As maternity options in California dry up, midwife training programs are fading

The room was buzzing at the women’s health simulation lab at California State University, Fullerton. That’s because on this day, everyone got their own anatomic model of a pelvis and a baby head.

Professor Angela Sojobi held up an example of a pelvis and mimicked how a baby moves through the birth canal.

“Pelvis out,” she told her students. On this day, the class of midwives in training was learning about the first stage of labor. Last week, students practiced catching babies with a mannequin in a birthing bed. Next week, they’ll learn how to suture using foam and raw chicken for practice.

Student Janine Ruiz said it was this sort of hands-on experience that helped her choose this school’s program. 

“We got to practice, like, how do we position our hands? It’s not a person, it’s a mannequin, so if we mess up, if we drop the baby, it’s OK. Nobody’s getting hurt. I couldn’t imagine my first experience of this being at the bedside. That would be terrifying,” she said.

Ruiz and other students are training to be certified nurse-midwives. These are registered nurses who have graduate-level training and provide pregnancy care, including delivering babies. Most work in hospitals. But there’s a shortage of midwives across the country.

Cal State Fullerton only graduates about 10 to 12 midwives per year. It’s the only masters-level program left in the state training these health care workers in a time where advocates say more maternal care providers are needed. The only other program in California, at University of California, San Francisco, has paused admissions as it changes to a doctoral degree, which requires significantly more training.

Sojobi said that will make it harder, especially for people of color, to enter the workforce. 

“It’s already difficult to recruit people of color,” she said. “Now we’re going to increase the amount of time you’re going to be in school and the amount of money you’re going to pay for school.”

She said midwives can play an important role in the Black maternal health crisis, where Black woman are three times more likely to die from pregnancy-related complications.

Studies have shown that being cared for by a midwife has led to fewer cesarean sections and fewer pre-term births. But only about 12% of births in the United States are attended by a midwife.

Sojobi said midwives can fill a critical gap as the country faces a shortage of thousands of maternal care providers.

“We need more people providing care for women. Nurse-midwives are very capable to provide this care,” she said. “For us to be able to start really changing the data on disparities between care, the people to do it are the nurse-midwives, and those are the people we have less of practicing.”

In an emailed statement, a spokesperson for UCSF said the doctoral program will cost an estimated $152,000 over 12 quarters. The master’s program cost $65,000 over six quarters.

The school said the shift is part of a national movement to change advanced nursing degrees to doctoral ones — and will better prepare graduates with more expertise as they navigate a complex health care landscape.

Students can take classes in subjects like health policy, leadership and health care innovation. 

But the American College of Nurse-Midwives is opposed to a doctoral requirement. Ginger Breedlove, past president of the group, said there’s no evidence that a higher degree increases the ability to safely provide care as a midwife.

“You may want to do a post-master’s doctoral degree if you want to teach, if you want to build your resume to go into administrative leadership, but not to practice,” she said.

She said in a time when the maternal health care crisis is so pressing, schools need to make programs more accessible. In California alone, nearly 50 maternity wards have closed over the last decade.