One of California鈥檚 two programs for training nurse-midwives has stopped admitting students while it revamps its curriculum to offer only doctoral degrees, a move that鈥檚 drawn howls of protest from alumni, health policy experts, and faculty who accuse the University of California of putting profits above public health needs.
UC-San Francisco鈥檚 renowned nursing school will graduate its final class of certified nurse-midwives next spring. Then the university will cancel its two-year master鈥檚 program in , along with other nursing disciplines, in favor of a three-year doctor of nursing practice, or DNP, degree. The change will pause UCSF鈥檚 nearly five decades-long training of nurse-midwives until at least 2025 and will more than double the cost to students.
State Assembly member Mia Bonta, who chairs the health committee, said she was 鈥渄isheartened鈥� to learn that UCSF was eliminating its master鈥檚 nurse-midwifery program and feared the additional time and costs to get a doctorate would deter potential applicants. 鈥淚nstead of adding hurdles, we need to be building and expanding a pipeline of culturally and racially concordant providers to support improved birth outcomes, especially for Black and Latina birthing people,鈥� she said in an email.
The switch to doctoral education is part of a national movement to require all advanced-practice registered nurses, including nurse-midwives and nurse practitioners, to earn doctoral degrees, Kristen Bole, a UCSF spokesperson, said in response to written questions. The doctoral training will feature additional classes in leadership and quality improvement.
But the movement, which dates to 2004, has not caught on the way the American Association of Colleges of Nursing envisioned when it called for doctorate-level education to be required for entry-level advanced nursing practice by 2015. That deadline came and went. Now, an acute need for maternal health practitioners has some universities moving in the other direction.
This year, Rutgers University reinstated the nurse-midwifery master鈥檚 training it had eliminated in 2016. The also restarted its master鈥檚 in nurse-midwifery program in 2022 after a 25-year hiatus. In addition, in Washington, D.C., in New Orleans, and the added master鈥檚 training in nurse-midwifery.
UCSF estimates tuition and fees will cost $152,000 for a three-year doctoral degree in midwifery, compared with $65,000 for a two-year master鈥檚. that 71% of nursing master鈥檚 students and 74% of nursing doctoral students rely on student loans, and nurses with doctorates earn negligibly or no more than nurses with master鈥檚 degrees.
Kim Q. Dau, who ran UCSF鈥檚 nurse-midwifery program for a decade, resigned in June because she was uncomfortable with the elimination of the master鈥檚 in favor of a doctoral requirement, she said, which is at odds with the state鈥檚 workforce needs and unnecessary for clinical practice.
鈥淭hey鈥檒l be equally prepared clinically but at more expense to the student and with a greater time investment,鈥� she said.
are registered nurses with graduate degrees in nurse-midwifery. Licensed in all 50 states, they work mostly in hospitals and can perform abortions and prescribe medications, though they are also trained in managing labor pain with showers, massage, and other natural means. Certified midwives, by contrast, study midwifery at the graduate level outside of nursing schools and are licensed only in some states. Certified professional midwives attend births outside of hospitals.
The California Nurse-Midwives Association also criticized UCSF鈥檚 program change, which comes amid a national maternal mortality crisis, a serious shortage of obstetric providers, and a growing reliance on midwives. According to the 2022 鈥溾�� report, the U.S. has the highest maternal mortality rate of any developed nation and needs thousands more midwives and other women鈥檚 health providers to bridge the swelling gap.
, founder and CEO of Grow Midwives, a national consulting firm, likened UCSF鈥檚 switch from master鈥檚 to doctoral training to 鈥渁n earthquake.鈥�
鈥淲hy are we delaying the entry of essential-care providers by making them go to an additional year of school, which adds nothing to their clinical preparedness or safety to serve the community?鈥� asked Breedlove, a past president of the American College of Nurse-Midwives. 鈥淲hy they have chosen this during one of the worst workforce shortages combined with the worst maternal health crisis we have had in 50 years is beyond my imagination.鈥�
A 2020 report published in failed to find that advanced-practice registered nurses with doctorates were more clinically proficient than those with master鈥檚 degrees. 鈥淯nfortunately, to date, the data are sparse,鈥� it concluded.
The American College of Nurse-Midwives also , as have trade associations for , citing 鈥渢he lack of scientific evidence that 鈥� doctoral-level education is beneficial to patients, practitioners, or society.鈥�
There is no evidence that doctoral-level nurse-midwives will provide better care, Breedlove said.
鈥淭his is profit over purpose,鈥� she added.
Bole disputed Breedlove鈥檚 accusation of a profit motive. Asked for reasons for the change, she offered broad statements: 鈥淭he decision to upgrade our program was made to ensure that our graduates are prepared for the challenges they will face in the evolving health care landscape.鈥�
Like Breedlove, , vice chair of the health policy committee for the , worries that UCSF鈥檚 switch to a doctoral degree will exacerbate the twin crises of maternal mortality and a shrinking obstetrics workforce across California and the nation.
On average, 10 to 12 nurse-midwives graduated from the UCSF master鈥檚 program each year over the past decade, Bole said. California鈥檚 remaining master鈥檚 program in nurse-midwifery is at , south of Los Angeles, and it graduated eight nurse-midwives last year and 11 this year.
More than half of rural counties in the U.S. lacked obstetric care in 2018, according to a .
In some parts of California, expectant mothers must drive two hours for care, said who runs Midtown Nurse Midwives, a Sacramento birth center. It has had to stop accepting new clients because it cannot find midwives.
Donnelly predicted the closure of UCSF鈥檚 midwifery program will significantly reduce the number of nurse-midwives entering the workforce and will inhibit people with fewer resources from attending the program. 鈥淪pecifically, I think it鈥檚 going to reduce folks of color, people from rural communities, people from poor communities,鈥� she said.
UCSF鈥檚 change will also likely undercut efforts to train providers from diverse backgrounds.
Natasha, a 37-year-old Afro-Puerto Rican mother of two, has spent a decade preparing to train as a nurse-midwife so she could help women like herself through pregnancy and childbirth. She asked to be identified only by her first name out of fear of reducing her chances of graduate school admission.
The UCSF program鈥檚 pause, plus the added time and expense to get a doctoral degree, has muddied her career path.
鈥淭he master鈥檚 was just the perfect program,鈥� said Natasha, who lives in the Bay Area and cannot travel to the other end of the state to attend CSU-Fullerton. 鈥淚鈥檓 frustrated, and I feel deflated. I now have to find another career path.鈥�
This article was produced by 麻豆女优 Health News, which publishes , an editorially independent service of the .听