OHIO LEGISLATIVE SERVICE COMMISSION
Office of Research Legislative Budget
www.lsc.ohio.gov and Drafting Office
H.B. 545 Bill Analysis
135th General Assembly
Click here for H.B. 545’s Fiscal Note
Version: As Introduced
Primary Sponsors: Reps. McClain and M. Miller
Effective Date:
Elizabeth Molnar, Attorney
SUMMARY
Regulates the practice of certified midwives and licensed midwives, including by
requiring them to be licensed by the Ohio Board of Nursing (certified midwives) or the
Department of Commerce (licensed midwives).
Expands the Board of Nursing’s existing authority to regulate certified nurse-midwives,
including by establishing conditions on their provision of certain midwifery services.
Authorizes certified midwives and licensed midwives to engage in specified activities,
including attending births in hospitals, homes, medical offices, and freestanding birthing
centers, and in the case of certified midwives, prescribing drugs.
Requires a certified midwife, like a certified nurse-midwife, to practice in collaboration
with a physician and to enter into a standard care arrangement with the collaborating
physician.
Creates the Licensed Midwifery Advisory Council to advise and make recommendations
to the Department of Commerce regarding the practice and regulation of licensed
midwives.
TABLE OF CONTENTS
Unauthorized practice as a certified midwife or licensed midwife ................................................ 3
Exemptions ............................................................................................................................. 3
Note on traditional midwives, certified professional midwives, and certified international
midwives...................................................................................................................................... 5
Use of titles ..................................................................................................................................... 6
License applications and renewals ................................................................................................. 6
Certified midwives – eligibility criteria ........................................................................................ 6
Note on advanced pharmacology .......................................................................................... 7
May 29, 2024
Office of Research and Drafting LSC Legislative Budget Office
Licensed midwives – eligibility criteria ........................................................................................ 7
Permitted and prohibited activities ................................................................................................ 8
Certified midwives....................................................................................................................... 8
Prescriptive authority ............................................................................................................. 9
Note on controlled substances............................................................................................... 9
Ohio Automated Rx Reporting System (OARRS) .................................................................. 10
Other drugs ........................................................................................................................... 10
Licensed midwives..................................................................................................................... 11
Administering drugs ............................................................................................................. 11
Prohibited activities .............................................................................................................. 12
Medical records ......................................................................................................................... 12
Collaboration and standard care arrangements........................................................................... 12
Failure to maintain a standard care arrangement .................................................................... 13
Informed consent.......................................................................................................................... 13
Home births and high risk pregnancies ........................................................................................ 14
Note on referrals ....................................................................................................................... 15
Transfer of care plans and home births ........................................................................................ 15
Time, place, and manner of delivery ............................................................................................ 16
Adverse incidents .......................................................................................................................... 16
Immunity from civil liability .......................................................................................................... 17
Annual reports .............................................................................................................................. 17
Disciplinary actions ....................................................................................................................... 18
Rulemaking authority.................................................................................................................... 19
Board of Nursing........................................................................................................................ 19
Department of Commerce ........................................................................................................ 19
Licensed Midwifery Advisory Council ........................................................................................... 20
Appointments, vacancies, and organization ............................................................................. 20
Department duties .................................................................................................................... 21
Board of Nursing membership ...................................................................................................... 21
Conforming changes ..................................................................................................................... 22
P a g e |2 H.B. 545
As Introduced
Office of Research and Drafting LSC Legislative Budget Office
DETAILED ANALYSIS
H.B. 545 regulates the practice of certified midwives and licensed midwives, including by
(1) requiring such midwives to be licensed by the Ohio Board of Nursing (certified midwives) or
Department of Commerce (licensed midwives), (2) specifying the activities in which they may
engage, and (3) establishing conditions on the provision of certain midwifery services.1 At
present, Ohio law does not recognize the practice of certified midwives or licensed midwives,
but does recognize that of certified nurse-midwives, a type of advanced practice registered
nurse (APRN) licensed by the Board who holds both of the following: a master’s or doctoral
degree in a nursing specialty or related field and certification in nurse-midwifery from a
national certifying organization approved by the Board.2
Unauthorized practice as a certified midwife or licensed midwife
The bill generally prohibits an individual from knowingly practicing as a certified midwife
unless the individual holds a current, valid license to do so issued by the Board of Nursing.3 It
also generally prohibits an individual from knowingly practicing as a licensed midwife unless the
individual holds a current, valid license to do so issued by the Department of Commerce. 4
In the event of a violation of either prohibition, the individual is guilty of a fifth degree
felony on a first offense, which is punishable by a fine of not more than $2,500 and a jail term
of six to 12 months and a fourth degree felony on each subsequent offense, which is punishable
by a fine of not more than $5,000 and a jail term of six to 18 months.5 Note that the bill delays
the application of each prohibition and its criminal penalties until January 1, 2026.6 The bill also
maintains current law prohibiting an APRN, including a certified nurse-midwife, from knowingly
practicing as such without a Board-issued license.7
Exemptions
The bill specifies that the prohibition on knowingly practicing as a certified midwife
without a license does not apply to any of the following individuals:
A physician, physician assistant, registered nurse, licensed practical nurse, APRN,
including a certified nurse-midwife, or licensed midwife who is licensed to practice in
Ohio;
1 R.C. Chapter 4723 and 4724.
2 R.C. 4723.41.
3 R.C. 4723.54
4 R.C. 4724.02.
5 R.C. 4723.99 and 4724.99. See also R.C. 2929.14 and 2929.18, neither in the bill.
6 Section 3.
7 R.C. 4723.03, not in the bill.
P a g e |3 H.B. 545
As Introduced
Office of Research and Drafting LSC Legislative Budget Office
A traditional midwife;
A student who is participating in a midwifery education program accredited by the
accreditation commission for midwifery education and who provides midwifery services
under the auspices of the program and under the supervision of a certified midwife
serving for the program as a faculty member, instructor, teaching assistant, or
preceptor.8
The bill also specifies that the prohibition on knowingly practicing as a licensed midwife
without a license does not apply to any of the following individuals:
A physician, physician assistant, registered nurse, licensed practical nurse, APRN,
including a certified nurse-midwife, or certified midwife who is licensed to practice in
Ohio;
A traditional midwife;
A student who is participating in a professional midwifery education program and who
provides midwifery services under the auspices of the program and under the
supervision of a licensed midwife serving for the program as a faculty member,
instructor, teaching assistant, or preceptor;
An individual who is participating in a professional midwifery apprenticeship and who
provides midwifery services as part of the apprenticeship program and under the
supervision of a licensed midwife serving for the program as an instructor, teaching
assistant, or preceptor;
An individual who provides midwifery services without a license while engaging in good
faith in the practice of a church’s religious tenets or in any religious act;
An individual who is not engaged in the practice of the religious tenets of any church or
in any religious act, but who provides midwifery services without a license to others
engaging in good faith in the practice of the religious tenets of any church or in any
religious act;
A member of a Native American community who provides midwifery services without a
license to other members of the community;
An individual who is participating in a midwifery apprenticeship under the supervision of
a traditional midwife and who provides midwifery services as part of the apprenticeship
program under the supervision of a traditional midwife;
8 R.C. 4723.54.
P a g e |4 H.B. 545
As Introduced
Office of Research and Drafting LSC Legislative Budget Office
A certified professional midwife or certified international midwife, but only if the
certified professional midwife or certified international midwife does not, as a part of
the midwife’s practice, obtain or administer drugs or perform surgical suturing.9
Note on traditional midwives, certified professional midwives, and
certified international midwives
The bill exempts a traditional midwife from the prohibition against practicing as a
certified midwife or licensed midwife without holding a license as such, thereby appearing to
allow such a midwife to perform many of the same midwifery services as certified midwives,
licensed midwives, and certified nurse-midwives holding licenses issued by either the Board of
Nursing or Department of Commerce.
Under the bill, a traditional midwife is defined to mean an individual who has entered
the midwifery profession through an apprenticeship program with an experienced practicing
midwife and does not hold a license to practice midwifery in Ohio.10 Under the bill, before
providing midwifery services, a traditional midwife must disclose to each client in writing that
he or she is not a licensed midwife.
The bill also exempts a certified professional midwife and certified international
midwife from the prohibition against practicing as a licensed midwife without holding a license,
thereby appearing to allow such a midwife to perform many of the same midwifery services as
a licensed midwife. To be eligible for the exemption, the certified professional midwife and
certified international midwife must not, as part of the midwife’s practice, obtain or administer
drugs or perform surgical suturing.11
The bill defines a certified professional midwife to mean an individual who is certified by
the North American Registry of Midwives, but is not a licensed midwife. A certified
international midwife is defined by the bill to mean an individual who is certified by the
International Registry of Midwives, but is not a licensed midwife.12 Thus, the primary difference
between a certified professional midwife or certified international midwife and a licensed
midwife is that the licensed midwife holds a license issued by the Department of Commerce
while the other two do not. Note that under the bill a licensed midwife must be certified as a
professional midwife by the North American Registry of Midwives, as an international midwife
by the International Registry of Midwives, or certified as a midwife by another certifying
organization approved by the Department.
9 R.C. 4724.02.
10 R.C. 4724.01.
11 R.C. 4724.02.
12 R.C. 4724.01.
P a g e |5 H.B. 545
As Introduced
Office of Research and Drafting LSC Legislative Budget Office
Use of titles
The bill prohibits a person from knowingly using the title “certified nurse-midwife,”
“certified midwife,” or “licensed midwife” or any other title implying that the person is a
certified nurse-midwife, certified midwife, or licensed midwife without holding a current, valid
license issued by the Board of Nursing (certified nurse-midwife or certified midwife) or
Department of Commerce (licensed midwife).13 An individual who violates the prohibition is
guilty of a misdemeanor of the first degree, which is generally punishable by a jail term of not
more than 180 days and a fine of not more than $1,000. 14 In the case of a violation for
knowingly using the title “licensed midwife” or otherwise implying that the person is a licensed
midwife, the bill specifies that an individual violator is subject to a $1,000 fine and a jail term of
not more than 180 days.15
License applications and renewals
An individual seeking an initial license to practice as a certified midwife must file an
application, which includes submitting a $45 fee, with the Board of Nursing in the manner
prescribed by the Board.16 If the Board determines that an applicant meets the eligibility
criteria outlined in the bill, the Board must issue the applicant a license.17 Each license is valid
for a two-year period, unless revoked or suspended, and may be renewed on application to the
Board, which includes submitting a $20 renewal fee.
Similarly, an individual seeking an initial license to practice as a licensed midwife must
file an application with the Department of Commerce in the manner prescribed by the
Department, with the application fee to be set in rule, with the amount not to exceed $45.18 If
the Department determines that an applicant meets the eligibility criteria outlined in the bill,
the Department must issue the applicant a license.19 Each license is valid for a two-year period,
unless revoked or suspended, and may be renewed on application to the Department, with the
renewal fee to be established in rule, with the amount not to exceed $20.
Certified midwives – eligibility criteria
To be eligible for an initial license to practice as a cert