S.F. 2152 Section 1. Section 147.1, subsections 3 and 6, Code 2014, 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, orthotist, 9 prosthetist, pedorthist, respiratory care practitioner, 10 practitioner of cosmetology arts and sciences, practitioner 11 of barbering, funeral director, dietitian, marital and family 12 therapist, mental health counselor, social worker, massage 13 therapist, midwife, athletic trainer, acupuncturist, nursing 14 home administrator, hearing aid dispenser, or sign language 15 interpreter or transliterator means a person licensed under 16 this subtitle . 17 6. “Profession” means medicine and surgery, podiatry, 18 osteopathic medicine and surgery, practice as a physician 19 assistant, psychology, chiropractic, nursing, dentistry, 20 dental hygiene, dental assisting, optometry, speech pathology, 21 audiology, pharmacy, physical therapy, physical therapist 22 assisting, occupational therapy, occupational therapy 23 assisting, respiratory care, cosmetology arts and sciences, 24 barbering, mortuary science, marital and family therapy, 25 mental health counseling, social work, dietetics, massage 26 therapy, midwifery, athletic training, acupuncture, nursing 27 home administration, hearing aid dispensing, sign language 28 interpreting or transliterating, orthotics, prosthetics, or 29 pedorthics. 30 Sec. 2. Section 147.13, Code 2014, is amended by adding the 31 following new subsection: 32 NEW SUBSECTION . 25. For midwifery, the board of midwifery. 33 Sec. 3. Section 147.14, subsection 1, Code 2014, is amended 34 by adding the following new paragraph: 35 -1- LSB 5965SS (6) 85 jr/nh 1/ 8

S.F. 2152 NEW PARAGRAPH . x. For midwifery, a total of seven members, 1 four members who are licensed midwives under chapter 148G; 2 one member who is licensed under chapter 148, is a practicing 3 family physician, and has professional experience consulting 4 for and collaborating with direct-entry midwives; and two 5 members who are not licensed midwives or licensed health care 6 providers who have received direct-entry midwifery services and 7 who shall represent the general public. 8 Sec. 4. Section 147.74, Code 2014, is amended by adding the 9 following new subsection: 10 NEW SUBSECTION . 5A. A midwife licensed under chapter 148G 11 may use the words “licensed midwife” or the initials “L.M.” 12 after the person’s name. 13 Sec. 5. NEW SECTION . 148G.1 Legislative intent. 14 The general assembly recognizes the need for a person to have 15 the freedom to choose the manner, cost, and setting for giving 16 birth. The general assembly finds that access to prenatal care 17 and delivery services is limited by the inadequate number of 18 providers of such services and that the practice of midwifery 19 may help to reduce this shortage. The general assembly also 20 recognizes the need for the safe and effective delivery of 21 newborn babies and the health, safety, and welfare of their 22 mothers in the delivery process. The general assembly, in 23 the interest of public health, promotes the regulation of the 24 practice of midwifery in Iowa for the purpose of protecting the 25 health and welfare of women and infants. The general assembly 26 recognizes that midwifery is a profession in its own right and 27 that it is not the practice of medicine or nursing. 28 Sec. 6. NEW SECTION . 148G.2 Definitions. 29 As used in this chapter, unless the context otherwise 30 requires: 31 1. “Board” means the board of midwifery. 32 2. “Licensed midwife” means a person who is licensed to 33 practice midwifery as provided in this chapter and has obtained 34 national certification from the North American registry of 35 -2- LSB 5965SS (6) 85 jr/nh 2/ 8

S.F. 2152 midwives, or a successor organization. 1 3. “Midwife” means a person who is trained to give the 2 necessary care and advice to women during pregnancy, labor, 3 and the post-birth period, to conduct normal deliveries on 4 the midwife’s own responsibility, and to care for the newly 5 born infant, and who is able to recognize the warning signs of 6 abnormal conditions requiring referral to or collaboration with 7 a physician. 8 4. “Midwifery” means the practice of attending women 9 experiencing low-risk pregnancies during pregnancy, labor, and 10 the post-birth period with the informed consent of the woman, 11 and the provision of comprehensive care of the pregnant woman 12 during the antepartal phase, intrapartal phase, and postpartal 13 phase, and the application of emergency care when necessary. 14 5. “Out-of-hospital” means any facility, institution, or 15 place which is not an ambulatory surgical center or a hospital, 16 such as a birth center as defined in section 135.61 or a 17 private home. 18 Sec. 7. NEW SECTION . 148G.3 Licensure —— licensed 19 midwifery. 20 1. Except as provided in section 146G.7, subsection 1, 21 beginning July 1, 2015, every person practicing as a licensed 22 midwife in this state must 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. A 33 person practicing as a midwife before July 1, 2015, shall be 34 issued a license without examination. 35 -3- LSB 5965SS (6) 85 jr/nh 3/ 8

S.F. 2152 3. The applicant shall hold a certified professional 1 midwife credential issued by the North American registry of 2 midwives or any other nationally accredited credential as 3 specified by the board. If an applicant has been subject to 4 prior revocation of a license to practice medicine or nursing, 5 the applicant shall not be eligible for licensure under this 6 chapter, except as determined by the board. 7 4. The board may request, at the applicant’s expense, that 8 the department of public safety perform a criminal history 9 check and the department of human services perform child and 10 dependent adult abuse record checks of the applicant. If an 11 applicant has a criminal record or a record of founded child or 12 dependent adult abuse, the board shall perform an evaluation to 13 determine whether the record warrants denial of licensure. 14 Sec. 8. NEW SECTION . 148G.4 Use of title —— penalty. 15 A person shall not use the title licensed midwife, describe 16 or imply that the person is a licensed midwife, or represent 17 the person as a licensed midwife unless the person is licensed 18 under this chapter or is licensed as a nurse-midwife under 19 chapter 152. 20 Sec. 9. NEW SECTION . 148G.5 Rules. 21 1. The board shall: 22 a. Adopt rules relating to standards for professional 23 conduct of persons licensed under this chapter. 24 b. Adopt rules consistent with this chapter and with 25 chapters 147 and 272C which are necessary for the performance 26 of its duties. 27 c. Act on matters concerning licensure and the processes 28 of applying for, granting, suspending, imposing supervisory 29 or probationary conditions upon, reinstating, and revoking a 30 license. 31 d. Administer the provisions of this chapter requiring 32 documentation required to demonstrate competence as a midwife, 33 and the processing of applications for licenses and license 34 renewal. 35 -4- LSB 5965SS (6) 85 jr/nh 4/ 8

S.F. 2152 e. Develop continuing education requirements as a condition 1 of license renewal. 2 f. Evaluate requirements for licensure in other states to 3 determine if reciprocity may be granted. 4 g. Establish and collect licensure fees as provided in 5 section 147.80 and retain fees as provided in section 147.82. 6 h. Establish procedures for the issuance, renewal, and 7 revocation or suspension of a license under this chapter. 8 i. Maintain a registry of licensed midwives and statistics 9 on the practice of midwifery utilizing vital statistics data. 10 2. In developing rules, the board may consult with 11 persons knowledgeable regarding the prenatal and postpartum 12 birth process, particularly those possessing experience with 13 out-of-hospital births, including but not limited to persons 14 licensed under chapter 148, certified professional midwives, 15 advanced registered nurse practitioners who are certified nurse 16 midwives, and women who have given birth in an out-of-hospital 17 setting. In developing rules relating to the practice of 18 midwifery, the board shall reflect the knowledge and skills 19 identified by the North American registry of midwives’ current 20 job description for the profession and the standards of 21 practice of midwifery established by the national association 22 of certified professional midwives or a successor organization. 23 3. Rules relating to the practice of midwifery shall be 24 consistent with the North American registry of midwives’ 25 current job description for the profession and the standards 26 of practice of midwifery established by the national 27 association of certified professional midwives or a successor 28 organization, and shall not expand the scope of practice of 29 midwifery established by the national association of certified 30 professional midwives or a successor organization. 31 4. At such time as the board determines that liability 32 insurance is available at an affordable price to certified 33 professional midwives, the board may mandate such coverage. 34 Until that time, each midwife shall comply with the disclosure 35 -5- LSB 5965SS (6) 85 jr/nh 5/ 8

S.F. 2152 requirements in section 148G.6. 1 Sec. 10. NEW SECTION . 148G.6 Client disclosure. 2 Prior to accepting a patient for midwifery care, a licensed 3 midwife shall provide information indicating all of the 4 following: 5 1. Evidence that the care provider is a licensed midwife 6 meeting the requirements of this chapter. 7 2. Whether the licensed midwife has malpractice liability 8 insurance coverage and the policy limits of such coverage. 9 3. The midwife’s educational background and relevant 10 experience, including experience in various birth settings. 11 4. The nature, scope, and location of the care to be 12 given, including the possibility of and the guidelines for 13 consultation, referral, or transfer of the patient to a 14 hospital from an out-of-hospital setting. 15 Sec. 11. NEW SECTION . 148G.7 Exceptions. 16 1. This chapter or chapter 148 or 152 does not prohibit 17 an unlicensed individual from providing services consistent 18 with the nature of the practice of midwifery to a woman who 19 has specifically requested that the individual provide the 20 services. 21 2. This chapter does not prevent qualified members of other 22 professions including but not limited to individuals licensed 23 under chapter 148 or 152 from providing services consistent 24 with the nature of the practice of midwifery. 25 3. This chapter does not prevent or prohibit a student 26 midwife from performing tasks related to the practice of 27 midwifery under the supervision of a licensed midwife, a 28 certified nurse midwife, or a licensed physician during 29 completion of the licensure process. 30 4. The practice of midwifery in this state prior to July 31 1, 2015, shall not constitute grounds for disciplinary action 32 by the board. The board may issue a license to a person who 33 has practiced midwifery in this state prior to that date upon 34 application and compliance with the provisions of this chapter 35 -6- LSB 5965SS (6) 85 jr/nh 6/ 8

S.F. 2152 and the rules adopted pursuant to this chapter. 1 Sec. 12. Section 272C.1, subsection 6, Code 2014, 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. 13. Section 272C.4, subsection 6, Code 2014, 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 , 148G.5, 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. 14. INITIAL APPOINTMENTS. 17 1. Notwithstanding any provision to the contrary in this 18 Act, the initial midwife appointees to the board of midwifery 19 shall fulfill the national certification requirements of the 20 North American registry of midwives. 21 2. Two of the initial midwife appointments to the board 22 shall be appointed for a one-year term, one shall be appointed 23 for a two-year term, and one shall be appointed for a 24 three-year term. The member who is licensed under chapter 25 148 shall be appointed for a two-year term, and the members 26 representing the general public shall each be appointed to a 27 three-year term. 28 EXPLANATION 29 The inclusion of this explanation does not constitute agreement with 30 the explanation’s substance by the members of the general assembly. 31 This bill creates new Code chapter 148G that provides for 32 the title practice of licensed midwives beginning July 1, 2015. 33 A midwife provides comprehensive maternity care, to low-risk 34 women, during the antepartum, intrapartum, or postpartum 35 -7- LSB 5965SS (6) 85 jr/nh 7/ 8

S.F. 2152 period. 1 The bill does not prohibit unlicensed practice; an 2 unlicensed individual may provide services consistent with 3 the nature of the practice of midwifery to a woman who has 4 specifically requested that the individual provide the 5 services. 6 The bill provides for the establishment of a seven-member 7 board of midwifery consisting of four members who are midwives, 8 one physician, and two members who represent the general 9 public. The bill provides for fees to fund the board and 10 provides penalties for violation of the licensure requirement; 11 those penalties are set out for all health-related boards in 12 Code chapters 147 and 272C. Code section 147.86 provides that 13 it is a serious misdemeanor to violate a provision of the 14 licensing laws. 15 A midwife practicing prior to the effective date of this Act 16 is not required to take the examination. 17 The board is similar in composition and responsibilities to 18 other health-related licensing boards. 19 -8- LSB 5965SS (6) 85 jr/nh 8/ 8