H.F. 449 Section 1. Section 147.1, subsections 3 and 6, Code 2011, 1 are amended to read as follows: 2 3. “Licensed” or “certified” , when applied to a physician 3 and surgeon, podiatric physician, osteopathic physician and 4 surgeon, physician assistant, psychologist, chiropractor, 5 nurse, dentist, dental hygienist, dental assistant, 6 optometrist, speech pathologist, audiologist, pharmacist, 7 physical therapist, physical therapist assistant, occupational 8 therapist, occupational therapy assistant, respiratory care 9 practitioner, practitioner of cosmetology arts and sciences, 10 practitioner of barbering, funeral director, dietitian, marital 11 and family therapist, mental health counselor, social worker, 12 massage therapist, midwife, athletic trainer, acupuncturist, 13 nursing home administrator, hearing aid dispenser, or sign 14 language interpreter or transliterator means a person licensed 15 under this subtitle. 16 6. “Profession” means medicine and surgery, podiatry, 17 osteopathic medicine and surgery, practice as a physician 18 assistant, psychology, chiropractic, nursing, dentistry, 19 dental hygiene, dental assisting, optometry, speech pathology, 20 audiology, pharmacy, physical therapy, physical therapist 21 assisting, occupational therapy, occupational therapy 22 assisting, respiratory care, cosmetology arts and sciences, 23 barbering, mortuary science, marital and family therapy, 24 mental health counseling, social work, dietetics, massage 25 therapy, midwifery, athletic training, acupuncture, nursing 26 home administration, hearing aid dispensing, or sign language 27 interpreting or transliterating. 28 Sec. 2. Section 147.2, subsection 1, Code 2011, is amended 29 to read as follows: 30 1. A person shall not engage in the practice of medicine 31 and surgery, podiatry, osteopathic medicine and surgery, 32 psychology, chiropractic, physical therapy, physical therapist 33 assisting, nursing, dentistry, dental hygiene, dental 34 assisting, optometry, speech pathology, audiology, occupational 35 -1- LSB 1641YH (7) 84 jr/nh 1/ 9

H.F. 449 therapy, occupational therapy assisting, respiratory care, 1 pharmacy, cosmetology arts and sciences, barbering, social 2 work, dietetics, marital and family therapy or mental health 3 counseling, massage therapy, midwifery, mortuary science, 4 athletic training, acupuncture, nursing home administration, 5 hearing aid dispensing, or sign language interpreting 6 or transliterating, or shall not practice as a physician 7 assistant, unless the person has obtained a license for that 8 purpose from the board for the profession. 9 Sec. 3. Section 147.13, Code 2011, is amended by adding the 10 following new subsection: 11 NEW SUBSECTION . 24. For midwifery, the board of midwifery. 12 Sec. 4. Section 147.14, subsection 1, Code 2011, is amended 13 by adding the following new paragraph: 14 NEW PARAGRAPH . x. For midwifery, a total of seven members, 15 three members who are licensed midwives under chapter 148F; 16 one member who is licensed under chapter 148, is a practicing 17 family physician, and has professional experience consulting 18 for and collaborating with direct-entry midwives; one member 19 who is an advanced registered nurse practitioner licensed under 20 chapter 152, is a certified nurse midwife, and has professional 21 experience consulting for and collaborating with direct-entry 22 midwives; and two members who are not licensed midwives or 23 licensed health care providers who have received direct-entry 24 midwifery services and who shall represent the general public. 25 Sec. 5. Section 147.74, Code 2011, is amended by adding the 26 following new subsection: 27 NEW SUBSECTION . 5A. A midwife licensed under chapter 148F 28 may use the words “licensed midwife” or the initials “L.M.” 29 after the person’s name. 30 Sec. 6. NEW SECTION . 148F.1 Definitions. 31 As used in this chapter, unless the context otherwise 32 requires: 33 1. “Board” means the board of midwifery. 34 2. “Licensed midwife” means a person who is licensed to 35 -2- LSB 1641YH (7) 84 jr/nh 2/ 9

H.F. 449 practice midwifery as provided in this chapter. 1 3. “Out-of-hospital” means any facility, institution, or 2 place which is not an ambulatory surgical center or a hospital, 3 such as a birth center as defined in section 135.61 or a 4 private home. 5 4. “Practice of midwifery” means the provision of primary 6 maternity care during the antepartum, intrapartum, and 7 postpartum periods by a person who is neither licensed to 8 practice under chapter 148 or 148C, nor a nurse recognized 9 by the Iowa board of nursing as an advanced registered nurse 10 practitioner who is a certified nurse midwife, and who is not 11 rendering emergency services without compensation. “Practice 12 of midwifery” may also include the carrying and administration 13 of certain medications during the practice of midwifery, 14 including oxytocin, as a postpartum antihemorrhagic agent, 15 oxygen, intravenous fluids for stabilization, vitamin K, eye 16 prophylactics, and other drugs or procedures as appropriate for 17 the scope of practice for licensed midwives as determined by 18 the board. 19 Sec. 7. NEW SECTION . 148F.2 Licensure —— licensed 20 midwifery. 21 1. Beginning July 1, 2013, every person practicing 22 midwifery in this state shall be licensed pursuant to this 23 chapter. The board shall adopt rules pursuant to chapters 17A, 24 147, and 272C establishing procedures for the licensing of new 25 and practicing midwives. 26 2. Prior to obtaining licensure, an applicant shall 27 successfully pass an examination prescribed and approved by 28 the board as determined in rule demonstrating competencies 29 in at least all of the following areas: risk assessment 30 and management; prenatal care; management of normal labor, 31 birth, and postpartum; newborn care up to six weeks; and adult 32 cardiopulmonary resuscitation and newborn resuscitation. 33 3. The applicant shall provide documentation, satisfactory 34 to the board, of all of the following: 35 -3- LSB 1641YH (7) 84 jr/nh 3/ 9

H.F. 449 a. Knowledge and proficiency of all didactic components 1 of midwifery, including definitions, signs and symptoms, 2 differential diagnosis for risk assessment, stabilization and 3 treatment, follow-up, referral, and transport. 4 b. Complete and thorough preparation as an assistant 5 midwife prior to assuming responsibility as a primary midwife. 6 Clinical care performed under supervision during training 7 including, at a minimum: 8 (1) Seventy-five prenatal exams. 9 (2) Twenty births as an assistant midwife. 10 (3) Twenty births as primary midwife from the onset of labor 11 to the delivery of the placenta and the stabilization of mother 12 and newborn. 13 (4) Twenty newborn exams. 14 (5) Forty postpartum exams. 15 c. Assessment and verification of performance of skills 16 during an intensive, hands-on skills assessment, performed for 17 and scored by an evaluator approved by the board. 18 d. Passage of a three-hundred-fifty-item national board 19 examination that covers all aspects of midwifery care as 20 identified by job analysis. 21 e. Evidence that the applicant has provided prenatal, 22 intrapartal, and postpartal care as well newborn assessment, 23 equivalent to a minimum of one thousand three hundred fifty 24 clinical contact hours under the direct supervision of one or 25 more instructors approved by the North American registry of 26 midwives. 27 4. The applicant shall hold a certified professional 28 midwife credential issued by the North American registry of 29 midwives or any other nationally accredited credential as 30 specified by the board. If an applicant has been subject to 31 prior revocation of a license to practice medicine or nursing, 32 the applicant shall not be eligible for licensure under this 33 chapter, except as determined by the board. 34 5. The board may request, at the applicant’s expense, that 35 -4- LSB 1641YH (7) 84 jr/nh 4/ 9

H.F. 449 the department of public safety perform a criminal history 1 check and the department of human services perform child 2 and dependent abuse record checks of the applicant. If an 3 applicant has a criminal record or a record of founded child or 4 dependent adult abuse, the board shall perform an evaluation to 5 determine whether the record warrants denial of licensure. 6 Sec. 8. NEW SECTION . 148F.3 Use of title —— penalty. 7 A person shall not use the title licensed midwife, describe 8 or imply that the person is a licensed midwife, or represent 9 the person as a licensed midwife unless the person is granted a 10 license under this chapter or is licensed as a nurse-midwife 11 under chapter 152. 12 Sec. 9. NEW SECTION . 148F.4 Rules. 13 1. The board shall: 14 a. Adopt rules relating to standards for professional 15 conduct of persons licensed under this chapter. 16 b. Adopt rules consistent with this chapter and with 17 chapters 147 and 272C which are necessary for the performance 18 of its duties. 19 c. Act on matters concerning licensure and the processes 20 of applying for, granting, suspending, imposing supervisory 21 or probationary conditions upon, reinstating, and revoking a 22 license. 23 d. Administer the provisions of this chapter requiring 24 documentation required to demonstrate competence as a midwife, 25 and the processing of applications for licenses and license 26 renewal. 27 e. Develop continuing education requirements as a condition 28 of license renewal. 29 f. Evaluate requirements for licensure in other states to 30 determine if reciprocity may be granted. 31 g. Establish and collect licensure fees as provided in 32 section 147.80 and retain fees as provided in section 147.82. 33 h. Establish procedures for the issuance, renewal, and 34 revocation or suspension of a license under this chapter. 35 -5- LSB 1641YH (7) 84 jr/nh 5/ 9

H.F. 449 i. Maintain a registry of licensed midwives and statistics 1 on the practice of midwifery utilizing vital statistics data. 2 2. In establishing rules, the board may consult with 3 persons knowledgeable regarding the prenatal and postpartum 4 birth process, particularly those possessing experience with 5 out-of-hospital births, including but not limited to persons 6 licensed under chapter 148, certified professional midwives, 7 advanced registered nurse practitioners who are certified nurse 8 midwives, and women who have given birth in an out-of-hospital 9 setting. In establishing rules, the board shall reflect the 10 knowledge and skills identified by the North American registry 11 of midwives’ current job description for the profession and the 12 standards of practice of midwifery established by the national 13 association of certified professional midwives or a successor 14 organization. 15 3. Rules relating to the practice of midwifery shall 16 not be inconsistent with the North American registry of 17 midwives’ current job description for the profession and the 18 standards of practice of midwifery established by the national 19 association of certified professional midwives or a successor 20 organization, and shall not expand the scope of practice of 21 midwifery established by the national association of certified 22 professional midwives or a successor organization. 23 4. At such time as the board determines that liability 24 insurance is available at an affordable price to certified 25 professional midwives, the board may mandate such coverage. 26 Until that time, each midwife shall comply with the disclosure 27 requirements of this chapter. 28 Sec. 10. NEW SECTION . 148F.5 Client disclosure. 29 Prior to accepting a patient for midwifery care, a licensed 30 midwife shall provide information indicating all of the 31 following: 32 1. Evidence that the care provider is a licensed midwife 33 meeting the requirements of this chapter. 34 2. Whether the licensed midwife has malpractice liability 35 -6- LSB 1641YH (7) 84 jr/nh 6/ 9

H.F. 449 insurance coverage and the policy limits of such coverage. 1 3. The midwife’s educational background and relevant 2 experience, including experience in various birth settings. 3 4. The nature, scope, and location of the care to be 4 given, including the possibility of and the guidelines for 5 consultation, referral, or transfer of the patient to a 6 hospital from an out-of-hospital setting. 7 Sec. 11. NEW SECTION . 148F.6 Exceptions. 8 1. This chapter does not prevent qualified members of other 9 professions including but not limited to individuals licensed 10 under chapter 148 or 152 from providing services consistent 11 with the nature of the practice of midwifery. 12 2. This chapter does not prevent or prohibit a student 13 midwife from performing tasks related to the practice of 14 midwifery under the supervision of a licensed midwife, a 15 certified nurse midwife, or a licensed physician during 16 completion of the licensure process. 17 3. The practice of midwifery in this state prior to July 18 1, 2013, shall not constitute grounds for disciplinary action 19 by the board. The board may issue a license to a person who 20 has practiced midwifery in this state upon application and 21 compliance with the provisions of this chapter and the rules 22 adopted pursuant to this chapter. 23 Sec. 12. NEW SECTION . 148F.7 Prohibited practice. 24 A person shall not practice midwifery, or represent that the 25 person is a midwife, unless the person is licensed as provided 26 in this chapter. 27 Sec. 13. NEW SECTION . 148F.8 Requirements for licensure —— 28 temporary license. 29 Beginning July 1, 2013, an individual who does not meet the 30 requirements for licensure by examination pursuant to section 31 148F.2 may apply for a one-year temporary license as determined 32 by the board in rules. Renewal of the temporary license shall 33 be determined by the board. The board may revoke a temporary 34 license if it determines that the temporary licensee has 35 -7- LSB 1641YH (7) 84 jr/nh 7/ 9

H.F. 449 violated standards established by rule. 1 Sec. 14. Section 272C.1, subsection 6, Code 2011, is amended 2 by adding the following new paragraph: 3 NEW PARAGRAPH . ag. The board of midwifery, created pursuant 4 to chapter 147. 5 Sec. 15. Section 272C.4, subsection 6, Code 2011, is amended 6 to read as follows: 7 6. Define by rule acts or omissions that are grounds for 8 revocation or suspension of a license under section 100D.5 , 9 105.22 , 147.55 , 148.6 , 148B.7 , 148F.4 , 152.10 , 153.34 , 154A.24 , 10 169.13 , 455B.219 , 542.10 , 542B.21 , 543B.29 , 544A.13 , 544B.15 , 11 or 602.3203 or chapter 151 or 155 , as applicable, and to define 12 by rule acts or omissions that constitute negligence, careless 13 acts, or omissions within the meaning of section 272C.3, 14 subsection 2 , paragraph “b” , which licensees are required to 15 report to the board pursuant to section 272C.9, subsection 2 . 16 Sec. 16. INITIAL APPOINTMENTS. 17 1. Notwithstanding any provision to the contrary in this 18 Act, initial professional appointees to the board of midwifery 19 shall fulfill the national certification requirements of the 20 North American registry of midwives. 21 2. One of the initial professional appointments to the 22 board shall be appointed for a one-year term, one member shall 23 be appointed for a two-year term, and one member shall be 24 appointed for a three-year term. The members who are licensed 25 under chapter 148 or 152 shall each be appointed for a two-year 26 term, and the members representing the general public shall 27 each be appointed to a three-year term. 28 Sec. 17. EFFECTIVE DATE. The sections of this Act amending 29 section 147.2, subsection 1, and enacting section 148F.8 take 30 effect July 1, 2013. 31 EXPLANATION 32 This bill creates new Code chapter 148F that provides for 33 the licensure of midwives beginning July 1, 2013. A midwife 34 is not an allopathic or osteopathic physician licensed under 35 -8- LSB 1641YH (7) 84 jr/nh 8/ 9

H.F. 449 Code chapter 148 or a nurse licensed under Code chapter 1 152 providing primary maternity care during the antepartum, 2 intrapartum, and postpartum periods. 3 The bill provides for the establishment of a seven-member 4 board of midwifery consisting of three members who are 5 midwives, one physician, one nurse, and two members who 6 represent the general public. The bill provides for fees to 7 fund the board and provides penalties for violation of the 8 practice requirement; those penalties are set out for all 9 health-related boards in Code chapters 147 and 272C. Code 10 section 147.86 provides that it is a serious misdemeanor to 11 violate a provision of the licensing laws. 12 The board is similar in composition and responsibilities to 13 other health-related licensing boards. 14 The provisions of the bill amending Code section 147.2 and 15 enacting Code section 148F.8, both prohibiting the practice of 16 midwifery without a license, take effect July 1, 2013. 17 -9- LSB 1641YH (7) 84 jr/nh 9/ 9