UCSF study: California nurse midwife workforce older, unevenly distributed and largely nationally certified

Kim Do, a certified nurse midwife and member of the research team, presented results from a 2022—23 workforce survey of California nurse midwives to the Nurse Midwifery Advisory Committee of the Board of Registered Nursing. The study was conducted by researchers at the University of California, San Francisco and funded by the California HealthCare Foundation.

The study surveyed 700 California-licensed nurse midwives and "received a 39.5% response rate," Do said. Respondents were weighted to be representative of the statewide licensed population. The research team reported that the average age of respondent nurse midwives was 50.4 years and that the workforce is distributed unevenly across the state, with the Greater Bay Area accounting for the largest share.

The survey found 76% of respondents were practicing midwifery and, among those, eight in 10 reported attending births. The presenters reported that around 76.1% of nurse midwives identified as white and that only 26.5% reported speaking Spanish as an additional language; the team noted this does not reflect the racial and linguistic diversity of California women of reproductive age.

On services, presenters said 82.8% of practicing nurse midwives provide prenatal care and 89.6% provide postpartum care; 78.2% provide preventive sexual and reproductive health services. The team reported roughly 30% of practicing nurse midwives provide medication abortion and about 4.8% provide aspiration abortion. The presenters also said 57.4% of respondents reported "always or almost always" practicing to the fullest extent of their legal scope, down from 72.4% in the BRN's 2017 workforce study.

Joanne Spetz, professor and director of the Philip R. Lee Institute for Health Policy Studies at UCSF, who served as principal investigator, joined Do for questions. Committee members and public commenters asked whether the reduced percentage reporting practice to full scope could be linked to continued institutional supervision despite legal changes that removed physician supervision in 2020. Do said the team did not have a definitive explanation in the survey data and suggested further study.

Members discussed barriers to expanding the midwifery workforce. Presenters and several committee members highlighted clinical preceptor shortages and geographic concentration of educational programs as likely contributors. Do and others said clinical precepting is time-consuming and often conflicts with productivity expectations in hospitals. Committee members noted only two California schools currently operating midwifery education programs, and that existing accreditation and clinical-site policies can limit where students can do required clinical experiences.

Public commenters representing clinical preceptors and the California Nurse Midwives Association supported the report's recommendations and urged state support for new programs and funding mechanisms such as Song-Brown to expand training capacity.

The committee received the presentation as information and opened the item for public comment; no formal board action was taken on the survey itself.

Ending: The presenters and committee flagged the need for additional research on regional differences, preceptor incentives and the causes of reported reductions in practicing to full scope; staff said those topics could inform future committee work and legislative or regulatory recommendations.