TO AMEND THE CODE OF LAWS OF SOUTH CAROLINA, 1976, TO ENACT THE "MIDWIFE PRACTICE ACT" BY ADDING CHAPTER 90 TO TITLE 44 SO AS TO REGULATE THE PRACTICE OF MIDWIFERY, TO CREATE THE SOUTH CAROLINA BOARD OF MIDWIFERY WITHIN THE DEPARTMENT OF HEALTH AND ENVIRONMENTAL CONTROL; TO DEFINE TERMS; TO SET FORTH CERTAIN MIDWIFE PRACTICE REQUIREMENTS AND PROHIBITIONS; TO PROVIDE CRITERIA FOR LICENSURE, INCLUDING EXAMINATION REQUIREMENTS; TO REQUIRE CONTINUING EDUCATION; TO PROVIDE FOR THE PROMULGATION OF REGULATIONS BY THE BOARD; AND FOR OTHER PURPOSES.
Be it enacted by the General Assembly of the State of South Carolina:
SECTION 1. This act may be cited and known as the "Midwife Practice Act".
SECTION 2. Title 44 of the 1976 Code is amended by adding:
Section 44-90-10. (A) It has long been recognized that most pregnancy, labor, and childbirth are normal physiologic events for both the woman and the baby, and that midwives have a long history of caring for and facilitating these normal functions. It also is now recognized that the practice of licensed midwifery in South Carolina is in need of a statute to govern and protect these events.
(B) Unless otherwise provided for in this chapter, this act applies to licensed midwives regulated by the Department of Health and Environmental Control. If there is a conflict between this chapter and Section 40-1-1, the provisions of this chapter control.
Section 44-90-20. (A) There is hereby established within the Department of Health and Environmental Control, the South Carolina Board of Midwifery, which consists of seven members. Four members must be licensed midwives appointed by the Governor upon nomination by all licensed midwives in this State through an election conducted by the board. The Governor may reject any or all of those nominated upon satisfactory showing of the unfitness of those rejected. If the Governor declines to appoint any of the nominees submitted, additional nominees must be submitted in the same manner as the initial nominees. Vacancies must be filled in the manner of the original appointment for the unexpired portion of the term. Three members must be appointed by the Governor in accordance with Chapter 1, Title 40. One must be a consumer of licensed midwifery care who does not derive any income or support from any midwifery or midwifery-related business and who are not related to a midwife or a person engaged in a midwifery-related business. One must be an advanced practice registered nurse or registered nurse practicing in maternity or newborn care. One must be a physician with training in perinatal or midwifery care.
(B) The members of the board shall serve terms of four years and until their successors are appointed and qualify. No person may serve more than two consecutive four-year terms; however, a person appointed to fill an unexpired term may be reappointed for two additional four-year terms. The Governor may remove a member of the board in accordance with Section 1-3-240. No member may be removed without first giving the member an opportunity to refute the charges filed against the member, who must be given a copy of the charges at the time they are filed.
(C) A majority of the board shall constitute a quorum. Any business conducted by the board must be by a positive majority vote. For purposes of this subsection, 'positive majority vote' means a majority vote of the entire membership of the board, reduced by any vacancies existing at the time.
(D) The board shall elect a chairperson from its members by a majority vote. The board shall meet at least annually at the call of the chair. The board may additionally meet at the call of the chair or at the written call of any two members of the board.
(E) Conditions arising which have not been addressed in this chapter shall be managed in accordance with the best practices as determined by the board.
(F) The board shall establish a committee for educational program approval, testing, and a peer review process to consult with the licensed midwives in questions of ethics, competency, and performance. The committee may make recommendations to deny, suspend, or revoke a license. The committee also may recommend specific educational objectives, apprenticeship, or other improvement measures as necessary for the advancement of midwifery and maternal-fetal outcomes in the State.
(G) The board shall evaluate consumer feedback forms issued through the licensed midwives to all consumers of licensed midwifery care. The department also shall issue to, collect, and evaluate yearly forms from the licensed midwives regarding their practices.
(H) The board is solely responsible for the inspection of records of mothers and newborns delivered by licensed midwives and shall promulgate regulations for such process.
(I) The board shall determine the conditions for which, at any time in the maternity cycle, the licensed midwife must recommend medical consultation or refer for medical care. These conditions must not infringe on the scope of practice for which the midwife is trained and certified.
(J) The board shall establish standards and procedures for transferring care from a licensed midwife to a hospital if the need arises, which shall include providing a board-approved completed transfer of care form for all transfers. The board shall require a licensed midwife to establish and maintain a written plan for the emergency notification of and transfer to a local hospital and to maintain current contact information for the appropriate staff at the receiving hospitals.
(K) The Midwifery Advisory Council in office at the time of the implementation of this chapter shall serve as the first Board of Midwifery until their terms expire and new members are appointed.
Section 44-90-30. The board shall have the authority and the responsibility to:
(1) receive applications for licensure, determine the qualifications of persons applying for licensure, provide licenses to applicants qualified under this chapter, and renew, suspend, revoke and reinstate licenses;
(2) establish fees for examination of applicants, licensure, renewal of licensure, and inspection;
(3) establish the minimum amount and type of continuing education to be required for each licensed midwife seeking renewal of the midwife's license;
(4) investigate complaints against persons who are licensed under this chapter;
(5) provide the process and implementation of routine inspections;
(6) undertake, when appropriate, disciplinary proceedings and disciplinary action against persons licensed under this chapter;
(7) promulgate and adopt regulations necessary to administer this chapter;
(8) authorize, by written agreement, the department to act as agent in its interest; and
(9) provide such other services and perform such other functions as are consistent with this chapter and necessary to fulfill its responsibilities.
Section 44-90-40. For the purposes of this chapter:
(1) 'Apprentice license' means a license issued by the Department of Health and environmental Control to authorize a person desiring to become a licensed midwife to obtain clinical experience under supervision of a South Carolina practicing physician, certified nurse midwife, advanced-practice registered nurse, or licensed midwife.
(2) 'Approved program' means a midwifery school or a midwifery training program which is approved by the board.
(3) 'Board' means the South Carolina State Board of Midwifery.
(4) 'Certified nurse midwife' means a nurse authorized by the South Carolina State Board of Nursing to practice as a certified nurse midwife.
(5) 'Client' means a woman under the care of a licensed midwife, as well as her fetus and newborn child.
(6) Department' means the South Carolina Department of Health and Environmental Control.
(7) 'Estimated due date' means the estimated date of delivery with a known date of conception, known date of last menstrual period or first trimester ultrasound.
(8) 'Facility' means any room, space, location, area, structure, mobile unit, or business, or any part of any of these places, where childbirth is practiced or conducted in a place or by persons licensed by the department.
(9) 'Licensed health care provider' means a physician, physician assistant, advanced practice registered nurse or certified nurse midwife.
(10) 'Licensed midwife' means a person who has completed all requirements set forth by the board, has successfully completed the examination process, and has been approved by the board for a license to be issued by the department.
(11) 'Low-risk client' means an individual who is at low or normal risk of developing complications during pregnancy and childbirth as evidenced by the absence of any preexisting maternal disease or disease arising during pregnancy or such other conditions as the board may identify in regulations.
(12) 'Midwifery Advisory Council' means the current council functioning under the department Regulation 61-24 (as enacted in 2013).
(13) 'Newborn' means an infant from the time of birth until six weeks or until breastfeeding support is no longer necessary.
(14) 'North American Registry of Midwives' or 'NARM' means the international certification agency that establishes and administers certification for the CPM credential.
(15) 'Physician' means a person who is currently practicing medicine and is licensed to practice medicine or osteopathy in South Carolina or contiguous states.
(16) 'Practice of midwifery', means providing maternity care that is consistent with a licensed midwife's training, education, and experience, to women and newborns during the antepartum, intrapartum, and postpartum periods.
(17) 'Supervision' means the coordination, direction, and continued evaluation at first hand of the person in training and obtaining clinical experience as an apprentice midwife within the scope of these provisions.
Section 44-90-50. (A) The midwife must be able at all times to recognize the warning signs of abnormal or potentially abnormal conditions necessitating referral to a licensed health care provider. It shall be the midwife's duty to consult with a licensed health care provider whenever there are significant deviations from the normal. The midwife's training and practice must reflect a particular emphasis on thorough risk assessment.
(B) At any time in the maternity cycle, the midwife must recommend medical consultation, or refer for medical care, any woman who:
(1) has a history of serious problems not discovered at the initial visit with a health care provider;
(2) develops a blood pressure of persistently greater than 141/90 or more;
(3) develops severe persistent headaches, epigastric pain, or visual disturbances;
(4) develops significant proteinuria or glycosuria;
(5) has convulsions of any kind;
(6) has significant vaginal bleeding before the onset of labor;
(7) has symptoms of kidney or urinary tract infection;
(8) has symptoms of vaginitis that does not respond to initial treatment;
(9) has symptoms of gonorrhea, syphilis, or genital herpes;
(10) smokes more than ten cigarettes per day and does not decrease usage;
(11) appears to abuse alcohol or drugs;
(12) does not improve nutrition within satisfactory limits;
(13) presents with anemia that does not respond to therapy;
(14) develops symptoms of diabetes;
(15) has excessive vomiting;
(16) has 'morning sickness' (nausea) continuing past twenty-four weeks gestation;
(17) develops symptoms of pulmonary disease;
(18) has polyhydramnios or oligohydramnios;
(19) has severe varicosities of the vulva or extremities;
(20) has fundal height measurements significantly inappropriate for gestational age;
(21) has suspected multiple gestation;
(22) has suspected malpresentation;
(23) has marked decrease in or cessation of fetal movements;
(24) has rupture of membranes or other signs of labor before completion of thirty-seven weeks gestation;
(25) is outside of normal parameters for term delivery;
(26) has a fever of 100.4 or higher for twenty-four-hours;
(27) demonstrates serious psychiatric illness or severe psychological problems;
(28) demonstrates unresolved fearfulness regarding home birth or midwife care, or otherwise desires consultation or transfer;
(29) develops respiratory distress in labor;
(30) has prolonged ruptured membranes without onset of labor
(31) has meconium-stained amniotic fluid with non-reassuring heart tones;
(32) has more than capillary bleeding in labor prior to delivery;
(33) has persistent or recurrent fetal heart tones significantly above or below the baseline, or late or irregular decelerations which do not disappear permanently with change in maternal position, or abnormally slow return to baseline after contractions;
(34) develops ketonuria or other signs of exhaustion;
(35) develops pathological retraction ring;
(36) does not show continued progress to delivery in second stage;
(37) has a partially separated placenta or atonic uterus;
(38) has bleeding before or after delivery of placenta; greater than 1000 cc or is symptomatic of shock;
(39) has firm uterus with no bleeding but retained placenta more than one hour;
(40) has significant change in blood pressure, pulse over 120, or is pale, cyanotic, weak or dizzy;
(41) retains placental or membrane fragments;
(42) has a greater than normal lochial flow;
(43) has placental abnormality;
(44) has platelet sensitization, hematological or coagulation disorders;
(45) has prior chemotherapy and/or radiation treatment for a malignancy;
(46) has cervical insufficiency;
(47) is HIV positive status; or
(48) uses opiates, such that the use places the infant at risk of neonatal abstinence syndrome.
Section 44-90-60. (A) Regulations promulgated by the board shall include standards for transferring care from a licensed midwife if the need arises.
(B) The following diagnoses, conditions, or symptoms should be transferred to a higher level of care:
(1) maternal fever in labor;
(2) suggestion of fetal jeopardy or abnormal fetal heart tones;
(3) current spontaneous premature labor;
(4) current preterm premature rupture of membranes;
(5) current pre-eclampsia;
(6) current hypertensive disease of pregnancy;
(7) uncontrolled bleeding;
(8) delivery injuries to the bladder or bowel;
(9) grand mal seizure;
(10) uncontrolled vomiting;
(11) coughing or vomiting of blood;