GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2001
H	1
HOUSE BILL 1014*

 
 
Short Title:	Certified Professional Midwives.	()	
Sponsors:	Representatives Morris;  Adams, Allred, Clary, Easterling, Fitch, Gulley, Johnson, Justus, Luebke, McAllister, McMahan, Sherrill, and Smith.	
Referred to:	Finance.	
April 9, 2001

A BILL TO BE ENTITLED
AN ACT to authorize the practice of midwifery by certified professional midwives.

The General Assembly of North Carolina enacts:
SECTION 1.  Chapter 90 of the General Statutes is amended by adding a new Article to read:
"Article 10B.
"Certified Professional Midwives.
"§ 90-178.17.  Legislative findings.
(a)	The General Assembly finds that certified professional midwives should be allowed to practice midwifery in this State for the following reasons:
(1)	Access to prenatal care and delivery services are limited by an inadequate number of providers.
(2)	Women should have the freedom to choose the manner, cost, and setting in which they give birth.
(3)	It is in the best interest of this State to remove obstacles to out-of-hospital deliveries and to encourage cooperation and consultation between licensed health care professionals and certified professional midwives.
(b)	The General Assembly also recognizes that the certified professional midwife requirements are based on widely accepted core competencies for midwifery, that the requirements represent national standards for non-nurse midwives, and that the practice of midwifery by certified professional midwives is the only credential that requires out-of-hospital training.
"§ 90-178.18.  Definitions.
The following definitions apply in this Article:
(1)	Approval. – Authorization from the North Carolina Supervisory Council of Certified Professional Midwives to practice midwifery in this State.
(2)	Certified Professional Midwife (CPM). – A person who has obtained national certification from the North American Registry of Midwives (NARM) after having demonstrated his or her qualifications through the application process, a practical skills assessment, and a written examination.
(3)	Consultation. – The exchange of information and advice with a physician regarding the client condition and indicated treatment.
(4)	Council. -- The North Carolina Supervisory Council of Certified Professional Midwives responsible for administering Article 10B of Chapter 90 of the General Statutes, which is a separate and independent branch of the Midwifery Joint Committee that administers Article 10A of Chapter 90 of the General Statutes.
(5)	Intrapartum care. – The term shall include:
a.	Assisting women during uncomplicated labor.
b.	Assisting with the spontaneous delivery of infants from 37 to 42 weeks gestation.
c.	Performing amniotomy.
d.	Performing emergency episiotomies.
e.	Providing intravenous fluids for hydration when needed.
(6)	Midwifery. – The provision of prenatal, intrapartum, and postpartum care for women experiencing normal pregnancies and newborn care for their infants in out-of-hospital settings. Midwifery may include well-woman care as defined in rules adopted by the Board, but does not include the practice of medicine as described in G.S. 90-178.2(3).
(7)	Newborn care. – The term shall include:
a.	Providing routine physical assessments including APGAR scoring.
b.	Maintaining thermal stability.
c.	Providing assistance to newborns to establish respiration, including the acquisition and use of oxygen when needed.
d.	The acquisition and use of Vitamin K.
e.	The acquisition and use of eye prophylaxis for opthalmia neonatorum.
f.	The ability to complete and file birth certificates.
(8)	North Carolina Registry of Midwives (NARM). – An international certification agency whose mission is to establish and administer certification for the 'Certified Professional Midwife' credential.
(9)	Postpartum care. – The term shall include:
a.	Management of the normal third stage of labor.
b.	The acquisition and use of oxytoxic drugs after delivery when needed.
c.	Repairing lacerations associated with childbirth, including the acquisition and use of local anesthesia.
d.	The acquisition and administration of Rhogam.
e.	The performance of evaluation examinations in the days and weeks following delivery.
(10)	Prenatal care. – The term shall include:
a.	Historical and physical assessments of pregnant women.
b.	Obtaining, ordering, and assessing the results of routine laboratory tests.
c.	The acquisition and administration of Rhogam.
d.	Supervising client use of prenatal vitamins, folic acid, iron, and nonprescription medicines.
"§ 90-178.19.  Approval required; exemptions.
(a)	On or after January 1, 2002, no person shall practice midwifery as defined in G.S. 90-178.18 unless that person has been approved by the Council as provided in this Article.
(b)	The provisions of this Article do not apply to:
(1)	A midwife licensed under Article 10A of this Chapter.
(2)	A physician licensed under Article 1 of this Chapter when engaged in the practice of medicine as defined by law.
(3)	The performance of medical acts by a physician assistant or nurse practitioner when performed in accordance with the rules of the North Carolina Medical Board.
(4)	The practice of nursing by a registered nurse engaged in the practice of nursing as defined by law.
(5)	The rendering of childbirth assistance in an emergency situation.
(6)	Individuals who are present at or assisting the certified professional midwife in the birth process, including family members or other caregivers invited by the birth mother, persons providing emergency medical care, doulas, or midwifery students or assistants who are under the supervision of a certified professional midwife approved under the provisions of this Article.
"§ 90-178.20.  The North Carolina Supervisory Council of Certified Professional Midwives.
(a)	Composition and Terms. – The North Carolina Supervisory Council of Certified Professional Midwives is created. The Council shall consist of seven members who shall serve staggered terms. The initial Council members shall be selected on or before October 1, 2001, as follows:
(1)	The General Assembly, upon the recommendation of the President Pro Tempore of the Senate, shall appoint one certified professional midwife and one woman who has received care from a certified professional midwife, both of whom shall serve for terms of three years.
(2)	The General Assembly, upon the recommendation of the Speaker of the House of Representatives, shall appoint one licensed physician who has experience working with midwives practicing in out-of-hospital settings, and one woman who has received care from a professional certified midwife, both of whom shall serve for terms of two years.
(3)	The Governor shall appoint two certified professional midwives who shall serve terms of one year, and one certified nurse midwife with out-of-hospital experience to serve a term of two years.
Upon the expiration of the terms of the initial Council members, members shall be elected by majority vote of the certified professional midwives in good standing. Members shall be elected for terms of three years and shall serve until their successors are elected. No member may serve more than two consecutive full terms.
(b)	Qualifications. – The certified professional midwife members shall hold current approvals from the Council, reside or be employed in this State, and remain in good standing with the Council during their terms.
(c)	Vacancies. – A vacancy shall be filled by majority vote of the certified professional midwives in good standing. All persons elected to fill vacancies shall serve the remainder of the unexpired term and until their successors have been duly elected and qualified.
(d)	Removal. – The Council may remove any of its members for neglect of duty, incompetence, or unprofessional conduct. A member subject to disciplinary proceedings in his or her capacity as a certified professional midwife shall be disqualified from participating in the official business of the Council until the charges have been resolved.
(e)	Compensation. – Each member of the Council shall receive per diem and reimbursement for travel and subsistence as provided in G.S. 93B-5.
(f)	Officers. – The officers of the Council shall be a chair, a vice-chair, and other officers deemed necessary by the Council to carry out the purposes of this Article. All officers shall be elected annually by the Council for two-year terms and shall serve until their successors are elected and qualified. No person may serve as chair for more than five consecutive years.
(g)	Meetings. – The Council shall hold its first meeting within 45 days after the appointment of its members, and shall hold at least two meetings each year to conduct business and to review the standards and rules previously adopted by the Council with guidance from the Midwives Alliance of North America's Core Competencies. The Council shall establish the procedures for calling, holding, and conducting regular and special meetings. A majority of Council members shall constitute a quorum.
"§ 90-178.21.  Powers of the Council.
The Council shall have the power and duty to:
(1)	Administer this Article.
(2)	Issue interpretations of this Article.
(3)	Adopt, amend, or repeal rules as may be necessary to carry out the provisions of this Article.
(4)	Employ and fix compensation of personnel that the Council determines is necessary to carry into effect the provisions of this Article and incur other expenses necessary to effectuate this Article.
(5)	Examine and determine the qualifications and fitness of applicants for approval, renewal of approval, and reciprocal approval.
(6)	Issue, renew, deny, suspend, or revoke approvals and carry out any disciplinary actions authorized by this Article.
(7)	Set fees for approval, approval renewal, and other services deemed necessary to carry out the purposes of this Article.
(8)	Maintain a current list of all persons who have been approved as a certified professional midwife under this Article and collect their annual statistics.
(9)	Address problems and concerns of practicing certified professional midwives in order to promote safety for the citizens of this State.
(10)	Conduct investigations for the purpose of determining whether violations of this Article or grounds for disciplining certified professional midwives exist.
(11)	Maintain a record of all proceedings and make available to all approved certified professional midwives and other concerned parties an annual report of all Council action.
(12)	Adopt a seal containing the name of the Council for use on all official documents and reports issued by the Council.
"§ 90-178.22.  Qualifications for approval.
An applicant shall be approved to practice as a certified professional midwife if the applicant meets all of the following qualifications:
(1)	Is at least 21 years of age.
(2)	Has obtained a high school diploma or its equivalent.
(3)	Completes an application on a form provided by the Council.
(4)	Submits evidence of certification by the North American Registry of Midwives.
(5)	Submits a client-informed consent document to the Council that shall include:
a.	Disclosure of the certified professional midwife's qualifications, experience, and training.
b.	A written protocol for medical emergencies and transportation to a hospital when needed.
c.	A description of the midwifery model of care.
d.	A description of the right to file a complaint and the procedures for filing a complaint.
e.	Any other information as deemed necessary by the Council to allow the client to make an informed decision in selecting a certified professional midwife and, if applicable, in choosing home birth.
(6)	Has proof of current adult and infant cardiopulmonary resuscitation (CPR) certification or neonatal resuscitation.
(7)	Pays the required fee under G.S. 90-178.24.
"§ 90-178.23.  Reciprocity; nonresident approval.
(a)	The Council may, upon application and payment of proper fees, grant approval to a person who resides in this State and has been approved to practice as a certified professional midwife in another state whose standards of competency are substantially equivalent to those provided in this Article.
(b)	The Council may, upon application and payment of proper fees, grant approval to a nonresident if the person meets the requirements of this Article or the person resides in a state that recognizes approvals issued by the Council.
"§ 90-178.24.  Expenses; fees.
(a)	All fees payable to the Council shall be deposited in the name of the Council in financial institutions designated by the Council as official depositories and shall be used to pay all expenses incurred in carrying out the purposes of this Article.
(b)	All salaries, compensation, and expenses incurred or allowed to carry out the purposes of this Article shall be paid by the Council exclusively out of the fees received by the Council as authorized by this Article or funds received from other sources. In no case shall any salary, expense, or other obligation of the Council be charged against the State treasury.
(c)	The Council shall establish fees not exceeding the following amounts:
(1)	Initial issuance of approval				$   400.00
(2)	Renewal of approval					$2,500.00
(3)	Late renewal fee						$   150.00.
"§ 90-178.25.  Issuance and renewal of approval.
The Council shall approve a person to practice as a certified professional midwife, upon payment of the fee required in G.S. 178.24, if the person has satisfactorily met the requirements of this Article as administered by the Council. All approvals to practice shall expire three years after the date they were issued unless renewed. All applications for renewal shall be filed with the Council and shall be accompanied by the renewal fee as required by G.S. 90-178.24 and proof of current certification from NARM. Compliance with NARM recertification requirements shall include: (i) current adult and infant CPR or neonatal resuscitation; and (ii) at least five hours of certified education units in a peer review workshop or five hours of peer review participation in addition to 25 hours of continuing education. An approval that has expired for failure to renew may be reinstated after the applicant pays the late and renewal fees as required by G.S. 90-178.24.
"§ 90-178.26.  Inactive status.
Upon request, the Council shall grant an approved certified professional midwife inactive status. While inactive, the person shall not practice midwifery as defined in this Article, in this State and shall not be subject to renewal of approval requirements established by the Council. However, while inactive, the person shall comply with all NARM certification requirements. The person may reactivate his or her approval by submitting a reactivation application to the Council and paying a renewal of approval fee that shall be prorated for the number of months remaining before the time the applicant would ordinarily be required to renew his or her approval.
"§ 90-178.27.  Suspension, revocation, and refusal to renew approval.
(a)	The Council may require remedial education, issue a letter of reprimand, deny, refuse to renew, suspend, or revoke an application for approval or an approval if the applicant or person who has been approved:
(1)	Gives false information or withholds material information from the Council in procuring or attempting to procure an approval.
(2)	Gives false information or withholds material information from the Council during the course of an investigation conducted by the Council.
(3)	Has been convicted of or pled guilty or no contest to a crime that indicates the person is unfit or incompetent to practice midwifery as defined in this Article or that indicates the person has deceived, defrauded, or endangered the public.
(4)	Has a habitual substance abuse problem or mental impairment that interferes with his or her ability to provide appropriate care as established by this Article or rules adopted by the Council.
(5)	Has demonstrated gross negligence, incompetency, or misconduct in the practice of midwifery as defined in this Article.
(6)	Has had an application for approval or an approval to practice midwifery in another jurisdiction denied, suspended, or revoked for reasons that would be grounds for similar action in this State.
(7)	Has willfully violated any provision of this Article or rules adopted by the Council.
(b)	The taking of any action authorized under subsection (a) of this section may be ordered by the Council after a hearing is held in accordance with Article 3A of Chapter 150B of the General Statutes. The Council may reinstate a revoked approval if it finds that the reasons for revocation no longer exist and that the person can reasonably be expected to perform the services authorized under this Article in a safe manner.
"§ 90-178.28.  Withdrawal by midwife.
(a)	Prenatal Period. -- A certified professional midwife may withdraw from responsibility for a client during the prenatal period if for any reason the certified professional midwife does not feel comfortable continuing as the client's midwife. The certified professional midwife may take into account: (i) the client's refusal to consult with a physician when the midwife believes consultation is required; (ii) the client's failure or refusal to follow recommendations made by the midwife; (iii) personality incompatibilities; or (iv) any other factor that the midwife believes may create an unwarranted risk to the client or child or interfere with the midwife's ability to care responsibly for the client or child. In the event the midwife withdraws, the midwife shall immediately notify the client in writing and cooperate with the client in finding alternative care.
(b)	After Onset of Labor. -- After the onset of labor, the midwife may withdraw only if the midwife believes he or she is unable to care responsibly for the client or newborn and the client refuses to transfer to a hospital. The midwife shall document the relevant events, and shall make reasonable attempts to ensure that the client is not left unattended, including contacting emergency medical personnel or a physician.
"§ 90-178.29.  Third-party reimbursement allowed.
Certified professional midwives approved to practice in this State shall receive third-party reimbursement from private agencies that provide coverage for maternity and obstetrical care.
"§ 90-178.30.  Enjoining illegal practices; immunity.
(a)	The Council may apply to the superior court for an order enjoining violations of this Article. Upon a showing by the Council that any person has violated this Article, the court may grant injunctive relief.
(b)	No physician, certified nurse midwife, or hospital providing emergency medical care or treatment to a woman or infant arising during childbirth as a consequence of the care received from a certified professional midwife as approved under this Article, shall be liable for any civil damages or any act or omission as a result of rendering the emergency medical care."
SECTION 2.  This act is effective when it becomes law.