The Brief

It’s a Thursday at Cal State Fullerton when a group of midwifery students each grab a model pelvis, to learn about how a baby’s head moves through the birth canal. Last week, students practiced catching babies with a mannequin in a birthing bed. Next week, they’ll learn how to suture, using foam and raw chicken for practice.

Student Janine Ruiz says it was this sort of hands-on experience that helped her choose this school’s program.

“We got to practice, like ‘how do we position our hands?’ I just feel so supported,” Ruiz said.

Cal State Fullerton only graduates about 10 to 12 midwives a year. Now, it’s the only-masters level program left in the state training these health-care workers, in a time where advocates say more maternal care providers are needed.

Certified nurse-midwives in California are registered nurses who have advanced degrees and care for people during pregnancy, including labor and delivery, and mostly work in hospitals. They make up the majority of the midwifery workforce. (There’s another type of midwife in California, known as certified professional midwives or licensed midwives, who oversee home births and at birthing centers).

The other state program

The state’s only other program, UC San Francisco, has paused admissions as it switches to a doctoral program. The school says it’s seeking accreditation to open admissions in 2025.

“We have lots and lots of evidence that at the master's level, nurse midwives are performing very good care,” said Liz Donnelly, a UCSF alum and the vice chair of the health policy committee with the California Nurse-Midwives Association. “There's not an argument for why we need to add on this additional year and increase the cost — and at a time in which the state is facing an access crisis.”

Studies have shown that being cared for by a midwife has been associated with fewer complications, like C-sections and preterm births. And advocates say midwives can help address the shortage of maternal health care. But in 2021, nurse-midwives attended to just 13 percent of births in California.

“There's a shortage of health-care providers, period,” said Angela Sojobi, assistant professor at CSU Fullerton’s School of Nursing and director of the nurse-midwifery program. “We need more people providing care for women, and nurse midwives are very capable of providing this care.”

A CalMatters investigation found that nearly 50 maternity wards have closed in the state over the last decade.

How midwives help with racial disparities 

Sojobi said nurse midwives can play an important role in the Black maternal care crisis, as well as free up OB-GYNs so they can care for higher-risk patients. Black birthing parents are three to four times more likely to die in California from pregnancy-related complications.

Sojobi, who started practicing in Nigeria, works as a midwife at Martin Luther King Jr. Community Hospital in South L.A., where the majority of her patients are people of color. She says when she walks into patients’ rooms, she often sees sighs of relief from patients who see a practitioner that looks like them.

Angela Sojobi with a mannequin patient at the women's health simulation lab at Cal State University Fullerton.

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“I've had patients look at me and say, ‘please, please don't let me die,’ you know, and all they're doing is having a baby, you know, so I've had to reassure them,” she said.

The midwifery workforce is still more than 80% white. Sojobi and other maternal care advocates worry that the change at UCSF will mean it will be harder for people of color to enter the workforce, given the extra time and cost of tuition.

Should midwifery require a doctorate?

The American College of Nurse-Midwives has opposed a doctoral requirement to practice as a midwife.

Midwifery students practice catching a model baby in a simulation lab at Cal State Fullerton.

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“It's the cost of education, the length of time … thereby reducing the number of new midwives entering the field without any really strong evidence that that additional training will improve health outcomes of the people in the communities that we care for,” said Jessica Brumley, the group’s president.

A spokesperson for UCSF said the school’s decision to move to a doctoral degree falls in line with a national movement to change advanced nursing programs to doctoral ones.

“The health challenges that California and the nation face are complex and ever-evolving, especially around reproductive health and in underserved communities. The new pathway will enable us to better prepare nurses to meet these complex needs and to fully serve as advocates for patients,” the spokesperson said.

Ginger Breedlove, CEO of Grow Midwives and former president of the American College of Nurse-Midwives said the maternal care crisis is too pressing. “The move that UCSF made is an absolute wrong move for not only our profession, but for the families trying to be served in California,” Breedlove said.

For midwifery professor Sojobi, she worries the number of graduates her school produces is a drop in the bucket in a state like California.

“And if that one school is only turning out two, three, maybe four minority midwives in a year, then we're really looking at an incredible shortage and a disservice to our women of color,” Sojobi said.

The University of California’s Board of Regents on Wednesday is slated to vote on a proposal that could hike tuition rates for incoming students beginning in fall 2027.

The UC system is facing state budget cuts and major uncertainty over federal funding as it continues to navigate ongoing conflicts with the Trump administration.

In a recent message to students, faculty and staff, UC President James Milliken said the system is grappling with “one of the gravest threats in [its] 157-year history,” highlighting fears about potential cuts to the $17 billion in federal funding it receives each year — including $1.7 billion in financial aid for students.

What's in the proposal?

The proposal aims to extend UC’s “Tuition Stability Plan,” which went into effect in 2022. Under that plan, annual tuition increases are capped at 5% and tuition is frozen for each incoming class for six years.

The proposal on deck contains key differences, including reducing the rate of undergraduate tuition set aside for financial aid, from 45% to 40%, along with a 1% increase to help pay for new or improved campus facilities.

The University of California Student Association (UCSA), which represents 230,000 undergraduates across nine campuses, opposes the tuition hikes, arguing that many students are already struggling to make ends meet.

“We understand that the university is in a really challenging fiscal period . . . [and] will likely renew the proposal,” said Vincent Rasso, the group’s director of government relations.

If the board adopts the plan, he added, members should, at a minimum, oppose reducing the rate of tuition dollars that support student aid. And instead of using tuition to pay for capital improvements, UCSA asks that a portion of that 1% hike be used to fund retention programs and students' basic needs.

The board's meeting is slated to start at 1:30 p.m. and available to stream online.

The U.S. may be entering another rough winter for flu, according to early data.

"The signs are, it could be a big season," says Richard Webby, who studies the flu at St. Jude Children's Research Hospital in Memphis. "The flu season might have a little bit of a punch to it this year."

The first clue to what may be in store is what influenza did during the Southern Hemisphere's winter. That often predicts what's coming for the Northern Hemisphere.

"They had some pretty decent flu activity in many parts of the Southern Hemisphere," Webby says. "It actually lasted for a longer period of time — the tail of the season went on for longer than typical."

And now, parts of the Northern Hemisphere, such as the United Kingdom, are being hit hard. That often foreshadows what's in store for the U.S.

Another clue is the Northern Hemisphere's dominant flu strain so far. It's an H3N2 flu virus, according to the Centers for Disease Control and Prevention flu tracker.

And H3N2 viruses "tend to be a little bit more problematic," Webby says. "When we have an H3N2 season, we tend to have a little bit more activity, a little bit more disease at the severe end of the spectrum."

The last major flu season dominated by H3N2 was 2016-2017.

In addition, a new H3N2 variant recently evolved and has become the dominant strain in the U.S.

"There is basically a new variant of influenza circulating that has mutated a little bit," says Caitlin Rivers, an epidemiologist at Johns Hopkins. "And that means that it's just different enough from what your body or the vaccine may recognize that it can kind of get around those protections."

And she says the flu shot this year "may not be as good a match as if we hadn't seen this new variant."

That said, data from the U.K. indicates the vaccines still make a difference, Rivers says. In the U.K., the vaccines appear to be about 70% to 75% protective against hospitalization in children and about 30% to 40% protective against hospitalization in adults.

So Rivers and others are urging anyone who hasn't already gotten a flu shot to get one.

"Definitely get it as soon as possible. Because activity is low right now. But it is increasing. And it will continue to increase straight through until we hit peak, which is usually around the holiday season. There's no sense in waiting when we are barreling into flu season," Rivers says.

It takes about two weeks for immunity to kick in. And people don't want to catch or spread the flu over Thanksgiving. The flu kills between roughly 12,000 and 52,000 people in the U.S. every winter.

"I do have concerns that uptake of both the influenza and the annual COVID vaccine won't be as high this year as it had been in previous years," Rivers said. She is concerned by rhetoric coming from federal health officials questioning "whether vaccines are safe and effective."

"We know that they are," she says. "And they are important for protecting against severe illness. So it's really important that people go out and get them this year."

In a written statement to NPR, a Health and Human Services spokesperson said: "It is too early to know what viruses will spread this season, in what proportion, and how well the vaccine will work in the United States."

The statement added: "The decision to vaccinate is a personal one. Individuals should speak to their healthcare provider on the risks and benefits of a vaccine."

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Despite record rainfall this month across Southern California, Rancho Palos Verdes officials say so far the damage to the city’s slow moving landslide appears to be minimal.

The Portuguese Bend area of the city sits on an ancient landslide that was accelerated by above average rainfall in 2022 and 2023, causing land to move 1 foot a week in some places. The movement has torn properties, roads and other infrastructure and a buyout program to convert red-tagged properties into open space.

To prepare for this winter’s deluge, officials took measures to slow down land movement, including installing a pipe in Altamira Canyon to prevent water from collecting at the toe of the canyon and covering the ground in some areas with pond liners.

“So far, it appears the impacts of the storm included a few areas of minor ponding on Palos Verde Drive South. The water was removed by pumps and the roadway remained passable,” Megan Barnes, a spokesperson for the city, told LAist in a statement.

The story was similar in other areas at risk of mudflows and landslides due to recently being scarred by fires. Despite inches of rain, no major damage was reported. Another storm system, however, is expected to move in Thursday through Friday.

Eva Albuja, a resident whose home is surrounded by multiple damaged homes — two red-tagged and three yellow-tagged — said the city needs to do more.

 ”The pooling of water is significant in our area,” she said, noting that the water pools under pond liners. “ I worry because I might be next with all the water problems that we're having.”

What to know about the Rancho Palos Verdes landslide

Albuja’s home is close to the intersection of Dauntless and Exultant drives, where a fissure has expanded to completely engulf the intersection. That area is closed to the public. She said city crews came to pump the water that was collecting only after addressing damages on the main thoroughfare through the landslide complex, Palos Verdes Drive South. By then, some of the water had sunk into the ground, which could cause problems down the line.

The ground in that area is made up of bentonite clay which slips and slides when wet. It’s a combination that has cost Rancho Palos Verdes tens of millions of dollars in repairs, wells to remove water from underground, and other infrastructure repairs. In the end, experts all the city can do is try to slow down the unstoppable.

Albuja, who has lived in Rancho Palos Verdes since 1978, said it’s been hard to witness the slow-moving destruction and homes being abandoned.

“It's heartbreaking,” she said.

Could smoking pot lead people to drink less alcohol?

In an elaborate and provocative experiment, scientists doled out joints and free drinks to see whether this idea — sometimes described as "California sober" — survived scientific scrutiny.

The new research offers some of the strongest data yet suggesting that smoking weed does, at least in the short term, curb how much people drink.

The findings were published in the American Journal of Psychiatry on Wednesday — and are sure to raise questions about the merits of swapping one of these substances for another, especially given growing concern in the public health field about the popularity of cannabis.

And the researchers are cautious about making any recommendations based on their findings at this point.

"We're not ready to tell people seeking treatment for alcohol, go ahead and substitute cannabis, and it will work out for you," says Jane Metrik, a professor of behavioral and social science at Brown University who led the study.

But the research does bring scientists closer to understanding the link between these two substances, at a time when many people are leaning on marijuana to cut back on drinking, without waiting for the evidence.

"This study really moves the field forward by helping to resolve one of the unresolved questions in the literature," says Jeff Wardell, a professor of psychology at York University. "This gives us more confidence that there's a real effect here."

Jane Metrik, left, and members of her lab working in the Bar Lab measuring alcoholic drinks and weighing cannabis.

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Getting high for science

In the Brown study, the team took pains to replicate the real-life circumstances of getting stoned and drinking, while still maintaining a tightly controlled study that could point toward a causal relationship.

They constructed a laboratory that resembles a bar, with comfy seats and a tap, and ensured each participant had their preferred alcoholic beverage on hand.

"We wanted to make sure that when given the opportunity, you would be really driven to drink," says Metrik, who ended up spending substantial time shuttling between liquor stores looking for special vintages and spirits.

The experiment included three separate sessions. In one of them, participants smoked a marijuana joint with higher levels of the psychoactive compound, THC; in another they used a lower potency strain; and the last, researchers gave them a placebo with a trace amount of THC that wasn't enough to get them high.

After toking up in a designated smoking room, each participant spent the next two hours in the "bar lab" on their own where they had the opportunity to drink up to eight mini drinks.

The people who smoked the higher potency cannabis ended up drinking 27% less alcohol, and the lower potency about 19% less, compared to the placebo. People who used cannabis also delayed their drinking.

"It is an important signal that we're detecting," says Metrik. "It is telling us that cannabinoids could play a potential therapeutic role in alcohol use disorder."

Previous research has suggested that cannabis may reduce alcohol cravings and how much people drink. But the results have been largely inconclusive, in part because the data often come from observational studies, which are less reliable and can be muddied by other factors. Animal studies have also indicated potential biological mechanisms behind weed's effect on alcohol; however, there's a question of how much this applies to humans.

The new study also builds on what a team of researchers in Colorado reported earlier this year in a slightly different experiment.

There, participants instead picked up their marijuana from a dispensary, smoked it at home and then visited a mobile lab parked nearby, where they were offered alcoholic beverages.

The amount people ended up drinking dropped by about 25% when they were already stoned. Cravings also went down.

"These findings are all converging on a similar story," says Hollis Karoly, an associate professor of psychiatry at the University of Colorado Anschutz who led the study. But she points out there are still big questions about how much you can extrapolate from this new evidence.

A lab member rolls a joint as part of the study of weed's effect on drinking.

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Replacing one problem with another?

One obvious limitation is that how someone behaves when every sip they are taking is under close observation may not necessarily reflect what happens in a much looser, real-world social setting.

And beyond that, Karoly says this pattern toward reduced alcohol consumption wasn't true for everyone in their study. In a minority of people, it actually led them to drink more.

"This really highlights the fact that individual differences matter," she says.

Another unanswered question centers on who's being studied.

Most of the people in the Brown trial met the criteria for "cannabis use disorder," and about 40% for alcohol use disorder. That could indicate their "drug of choice" was not necessarily alcohol in the first place, says Rajita Sinha, a professor of psychiatry at Yale University.

For people with problem drinking, cannabis might be a potential treatment, she says. This approach, on the other hand, "may also be promoting more cannabis use and that would be problematic."

"Once you're in the throes of daily cannabis use, it's very hard to kick that habit," she says.

Those involved in this work acknowledge the tension in this line of research.

Cannabis doesn't carry the same risks of extreme harm as alcohol, which is a leading cause of preventable death in the U.S and kills more than 170,000 people a year.

But Wardell says cannabis is clearly "not a harm-free substance," either.

While research on its effect has not kept up with its surging popularity, studies have shown marijuana can impair cognition and memory, trigger a serious gastrointestinal syndrome that causes nausea and vomiting, increase the risk of psychosis and other psychiatric illness, and impact relationships and social functioning.

And Wardell says this latest study doesn't actually tell us whether the negative outcomes of alcohol are worse than cannabis in the long run.

"We would have to choose which one for a given individual might be less harmful and make sure that it's not inadvertently just replacing one problem with another," he says.

In her role as a clinical psychologist, Metrik at Brown has seen some patients with severe alcoholism who successfully stopped drinking with the help of cannabis, though some have then gone on to develop issues with that drug.

In her mind, the problem right now is that many people are relying on cannabis to treat their alcohol problems, without any guidance.

"We see this all the time, and we don't know what to tell them," she says. "There's no clear messaging,"
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