How Midwifery Went from Radical Concept to Transformative Care
UCSF’s Midwifery Partnership with Zuckerberg San Francisco General Changed the Game for Access and Agency in Childbirth
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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.
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.
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.”
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.
Everything is about teamwork.
The unique comradery at ZSFG is foundational to the care it provides.
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.
“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
“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.”
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.