H.F. 453 Section 1. MIDWIFERY LICENSURE —— LEGISLATIVE FINDINGS 1 AND INTENT. The general assembly recognizes the need for a 2 person to have the freedom to choose the manner, cost, and 3 setting for giving birth. The general assembly finds that 4 access to prenatal care and delivery services is limited by 5 the inadequate number of providers of such services and that 6 the practice of midwifery may help to reduce this shortage. 7 The general assembly also recognizes the need for the safe and 8 effective delivery of newborn babies and the health, safety, 9 and welfare of their mothers in the delivery process. The 10 general assembly, in the interest of public health, promotes 11 the regulation of the practice of midwifery in Iowa for the 12 purpose of protecting the health and welfare of women and 13 infants. The general assembly recognizes that midwifery is a 14 profession in its own right and that it is not the practice of 15 medicine or nursing. 16 Sec. 2. Section 147.1, subsections 3 and 6, Code 2017, are 17 amended to read as follows: 18 3. “Licensed” or “certified” , when applied to a physician 19 and surgeon, podiatric physician, osteopathic physician and 20 surgeon, physician assistant, psychologist, chiropractor, 21 nurse, dentist, dental hygienist, dental assistant, 22 optometrist, speech pathologist, audiologist, pharmacist, 23 physical therapist, physical therapist assistant, occupational 24 therapist, occupational therapy assistant, orthotist, 25 prosthetist, pedorthist, respiratory care practitioner, 26 practitioner of cosmetology arts and sciences, practitioner 27 of barbering, funeral director, dietitian, marital and family 28 therapist, mental health counselor, respiratory care and 29 polysomnography practitioner, polysomnographic technologist, 30 social worker, massage therapist, midwife, athletic trainer, 31 acupuncturist, nursing home administrator, hearing aid 32 specialist, or sign language interpreter or transliterator 33 means a person licensed under this subtitle . 34 6. “Profession” means medicine and surgery, podiatry, 35 -1- LSB 2420YH (2) 87 tr/nh 1/ 8

H.F. 453 osteopathic medicine and surgery, practice as a physician 1 assistant, psychology, chiropractic, nursing, dentistry, 2 dental hygiene, dental assisting, optometry, speech pathology, 3 audiology, pharmacy, physical therapy, physical therapist 4 assisting, occupational therapy, occupational therapy 5 assisting, respiratory care, cosmetology arts and sciences, 6 barbering, mortuary science, marital and family therapy, mental 7 health counseling, polysomnography, social work, dietetics, 8 massage therapy, midwifery, athletic training, acupuncture, 9 nursing home administration, practice as a hearing aid 10 specialist, sign language interpreting or transliterating, 11 orthotics, prosthetics, or pedorthics. 12 Sec. 3. Section 147.2, subsection 1, Code 2017, is amended 13 to read as follows: 14 1. A person shall not engage in the practice of medicine 15 and surgery, podiatry, osteopathic medicine and surgery, 16 psychology, chiropractic, physical therapy, physical 17 therapist assisting, nursing, dentistry, dental hygiene, 18 dental assisting, optometry, speech pathology, audiology, 19 occupational therapy, occupational therapy assisting, 20 orthotics, prosthetics, pedorthics, respiratory care, 21 pharmacy, cosmetology arts and sciences, barbering, social 22 work, dietetics, marital and family therapy or mental health 23 counseling, massage therapy, midwifery, mortuary science, 24 polysomnography, athletic training, acupuncture, nursing 25 home administration, or sign language interpreting or 26 transliterating, or shall not practice as a physician assistant 27 or a hearing aid specialist, unless the person has obtained a 28 license for that purpose from the board for the profession. 29 Sec. 4. Section 147.13, Code 2017, is amended by adding the 30 following new subsection: 31 NEW SUBSECTION . 25. For midwifery, the board of midwifery. 32 Sec. 5. Section 147.14, subsection 1, Code 2017, is amended 33 by adding the following new paragraph: 34 NEW PARAGRAPH . x. For midwifery, a total of seven members, 35 -2- LSB 2420YH (2) 87 tr/nh 2/ 8

H.F. 453 four members who are licensed midwives under chapter 148H; 1 one member who is licensed under chapter 148, is a practicing 2 family physician, and has professional experience consulting 3 for and collaborating with direct-entry midwives; and two 4 members who are not licensed midwives or licensed health care 5 providers who have received direct-entry midwifery services and 6 who shall represent the general public. 7 Sec. 6. Section 147.74, Code 2017, is amended by adding the 8 following new subsection: 9 NEW SUBSECTION . 5A. A midwife licensed under chapter 148H 10 may use the words “licensed midwife” or the initials “L.M.” 11 after the person’s name. 12 Sec. 7. NEW SECTION . 148H.1 Definitions. 13 As used in this chapter, unless the context otherwise 14 requires: 15 1. “Board” means the board of midwifery created under 16 chapter 147. 17 2. “Licensed midwife” means a person who is licensed to 18 practice midwifery as provided in this chapter. 19 3. “Midwife” means a person who is trained to give the 20 necessary care and advice to a woman during pregnancy, labor, 21 and the postnatal period, to conduct normal deliveries on the 22 midwife’s own responsibility, and to care for the newly born 23 infant, and who is able to recognize the warning signs of 24 abnormal conditions requiring referral to or collaboration with 25 a physician. 26 4. “Midwifery” means the practice of attending to a woman 27 experiencing a low-risk pregnancy during pregnancy, labor, and 28 the postnatal period with the informed consent of the woman, 29 and the provision of comprehensive care of the pregnant woman 30 during the antepartum phase, intrapartum phase, and postpartum 31 phase, and the application of emergency care when necessary. 32 5. “Out-of-hospital” means any facility, institution, or 33 place which is not an ambulatory surgical center or a hospital, 34 such as a birth center as defined in section 135.61 or a 35 -3- LSB 2420YH (2) 87 tr/nh 3/ 8

H.F. 453 private home. 1 Sec. 8. NEW SECTION . 148H.2 Licensure —— licensed 2 midwifery. 3 1. Every person engaged in the practice of midwifery in this 4 state shall be licensed pursuant to this chapter. 5 2. Prior to obtaining licensure, an applicant shall 6 successfully pass an examination approved by the board by rule 7 demonstrating competencies in at least all of the following 8 areas: risk assessment and management; prenatal care; 9 management of normal labor, birth, and postpartum; newborn care 10 up to six weeks; and adult cardiopulmonary resuscitation and 11 newborn resuscitation. 12 3. The applicant shall hold a certified professional 13 midwife credential issued by the North American registry of 14 midwives or any other nationally accredited credential as 15 specified by the board. If an applicant has been subject to 16 prior revocation of a license to practice medicine or nursing, 17 the applicant shall not be eligible for licensure under this 18 chapter, except as determined by the board. 19 4. The board may request, at the applicant’s expense, that 20 the department of public safety perform a criminal history 21 check and the department of human services perform child and 22 dependent adult abuse record checks of the applicant. If an 23 applicant has a criminal record or a record of founded child or 24 dependent adult abuse, the board shall perform an evaluation to 25 determine whether the record warrants denial of licensure. 26 Sec. 9. NEW SECTION . 148H.3 Use of title —— penalty. 27 A person shall not use the title “licensed midwife”, 28 describe or imply that the person is a licensed midwife, or 29 represent the person as a licensed midwife unless the person is 30 licensed under this chapter or is licensed as a nurse-midwife 31 under chapter 152. 32 Sec. 10. NEW SECTION . 148H.4 Rules. 33 1. The board shall: 34 a. Adopt rules relating to standards for professional 35 -4- LSB 2420YH (2) 87 tr/nh 4/ 8

H.F. 453 conduct of persons licensed under this chapter. 1 b. Adopt rules consistent with this chapter and with 2 chapters 17A, 147, and 272C which are necessary for the 3 performance of the board’s duties. 4 c. Act on matters concerning licensure and the processes 5 of applying for, granting, suspending, imposing supervisory 6 or probationary conditions upon, reinstating, and revoking a 7 license. 8 d. Administer the provisions of this chapter requiring 9 documentation required to demonstrate competence as a midwife, 10 and the processing of applications for licenses and license 11 renewal. 12 e. Develop continuing education requirements as a condition 13 of license renewal. 14 f. Evaluate requirements for licensure in other states to 15 determine if reciprocity may be granted. 16 g. Establish and collect licensure fees as provided in 17 section 147.80 and retain fees as provided in section 147.82. 18 h. Establish procedures for the issuance, renewal, and 19 revocation or suspension of a license under this chapter. 20 i. Maintain a registry of licensed midwives and statistics 21 on the practice of midwifery utilizing vital statistics data. 22 2. In developing rules, the board may consult with 23 persons knowledgeable regarding the prenatal and postpartum 24 birth process, particularly those possessing experience 25 with out-of-hospital births, including but not limited to 26 persons licensed under chapter 148, certified professional 27 midwives, advanced registered nurse practitioners who are 28 certified nurse-midwives, and women who have given birth in 29 an out-of-hospital setting. In developing rules relating 30 to the practice of midwifery, the board shall reflect the 31 knowledge and skills identified by the North American registry 32 of midwives’ current job description for the profession and the 33 standards of practice of midwifery established by the national 34 association of certified professional midwives or a successor 35 -5- LSB 2420YH (2) 87 tr/nh 5/ 8

H.F. 453 organization. 1 3. Rules relating to the practice of midwifery shall be 2 consistent with the North American registry of midwives’ 3 current job description for the profession and the standards 4 of practice of midwifery established by the national 5 association of certified professional midwives or a successor 6 organization, and shall not expand the scope of practice of 7 midwifery established by the national association of certified 8 professional midwives or a successor organization. 9 Sec. 11. NEW SECTION . 148H.5 Client disclosure. 10 Prior to accepting a patient for midwifery care, a licensed 11 midwife shall provide information to the patient indicating all 12 of the following: 13 1. Evidence that the care provider is a licensed midwife 14 meeting the requirements of this chapter. 15 2. Whether the licensed midwife has malpractice liability 16 insurance coverage and the policy limits of such coverage. 17 3. The midwife’s educational background and relevant 18 experience, including experience in various birth settings. 19 4. The nature, scope, and location of the care to be 20 given, including the possibility of and the guidelines for 21 consultation, referral, or transfer of the patient to a 22 hospital from an out-of-hospital setting. 23 Sec. 12. NEW SECTION . 148H.6 Exceptions. 24 1. This chapter does not prevent qualified members of other 25 professions including but not limited to individuals licensed 26 under chapter 148 or 152 from providing services consistent 27 with the nature of the practice of midwifery. 28 2. This chapter does not prevent or prohibit a student 29 midwife from performing tasks related to the practice of 30 midwifery under the supervision of a licensed midwife, a 31 certified nurse-midwife, or a licensed physician during 32 completion of the licensure process. 33 3. The practice of midwifery in this state prior to July 1, 34 2017, shall not constitute grounds for disciplinary action by 35 -6- LSB 2420YH (2) 87 tr/nh 6/ 8

H.F. 453 the board. The board may issue a license to a person who has 1 practiced midwifery in this state prior to that date upon that 2 person’s application and compliance with the provisions of this 3 chapter and the rules adopted pursuant to this chapter. 4 Sec. 13. NEW SECTION . 148H.7 Requirements for licensure —— 5 temporary license. 6 An individual who does not meet the requirements for 7 licensure by examination pursuant to section 148H.2 may apply 8 for a one-year temporary license, the qualifications for 9 which shall be determined by the board by rule. Renewal of 10 the temporary license shall be determined by the board. The 11 board may revoke a temporary license if it determines that the 12 temporary licensee has violated standards established by rule. 13 Sec. 14. Section 272C.1, subsection 6, Code 2017, is amended 14 by adding the following new paragraph: 15 NEW PARAGRAPH . ah. The board of midwifery, created pursuant 16 to chapter 147. 17 Sec. 15. Section 272C.4, subsection 6, Code 2017, is amended 18 to read as follows: 19 6. Define by rule acts or omissions that are grounds for 20 revocation or suspension of a license under section 100D.5 , 21 105.22 , 147.55 , 148.6 , 148B.7 , 148H.4, 152.10 , 153.34 , 154A.24 , 22 169.13 , 455B.219 , 542.10 , 542B.21 , 543B.29 , 544A.13 , 544B.15 , 23 or 602.3203 or chapter 151 or 155 , as applicable, and to define 24 by rule acts or omissions that constitute negligence, careless 25 acts, or omissions within the meaning of section 272C.3, 26 subsection 2 , paragraph “b” , which licensees are required to 27 report to the board pursuant to section 272C.9, subsection 2 . 28 Sec. 16. INITIAL APPOINTMENTS. 29 1. Notwithstanding any provision to the contrary in this 30 Act, the initial midwife appointees to the board of midwifery 31 created pursuant to this Act shall fulfill the national 32 certification requirements of the North American registry of 33 midwives. 34 2. One of the initial midwife appointments to the board 35 -7- LSB 2420YH (2) 87 tr/nh 7/ 8

H.F. 453 shall be appointed for a one-year term, one shall be appointed 1 for a two-year term, and one shall be appointed for a 2 three-year term. The member who is licensed under chapter 3 148 shall be appointed for a two-year term, and the members 4 representing the general public shall each be appointed to a 5 three-year term. 6 EXPLANATION 7 The inclusion of this explanation does not constitute agreement with 8 the explanation’s substance by the members of the general assembly. 9 This bill creates new Code chapter 148H that provides for 10 the licensure of midwives beginning July 1, 2017. A midwife, 11 as defined by the bill, provides comprehensive maternity care 12 to low-risk women during the antepartum, intrapartum, or 13 postpartum period. 14 The bill provides for the establishment of a seven-member 15 board of midwifery consisting of four members who are midwives, 16 one physician, and two members who represent the general 17 public. The bill provides for fees to fund the board and 18 provides penalties for violation of the licensure requirement; 19 those penalties are set out for all health-related boards in 20 Code chapters 147 and 272C. Code section 147.86 provides that 21 it is a serious misdemeanor to violate a provision of the 22 licensing laws. 23 The board is similar in composition and responsibilities to 24 other health-related licensing boards. 25 The bill provides that a midwife practicing prior to 26 the effective date of the bill is not required to take an 27 examination for licensure. 28 -8- LSB 2420YH (2) 87 tr/nh 8/ 8