Many California families want to bring their babies into the world outside of a hospital, but the state isn’t making it easy for them. Half of the state’s birth centers have closed since 2020, leaving only four licensed facilities open.
Birth centers don’t need a state license to operate, but the expensive and onerous process of obtaining one is one of the primary reasons why birth centers are failing. Most insurers and Medi-Cal, the state’s public health insurance program for low-income residents, will only work with licensed facilities.
Compounding the problem is the rapid closure of hospital labor wards, creating maternity care deserts in communities of all sizes.
That’s why Assemblymember Mia Bonta, a Democrat from Oakland and chairperson of the Health Committee, is planning to introduce a bill today to ease birth center licensing requirements.
“Eliminating requirements that are only driving up prices for providers and are irrelevant to patient safety is a much- needed step to ensure our remaining birth centers can stay afloat and lay the groundwork for more facilities to open,” Bonta said.
The bill, Bonta plans to introduce, would delete a requirement that birth centers participate in a specific Medi-Cal benefit known as the comprehensive perinatal services program, which includes services such as nutrition counseling and psychosocial support. Until recently, midwives weren’t allowed to participate in the program, making birth center licensure nearly impossible.
Advocates say removing the requirement entirely will further streamline the process and actually allow them to serve more low-income clients.
The bill is part of a larger legislative effort by Bonta to protect access to reproductive health care during the coming Trump administration. Bonta’s other planned bills seek to preserve access to abortions at all hospitals, including ones affiliated with religious organizations, in the event of an emergency and to pay for over-the-counter birth control for Medi-Cal patients.
Licensed midwives and certified nurse midwives can provide prenatal and postpartum care as well as low-risk deliveries outside of hospitals. They direct higher-risk pregnancies to hospitals. Birth centers are midwife-run clinics for low-risk births.
In March, the state’s first licensed and accredited birth center closed after three decades of operation. The San Diego facility, which delivered more than 5,600 babies over the years, was unable to keep up with mounting costs. Many others have followed suit. At least 19 birth centers have closed in the past four years, accompanied by the closure of more than 50 hospital maternity wards, according to CalMatters reporting.
The closures disproportionately affect rural communities and people of color, deepening a maternal health care crisis, said Sandra Poole, a lobbyist with the Western Center for Law and Poverty, which is co-sponsoring the bill.
“We have a whole population that is losing access to maternal care, and we’re hearing more and more for various reasons — whether it’s mistrust of hospitals or just wanting the ability to have their births in a more homelike setting — that folks, particularly people of color, would rather have their birth at a birth center,” Poole said. “But they’re just not afforded that opportunity especially if they’re on Medi-Cal.”
Medi-Cal pays for more than half of the births in California, and 80% of those babies are not white, according to state data. A statewide survey also suggests that people of color want alternative birth support such as midwives and doulas more than any other demographic group. Lack of insurance coverage is the most commonly cited barrier to that care, according to the survey from the California Health Care Foundation.
California is known for having the strictest licensing requirements for birth centers in the country, according to the American Association of Birth Centers. Midwives have previously told CalMatters that they had to leave the state and even the country because it was too difficult to operate in California.
Bethany Sasaki, president of the state chapter of the American Association of Birth Centers, said it’s “heartbreaking” that this legislative effort is coming too late to save the birth centers that have closed already, but it is an important first step. Sasaki closed her Sacramento birth center earlier this year after the state refused to grant her a license.
“This is step one to the long process of improving access to midwives and safe out of hospital birth,” Sasaki said.
