H.F. _____ Section 1. Section 147.1, subsections 3 and 6, Code 2021, 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, genetic counselor, physician assistant, psychologist, 5 chiropractor, nurse, dentist, dental hygienist, dental 6 assistant, optometrist, speech pathologist, audiologist, 7 pharmacist, physical therapist, physical therapist assistant, 8 occupational therapist, occupational therapy assistant, 9 orthotist, prosthetist, pedorthist, respiratory care 10 practitioner, practitioner of cosmetology arts and sciences, 11 practitioner of barbering, funeral director, dietitian, 12 behavior analyst, assistant behavior analyst, marital and 13 family therapist, mental health counselor, midwife, respiratory 14 care and polysomnography practitioner, polysomnographic 15 technologist, social worker, massage therapist, athletic 16 trainer, acupuncturist, nursing home administrator, hearing 17 aid specialist, or sign language interpreter or transliterator 18 means a person licensed under this subtitle . 19 6. “Profession” means medicine and surgery, podiatry, 20 osteopathic medicine and surgery, genetic counseling, practice 21 as a physician assistant, psychology, chiropractic, nursing, 22 dentistry, dental hygiene, dental assisting, optometry, speech 23 pathology, audiology, pharmacy, physical therapy, physical 24 therapist assisting, occupational therapy, occupational therapy 25 assisting, respiratory care, cosmetology arts and sciences, 26 barbering, mortuary science, applied behavior analysis, marital 27 and family therapy, mental health counseling, midwifery, 28 polysomnography, social work, dietetics, massage therapy, 29 athletic training, acupuncture, nursing home administration, 30 practice as a hearing aid specialist, sign language 31 interpreting or transliterating, orthotics, prosthetics, or 32 pedorthics. 33 Sec. 2. Section 147.13, Code 2021, is amended by adding the 34 following new subsection: 35 -1- LSB 1348YC (6) 89 ss/rh 1/ 10

H.F. _____ NEW SUBSECTION . 25. For midwifery, the board of midwifery. 1 Sec. 3. Section 147.14, subsection 1, Code 2021, is amended 2 by adding the following new paragraph: 3 NEW PARAGRAPH . x. For midwifery, a total of seven members, 4 four members who are professional midwives eligible for 5 licensure under chapter 148I; one member who is licensed under 6 chapter 148, is certified by the American college of obstetrics 7 and gynecology, and has professional experience consulting 8 for and collaborating with direct-entry midwives; one member 9 who is a nurse midwife; and one member who is not a licensed 10 midwife or a licensed health care provider who has received 11 direct-entry midwifery services and who shall represent the 12 general public. 13 Sec. 4. Section 147.74, Code 2021, is amended by adding the 14 following new subsection: 15 NEW SUBSECTION . 28. A midwife licensed under chapter 148I 16 may use the words “licensed midwife” or the initials “L.M.” 17 after the person’s name. 18 Sec. 5. NEW SECTION . 148I.1 Definitions. 19 As used in this chapter, unless the context otherwise 20 requires: 21 1. “Board” means the board of midwifery created pursuant to 22 chapter 147. 23 2. “Certified nurse midwife” or “CNM” means a registered 24 nurse who holds a current, valid certification from the 25 American midwifery certification board. 26 3. “Certified professional midwife” or “CPM” means a person 27 who holds a current, valid certification with the North 28 American registry of midwives or its successor organization. 29 4. “Client” means a person under the care of a midwife and 30 such person’s fetus or newborn. 31 5. “Licensed midwife” means a person licensed under this 32 chapter to practice midwifery in Iowa. 33 6. “Midwife” means a person practicing midwifery. 34 7. “Midwifery” means the practice of providing primary 35 -2- LSB 1348YC (6) 89 ss/rh 2/ 10

H.F. _____ maternity care to a client during the preconception, 1 antepartum, intrapartum, and postpartum periods and newborn 2 care up to six weeks. 3 8. “Midwifery bridge certificate” or “MBC” means a 4 certificate issued by the North American registry of midwives 5 or its successor organization that documents completion of 6 accredited continuing education for certified professional 7 midwives based upon identified areas to address education 8 in emergency skills and other competencies set by the 9 international confederation of midwives. 10 Sec. 6. NEW SECTION . 148I.2 Licensure —— licensed 11 midwifery. 12 1. Except as provided in section 148I.3, beginning July 1, 13 2022, every person practicing midwifery in this state shall be 14 licensed pursuant to this chapter. The board shall adopt rules 15 pursuant to chapters 17A, 147, and 272C establishing procedures 16 for the licensure of new and practicing midwives. 17 2. Prior to obtaining a license to practice midwifery, an 18 applicant shall meet all of the following requirements: 19 a. Be at least twenty-one years old. 20 b. Submit proof of a high school diploma or its equivalent. 21 c. Submit proof of a current national certification as a 22 certified professional midwife from the North American registry 23 of midwives or its successor organization. 24 d. (1) Submit proof of completion of an educational program 25 or pathway accredited by the midwifery education accreditation 26 council, except as otherwise provided in this paragraph. 27 (2) A certified professional midwife certified before 28 January 1, 2021, and who received certification other than 29 through completion of an educational program or pathway 30 described in subparagraph (1) shall obtain a midwifery bridge 31 certificate from the North American registry of midwives or its 32 successor organization in order to obtain licensure in Iowa. 33 (3) A person licensed to practice midwifery in a state 34 that does not require completion of an educational program or 35 -3- LSB 1348YC (6) 89 ss/rh 3/ 10

H.F. _____ pathway described in subparagraph (1), shall obtain a midwifery 1 bridge certificate from the North American registry of midwives 2 or its successor organization in order to obtain licensure in 3 Iowa. 4 e. Submit an application fee as prescribed by the board by 5 rule. 6 3. The board may request, at the applicant’s expense, that 7 the department of public safety perform a criminal history 8 check and the department of human services perform child and 9 dependent adult abuse record checks of the applicant. If an 10 applicant has a criminal record or a record of founded child or 11 dependent adult abuse, the board shall perform an evaluation to 12 determine whether the record warrants denial of licensure. 13 Sec. 7. NEW SECTION . 148I.3 Exceptions. 14 1. This chapter does not do any of the following: 15 a. Limit or regulate the practice of qualified members 16 of other professions including but not limited to advanced 17 registered nurse practitioner midwives under chapter 152, 18 advanced practice registered nurse midwives under chapter 152E, 19 or certified nurse midwives, from providing services that would 20 constitute midwifery under this chapter. 21 b. Apply to a person who is a member of a Native American or 22 Amish community who provides traditional midwife services to 23 such a community. 24 c. Apply to a person who, in good faith, engages in the 25 practice of the religious tenets of a church or a religious act 26 if no fee is contemplated, charged, or received. 27 d. Apply to a person rendering aid in an emergency. 28 e. Apply to a student midwife currently enrolled in an 29 accredited midwifery education program and providing services 30 to clients under the direct, on-site, in-person supervision of 31 a certified professional midwife who is licensed and registered 32 as a preceptor with the North American registry of midwives or 33 its successor organization. 34 f. Apply to an advanced registered nurse practitioner 35 -4- LSB 1348YC (6) 89 ss/rh 4/ 10

H.F. _____ licensed under chapter 152, an advanced practice registered 1 nurse under chapter 152E, or a certified nurse midwife. 2 2. The practice of midwifery shall not constitute the 3 practice of medicine, certified nurse midwifery, certified 4 midwifery, or emergency medical care to the extent that a 5 midwife advises, attends, or assists a person during pregnancy, 6 labor, childbirth, or the postpartum period. 7 Sec. 8. NEW SECTION . 148I.4 Board —— rules. 8 1. The board shall adopt rules consistent with this chapter 9 and chapter 147 which are necessary for the performance of the 10 board’s duties. The rules shall do all of the following: 11 a. Regulate the practice of midwifery based on rules 12 established by the national association of certified 13 professional midwives and the North American registry of 14 midwives or its successor organization. 15 b. Define professional and unprofessional conduct. 16 c. Permit a licensee to obtain appropriate screening and 17 testing for clients, including but not limited to laboratory 18 tests and ultrasounds. 19 d. Permit a licensee to obtain and administer all of the 20 following during the practice of midwifery: 21 (1) Antihemorrhagic agents including but not limited to 22 oxytocin, misoprostol, and methylergonovine. 23 (2) Intravenous fluids for stabilization of the laboring 24 person. 25 (3) Neonatal injectable vitamin K. 26 (4) Newborn antibiotic eye prophylaxis. 27 (5) Oxygen. 28 (6) Intravenous antibiotics for group B streptococcal 29 antibiotic prophylaxis. 30 (7) Rho (D) immune globulin. 31 (8) Local anesthetic. 32 (9) Epinephrine. 33 (10) Other drugs consistent with the practice of certified 34 professional midwifery. 35 -5- LSB 1348YC (6) 89 ss/rh 5/ 10

H.F. _____ e. Permit a licensee to administer a drug prescribed by a 1 licensed health care provider for a client of a licensee. 2 f. Prohibit a licensee from using forceps or a vacuum 3 extractor. 4 g. Require a licensee to develop a written plan for the 5 consultation, collaboration, emergency transfer, and transport 6 of the birthing client and newborn when necessary, and to 7 submit that plan to the board. 8 h. Require a licensee to provide each client with, and 9 maintain a record of, a signed consent form that describes the 10 licensee’s qualifications, a copy of the licensee’s emergency 11 plan, whether the licensee carries professional liability 12 insurance, and the benefits and risks of birth in the client’s 13 setting of choice. 14 i. Require a licensee to report client data to the midwives 15 alliance of North America statistics registry, the American 16 association of birth centers perinatal data registry, or other 17 similar databases, and to verify the submission of such data 18 with the board. 19 j. Adopt continuing education requirements consistent with 20 those required by the North American registry of midwives or 21 its successor organization. 22 k. Establish requirements for peer review. 23 l. Require a licensee to file a birth certificate for each 24 birth. 25 m. Establish an annual license fee. 26 n. Require a licensee to comply with sections 136A.5 and 27 136A.5A. 28 2. The board shall not adopt rules that do any of the 29 following: 30 a. Permit a licensee to order or administer narcotic drugs. 31 b. Limit the location where a licensee may practice 32 midwifery. 33 c. Require a licensee to practice under the supervision of 34 or under a collaborative practice agreement with another health 35 -6- LSB 1348YC (6) 89 ss/rh 6/ 10

H.F. _____ care provider. 1 Sec. 9. NEW SECTION . 148I.5 Liability —— limitation. 2 A health care provider accepting a transfer of a client from 3 a licensed midwife shall not be liable for outcomes arising 4 from actions of the licensed midwife. 5 Sec. 10. NEW SECTION . 148I.6 Use of title —— penalty. 6 A person shall not use the title “licensed midwife”, or 7 describe or imply that the person is a licensed midwife, or 8 represent that person as a licensed midwife unless the person 9 is licensed under this chapter. 10 Sec. 11. Section 272C.1, subsection 6, Code 2021, is amended 11 by adding the following new paragraph: 12 NEW PARAGRAPH . ah. The board of midwifery, created pursuant 13 to chapter 147. 14 Sec. 12. Section 272C.4, subsection 6, Code 2021, is amended 15 to read as follows: 16 6. Define by rule acts or omissions that are grounds for 17 revocation or suspension of a license under section 100D.5 , 18 105.22 , 147.55 , 148.6 , 148B.7 , 152.10 , 153.34 , 154A.24 , 169.13 , 19 455B.219 , 542.10 , 542B.21 , 543B.29 , 544A.13 , 544B.15 , or 20 602.3203 or chapter 148I, 151 , or 155 , as applicable, and to 21 define by rule acts or omissions that constitute negligence, 22 careless acts, or omissions within the meaning of section 23 272C.3, subsection 2 , paragraph “b” , which licensees are 24 required to report to the board pursuant to section 272C.9, 25 subsection 2 . 26 Sec. 13. NEW SECTION . 514C.12A Licensed midwife services. 27 1. Notwithstanding section 514C.6, a person who provides 28 an individual or group policy of accident or health insurance 29 or individual or group hospital or health care service 30 contract issued pursuant to chapter 509, 509A, 514, or 514A 31 or an individual or group health maintenance organization 32 contract issued and regulated under chapter 514B, which is 33 delivered, amended, or renewed on or after July 1, 1996, and 34 which provides maternity benefits, which are not limited to 35 -7- LSB 1348YC (6) 89 ss/rh 7/ 10

H.F. _____ complications of pregnancy, or newborn care benefits, shall 1 provide coverage for maternity services rendered by a midwife 2 licensed pursuant to chapter 148I, regardless of the site of 3 services, in accordance with guidelines adopted by rule by the 4 commissioner. 5 2. Coverage for maternity services provided by a licensed 6 midwife shall not be subject to any greater copayment, 7 deductible, or coinsurance than is applicable to any other 8 similar benefits provided by the plan. 9 3. A person who provides an individual or group policy of 10 accident or health insurance or individual or group hospital or 11 health care service contract issued pursuant to chapter 509, 12 509A, 514, or 514A or an individual or group health maintenance 13 organization contract issued and regulated under chapter 514B 14 may require that maternity services be provided by a licensed 15 midwife under contract with the person. 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 created pursuant to this Act shall fulfill the national 20 certification requirements of the North American registry of 21 midwives or its successor organization. 22 2. One of the initial midwife appointments to the board 23 shall be appointed for a one-year term, one shall be appointed 24 for a two-year term, one shall be appointed for a three-year 25 term, and one shall be appointed for a four-year term. The 26 member who is licensed under chapter 148 shall be appointed for 27 a two-year term, the member representing the general public 28 shall be appointed to a three-year term, and the member who is 29 a certified nurse midwife shall be appointed to a four-year 30 term. 31 EXPLANATION 32 The inclusion of this explanation does not constitute agreement with 33 the explanation’s substance by the members of the general assembly. 34 This bill relates to the practice of midwifery in Iowa. 35 -8- LSB 1348YC (6) 89 ss/rh 8/ 10

H.F. _____ The bill requires a person practicing midwifery in Iowa 1 to obtain a license to practice beginning July 1, 2022. The 2 bill exempts from regulation health care providers providing 3 services consistent with midwifery, members of Native American 4 tribes or Amish communities providing traditional midwife 5 services, persons who gratuitously engage in the practice of 6 the religious tenets of a church or a religious act, student 7 midwives, and persons rendering emergency aid. Prior to 8 obtaining a midwifery license, a person must be at least 9 21 years of age, submit proof of a high school diploma or 10 equivalent, submit a fee, submit proof of having completed an 11 educational program or pathway, and hold a current certified 12 professional midwife certificate from the North American 13 registry of midwives. The bill prohibits any person other than 14 a licensed midwife from using the title “licensed midwife”. 15 The bill provides an alternative means to completion of an 16 educational program or pathway for persons who received a 17 certified professional midwife certification prior to January 18 1, 2021, or who received a license from a state that does not 19 require completion of an educational program or pathway. 20 The bill creates the board of midwifery to regulate the 21 practice of midwifery in Iowa and makes conforming changes to 22 Code chapters 147 and 272C. The bill requires the board to 23 adopt certain rules for the practice of midwifery and prohibits 24 the board from adopting rules allowing a licensed midwife to 25 order or administer narcotics, limiting the locations where 26 a midwife may practice, or requiring a midwife to practice 27 under a collaborative practice agreement with another health 28 care provider. The bill provides certain requirements for 29 membership on the board of midwifery. 30 The bill limits the liability of a health care provider 31 accepting a transfer of clients from a licensed midwife with 32 respect to outcomes that are the result of actions of the 33 midwife. The bill also requires insurance providers that 34 provide maternity benefits to cover maternity services provided 35 -9- LSB 1348YC (6) 89 ss/rh 9/ 10