Midwives

The Midwifery Practice Act specifies the requirements for licensure and the scope of practice for a licensed midwife. Assembly Bill 1308 (Bonilla, Chapter 665, Statutes of 2013) made significant amendments to various Business and Professions Code sections governing the practice of midwifery in California. The changes became effective January 1, 2014. The law provides that:

• The holder of a midwifery license may attend cases of normal pregnancy and childbirth (see definition below) and provide prenatal, intrapartum, and postpartum care, including family-planning care, for the mother, and immediate care for the newborn.
• The practice of midwifery does not include the assisting of childbirth by any artificial, forcible, or mechanical means, nor the performance of any version of these means.
• Midwives are not authorized to practice medicine or to perform surgery.
• Licensed midwives are authorized to directly obtain supplies and devices, obtain and administer drugs and diagnostic tests, order testing, and receive reports that are necessary to the practice of midwifery and consistent with their scope of practice.
• No person, other than a licensed midwife, may hold themselves out as a licensed midwife or use any other term which may indicate or imply that they are a licensed midwife.

Normal Pregnancy / Required Referrals / Transfer of Care

• The licensed midwife may assist a woman in childbirth as long as progress meets criteria accepted as normal.
• Normal pregnancy and childbirth is defined as meeting all of the following conditions:
  1. There is an absence of any preexisting maternal disease or condition likely to affect the pregnancy.
  2. There is an absence of significant disease arising from the pregnancy.
  3. There is a singleton fetus.
  4. There is a cephalic presentation.
  5. The gestational age of the fetus is greater than 37 0⁄7 weeks and less than 42 0⁄7 completed weeks of pregnancy.
  6. Labor is spontaneous or induced in an outpatient setting.
• If a potential client does not meet criteria #1 and #2 above, but does meet criteria #3-#6, and still wishes to be a client of the midwife, the midwife must provide the woman with a referral for an examination by a physician trained in obstetrics and gynecology. If the physician determines that the risk factors presented by the client's disease or condition are not likely to significantly affect the course of pregnancy and childbirth, then the midwife may assist the woman in pregnancy and childbirth.
• If at any point during a pregnancy, childbirth, or postpartum care a client's condition deviates from normal, the licensed midwife must immediately refer or transfer the client to a physician. The licensed midwife may consult and remain in consultation with the physician after the referral or transfer.
• If the physician determines that the client's condition or concern has been resolved such that the risk factors are not likely to significantly affect the course of pregnancy or childbirth, the licensed midwife may resume primary care of the client.
• If, however, the physician determines that the client's condition or concern has not been resolved, the licensed midwife may provide concurrent care with a physician and, if authorized by the client, be present during the labor and childbirth, and resume postpartum care, if appropriate. The licensed midwife may not resume primary care of the client under these circumstances.
• A licensed midwife may not provide or continue to provide midwifery care to a woman with a risk factor that will significantly affect the course of pregnancy and childbirth, regardless of whether a woman has consented to this care or refused care by a physician.
• If a client is transferred to a hospital, the licensed midwife must provide records, including prenatal records, and speak with the receiving physician and surgeon about labor up to the point of the transfer. The hospital shall report each transfer of a planned out-of-hospital birth to the Medical Board of California (Board) and the California Maternal Quality Care Collaborative using a standardized form developed by the Board.

Mandatory Disclosure

A licensed midwife must disclose to a prospective client, both orally and in writing, and obtain the client's informed consent for all of the following:

• The client is retaining a licensed midwife, not a certified nurse-midwife, and the licensed midwife is not supervised by a physician and surgeon.
• The midwife's current licensure status and license number.
• The practice settings in which the licensed midwife practices.
• Whether or not he or she has liability coverage for the practice of midwifery.
• The fact that many physicians do not have liability insurance coverage for services provided to someone having a planned out-of-hospital birth.
• Acknowledgment that if the client is advised to consult with a physician, failure to do so may affect the client's legal rights in any professional negligence actions against a physician, licensed health care professional, or hospital.
• There are conditions that are outside the scope of practice of a licensed midwife that will result in a referral for a consultation from, or transfer of care to, a physician.
• The specific arrangements for the transfer of care during the prenatal period, hospital transfer during the intrapartum and postpartum periods, and access to appropriate emergency medical services for mother and baby if necessary, and recommendations for preregistration at a hospital that has obstetric emergency services and is most likely to receive the transfer.
• If, during the course of care, the client is informed that she has or may have a condition indicating the need for a mandatory transfer, the licensed midwife must initiate the transfer.
• The laws regulating licensed midwifery practices and the procedure for reporting complaints to the Board are available on the Board's website.
• Consultation with a physician does not alone create a physician-patient relationship or any other relationship with the physician. The informed consent must specifically state that the licensed midwife and the consulting physician are not employees, partners, associates, agents, or principals of one another. The licensed midwife must inform the patient that they are independently licensed and practicing midwifery and in that regard are solely responsible for the services they provide.
• The disclosure and consent must be signed by both the licensed midwife and the client and a copy of the disclosure and consent must be placed in the client's medical record.

View a sample disclosure and consent form meeting these requirements.

Licensed Midwife Annual Report

• Each midwife who assists, or supervises a student midwife in assisting, in childbirth that occurs in an out-of-hospital setting must annually report to the Office of Statewide Health Planning and Development (OSHPD). The report must be submitted no later than March 30th, for the prior calendar year.

Discipline

The Board may suspend, revoke, or place on probation the license of a licensed midwife, or take other appropriate disciplinary action for any of the following:

• Unprofessional conduct.
• Procuring a license by fraud or misrepresentation.
• Conviction of a crime substantially related to the qualifications, function and duties of a licensed midwife.
• Procuring, aiding, abetting, attempting, agreeing to procure, offering to procure, or assisting at, a criminal abortion.
• 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 the laws regulating midwives.
• Making or giving false statements or information in connection with the application for issuance of a license.
• Impersonating any applicant or acting as proxy for any applicant in an examination required for licensure.
• Impersonating another licensed practitioner, or permitting or allowing another person to use their license for the purpose of providing midwifery services.
• 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 of Chapter 5. Violators of this article are guilty of a misdemeanor.
• Failing to do any of the following when required:
  1. Consult with a physician and surgeon.
  2. Refer a client to a physician and surgeon.
  3. Transfer a client to a hospital.