H.B. 751
GENERAL ASSEMBLY OF NORTH CAROLINA
Apr 18, 2023
SESSION 2023 HOUSE PRINCIPAL CLERK
H D
HOUSE BILL DRH30253-NB-140
Short Title: Accessing Midwives Act. (Public)
Sponsors: Representative Belk.
Referred to:
1 A BILL TO BE ENTITLED
2 AN ACT TO ESTABLISH THE CERTIFIED PROFESSIONAL MIDWIVES LICENSING
3 ACT.
4 The General Assembly of North Carolina enacts:
5 SECTION 1. Chapter 90 of the General Statutes is amended by adding a new Article
6 to read:
7 "Article 10B.
8 "Certified Professional Midwives.
9 "§ 90-178.10. Title.
10 This Article may be cited as the "Accessing Midwives Act."
11 "§ 90-178.11. Definitions.
12 The following definitions apply in this Article:
13 (1) AMCB. – American Midwifery Certification Board.
14 (2) Antepartal. – Occurring during pregnancy.
15 (3) Certified Midwife (CM). – A person who has obtained national certification
16 from the American Midwifery Certification Board (AMCB).
17 (4) Certified Nurse-Midwife (CNM). – A person approved to practice
18 Nurse-Midwifery under Article 10A of this Chapter.
19 (5) Certified Professional Midwife (CPM). – A person who has obtained national
20 certification from the North American Registry of Midwives (NARM).
21 (6) Collaboration. – The process by which a licensed midwife and a physician or
22 other appropriate health care provider jointly manage the care of a client, as
23 defined by Board rule.
24 (7) Consultation. – The exchange of information and advice regarding the client's
25 condition and indicated treatment with a licensed physician or certified nurse
26 midwife.
27 (8) Council. – The North Carolina Council of Midwives, a subcommittee of the
28 Division of Health Service Regulation.
29 (9) Department. – The North Carolina Department of Health and Human
30 Services.
31 (10) Division. – The Division of Health Service Regulation within the Department
32 of Health and Human Services to which the North Carolina Council of
33 Midwives reports.
34 (11) Health care provider. – As defined in G.S. 90-21.11.
35 (12) ICM. – International Confederation of Midwives.
36 (13) Intrapartal. – Occurring during the process of giving birth.
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1 (14) Licensed physician. – A physician duly licensed in this State to practice
2 medicine under Article 1 of this Chapter.
3 (15) Licensee. – A Certified Professional Midwife who holds the CPM credential
4 or a Certified Midwife who holds the CM credential and is licensed to practice
5 midwifery under this Article.
6 (16) Midwife. – A person who is trained to (i) give the necessary care and advice
7 to women during pregnancy, labor, and the post-birth period, (ii) conduct
8 normal deliveries as the midwife's own responsibility, (iii) care for the newly
9 born infant, and (iv) recognize the warning signs of abnormal conditions
10 requiring referral to or collaboration with a licensed physician or other
11 licensed health care provider.
12 (17) Midwifery. – The provision of primary health or maternity care to
13 childbearing people and infants.
14 (18) NACPM. – The National Association of Certified Professional Midwives.
15 (19) NARM. – The North American Registry of Midwives.
16 (20) Postpartal. – Occurring subsequent to birth.
17 (21) US MERA. – United States Midwifery Education, Regulation, and
18 Association.
19 "§ 90-178.12. License required; exemptions.
20 (a) No person shall practice or offer to practice midwifery as defined in this Article or
21 otherwise indicate or imply that the person is a licensed Certified Professional Midwife or
22 Certified Midwife unless the person is currently licensed as provided in this Article.
23 (b) The provisions of this Article do not apply to any of the following:
24 (1) An individual approved to practice midwifery under Article 10A of this
25 Chapter.
26 (2) A physician licensed to practice medicine under Article 1 of this Chapter when
27 engaged in the practice of medicine as defined by law.
28 (3) The performance of medical acts by a physician assistant or nurse practitioner
29 when performed in accordance with the rules of the North Carolina Medical
30 Board.
31 (4) The practice of nursing by a registered nurse engaged in the practice of nursing
32 under Article 9A of this Chapter.
33 (5) The rendering of childbirth assistance in an emergency situation.
34 (6) Individuals who are present during the birth process or assisting the certified
35 professional midwife in the birth process, including family members, birth
36 workers, or other caregivers invited by the birthing person, midwifery
37 students, and assistants who are under the supervision of a midwife licensed
38 under the provisions of this Article.
39 (7) A traditional birth attendant practicing midwifery without a license if the
40 traditional birth attendant has cultural or religious traditions that have
41 historically included the attendance of traditional birth attendants at births and
42 that birth attendant serves only the families in that distinct cultural or religious
43 group.
44 "§ 90-178.13. The North Carolina Council of Midwives.
45 (a) Composition and Terms. – The North Carolina Council of Midwives is created. The
46 Council shall consist of seven members who shall serve staggered terms. The Council members
47 shall be appointed by the Secretary of the Department of Health and Human Services, and the
48 initial Council members shall be appointed on or before October 1, 2023, or within three months
49 of this Article becoming law, whichever is later, as follows:
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1 (1) Four Certified Professional Midwives, one of whom shall serve for a term of
2 four years, two of whom shall serve for terms of three years, and one of whom
3 shall serve for a term of two years.
4 (2) One licensed physician who is knowledgeable in midwifery care who shall
5 serve for a term of four years.
6 (3) One community birth consumer who shall serve for a term of two years.
7 (4) One Certified Nurse-Midwife experienced in community birth who shall serve
8 a term of two years.
9 Upon the expiration of the terms of the initial Council members, members shall be appointed
10 for terms of four years and shall serve until their successors are appointed. No member may serve
11 more than two consecutive terms.
12 (b) Qualifications. – Each Council member shall be a resident of this State. The members
13 who are health care providers shall hold current licenses from the Council and remain in good
14 standing with the Council during their terms.
15 (c) Vacancies. – Any vacancy shall be filled by the Secretary of the Department of Health
16 and Human Services. Appointees to fill vacancies shall serve the remainder of the unexpired term
17 and until their successors have been duly appointed.
18 (d) Removal. – The Council may remove any of its members for neglect of duty,
19 incompetence, or unprofessional conduct. If a Council member is absent from three consecutive
20 Council meetings without excuse, that member shall be removed from office, and a new member
21 shall be appointed by the Secretary of the Department of Health and Human Services. An absence
22 shall be deemed excused if caused (i) by a health problem or condition verified in writing by a
23 licensed physician or (ii) by an accident or similar unforeseeable tragedy or event, on or before
24 the next Council meeting. A member subject to disciplinary proceedings in the member's capacity
25 as a health care provider shall be disqualified from participating in the official business of the
26 Council until the charges have been resolved.
27 (e) Compensation. – Each member of the Council shall receive per diem and
28 reimbursement for travel and subsistence as provided in G.S. 93B-5.
29 (f) Officers. – The officers of the Council shall be a chair, a vice-chair, and other officers
30 deemed necessary by the Council to carry out the purposes of this Article. All officers shall be
31 elected annually by the Council for two-year terms and shall serve until their successors are
32 elected and qualified. No person may serve as chair for more than six consecutive years.
33 (g) Meetings. – The Council shall hold its first meeting within 45 days after the
34 appointment of its members and shall hold at least two meetings each year to conduct business
35 and to review the standards and rules previously adopted by the Council. The Council shall
36 establish the procedures for calling, holding, and conducting regular and special meetings. A
37 majority of Council members shall constitute a quorum. The Council shall hold such meetings
38 during the year as it deems necessary, one of which shall be an annual meeting. The Department,
39 the chairperson, or a majority of the Council shall have the authority to call additional meetings.
40 (h) Notice of Meeting; Records. – Public notice shall be given for all meetings and all
41 meetings are open to the public. All records are available to the public. Persons wishing to obtain
42 copies of records may request copies, in writing, from the Council.
43 (i) The Council shall adopt rules within one year of the initial meeting to implement the
44 provisions of this Article.
45 "§ 90-178.14. Powers and duties of the Council.
46 In consultation with the Division and with guidance from the National Association of
47 Certified Professional Midwives Standards of Practice, the Council shall have the following
48 powers and duties:
49 (1) Administer this Article.
50 (2) Issue interpretations of this Article.
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1 (3) Adopt, amend, or repeal rules as may be necessary to carry out the provisions
2 of this Article, including rules relating to the administration of medications
3 consistent with a licensed midwife's training and scope of practice.
4 (4) Verify the credentials and qualifications of applicants for licensure, license
5 renewal, and reciprocal licensure.
6 (5) Issue, renew, deny, suspend, or revoke licensure and carry out any disciplinary
7 actions authorized by this Article.
8 (6) Set fees for licensure, license renewal, and other services deemed necessary
9 to carry out the purposes of this Article, and not to exceed five hundred dollars
10 ($500.00) over a two-year period.
11 (7) Maintain a current list of all persons who have been licensed as midwives
12 under this Article and, using a statistically validated data collection tool,
13 collect and review annual practice reports.
14 (8) Address problems and concerns of licensed midwives in order to promote
15 safety for the citizens of this State.
16 (9) Conduct investigations for the purpose of determining whether violations of
17 this Article or grounds for disciplining midwives exist.
18 (10) Maintain a record of all proceedings and make available to all licensed
19 midwives and other concerned parties an annual report of all Council action.
20 (11) Adopt a seal containing the name of the Council for use on all official
21 documents and reports issued by the Council.
22 (12) Educate the public and other providers of maternity care about the role of the
23 licensed midwife.
24 "§ 90-178.15. Requirements for licensure.
25 An applicant shall be licensed to practice as a midwife under this Article if the applicant
26 meets all of the following requirements:
27 (1) Completes an application on a form approved by the Council.
28 (2) Has completed all required educational and clinical training, including
29 education in emergency skills for pregnancy, birth, and newborn care and
30 other midwifery topics addressing all ICM Core Competencies, as determined
31 by US MERA, and has earned the national midwifery certification credential
32 awarded by a national midwifery certification agency accredited by the
33 National Commission on Certifying Agencies (NCCA), the accrediting body
34 of the Institute of Credentialing Excellence.
35 (3) Submits proof to the Council of current cardiopulmonary resuscitation (CPR)
36 certification and neonatal resuscitation (NRP) certification.
37 (4) Has read, understands, and agrees to practice under the guidelines set forth in
38 this Article and any rules adopted pursuant to this Article.
39 (5) Pays the required fees in accordance with G.S. 90-178.19.
40 "§ 90-178.16. Responsibilities of a licensed midwife; display of license.
41 (a) A Certified Professional Midwife licensed under this Article shall practice according
42 to the National Association of Certified Professional Midwives (NACPM) Standards of Practice
43 and shall have the following responsibilities:
44 (1) Provide care for the healthy client who is expected to have a normal
45 pregnancy, labor, birth, and postpartal phase in the setting of their choice.
46 (2) Ensure that the client has signed an informed consent form. This form shall
47 include information to inform the client of the qualifications of the licensee,
48 and the process of shared decision making and refusal.
49 (3) Order routine antepartal or postpartal screening or laboratory analysis to be
50 performed by a licensed laboratory or testing facility, when necessary.
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1 (4) Develop an emergency plan in collaboration with the client that shall include
2 transfer plans for the client in the event of an emergency.
3 (5) Determine the progress of labor, monitor fetal and maternal status, and when
4 labor is well-established, be available until delivery is accomplished.
5 (6) Remain with the mother during the postpartal period until the conditions of
6 the mother and newborn are stabilized.
7 (7) Instruct the parents regarding the requirements of newborn screening.
8 (8) Instruct the parents regarding the requirement of newborn hearing screening.
9 (9) Submit and maintain a birth certificate of live birth in accordance with the
10 requirements of Article 4 of Chapter 130A of the General Statutes.
11 (10) Practice in compliance with the requirements of this Article and any rules
12 adopted pursuant to this Article.
13 (b) A midwife licensed pursuant to this Article shall display the license at all times in a
14 conspicuous place where the licensed midwife is practicing, when applicable.
15 "§ 90-178.17. License renewal; inactive status; lapsed license.
16 (a) An initial license to practice as a midwife shall be valid for two years. After the initial
17 license expires, a license shall be renewed every two years. All applications for renewal shall be
18 filed with the Council and shall be accompanied by the renewal fee in accordance with
19 G.S. 90-178.19 and proof of current certification from NARM or AMCB. Compliance with
20 NARM or AMCB recertific