Midwives Blame California Rules for Hampering Birth Centers Amid Maternity Care Crisis - Times of San Diego
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California’s Maternity Deserts Deepen as Birth Centers Struggle Under Regulatory Burdens
By [ChatGPT]
As politicians fret about the impending demographic collapse, with birthrates falling, parents who are willing and able to bring children into the world struggle to find maternity care. Families seeking a reasonable cost of living are priced out of urban areas. In one soch case, Jessie Mazar clutched the grab handle of her husband’s pickup truck, wincing through contractions as they navigated a 90-minute drive on winding rural roads to the closest hospital with a maternity unit. The hospital near her home in Quincy, just seven minutes away, no longer delivers babies.
This scenario has become increasingly common across California, where 56 hospitals—approximately one in six—have shuttered their maternity wards in the past decade due to financial pressures and staffing shortages. The closures have left rural areas with vast maternity care deserts, forcing pregnant individuals to travel long distances to give birth or risk delivering without proper medical care.
In theory, midwife-led birth centers could provide a vital solution, offering safe, cost-effective care for low-risk pregnancies. But strict state regulations, lengthy licensing processes, and costly infrastructure requirements are making it nearly impossible for such centers to operate.
“All they’ve essentially done is made it more dangerous to have a baby,” said Sacramento midwife Bethany Sasaki, whose Midtown Birth Center was recently forced to close. “People have to drive two hours now because a birth center can’t open, so it’s more dangerous. People are going to be having babies in cars on the side of the road.”
A Broken System
Over the past decade, the number of licensed birth centers in California has dropped from 12 to just five. Those closures reflect a regulatory system critics describe as overly burdensome. Obtaining a license can take as long as four years, with facilities held to building standards meant for primary care clinics and hospitals—such as hospital-grade ventilation systems—despite serving healthy mothers and infants.
For example, the Monterey Birth & Wellness Center closed after spending $50,000 on renovations to meet state standards, only to face an additional $50,000 bill to install galvanized steel heating vents. Owner Caroline Cusenza ultimately shut her doors, calling the regulations “financially unsustainable.”
Proposed Legislation Aims for Reform
State Assemblymember Mia Bonta, an Oakland Democrat, recently introduced a bill to overhaul the licensing process and relax some of the most prohibitive requirements for birth centers. The legislation aims to modernize outdated rules, streamline approvals, and reevaluate restrictions like the 30-minute drive-time limit from a birth center to a hospital.
“We know that alternative birth centers lead to often better outcomes, lower-risk births, and lower maternal mortality and morbidity,” Bonta said. “We must fix this broken system.”
The bill has garnered support from health policy advocates, including Sandra Poole of the Western Center on Law & Poverty, who emphasized the need for regulatory updates. “Where there’s nothing right now, a birth center is certainly a better alternative to not having any maternal care,” Poole said.
A Model for the Future
In Quincy, local officials are proposing the “Plumas model,” a midwife-led birth center with on-call doctor backup and a nearby perinatal unit. Advocates hope the model will be replicated statewide, offering a lifeline to rural communities left behind by hospital closures.
Jessie Mazar, who delivered her baby at a hospital in Truckee after her harrowing drive, is hopeful about the possibility of delivering her second child closer to home. “That would be convenient,” she said, “but we’re not holding our breath.”
The Stakes Are High
Midwife-led births have been shown to reduce cesarean rates, increase breastfeeding, and improve infant health, all at a fraction of the cost of hospital births. But without systemic change, experts warn that California’s maternity care crisis will only deepen.
“The state is in dire need of accessible, affordable options for maternal care,” said Robert Moore, chief medical officer of Partnership HealthPlan of California. “Every day we delay reform, we’re putting more mothers and babies at risk.”
As lawmakers debate Bonta’s proposed bill, families in rural California continue to face perilous journeys to deliver their babies—waiting for the day when maternity care is no longer out of reach.
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