Kathleen Belzer was awakened to her future path and passion as an undergraduate while working briefly with a midwife at Enloe Medical Center. Already drawn to the sciences and working with people, she was especially intrigued by maternity, birth, and newborns. She was also struck by how this midwife was allowed to work independently as she cared for patients and able to support the entire birthing process in a personal way.
This was Belzer’s lightbulb moment.
“There wasn’t a lot of talk about health equity back then, but inherently in me was always the drive for ensuring every person got high-quality care. That is really the midwifery model—it’s very patient-focused,” she said. “What we do is considered ‘high-touch’ care, where we take our time and look at the journey of the whole person.”
Belzer (Nursing, ’86) has now been a certified nurse midwife practicing in California for 27 years and is known statewide as a leader for fair and equal maternity care and the rights of midwives to provide treatment where it’s needed most. As former president of the California Nurse Midwives Association, a chief contributor to the recently passed Senate Bill 1237 (the Justice and Equity in Maternity Act), and founding member of the California Nurse-Midwives Foundation, her efforts are laser-focused on diversifying the midwifery workforce.
Historically, midwifery came from immigrant women serving their communities, but today, white women represent 90 percent of the workforce. Belzer is driving change by fostering and funding ways for people of color to train in the field and by supporting legislation to address race-based disparities and improve maternal health outcomes—especially for underserved and marginalized communities. One of the best ways to improve outcomes for people of color, she said, is to have people of color caring for people of color.
Belzer has worked in a variety of settings throughout her remarkable career, including an out-of-hospital midwifery-owned birth center, private collaborative practices with obstetricians and midwives, and community health clinics. She has also worked in an academic setting at the University of California San Francisco, teaching medical students and residents.
Belzer lives in Marin County with her husband John. She currently works at Kaiser Permanente Napa-Solano where she supports patients through their prenatal period, their labor and birth, and their postpartum period, and will be lecturing on maternity, newborn, and women’s health, and nursing at the Dominican University of California this fall.
How do you describe your work as an advocate for equity in maternity care?
Where I live we have great hospitals and great insurance, and therefore, great care. If you are a person who lives in another community without resources and insurance, the quality of care is very different. Racism has deep roots in the medical system. Consider the profession of nursing—it was white women who got an education, and therefore white women who became the nurses and midwives.
When I was younger I didn’t really think about that, but I could tell my patients had a hard time connecting and trusting the care they received from me. I just don’t share their lived experience. I would bring in a Black physician that I worked with and the entire interaction changed. There is a built-in sense of community there that I don’t belong to.
A major focus of the California Nurse-Midwives Foundation is creating funding streams for midwifery students of color and maternity care programs and birth centers for people within their own communities. We were able to help fund a great program in Alameda County, for instance, called BElovedBIRTH Black Centering. It is run completely by Black providers and addresses challenges like food insecurity and transportation, and every woman in the program gets a photoshoot with a Black photographer while they’re pregnant.
How does midwifery affect the changes you want to see in maternity care?
Midwifery is not high-volume care—it’s time intensive. I end up staying in rooms with patients for a really long time because I open up a space where they can feel safe to express themselves. I stay late, learning about their struggles and their specific needs. There is a great deal of counseling that goes into midwifery.
Ultimately, midwifery has the potential to improve access to care for everyone. The Justice and Maternity Care Act asks to remove physician supervision from midwives’ work so that more certified nurse midwives can open up a practice in areas where there are no providers. Unfortunately, the passing of the bill hasn’t yet given us that independence. Hospital systems can still require a physician to cosign our work, which is really frustrating because some of these physicians have only been practicing for a year while I’ve been doing this for almost 30.
How do you remain positive and motivated doing such challenging work?
I work with great organizations and amazing individuals who are as passionate and driven as I am. And I am still working clinically, so I get to take care of women during the most amazing, life-changing experience for them. Being there during those moments is really sustaining.
And I’m really excited about creating diversity on our team and throughout broader maternity care. We need the voices of other people who can speak to their communities, and I’m really energized about bringing them on and creating momentum for a larger shift.
Being a midwife is a hard job—it can be all night and all day, sometimes—but I have been blessed. And it all started at Chico State!
What advice do you have for students who want to be advocates for change?
I think it’s not so much on them but on us to mentor them and create space so that they can step up into leadership positions. I just changed my work status to per diem so that we could hire two midwives of color. It’s really hard to get the institutions to do what needs to be done, so I basically stepped down from my role so that we had room to hire. I’m in a place where I have the financial ability to do that, and we need to start thinking in that direction.
How do you “Do and Dare” to transform tomorrow, for yourself and for others?
When I see something that’s not right, I don’t just roll my eyes and say, “Well, this is just the way things are.” I really try to get people to pay attention and address what needs changing. And I was raised to appreciate every person’s individuality and what they have to offer—I look at everyone as deserving. I want to make a difference in people’s lives by showing them that they are worthy and by encouraging them to speak up and advocate for themselves and others. Empowering women, especially, is what fills me up the most.