Direct-Entry Midwife Education, Practice, and Patients in California

Improving access to midwifery care has been identified as a strategy to address shortages of reproductive health clinicians and ensure person-centered, equitable care. This article describes findings from a new survey of licensed midwives (LMs) in California, who enter the profession without a nursing background. The data offer new insights into LMs' demographics, training, client population, and practice experiences. LMs predominantly have their own practices, typically working with another midwife and/or an assistant or student, and have relatively small numbers of clients each year. Most of the births they attend occur in homes and birth centers. Many LMs report a lack of understanding of and support for their expertise by physicians and hospitals. Despite these challenges, most LMs are satisfied with their careers. LMs contribute to person-centered care, offering alternatives to hospital birth and expanding access to the midwifery model of care.