SECTIONS 2505-2521 - California Statutes

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 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 approved by
the board.

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 and surgeon
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 and
surgeon.
(d) The ratio of licensed midwives to supervising physicians and
surgeons shall not be greater than four individual licensed midwives
to one individual supervising physician and surgeon.
(e) A midwife is not authorized to practice medicine and surgery
by this article.
(f) The board shall, not later than July 1, 2003, adopt in
accordance with the Administrative Procedure Act (Chapter 3.5
(commencing with Section 11340) of Part 1 of Division 3 of Title 2 of
the Government Code), regulations defining the appropriate standard
of care and level of supervision required for the practice of
midwifery.

2508. (a) A licensed midwife shall disclose in oral and written
form to a prospective client all of the following:
(1) All of the provisions of Section 2507.
(2) If the licensed midwife does not have liability coverage for
the practice of midwifery, he or she shall disclose that fact.
(3) 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.
(4) The procedure for reporting complaints to the Medical Board of
California.
(b) The disclosure shall be signed by both the licensed midwife
and the client and a copy of the disclosure shall be placed in the
client's medical record.
(c) The Medical Board of California may prescribe the form for the
written disclosure statement required to be used by a licensed
midwife under this section.

2509. The board shall create and appoint a Midwifery Advisory
Council consisting of licensees of the board in good standing, who
need not be members of the board, and members of the public who have
an interest in midwifery practice, including, but not limited to,
home births. At least one-half of the council members shall be
California licensed midwives. The council shall make recommendations
on matters specified by the board.

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
approved by the board. 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. The examination for licensure
as a midwife may be conducted by the Division of Licensing under a
uniform examination system, and the division may contract with
organizations to administer the examination in order to carry out
this purpose. The Division of Licensing may, in its discretion,
designate additional written examinations for midwifery licensure
that the division determines are equivalent 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) of Section
2512.5.

2514. Nothing in this chapter shall be construed to prevent a bona
fide student who is enrolled or participating in a midwifery
education program or who is enrolled in a program of supervised
clinical training from engaging in the practice of midwifery in this
state, as part of his or her course of study, if both of the
following conditions are met:
(a) The student is under the supervision of a licensed midwife,
who holds a clear and unrestricted license in this state, who is
present on the premises at all times client services are provided,
and who is practicing pursuant to Section 2507, or a physician and
surgeon.
(b) The client is informed of the student's status.

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.

2516. (a) Each licensed midwife who assists, or supervises a
student midwife in assisting, in childbirth that occurs in an
out-of-hospital setting shall annually report to the Office of
Statewide Health Planning and Development. The report shall be
submitted no later than March 30, with the first report due in March
2008, for the prior calendar year, in a form specified by the board
and shall contain all of the following:
(1) The midwife's name and license number.
(2) The calendar year being reported.
(3) The following information with regard to cases in California
in which the midwife, or the student midwife supervised by the
midwife, assisted during the previous year when the intended place of
birth at the onset of care was an out-of-hospital setting:
(A) The total number of clients served as primary caregiver at the
onset of care.
(B) The total number of clients served with collaborative care
available through, or given by, a licensed physician and surgeon.
(C) The total number of clients served under the supervision of a
licensed physician and surgeon.
(D) The number by county of live births attended as primary
caregiver.
(E) The number, by county, of cases of fetal demise, infant
deaths, and maternal deaths attended as primary caregiver at the
discovery of the demise or death.
(F) The number of women whose primary care was transferred to
another health care practitioner during the antepartum period, and
the reason for each transfer.
(G) The number, reason, and outcome for each elective hospital
transfer during the intrapartum or postpartum period.
(H) The number, reason, and outcome for each urgent or emergency
transport of an expectant mother in the antepartum period.
(I) The number, reason, and outcome for each urgent or emergency
transport of an infant or mother during the intrapartum or immediate
postpartum period.
(J) The number of planned out-of-hospital births at the onset of
labor and the number of births completed in an out-of-hospital
setting.
(K) The number of planned out-of-hospital births completed in an
out-of-hospital setting that were any of the following:
(i) Twin births.
(ii) Multiple births other than twin births.
(iii) Breech births.
(iv) Vaginal births after the performance of a cesarean section.
(L) A brief description of any complications resulting in the
morbidity or mortality of a mother or an infant.
(M) Any other information prescribed by the board in regulations.
(b) The Office of Statewide Health Planning and Development shall
maintain the confidentiality of the information submitted pursuant to
this section, and shall not permit any law enforcement or regulatory
agency to inspect or have copies made of the contents of any reports
submitted pursuant to subdivision (a) for any purpose, including,
but not limited to, investigations for licensing, certification, or
regulatory purposes.
(c) The office shall report to the board, by April 30, those
licensees who have met the requirements of subdivision (a) for that
year.
(d) The board shall send a written notice of noncompliance to each
licensee who fails to meet the reporting requirement of subdivision
(a). Failure to comply with subdivision (a) will result in the
midwife being unable to renew his or her license without first
submitting the requisite data to the Office of Statewide Health
Planning and Development for the year for which that data was missing
or incomplete. The board shall not take any other action against the
licensee for failure to comply with subdivision (a).
(e) The board, in consultation with the office and the Midwifery
Advisory Council, shall devise a coding system related to data
elements that require coding in order to assist in both effective
reporting and the aggregation of data pursuant to subdivision (f).
The office shall utilize this coding system in its processing of
information collected for purposes of subdivision (f).
(f) The office shall report the aggregate information collected
pursuant to this section to the board by July 30 of each year. The
board shall include this information in its annual report to the
Legislature.
(g) Notwithstanding any other provision of law, a violation of
this section shall not be a crime.

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 for the examination shall be the cost of administering
the examination to the applicant, as determined by the organization
that has entered into a contract with the Division of Licensing for
the purposes set forth in subdivision (a) of Section 2512.5.
Notwithstanding subdivision (b), that fee may be collected and
retained by that organization.
(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.