Calif. Licensed Midwifery & Nurse Midwifery Laws

THE MIDWIFERY LICENSING ACT OF 1993

Note: Governor Gray Davis signed SB1479 into law on September 1, 2000
revising The Midwifery Practice Act of 1993 governing the practices of licensed direct-entry (non-nurse)
midwives who practice in out of hopsital settings, requiring that Licensed Midwives make
arrangements for medical consultation with a Supervising Physician
and arrangements for transfer of care to a physician during the prenatal, labor, and postpartum periods,
and to disclose the status of whether or not they carry malpractice insurance.

The Codes Governing Nurse Midwifery in California


THE LICENSED MIDWIFERY LAW:

CALIFORNIA CODES BUSINESS AND PROFESSIONS CODE SECTION 2505-2521


2505. This article shall be known and may be cited as the Licensed Midwifery Practice Act of 1993.

2506. As used in this article the following definitions shall apply: (a) "Board" means the Division of Licensing of the Medical Board of California. (b) "Licensed midwife" means an individual to whom a license to practice midwifery has been issued pursuant to this article. (c) "Certified nurse-midwife" means a person to whom a certificate has been issued pursuant to Article 2.5 (commencing with Section 2746) of Chapter 6. (d) "Accrediting organization" means an organization recognized by the United States Department of Education, Division of Accreditation.

2507. (a) The license to practice midwifery authorizes the holder, under the supervision of a licensed physician and surgeon, to attend cases of normal childbirth and to provide prenatal, intrapartum, and postpartum care, including family-planning care, for the mother, and immediate care for the newborn. (b) As used in this article, the practice of midwifery constitutes the furthering or undertaking by any licensed midwife, under the supervision of a licensed physician and surgeon who has current practice or training in obstetrics, to assist a woman in childbirth so long as progress meets criteria accepted as normal. All complications shall be referred to a physician immediately. The practice of midwifery does not include the assisting of childbirth by any artificial, forcible, or mechanical means, nor the performance of any version. (c) As used in this article, "supervision" shall not be construed to require the physical presence of the supervising physician. (d) The ratio of licensed midwives to supervising physicians shall not be greater than four individual licensed midwives to one individual supervising physician. (e) A midwife is not authorized to practice medicine and surgery by this article.

2508. (a) If a licensed midwife does not have liability coverage for the practice of midwifery, he or she shall disclose to a client that fact. (b) A licensed midwife shall disclose to a client that a specific physician is being briefed regularly concerning the client's pregnancy and that the physician is prepared to take care of complications in the hospital if necessary.

2511. (a) No person, other than one who has been licensed to practice midwifery by the board, shall hold himself or herself out as a licensed midwife, or use any other term indicating or implying that he or she is a licensed midwife. (b) Nothing in this article shall be construed to limit in any manner the practice of an individual to whom a certificate has been issued pursuant to Article 2.5 (commencing with Section 2746) of Chapter 6, or to prevent an individual to whom a certificate has been issued pursuant to Article 2.5 (commencing with Section 2746) of Chapter 6 from holding himself or herself out as a certified nurse-midwife, nurse midwife, midwife, or from using the initials "CNM."

2512. The board shall issue a license to practice midwifery to all applicants who meet the requirements of this article and who pay the fee required by Section 2520.

2512.5. A person is qualified for a license to practice midwifery when he or she satisfies one of the following requirements: (a) (1) Successful completion of a three-year postsecondary midwifery education program accredited by an accrediting organization recognized by the United States Department of Education, Division of Accreditation. Upon successful completion of the education requirements of this article, the applicant shall successfully complete a comprehensive licensing examination adopted by the board which is equivalent, but not identical, to the examination given by the American College of Nurse Midwives. (2) The midwifery education program curriculum shall consist of not less than 84 semester units or 126 quarter units. The course of instruction shall be presented in semester or quarter units under the following formula: (A) One hour of instruction in the theory each week throughout a semester or quarter equals one unit. (B) Three hours of clinical practice each week throughout a semester or quarter equals one unit. (3) The midwifery education program shall provide both academic and clinical preparation equivalent, but not identical to that provided in programs accredited by the American College of Nurse Midwives, which shall include, but not be limited to, preparation in all of the following areas: (A) The art and science of midwifery, one-half of which shall be in theory and one-half of which shall be in clinical practice. Theory and clinical practice shall be concurrent in the areas of maternal and child health, including, but not limited to, labor and delivery, neonatal well care, and postpartum care. (B) Communications skills that include the principles of oral, written, and group communications. (C) Anatomy and physiology, genetics, obstetrics and gynecology, embryology and fetal development, neonatology, applied microbiology, chemistry, child growth and development, pharmacology, nutrition, laboratory diagnostic tests and procedures, and physical assessment. (D) Concepts in psychosocial, emotional, and cultural aspects of maternal and child care, human sexuality, counseling and teaching, maternal and infant and family bonding process, breast feeding, family planning, principles of preventive health, and community health. (E) Aspects of the normal pregnancy, labor and delivery, postpartum period, newborn care, family planning or routine gynecological care in alternative birth centers, homes, and hospitals. (F) The following shall be integrated throughout the entire curriculum: (i) Midwifery process. (ii) Basic intervention skills in preventive, remedial, and supportive midwifery. (iii) The knowledge and skills required to develop collegial relationships with health care providers from other disciplines. (iv) Related behavioral and social sciences with emphasis on societal and cultural patterns, human development, and behavior related to maternal and child health, illness, and wellness. (G) Instruction shall also be given in personal hygiene, client abuse, cultural diversity, and the legal, social, and ethical aspects of midwifery. (H) The program shall include the midwifery management process, which shall include all of the following: (i) Obtaining or updating a defined and relevant data base for assessment of the health status of the client. (ii) Identifying problems based upon correct interpretation of the data base. (iii) Preparing a defined needs or problem list, or both, with corroboration from the client. (iv) Consulting, collaborating with, and referring to, appropriate members of the health care team. (v) Providing information to enable clients to make appropriate decisions and to assume appropriate responsibility for their own health. (vi) Assuming direct responsibility for the development of comprehensive, supportive care for the client and with the client. (vii) Assuming direct responsibility for implementing the plan of care. (viii) Initiating appropriate measures for obstetrical and neonatal emergencies. (ix) Evaluating, with corroboration from the client, the achievement of health care goals and modifying the plan of care appropriately. (b) Successful completion of an educational program that the board has determined satisfies the criteria of subdivision (a) and current licensure as a midwife by a state with licensing standards that have been found by the board to be equivalent to those adopted by the board pursuant to this article.

2513. (a) An approved midwifery education program shall offer the opportunity for students to obtain credit by examination for previous midwifery education and clinical experience. The applicant shall demonstrate, by practical examination, the clinical competencies described in Section 2514 or established by regulation pursuant to Section 2514.5. The midwifery education program's credit by examination policy shall be approved by the board, and shall be available to applicants upon request. The proficiency and practical examinations shall be approved by the board. (b) Completion of clinical experiences shall be verified by a licensed midwife or certified nurse-midwife, and a physician and surgeon, all of whom shall be current in the knowledge and practice of obstetrics and midwifery. Physicians and surgeons, licensed midwives, and certified nurse-midwives who participate in the verification and evaluation of an applicant's clinical experiences shall show evidence of current practice. The method used to verify clinical experiences shall be approved by the board. (c) Upon successful completion of the requirements of paragraphs (1) and (2), the applicant shall also complete the licensing examination described in paragraph (1) of subdivision (a).

2514.5. (a) Within 60 days following January 1, 1998, the board shall adopt regulations setting forth educational requirements. To develop these regulations, the board shall update the educational requirements set forth in Sections 2512.5, 2513, and 2514. These updated sections shall reflect national standards for the practice of midwifery and shall be subject to public hearings prior to adoption. The board shall review and update the regulations every two years. (b) The board shall adopt the written examination required by this article by July 1, 1994.

2515. The board shall approve specific educational programs intended to meet the requirements of subdivision (a) of Section 2512.5 and Section 2514 for the course of academic study, documentation of experience and skill, and clinical evaluation. These programs shall also be accredited by an accrediting organization approved by the board.

2515.5. Each applicant shall show by evidence satisfactory to the board that he or she has met the educational standards established by the board pursuant to this article or the equivalent thereof.

2517. A person who has been convicted of a misdemeanor violation of Section 2052, prior to the effective date of this article, shall not be barred from licensure under this article solely because of that conviction.

2518. (a) Licenses issued pursuant to this article shall be renewable every two years upon payment of the fee prescribed by Section 2520 and submission of documentation that the licenseholder has completed 36 hours of continuing education in areas that fall within the scope of the practice of midwifery, as specified by the board. (b) Each license not renewed shall expire, but may be reinstated within five years from the expiration upon payment of the prescribed fee and upon submission of proof of the applicant's qualifications as the board may require.

2519. The board may suspend or revoke the license of a midwife for any of the following: (a) Unprofessional conduct, which includes, but is not limited to, all of the following: (1) Incompetence or gross negligence in carrying out the usual functions of a licensed midwife. (2) Conviction of a violation of Section 2052, in which event, the record of the conviction shall be conclusive evidence thereof. (3) The use of advertising which is fraudulent or misleading. (4) Obtaining or possessing in violation of law, or prescribing, or except as directed by a licensed physician and surgeon, dentist, or podiatrist administering to himself or herself, or furnishing or administering to another, any controlled substance as defined in Division 10 (commencing with Section 11000) of the Health and Safety Code or any dangerous drug as defined in Article 8 (commencing with Section 4210) of Chapter 9 of Division 2 of the Business and Professions Code. (5) The use of any controlled substance as defined in Division 10 (commencing with Section 11000) of the Health and Safety Code, or any dangerous drug as defined in Article 8 (commencing with Section 4210) of Chapter 9 of Division 2 of the Business and Professions Code, or alcoholic beverages, to an extent or in a manner dangerous or injurious to himself or herself, any other person, or the public or to the extent that such use impairs his or her ability to conduct with safety to the public the practice authorized by his or her license. (6) Conviction of a criminal offense involving the prescription, consumption, or self-administration of any of the substances described in paragraphs (4) and (5), or the possession of, or falsification of, a record pertaining to, the substances described in paragraph (4), in which event the record of the conviction is conclusive evidence thereof. (7) Commitment or confinement by a court of competent jurisdiction for intemperate use of or addiction to the use of any of the substances described in paragraphs (4) and (5), in which event the court order of commitment or confinement is prima facie evidence of such commitment or confinement. (8) Falsifying, or making grossly incorrect, grossly inconsistent, or unintelligible entries in any hospital, patient, or other record pertaining to the substances described in subdivision (a). (b) Procuring a license by fraud or misrepresentation. (c) Conviction of a crime substantially related to the qualifications, functions, and duties of a midwife, as determined by the board. (d) Procuring, aiding, abetting, attempting, agreeing to procure, offering to procure, or assisting at, a criminal abortion. (e) Violating or attempting to violate, directly or indirectly, or assisting in or abetting the violation of, or conspiring to violate any provision or term of this chapter. (f) Making or giving any false statement or information in connection with the application for issuance of a license. (g) Impersonating any applicant or acting as proxy for an applicant in any examination required under this chapter for the issuance of a license or a certificate. (h) Impersonating another licensed practitioner, or permitting or allowing another person to use his or her license or certificate for the purpose of providing midwifery services. (i) Aiding or assisting, or agreeing to aid or assist any person or persons, whether a licensed physician or not, in the performance of or arranging for a violation of any of the provisions of Article 12 (commencing with Section 2221) of Chapter 5.

2520. (a) (1) The fee to be paid upon the filing of a license application shall be fixed by the board at not less than seventy-five dollars ($75) nor more than three hundred dollars ($300). (2) The fee for renewal of the midwife license shall be fixed by the board at not less than fifty dollars ($50) nor more than two hundred dollars ($200). (3) The delinquency fee for renewal of the midwife license shall be 50 percent of the renewal fee in effect on the date of the renewal of the license, but not less than twenty-five dollars ($25) nor more than fifty dollars ($50). (4) The fee to be paid for the licensing examination shall be fixed by the board at not less than two hundred dollars ($200) nor more than three hundred fifty dollars ($350). (b) The fees prescribed by this article shall be deposited in the Licensed Midwifery Fund, which is hereby established, and shall be available, upon appropriation, to the board for the purposes of this article.

2521. Any person who violates this article is guilty of a misdemeanor.

For answers to your questions about the midwifery licensing challenge program established by Seattle Midwifery School and California Association of Midwives, please contact Carrie Sparrevohn, LM at 530-750-2220 or e-mail her at: beads@davis.com.

If you are a licensed midwife who is having problems with barriers to practice, please contact Karen Ehrich, LM, CPM in Northern California at 408-425-3326, or Paula Tipton-Healy, LM in Southern California at 760-944-3987.

If you are an aspiring midwife desiring information on entering the profession, please go to: www.socalbirth.org/pathways/



CODES PERTAINING TO NURSE-MIDWFERY PRACTICE

2746. The board shall issue a certificate to practice nurse-midwifery to any person who qualifies under this article and is licensed pursuant to the provisions of this chapter.

2746.1. Every applicant for a certificate to practice nurse-midwifery shall comply with all the provisions of this article in addition to the provisions of this chapter.

2746.2. Each applicant shall show by evidence satisfactory to the board that he has met the educational standards established by the board or has at least the equivalent thereof. The board is authorized to appoint a committee of qualified physicians and nurses, including, but not limited to, obstetricians and nurse-midwives, to develop the necessary standards relating to educational requirements, ratios of nurse-midwives to supervising physicians, and associated matters.

2746.3. Midwife's certificates issued by the Medical Board of California prior to the effective date of this article shall be renewable only by such board.

2746.4. Nothing in this article shall be construed to prevent the practice of midwifery by a person possessing a midwife's certificate issued by the Medical Board of California on the effective date of this article.

2746.5. The certificate to practice nurse-midwifery authorizes the holder, under the supervision of a licensed physician and surgeon, to attend cases of normal childbirth and to provide prenatal, intrapartum, and postpartum care, including family-planning care, for the mother, and immediate care for the newborn. As used in this chapter, the practice of nurse-midwifery constitutes the furthering or undertaking by any certified person, under the supervision of a licensed physician and surgeon who has current practice or training in obstetrics, to assist a woman in childbirth so long as progress meets criteria accepted as normal. All complications shall be referred to a physician immediately. The practice of nurse-midwifery does not include the assisting of childbirth by any artificial, forcible, or mechanical means, nor the performance of any version. As used in this article, "supervision" shall not be construed to require the physical presence of the supervising physician. A nurse-midwife is not authorized to practice medicine and surgery by the provisions of this chapter.

2746.51. Neither this chapter nor any other provision of law shall be construed to prohibit a certified nurse-midwife from furnishing drugs or devices when all of the following apply: (a) The drugs or devices are furnished incidentally to the provision of family planning services, as defined in Section 14503 of the Welfare and Institutions Code, or are furnished incidental to the provision of routine health care or perinatal care, as defined in subdivision (d) of Section 284 of the Health and Safety Code, rendered to essentially healthy persons within a facility specified in subdivision (a), except in the case of sole practitioners, and subdivision (b), (c), (d), (i), or (j) of Section 1206 of, a clinic as specified in Section 1204 of, a general acute care hospital as defined in subdivision (a) of Section 1250 of, or a special hospital specified as a maternity hospital in subdivision (f) of Section 1250 of, the Health and Safety Code. (b) The certified nurse-midwife is functioning pursuant to a standardized procedure, as defined by current law in Section 2725. The standardized procedure shall be developed and approved by the supervising physician and surgeon, the certified nurse-midwife, and the facility administrator or his or her designee. (c) The standardized procedure covering the furnishing of drugs or devices shall specify which certified nurse-midwife may furnish drugs or devices, which drugs or devices may be furnished, under what circumstances, the extent of physician and surgeon supervision, the method of periodic review of the certified nurse-midwife's competence, including peer review, and review of the provisions of the standardized procedure. (d) The furnishing of drugs or devices by a certified nurse-midwife occurs under physician and surgeon supervision. Physician and surgeon supervision shall not be construed to require the physical presence of the physician, but does include (1) collaboration on the development of the standardized procedure, (2) approval of the standardized procedure, and (3) availability by telephonic contact at the time of patient examination by the certified nurse-midwife. (e) For purposes of this section, no physician and surgeon shall supervise more than four certified nurse-midwives at one time. (f) Drugs or devices furnished by a certified nurse-midwife shall not include controlled substances under the California Uniform Controlled Substances Act, (Division 10 (commencing with Section 11000) of the Health and Safety Code) and shall be further limited to those drugs agreed upon by the certified nurse-midwife and physician and surgeon and specified in the standardized procedure. (g) The board has certified in accordance with subdivision (h) that the certified nurse-midwife has satisfactorily completed (1) at least six month's physician and surgeon supervised experience in the furnishing of drugs or devices and (2) a course in pharmacology covering the drugs or devices to be furnished under this section. The board shall establish the requirements for satisfactory completion of this subdivision. (h) The furnishing of drugs or devices by certified nurse-midwives is conditional on the issuance by the board of a number to the applicant who has successfully completed the requirements of subdivision (g). The number shall be included on all transmittals of orders for drugs or devices by the certified nurse-midwife. The board shall make the list available to the California State Board of Pharmacy. The board shall charge the applicant fees for application, renewal, and penalty for failure to timely renew that are equal to the fees charged to nurse practitioners pursuant to Section 2836.3. (i) Furnishing of drugs or devices by a certified nurse-midwife means the act of making a pharmaceutical agent or agents available to the patient in strict accordance with a standardized procedure.

2746.52. Notwithstanding Section 2746.5, the certificate to practice nurse-midwifery authorizes the holder to perform and repair episiotomies, and to repair first-degree and second-degree lacerations of the perineum, in a licensed acute care hospital, as defined in subdivision (a) of Section 1250 of the Health and Safety Code, and a licensed alternate birth center, as defined in paragraph (4) of subdivision (b) of Section 1204 of the Health and Safety Code, but only if all of the following conditions are met: (a) The supervising physician and surgeon and any backup physician and surgeon is credentialed to perform obstetrical care in the facility. (b) The episiotomies are performed pursuant to protocols developed and approved by all of the following: (1) The supervising physician and surgeon. (2) The certified nurse-midwife. (3) The director of the obstetrics department or the director of the family practice department, or both, if a physician and surgeon in the obstetrics department or the family practice department is a supervising physician and surgeon, or an equivalent person if there is no specifically identified obstetrics department or family practice department. (4) The interdisciplinary practices committee, if applicable. (5) The facility administrator or his or her designee. (c) The protocols, and the procedures which shall be developed pursuant to the protocols, shall relate to the performance and repair of episiotomies and the repair of first-degree and second-degree lacerations of the perineum, and shall do all of the following: (1) Ensure that all complications are referred to a physician and surgeon immediately. (2) Ensure immediate care of patients who are in need of care beyond the scope of practice of the certified nurse midwife, or emergency care for times when the supervising physician and surgeon is not on the premises. (3) Establish the number of certified nurse-midwives that a supervising physician and surgeon may supervise.

2746.7. An applicant for certification pursuant to this article shall submit a written application in the form prescribed by the board, accompanied by the fee prescribed by Section 2815.5.

2746.8. Each certificate issued pursuant to this article shall be renewable biennially, and each person holding a certificate under this article shall apply for a renewal of his certificate and pay the biennial renewal fee required by Section 2815.5 every two years on or before the last day of the month following the month in which his birthday occurs, beginning with the second birthday following the date on which the certificate was issued, whereupon the board shall renew the certificate. Each such certificate not renewed in accordance with this section shall expire but may within a period of eight years thereafter be reinstated upon payment of the biennial renewal fee and penalty fee required by Section 2815.5 and upon submission of such proof of the applicant's qualifications as may be required by the board, except that during such eight-year period no examination shall be required as a condition for the reinstatement of any such expired certificate which has lapsed solely by reason of nonpayment of the renewal fee. After the expiration of such eight-year period the board may require as a condition of reinstatement that the applicant pass such examination as it deems necessary to determine his present fitness to resume the practice of nurse-midwifery.



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