H.F. 188 Section 1. Section 147.1, subsections 3 and 6, Code 2015, 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 147.2, subsection 1, Code 2015, is amended 31 to read as follows: 32 1. A person shall not engage in the practice of medicine 33 and surgery, podiatry, osteopathic medicine and surgery, 34 psychology, chiropractic, physical therapy, physical 35 -1- LSB 2150YH (2) 86 tr/nh 1/ 9

H.F. 188 therapist assisting, nursing, dentistry, dental hygiene, 1 dental assisting, optometry, speech pathology, audiology, 2 occupational therapy, occupational therapy assisting, 3 orthotics, prosthetics, pedorthics, respiratory care, 4 pharmacy, cosmetology arts and sciences, barbering, social 5 work, dietetics, marital and family therapy or mental health 6 counseling, massage therapy, midwifery, mortuary science, 7 athletic training, acupuncture, nursing home administration, 8 hearing aid dispensing, or sign language interpreting 9 or transliterating, or shall not practice as a physician 10 assistant, unless the person has obtained a license for that 11 purpose from the board for the profession. 12 Sec. 3. Section 147.13, Code 2015, is amended by adding the 13 following new subsection: 14 NEW SUBSECTION . 25. For midwifery, the board of midwifery. 15 Sec. 4. Section 147.14, subsection 1, Code 2015, is amended 16 by adding the following new paragraph: 17 NEW PARAGRAPH . x. For midwifery, a total of seven members, 18 three members who are licensed midwives under chapter 148G; 19 one member who is licensed under chapter 148, is a practicing 20 family physician, and has professional experience consulting 21 for and collaborating with direct-entry midwives; one member 22 who is an advanced registered nurse practitioner licensed 23 under chapter 152, is certified by the American midwifery 24 certification board as a nurse-midwife, and has professional 25 experience consulting for and collaborating with direct-entry 26 midwives; and two members who are not licensed midwives or 27 licensed health care providers who have received direct-entry 28 midwifery services and who shall represent the general public. 29 Sec. 5. Section 147.74, Code 2015, is amended by adding the 30 following new subsection: 31 NEW SUBSECTION . 5A. A midwife licensed under chapter 148G 32 may use the words “licensed midwife” or the initials “L.M.” 33 after the person’s name. 34 Sec. 6. NEW SECTION . 148G.1 Definitions. 35 -2- LSB 2150YH (2) 86 tr/nh 2/ 9

H.F. 188 As used in this chapter, unless the context otherwise 1 requires: 2 1. “Board” means the board of midwifery created under 3 chapter 147. 4 2. “Licensed midwife” means a person who is licensed to 5 practice midwifery as provided in this chapter. 6 3. “Out-of-hospital” means any facility, institution, or 7 place which is not an ambulatory surgical center or a hospital, 8 such as a birth center as defined in section 135.61 or a 9 private home. 10 4. “Practice of midwifery” means the provision of primary 11 maternity care during the antepartum, intrapartum, or 12 postpartum period by a person who is neither licensed to 13 practice under chapter 148 or 148C, nor a nurse recognized 14 by the board of nursing as an advanced registered nurse 15 practitioner who is a certified nurse-midwife, and who is not 16 rendering emergency services without compensation. “Practice 17 of midwifery” may also include the carrying and administration 18 of certain medications during the practice of midwifery, 19 including oxytocin, as a postpartum antihemorrhagic agent, 20 oxygen, intravenous fluids for stabilization, vitamin K, eye 21 prophylactics, and other drugs or procedures as appropriate for 22 the scope of practice for licensed midwives as determined by 23 the board. 24 Sec. 7. NEW SECTION . 148G.2 Licensure —— licensed 25 midwifery. 26 1. Beginning July 1, 2016, every person engaged in the 27 practice of midwifery in this state shall be licensed pursuant 28 to this chapter. 29 2. Prior to obtaining licensure, an applicant shall 30 successfully pass an examination approved by the board by rule 31 demonstrating competencies in at least all of the following 32 areas: risk assessment and management; prenatal care; 33 management of normal labor, birth, and postpartum; newborn care 34 up to six weeks; and adult cardiopulmonary resuscitation and 35 -3- LSB 2150YH (2) 86 tr/nh 3/ 9

H.F. 188 newborn resuscitation. 1 3. The applicant shall provide documentation, satisfactory 2 to the board, of all of the following: 3 a. Knowledge and proficiency of all didactic components 4 of midwifery, including definitions, signs and symptoms, 5 differential diagnosis for risk assessment, stabilization and 6 treatment, follow-up, referral, and transport. 7 b. Complete and thorough preparation as an assistant midwife 8 prior to assuming responsibility as a primary midwife which 9 shall include clinical care performed under supervision during 10 training including, at a minimum: 11 (1) Seventy-five prenatal exams. 12 (2) Twenty births as an assistant midwife. 13 (3) Twenty births as primary midwife from the onset of labor 14 to the delivery of the placenta and the stabilization of mother 15 and newborn. 16 (4) Twenty newborn exams. 17 (5) Forty postpartum exams. 18 c. Assessment and verification of performance of skills 19 during an intensive, hands-on skills assessment, performed for 20 and scored by an evaluator approved by the board. 21 d. Passage of a three-hundred-fifty-item national board 22 examination that covers all aspects of midwifery care as 23 identified by job analysis approved by the board. 24 e. Evidence that the applicant has provided prenatal, 25 intrapartal, and postpartal care as well newborn assessment, 26 equivalent to a minimum of one thousand three hundred fifty 27 clinical contact hours under the direct supervision of one or 28 more instructors approved by the North American registry of 29 midwives. 30 4. The applicant shall hold a certified professional 31 midwife credential issued by the North American registry of 32 midwives or any other nationally accredited credential as 33 specified by the board. If an applicant has been subject to 34 prior revocation of a license to practice medicine or nursing, 35 -4- LSB 2150YH (2) 86 tr/nh 4/ 9

H.F. 188 the applicant shall not be eligible for licensure under this 1 chapter, except as determined by the board. 2 5. The board may request, at the applicant’s expense, that 3 the department of public safety perform a criminal history 4 check and the department of human services perform child and 5 dependent adult abuse record checks of the applicant. If an 6 applicant has a criminal record or a record of founded child or 7 dependent adult abuse, the board shall perform an evaluation to 8 determine whether the record warrants denial of licensure. 9 Sec. 8. NEW SECTION . 148G.3 Use of title —— penalty. 10 A person shall not use the title “licensed midwife”, 11 describe or imply that the person is a licensed midwife, or 12 represent the person as a licensed midwife unless the person is 13 licensed under this chapter or is licensed as a nurse-midwife 14 under chapter 152. 15 Sec. 9. NEW SECTION . 148G.4 Rules. 16 1. The board shall: 17 a. Adopt rules relating to standards for professional 18 conduct of persons licensed under this chapter. 19 b. Adopt rules consistent with this chapter and with 20 chapters 17A, 147, and 272C which are necessary for the 21 performance of its duties. 22 c. Act on matters concerning licensure and the processes 23 of applying for, granting, suspending, imposing supervisory 24 or probationary conditions upon, reinstating, and revoking a 25 license. 26 d. Administer the provisions of this chapter requiring 27 documentation required to demonstrate competence as a midwife, 28 and the processing of applications for licenses and license 29 renewal. 30 e. Develop continuing education requirements as a condition 31 of license renewal. 32 f. Evaluate requirements for licensure in other states to 33 determine if reciprocity may be granted. 34 g. Establish and collect licensure fees as provided in 35 -5- LSB 2150YH (2) 86 tr/nh 5/ 9

H.F. 188 section 147.80 and retain fees as provided in section 147.82. 1 h. Establish procedures for the issuance, renewal, and 2 revocation or suspension of a license under this chapter. 3 i. Maintain a registry of licensed midwives and statistics 4 on the practice of midwifery utilizing vital statistics data. 5 2. In developing rules, the board may consult with 6 persons knowledgeable regarding the prenatal and postpartum 7 birth process, particularly those possessing experience 8 with out-of-hospital births, including but not limited to 9 persons licensed under chapter 148, certified professional 10 midwives, advanced registered nurse practitioners who are 11 certified nurse-midwives, and women who have given birth in 12 an out-of-hospital setting. In developing rules relating 13 to the practice of midwifery, the board shall reflect the 14 knowledge and skills identified by the North American registry 15 of midwives’ current job description for the profession and the 16 standards of practice of midwifery established by the national 17 association of certified professional midwives or a successor 18 organization. 19 3. Rules relating to the practice of midwifery shall be 20 consistent with the North American registry of midwives’ 21 current job description for the profession and the standards 22 of practice of midwifery established by the national 23 association of certified professional midwives or a successor 24 organization, and shall not expand the scope of practice of 25 midwifery established by the national association of certified 26 professional midwives or a successor organization. 27 4. At such time as the board determines that liability 28 insurance is available at an affordable price to certified 29 professional midwives, the board may mandate such coverage. 30 Until that time, each midwife shall comply with the disclosure 31 requirements in section 148G.5. 32 Sec. 10. NEW SECTION . 148G.5 Client disclosure. 33 Prior to accepting a patient for midwifery care, a licensed 34 midwife shall provide information to the patient indicating all 35 -6- LSB 2150YH (2) 86 tr/nh 6/ 9

H.F. 188 of the following: 1 1. Evidence that the care provider is a licensed midwife 2 meeting the requirements of this chapter. 3 2. Whether the licensed midwife has malpractice liability 4 insurance coverage and the policy limits of such coverage. 5 3. The midwife’s educational background and relevant 6 experience, including experience in various birth settings. 7 4. The nature, scope, and location of the care to be 8 given, including the possibility of and the guidelines for 9 consultation, referral, or transfer of the patient to a 10 hospital from an out-of-hospital setting. 11 Sec. 11. NEW SECTION . 148G.6 Exceptions. 12 1. This chapter does not prevent qualified members of other 13 professions including but not limited to individuals licensed 14 under chapter 148 or 152 from providing services consistent 15 with the nature of the practice of midwifery. 16 2. This chapter does not prevent or prohibit a student 17 midwife from performing tasks related to the practice of 18 midwifery under the supervision of a licensed midwife, a 19 certified nurse-midwife, or a licensed physician during 20 completion of the licensure process. 21 3. The practice of midwifery in this state prior to July 1, 22 2016, shall not constitute grounds for disciplinary action by 23 the board. The board may issue a license to a person who has 24 practiced midwifery in this state prior to that date upon that 25 person’s application and compliance with the provisions of this 26 chapter and the rules adopted pursuant to this chapter. 27 Sec. 12. NEW SECTION . 148G.7 Prohibited practice. 28 A person shall not practice midwifery, or represent that the 29 person is a midwife, unless the person is licensed as provided 30 in this chapter. 31 Sec. 13. NEW SECTION . 148G.8 Requirements for licensure —— 32 temporary license. 33 Beginning July 1, 2016, an individual who does not meet 34 the requirements for licensure by examination pursuant to 35 -7- LSB 2150YH (2) 86 tr/nh 7/ 9

H.F. 188 section 148G.2 may apply for a one-year temporary license, the 1 qualifications for which shall be determined by the board by 2 rule. Renewal of the temporary license shall be determined 3 by the board. The board may revoke a temporary license if it 4 determines that the temporary licensee has violated standards 5 established by rule. 6 Sec. 14. Section 272C.1, subsection 6, Code 2015, is amended 7 by adding the following new paragraph: 8 NEW PARAGRAPH . ag. The board of midwifery, created pursuant 9 to chapter 147. 10 Sec. 15. Section 272C.4, subsection 6, Code 2015, is amended 11 to read as follows: 12 6. Define by rule acts or omissions that are grounds for 13 revocation or suspension of a license under section 100D.5 , 14 105.22 , 147.55 , 148.6 , 148B.7 , 148G.4, 152.10 , 153.34 , 154A.24 , 15 169.13 , 455B.219 , 542.10 , 542B.21 , 543B.29 , 544A.13 , 544B.15 , 16 or 602.3203 or chapter 151 or 155 , as applicable, and to define 17 by rule acts or omissions that constitute negligence, careless 18 acts, or omissions within the meaning of section 272C.3, 19 subsection 2 , paragraph “b” , which licensees are required to 20 report to the board pursuant to section 272C.9, subsection 2 . 21 Sec. 16. INITIAL APPOINTMENTS. 22 1. Notwithstanding any provision to the contrary in this 23 Act, the initial midwife appointees to the board of midwifery 24 created pursuant to this Act shall fulfill the national 25 certification requirements of the North American registry of 26 midwives. 27 2. One of the initial midwife appointments to the board 28 shall be appointed for a one-year term, one shall be appointed 29 for a two-year term, and one shall be appointed for a 30 three-year term. The members who are licensed under chapter 31 148 or 152 shall each be appointed for a two-year term, and the 32 members representing the general public shall each be appointed 33 to a three-year term. 34 Sec. 17. EFFECTIVE DATE. The following provision or 35 -8- LSB 2150YH (2) 86 tr/nh 8/ 9

H.F. 188 provisions of this Act take effect July 1, 2016: 1 1. The section of this Act amending section 147.2, 2 subsection 1. 3 2. The section of this Act enacting section 148G.7. 4 EXPLANATION 5 The inclusion of this explanation does not constitute agreement with 6 the explanation’s substance by the members of the general assembly. 7 This bill creates new Code chapter 148G that provides for 8 the licensure of midwives beginning July 1, 2016. A midwife 9 is not an allopathic or osteopathic physician licensed under 10 Code chapter 148 or a nurse licensed under Code chapter 11 152 providing primary maternity care during the antepartum, 12 intrapartum, or postpartum period. 13 The bill provides for the establishment of a seven-member 14 board of midwifery consisting of three members who are 15 midwives, one physician, one nurse, and two members who 16 represent the general public. The bill provides for fees to 17 fund the board and provides penalties for violation of the 18 licensure requirement; those penalties are set out for all 19 health-related boards in Code chapters 147 and 272C. Code 20 section 147.86 provides that it is a serious misdemeanor to 21 violate a provision of the licensing laws. 22 The board is similar in composition and responsibilities to 23 other health-related licensing boards. 24 The provisions of the bill amending Code section 147.2 and 25 enacting Code section 148G.7, both prohibiting the practice of 26 midwifery without a license, take effect July 1, 2016. 27 -9- LSB 2150YH (2) 86 tr/nh 9/ 9