends in midwifery education in California and the United States;
   2. A financial sustainability plan, including long-term education program financing, cost of educating midwives in California, and the options for financial stability of midwifery education;
   3. Assess available state and federal funding resources to cover student tuition and fees, and report on average student debt per program upon program completion;
   4. Identify and propose pathways to diversify the midwifery student pipeline;
   5. Identify institutions and programs of study that are equipped to house midwifery education programs, including those outside of schools of nursing;
   6. Identify viable education programs that can serve both rural and urban geographic areas;
   7. Consider education consortium models that pool resources to support student didactic education and allow them to stay in their communities while completing their education;
   8. Identify and propose solutions to address the shortage of clinical preceptors and precepting sites;
   9. Identify sites for inter-professional education between resident obstetricians and midwives;
   10. Consider innovations in education and training that allow nurse-midwives and licensed midwives to train together, with separate exit requirements specific to their path;
   11. Ensure that proposed solutions for midwifery education meet the needs of California birthing families and future midwives;
   12. Current and projected needs for midwifery and reproductive health care professionals; and,
   13. Assessment of jobs available for new graduates and projected growth.
2. Requires HCAI to submit a report from the study’s findings to the Legislature, to post the report on HCAI’s internet website, and to notify all persons in HCAI’s reproductive health and maternity care electronic mailing list no later than 36 months after actual appropriation of funds to HCAI.
3. States that it is the Legislature’s intent to study the existing and projected opportunities and barriers to establishing, operating, and attending accessible, high-quality midwifery education programs that will serve the maternity and reproductive health needs of Californians.

EXISTING LAW:

1. Requires HCAI to establish a program to contract with programs that train certified nurse-midwives and programs that train licensed midwives in accordance with the global standards for midwifery education and the international definition of “midwife” as established by the International Confederation of Midwives in order to increase the number of students receiving quality education and training as a certified nurse-midwife or as a licensed midwife. [Health and Safety Code § 128298]
2. Requires HCAI to only contract with programs that train certified nurse-midwives and programs that train licensed midwives that, at minimum, include, or that intend to create, a component of training designed for medically underserved multicultural communities, lower socioeconomic neighborhoods, or rural communities, and that are organized to prepare program graduates for service in those neighborhoods and communities, or that seek to recruit and retain racially and ethnically diverse students, underrepresented groups, or people from underserved or historically marginalized communities. [Ibid.]
3. Authorizes HCAI to adopt standards and regulations necessary to carry out the provisions of 2) above. Authorizes HCAI, in adopting eligibility standards for programs that train certified nurse-midwives and licensed midwives in accordance with the standards set forth, to accept those educational standards and competencies established by the respective state licensing and regulatory bodies for certified nurse-midwives and for licensed midwives. Requires HCAI to take care not to implement education or competency standards beyond what is required for the training programs by their respective state licensing and regulatory bodies that could inadvertently create an unnecessary barrier for training programs to obtain funding for the training of midwives in California. [Ibid.]
4. Requires HCAI to develop alternative strategies to provide long-term stability for, or expansion of, the provisions above, such as through funding provided by private foundations and administered by HCAI for the purposes of carrying out this article. [Ibid.]

FISCAL EFFECT: Unknown. This bill has not yet been analyzed by a fiscal committee.

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, California is facing a maternity and reproductive health care crisis. Communities across California face severe lack of access to reproductive health and maternity care. The author states that midwifery care has demonstrated excellent clinical outcomes but is underutilized, and this bill advances the future of midwifery care in California by requiring a landscape analysis of the state to consider truly innovative and financially sustainable educational options, with a focus on the communities who need midwifery care the most. This study will evaluate opportunities to diversify the midwife pipeline, assessing barriers to educational pathways, and identifying potential solutions to expand the number of programs preparing high-quality, culturally responsive, maternal healthcare providers. This analysis will inform future strategies to develop a robust and well-trained midwife workforce to fill California’s maternity and reproductive health provider shortages across the state. The author concludes that California has an opportunity to strategically invest in midwifery education programs and the landscape analysis required under this bill will help ensure that strategic investment in midwifery education builds sustainable cost-effective programs for a robust and reliable workforce.
2. BACKGROUND. Communities around California face a severe lack of access to reproductive health and maternity care. The California Hospital Association reports that between 2014 to 2024, more than 50 maternity units closed throughout the state. The maternity workforce shortage is one of three key drivers, with a projected shortage of 1,100 OB/GYNs in California by 2030.
   1. Midwives. Midwives are licensed clinicians who play a key role in the maternity care workforce. California credentials two types of midwives: licensed midwives (LMs) and nurse-midwives (NMs). Both types of midwives provide care during pregnancy, childbirth, and postpartum, although they have different clinical training and licensure. According to the California Health Care Foundation October 2024 report, “California’s Midwife Workforce: Practice Settings, Work Environments, and Future Practice Plans,” the number of NMs licensed in California was stable between 2017 and 2023, fluctuating between a low of 1,157 and a high of 1,175 NMs. Over the same period, the number of LMs increased 22%, from 376 in 2017 to 458 in 2023. Not all licensed NMs and LMs practice as midwives.
   2. California births. There were 419,104 births in California in 2022. The majority of these births had a physician as the primary attendant, although midwife attendants have increased over the last decade. Midwives serving as a primary attendant increased from 9% of births in 2012 to 14% of births in 2022, with the majority of these being NMs.

California NMs and LMs collectively attend approximately 14% of births in California, but could provide greater health care access with workforce expansion. Nurse-midwifery is a mandated Medi-Cal benefit, but access to midwifery care across the state is highly variable.

• 1. Positive health outcomes. According to a 2014 study, “Improvement of Maternal and Newborn Health Through Midwifery,” published in The Lancet, when midwives are integrated into health systems, we find more positive health outcomes, including spontaneous vaginal birth, labor after Cesarean, vaginal birth after Cesarean, breastfeeding, patient confidence and control, patient centered care, and lower costs. We also see fewer undesirable health outcomes: cesarean birth, operative vaginal delivery, induction of labor, episiotomy, perineal lacerations, use of pain medicine, epidural anesthesia, continuous fetal monitoring, neonatal intensive care unit (NICU) admissions, preterm birth and low birth weight infants, infant emergency department visits and hospitalizations, and neonatal deaths. As noted above, the number of births attended by California NMs and LMs has increased over time and in 2022, they attended approximately 14% of total births in the state.

With increased access to midwifery care, this proportion would increase and thereby improve maternal and newborn outcomes associated with midwifery care.

• 1. California Reproductive Health Service Corps. AB 1918 (Petrie-Norris), Chapter 561, Statutes of 2022, establishes the California Reproductive Health Service Corps program within HCAI to reduce the debt burden of current and future health care professionals dedicated to providing reproductive health care in underserved areas of California. HCAI entered into agreements with two leading reproductive health training organizations, Training in Early Abortion for Comprehensive Healthcare (TEACH) and Empower RX, who are leading a collaborative effort with multiple partners to implement and expand curricula/training opportunities in abortion and abortion related care for health workers ranging from allied health professionals to advanced practitioners. These efforts are ongoing through 2028. HCAI awarded 343 individuals loan repayment and scholarships through the clinical infrastructure funds. These awardees committed to providing reproductive health services. HCAI has multiple existing loan repayment and scholarship programs that cover the full array of health professionals who provide reproductive health services. HCAI augmented existing programs to award individuals providing those services or currently in training to provide those services in the future. All of the funds from the Reproductive Health Service Corps have been obligated.

1. SUPPORT. The California Nurse Midwives Association (CNMA) is the sponsor of this bill and states that communities around California face a severe lack of access to reproductive health and maternity care. Between 2014 to 2024, more than 50 maternity units closed throughout the state. Midwifery care has demonstrated excellent clinical outcomes, but they are underutilized and can be mobilized to help address provider shortages. California currently only has one nurse-midwifery program accepting students: the California State University Fullerton master’s degree in nurse-midwifery. There are currently no licensed midwife programs in California. To fill the state’s needs, midwifery education should aim to serve parts of the state with the most significant provider shortages and maternity care needs. Midwifery education programs are required to meet high quality standards and can successfully prepare the midwife workforce in California. CNMA concludes that this bill will ultimately increase access to clinical placement sites appropriate to midwifery scope of practice.
2. RELATED LEGISLATION.
   1. AB 55 (Bonta) would remove the requirement that an alternative birth center (ABC) be a comprehensive perinatal services provider (CPSP) as a condition of licensure, and a condition for Medi-Cal reimbursement. The bill would also remove the requirement that an ABC be 30 minutes from a hospital. AB 55 is pending in the Assembly Health Committee.
   2. SB 669 (McGuire) would require the Department of Public Health, in consultation with specified stakeholders, to establish a 5-year pilot project to allow critical access and individual and small system rural hospitals to establish standby perinatal medical services, as defined. SB 669 is currently pending in the Senate Health Committee.
3. PREVIOUS LEGISLATION.
   1. SB 65 (Skinner), Chapter 449, Statutes of 2021, establishes the California Momnibus Act, which, among other provisions, requires HCAI to work to increase the number of students receiving training as certified NMs or LMs.
   2. AB 1918 (Petrie-Norris), Chapter 561, Statutes of 2022, establishes the California Reproductive Health Service Corps program within HCAI to reduce the debt burden of current and future health care professionals dedicated to providing reproductive health care in underserved areas of California.

REGISTERED SUPPORT / OPPOSITION:

Support

California Nurse Midwives Association (sponsor)
Essential Access Health
Planned Parenthood Affiliates of California
San Francisco Bay Area Black & Jewish Unity Coalition
Western Center on Law & Poverty, INC.

Opposition

None on file

Analysis Prepared by: Lara Flynn / HEALTH / (916) 319-2097