In the early to mid 1970’s, the midwife was a radical concept that challenged the orthodoxy of hospital-controlled birth.

The State of California had stopped issuing Midwife licenses in 1949, and only three older, certified midwives remained in the entire state, and 99.4% of babies were delivered in hospitals, mostly by white male doctors. The Women’s Movement of the 1970’s took on this supremacy, with support from UC San Francisco nurses and physicians being central to their efforts.

 

Deena Mallareddy, a midwife, smiles as she sits among a group of other midwives. She is of South Asian descent and has long, curly hair.
UCSF’s Centering Pregnancy Program, part of its Midwife Clinic at ZSFG in partnership with the Homeless Prenatal Program, invites pregnant persons to community clinic sessions, creating cohorts of patient-led groups of 10-12. “Instead of making everyone check their lives at the door as they come for care, we flip that and bring the care to them. The cohort model invites mothers to be with other mothers and grow with them through term.” Expert midwives like Deena Mallareddy, CNM, MSN, attend group sessions to provide check-ups, facilitate patient led conversations and help form support bonds between pregnant people. Photos by Susan Merrell

 


Two pioneering midwives from UCSF – Susan Leibel, CNM, and Rosemary Man, PhD, CNM – helped transform birthing options, not just in San Francisco but across the state. Thanks to their incredible efforts as part of the American College of Midwives, California lawmakers approved a new statute to license nurse midwifes in 1974.

A year later, in 1975, obstetricians and gynecologists (OB/GYN) and certified nurse midwives (CNM) at UCSF helped establish San Francisco’s first ever hospital-based midwife program. Additional investment in the clinic followed with the creation of a new Family Birth Center in 1976 that provided a calmer, more homelike setting and additional delivery options.

 
A midwife checks the pregnant belly of a woman laying down.
A midwife checks the pregnant belly of a woman laying down.

Expecting mother Edelmira Diaz receives a “belly check” from Mallareddy in group clinic. Belly checks are an important assessment of fundal height that tracks the baby’s growth between sessions. By providing mobile care and meeting pregnant people where they are, midwives lower the threshold to access prenatal care, provide welcoming alternative spaces for check-ups and make check-ins fit into a healthy rhythm of everyday life.

Midwife Deena Mallareddy places a heartbeat listening device over the pregnant belly of Jacqueline Miranda. Jacqueline lays on a bed in a room with a Japanese-style screen a small plant.

Mallareddy and Jacqueline Miranda listen to the fetal heart tones of Miranda’s baby via doppler machine as a regular part of the Centering Pregnancy Program.

 

The new midwifery program at ZSFG quickly began to transform how the hospital cared for pregnant people, funded by a unique partnership between UCSF, San Francisco Department of Public Health (SFDPH) and ZSFG. Thanks to this partnership, which started in 1873 and celebrates its 150th anniversary in 2023, every doctor and many nurses at ZSFG are also faculty at UCSF, and are empowered to develop clinics that address pressing community needs.

“This is person-centered care. It’s rooted in the idea that someone who’s giving birth has the right to be in charge of their own care,” says Deena Mallareddy, CNM, MSN, and associate clinical professor at UCSF’s School of Nursing. “It’s a beautiful thing to be in relationship with our clients, the entire care team, our partnerships and our collective communities.”

 

A pregnant woman of Hispanic descent holds her pregnant belly as she closes her eyes and meditates.
The Centering Pregnancy Program leads a meditation and visualization session in Spanish, asking mothers to visualize their baby’s healthy birth, growth and life while centering themselves in breath. “It’s encouraging them through meditation to rely on themselves, to ground themselves in their own bodies using breath, to visualize a healthy life for their baby and know they have everything they need inside of them to make it happen,” says Mallareddy.

 


Today, ZSFG provides comprehensive midwife support before, during and after birth – delivering prenatal, delivery and community care at San Francisco’s central public hospital to any patient who chooses. The clinic also provides community support, including through its innovative Centering Pregnancy Program, created in partnership with the Homeless Prenatal Program. The clinic especially focuses on serving vulnerable populations. ZSFG also continues to be the primary clinical training site for Certified Nurse Midwife students at the UCSF School of Nursing where partnerships aimed at diversifying midwife nursing are a continued legacy of the program.

Thanks to the incredible work of UCSF nurse midwives, and an enduring San Francisco partnership promoting public health, what was once a radical concept on the outskirts of the medical establishment is now a cherished part of helping to grow healthy families across San Francisco.

 
Deena Mallareddy (left), Ashley Vance (center), and Andrew Grimes (right) discuss a patient in a hospital wing. They wear teal scrubs.
Deena Mallareddy (left), Ashley Vance (center), and Andrew Grimes (right) discuss a patient in a hospital wing. They wear teal scrubs.

Deena Mallareddy, CNM, MSN, Attending Physician Ashley Vance, MD, and resident Andrew Grimes discuss the needs of an expecting patient. Mallareddy, like many nurses and all ZSFG doctors, are faculty at UCSF, meaning they practice in the general hospital and also teach at UCSF’s medical and nursing schools. Mallareddy’s Advanced Midwifery course, taught at UCSF’s Parnassus campus, is directly informed by her work at ZSFG as a certified midwife. This unique faculty-doctor partnership between ZSFG, San Francisco Department of Public Health and UCSF began in 1873, and celebrates its 150th anniversary in 2023. It’s a legacy that continues to advance how health care is provided, taught and enhanced for each new generation. In the Labor and Delivery ward, this dual role holds a unique responsibility: concurrent stewardship of multiple generations of our newest of San Francisco residents, both from birth and university.

 

Everything is about teamwork.

 

A team of medical staff wearing teal scrubs gathers on a hospital wing floor to disucss patients.
At safety rounds on the floor at the hospital, medical staff at ZSFG check-in about the patients in their care, sharing updates, developments and what needs to be monitored.
A nurse midwife leans against a doorframe as she reads from a medical record. Another nurse stands beside her holding a clipboard. They both wear teal scrubs.
Nurse midwives provide an independent and additional layer of information and care through the full term of pregnancy – not just to the patient, but also to nurses, doctors and residents across the ward. As expert independent health practitioners and advocates that manage the care of their patients, midwives are uniquely placed as liaisons, emissaries and partners on deeply skilled and cross functional health provider teams.

 

 

The unique comradery at ZSFG is foundational to the care it provides.

 

 

A group of medical staff wearing teal scrubs laugh together as one of them shows something on her phone.

 


Hours before delivery, Alexandra Flores, RN, checks expecting mother Felicia Tijerino’s vitals as Deena Mallareddy, CNM, MSN, helps Tijerino prepare physically and mentally. Holistic care, providing for all the patient’s needs – physical, mental, emotional and even social – are a core part of the midwifery model of care.
 

 

A Black pregnant mother lays on a hospital bed while midwife Deena Mallareddy sits by her side.

 


“As a midwife serving the community for 24 years, I truly feel that ZSFG is as close as you can get to core concepts of midwifery care, such as trusting physiologic birth and having agency, in a hospital setting. A lot of that is the respect, resources and partnerships created through DPH and UCSF. It takes all of that. Most of all, it takes a talented, committed and justice minded group of midwives and colleagues to create a program this special.”

– Deena Mallareddy, CNM, MSN, UCSF associate clinical professor
 

 

A Black pregnant mother lays on a hospital bed while midwife Deena Mallareddy sits by her side.

 


“It’s not just my job but my responsibility to create and hold space where a laboring person feels empowered and safe to give birth,” says Mallareddy. “When people feel listened to and seen, feel respected, feel cared for, the experience can be transformative and more than going home with a happy, healthy baby. That’s why we’re here, and why this program was created. I’m so proud to be part of it.”
 

 

A pair of hands hold a newborn baby's feet.

 


On May 9, 2023, at 4:13 a.m., Felicia Tijerino gave birth to Feliciano Jeremiah Tijerino, 7 pounds, 2 ounces, a healthy happy baby boy, at ZSFG.
 

 

A Black mother tenderly holds her newborn son in a hospital bed.

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