Be it enacted by the General Assembly of the State of South Carolina:

SECTION     1.     Chapter 47, Title 40 of the 1976 Code is amended by adding:

"Article 11

South Carolina Midwife Practice Act

    Section 40-47-1705.     This act may be cited and known as the "South Carolina Midwife Practice Act".

    Section 40-47-1710.     As used in this article:

    (1)     'Apprentice license' means a license issued by the Board of Medical Examiners 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' or 'Board of Medical Examiners' means the State Board of Medical Examiners for South Carolina.

    (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)     '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.

    (7)     '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 board.

    (8)     'Licensed health care provider' means a physician, physician assistant, advanced practice registered nurse, or certified nurse midwife.

    (9)     'Licensed midwife' means a person who has completed all requirements of the board to practice midwifery pursuant to this article, has successfully completed the examination process, and has been approved by the board for licensure.

    (10)     '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.

    (11)     'Newborn' means an infant from the time of birth until six weeks or until breastfeeding support is no longer necessary.

    (12)     'Physician' means a person who is currently practicing medicine and is licensed to practice medicine or osteopathy in South Carolina or contiguous states.

    (13)     '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.

    (14)     '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 40-47-1715.     This article does not apply to any of the following:

    (1)     a certified nurse midwife, unless the certified nurse midwife chooses to become a licensed midwife;

    (2)     a student midwife-in-training under the direct supervision of a licensed midwife;

    (3)     a person rendering aid in an emergency where no fee for the service is contemplated, charged, or received;

    (4)     a person administering care to a member of such person's family; or

    (5)     the practice of a profession by an individual who is licensed, certified or registered under other laws of this State and is performing services within the authorized scope of practice.

    Section 40-47-1720.     (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 midwifery by licensed midwives in South Carolina is in need of a practice act to govern and protect these events.

    (B)     Unless otherwise provided for in this article, this article applies to licensed midwives regulated by the Board of Medical Examiners. If there is a conflict between this article and Chapter 89, Title 44, the provisions of this article control.

    Section 40-47-1725.     (A)(1)     The Board of Medical Examiners 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, apprenticeships, or other improvement measures as necessary for the advancement of midwifery and maternal-fetal outcomes in the State.

        (2)     The Midwifery Advisory Council of the Department of Health and Environmental Control in office at the time of the implementation of this article shall serve as the first committee until their terms expire and new members are appointed by the board.

    (B)     The board shall establish standards and procedures for transferring care from a licensed midwife to a hospital if the need arises, which must 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.

    (C)     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 licensed midwife is trained and certified. A condition that arises that has not been addressed in this article must be managed in accordance with the best practices as determined by the board.

    (D)     The board shall evaluate consumer feedback forms issued through the licensed midwives to all consumers of licensed midwifery care. The board also shall issue to, collect, and evaluate yearly forms from the licensed midwives regarding their practices.

    (E)     The board is solely responsible for the inspection of records of mothers and newborns delivered by licensed midwives and shall promulgate regulations to implement the provisions of this subsection.


    Section 40-47-1730.     The board has 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 article, 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 article;

    (5)     provide the process and implementation of routine inspections;

    (6)     undertake, when appropriate, disciplinary proceedings and disciplinary action against persons licensed under this article;

    (7)     promulgate regulations necessary to administer this article; and

    (8)     provide such other services and perform such other functions as are consistent with this article and necessary to fulfill its responsibilities.

    Section 40-47-1735.     (A)     A licensed 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 is the licensed midwife's duty to consult with a licensed health care provider whenever there are significant deviations from the normal. The licensed midwife's training and practice must reflect a particular emphasis on thorough risk assessment.

    (B)     At any time in the maternity cycle, the licensed 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 licensed 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 40-47-1740.     (A)     A licensed midwife must be able to carry out emergency measures in the absence of medical help. A licensed midwife must be trained to deal effectively with those life-threatening complications most likely to arise in the course of childbirth, as defined by the board.

    (B)     Examples of life-threatening complications include, at a minimum:

        (1)     respiratory or circulatory failure in mother or infant;

        (2)     postpartum hemorrhage;

        (3)     cord prolapse;

        (4)     tight nuchal cord;

        (5)     multiple births and malpresentations;

        (6)     shoulder dystocia;

        (7)     gross prematurity or intrauterine growth retardation; and

        (8)     serious congenital anomalies.

    Section 40-47-1745.     (A)     A licensed midwife who deems it necessary to transfer or terminate care pursuant to the provisions of this article, or any regulations promulgated pursuant to this article, shall transfer or terminate care, and the action may not be regarded as having abandoned care or wrongfully terminated services.

    (B)     A licensed midwife who discontinues care for a client who no longer qualifies for services under the provisions of this article, or any regulations promulgated pursuant to this article, may not be deemed to have abandoned care.

    Section 40-47-1750.     (A)     At or before the second trimester or as soon thereafter as care occurs, if such testing has not yet occurred, the licensed midwife may order the following laboratory tests:

        (1)     a serological test for syphilis, either rapid plasma reagin (RPR) or venereal disease research laboratory;

        (2)     blood group;

        (3)     Rh factor and antibody screen;

        (4)     rubella titer;

        (5)     complete blood count;

        (6)     gonorrhea screen;

        (7)     urine culture;

        (8)     chlamydia screen;

        (9)     hepatitis B, hepatitis C, and human immune deficiency virus (HIV); and

        (10)     a prenatal panel screening as defined by individual laboratory criteria.

    (B)     Throughout the pregnancy, the licensed midwife may order the following as appropriate: