CALIFORNIA CODES
BUSINESS AND PROFESSIONS CODE
SECTION 2505-2521

2505.  This article shall be known and may be cited as the Licensed
Midwifery Practice Act of 1993.




2506.  As used in this article the following definitions shall
apply:
   (a) "Board" means the Division of Licensing of the Medical Board
of California.
   (b) "Licensed midwife" means an individual to whom a license to
practice midwifery has been issued pursuant to this article.
   (c) "Certified nurse-midwife" means a person to whom a certificate
has been issued pursuant to Article 2.5 (commencing with Section
2746) of Chapter 6.
   (d) "Accrediting organization" means an organization recognized by
the United States Department of Education, Division of
Accreditation.




2507.  (a) The license to practice midwifery authorizes the holder,
under the supervision of a licensed physician and surgeon, to attend
cases of normal childbirth and to provide prenatal, intrapartum, and
postpartum care, including family-planning care, for the mother, and
immediate care for the newborn.
   (b) As used in this article, the practice of midwifery constitutes
the furthering or undertaking by any licensed midwife, under the
supervision of a licensed physician and surgeon who has current
practice or training in obstetrics, to assist a woman in childbirth
so long as progress meets criteria accepted as normal.  All
complications shall be referred to a physician immediately.  The
practice of midwifery does not include the assisting of childbirth by
any artificial, forcible, or mechanical means, nor the performance
of any version.
   (c) As used in this article, "supervision" shall not be construed
to require the physical presence of the supervising physician.
   (d) The ratio of licensed midwives to supervising physicians shall
not be greater than four individual licensed midwives to one
individual supervising physician.
   (e) A midwife is not authorized to practice medicine and surgery
by this article.




2508.  (a) If a licensed midwife does not have liability coverage
for the practice of midwifery, he or she shall disclose to a client
that fact.
   (b) A licensed midwife shall disclose to a client that a specific
physician is being briefed regularly concerning the client's
pregnancy and that the physician is prepared to take care of
complications in the hospital if necessary.




2511.  (a) No person, other than one who has been licensed to
practice midwifery by the board, shall hold himself or herself out as
a licensed midwife, or use any other term indicating or implying
that he or she is a licensed midwife.
   (b) Nothing in this article shall be construed to limit in any
manner the practice of an individual to whom a certificate has been
issued pursuant to Article 2.5 (commencing with Section 2746) of
Chapter 6, or to prevent an individual to whom a certificate has been
issued pursuant to Article 2.5 (commencing with Section 2746) of
Chapter 6 from holding himself or herself out as a certified
nurse-midwife, nurse midwife, midwife, or from using the initials
"CNM."



2512.  The board shall issue a license to practice midwifery to all
applicants who meet the requirements of this article and who pay the
fee required by Section 2520.




2512.5.  A person is qualified for a license to practice midwifery
when he or she satisfies one of the following requirements:
   (a) (1) Successful completion of a three-year postsecondary
midwifery education program accredited by an accrediting organization
recognized by the United States Department of Education, Division of
Accreditation.  Upon successful completion of the education
requirements of this article, the applicant shall successfully
complete a comprehensive licensing examination adopted by the board
which is equivalent, but not identical, to the examination given by
the American College of Nurse Midwives.
   (2) The midwifery education program curriculum shall consist of
not less than 84 semester units or 126 quarter units.  The course of
instruction shall be presented in semester or quarter units under the
following formula:
   (A) One hour of instruction in the theory each week throughout a
semester or quarter equals one unit.
   (B) Three hours of clinical practice each week throughout a
semester or quarter equals one unit.
   (3) The midwifery education program shall provide both academic
and clinical preparation equivalent, but not identical to that
provided in programs accredited by the American College of Nurse
Midwives, which shall include, but not be limited to, preparation in
all of the following areas:
   (A) The art and science of midwifery, one-half of which shall be
in theory and one-half of which shall be in clinical practice.
Theory and clinical practice shall be concurrent in the areas of
maternal and child health, including, but not limited to, labor and
delivery, neonatal well care, and postpartum care.
   (B) Communications skills that include the principles of oral,
written, and group communications.
   (C) Anatomy and physiology, genetics, obstetrics and gynecology,
embryology and fetal development, neonatology, applied microbiology,
chemistry, child growth and development, pharmacology, nutrition,
laboratory diagnostic tests and procedures, and physical assessment.

   (D) Concepts in psychosocial, emotional, and cultural aspects of
maternal and child care, human sexuality, counseling and teaching,
maternal and infant and family bonding process, breast feeding,
family planning, principles of preventive health, and community
health.
   (E) Aspects of the normal pregnancy, labor and delivery,
postpartum period, newborn care, family planning or routine
gynecological care in alternative birth centers, homes, and
hospitals.
   (F) The following shall be integrated throughout the entire
curriculum:
   (i) Midwifery process.
   (ii) Basic intervention skills in preventive, remedial, and
supportive midwifery.
   (iii) The knowledge and skills required to develop collegial
relationships with health care providers from other disciplines.
   (iv) Related behavioral and social sciences with emphasis on
societal and cultural patterns, human development, and behavior
related to maternal and child health, illness, and wellness.
   (G) Instruction shall also be given in personal hygiene, client
abuse, cultural diversity, and the legal, social, and ethical aspects
of midwifery.
   (H) The program shall include the midwifery management process,
which shall include all of the following:
   (i) Obtaining or updating a defined and relevant data base for
assessment of the health status of the client.
   (ii) Identifying problems based upon correct interpretation of the
data base.
   (iii) Preparing a defined needs or problem list, or both, with
corroboration from the client.
   (iv) Consulting, collaborating with, and referring to, appropriate
members of the health care team.
   (v) Providing information to enable clients to make appropriate
decisions and to assume appropriate responsibility for their own
health.
   (vi) Assuming direct responsibility for the development of
comprehensive, supportive care for the client and with the client.
   (vii) Assuming direct responsibility for implementing the plan of
care.
   (viii) Initiating appropriate measures for obstetrical and
neonatal emergencies.
   (ix) Evaluating, with corroboration from the client, the
achievement of health care goals and modifying the plan of care
appropriately.
   (b) Successful completion of an educational program that the board
has determined satisfies the criteria of subdivision (a) and current
licensure as a midwife by a state with licensing standards that have
been found by the board to be equivalent to those adopted by the
board pursuant to this article.




2513.  (a) An approved midwifery education program shall offer the
opportunity for students to obtain credit by examination for previous
midwifery education and clinical experience.  The applicant shall
demonstrate, by practical examination, the clinical competencies
described in Section 2514 or established by regulation pursuant to
Section 2514.5.  The midwifery education program's credit by
examination policy shall be approved by the board, and shall be
available to applicants upon request.  The proficiency and practical
examinations shall be approved by the board.
   (b) Completion of clinical experiences shall be verified by a
licensed midwife or certified nurse-midwife, and a physician and
surgeon, all of whom shall be current in the knowledge and practice
of obstetrics and midwifery.  Physicians and surgeons, licensed
midwives, and certified nurse-midwives who participate in the
verification and evaluation of an applicant's clinical experiences
shall show evidence of current practice.  The method used to verify
clinical experiences shall be approved by the board.
   (c) Upon successful completion of the requirements of paragraphs
(1) and (2), the applicant shall also complete the licensing
examination described in paragraph (1) of subdivision (a).




2514.5.  (a) Within 60 days following January 1, 1998, the board
shall adopt regulations setting forth educational requirements.  To
develop these regulations, the board shall update the educational
requirements set forth in Sections 2512.5, 2513, and 2514.  These
updated sections shall reflect national standards for the practice of
midwifery and shall be subject to public hearings prior to adoption.
  The board shall review and update the regulations every two years.

   (b) The board shall adopt the written examination required by this
article by July 1, 1994.




2515.  The board shall approve specific educational programs
intended to meet the requirements of subdivision (a) of Section
2512.5 and Section 2514 for the course of academic study,
documentation of experience and skill, and clinical evaluation.
These programs shall also be accredited by an accrediting
organization approved by the board.




2515.5.  Each applicant shall show by evidence satisfactory to the
board that he or she has met the educational standards established by
the board pursuant to this article or the equivalent thereof.




2517.  A person who has been convicted of a misdemeanor violation of
Section 2052, prior to the effective date of this article, shall not
be barred from licensure under this article solely because of that
conviction.



2518.  (a) Licenses issued pursuant to this article shall be
renewable every two years upon payment of the fee prescribed by
Section 2520 and submission of documentation that the licenseholder
has completed 36 hours of continuing education in areas that fall
within the scope of the practice of midwifery, as specified by the
board.
   (b) Each license not renewed shall expire, but may be reinstated
within five years from the expiration upon payment of the prescribed
fee and upon submission of proof of the applicant's qualifications as
the board may require.




2519.  The board may suspend or revoke the license of a midwife for
any of the following:
   (a) Unprofessional conduct, which includes, but is not limited to,
all of the following:
   (1) Incompetence or gross negligence in carrying out the usual
functions of a licensed midwife.
   (2) Conviction of a violation of Section 2052, in which event, the
record of the conviction shall be conclusive evidence thereof.
   (3) The use of advertising which is fraudulent or misleading.
   (4) Obtaining or possessing in violation of law, or prescribing,
or except as directed by a licensed physician and surgeon, dentist,
or podiatrist administering to himself or herself, or furnishing or
administering to another, any controlled substance as defined in
Division 10 (commencing with Section 11000) of the Health and Safety
Code or any dangerous drug as defined in Article 8 (commencing with
Section 4210) of Chapter 9 of Division 2 of the Business and
Professions Code.
   (5) The use of any controlled substance as defined in Division 10
(commencing with Section 11000) of the Health and Safety Code, or any
dangerous drug as defined in Article 8 (commencing with Section
4210) of Chapter 9 of Division 2 of the Business and Professions
Code, or alcoholic beverages, to an extent or in a manner dangerous
or injurious to himself or herself, any other person, or the public
or to the extent that such use impairs his or her ability to conduct
with safety to the public the practice authorized by his or her
license.
   (6) Conviction of a criminal offense involving the prescription,
consumption, or self-administration of any of the substances
described in paragraphs (4) and (5), or the possession of, or
falsification of, a record pertaining to, the substances described in
paragraph (4), in which event the record of the conviction is
conclusive evidence thereof.
   (7) Commitment or confinement by a court of competent jurisdiction
for intemperate use of or addiction to the use of any of the
substances described in paragraphs (4) and (5), in which event the
court order of commitment or confinement is prima facie evidence of
such commitment or confinement.
   (8) Falsifying, or making grossly incorrect, grossly inconsistent,
or unintelligible entries in any hospital, patient, or other record
pertaining to the substances described in subdivision (a).
   (b) Procuring a license by fraud or misrepresentation.
   (c) Conviction of a crime substantially related to the
qualifications, functions, and duties of a midwife, as determined by
the board.
   (d) Procuring, aiding, abetting, attempting, agreeing to procure,
offering to procure, or assisting at, a criminal abortion.
   (e) Violating or attempting to violate, directly or indirectly, or
assisting in or abetting the violation of, or conspiring to violate
any provision or term of this chapter.
   (f) Making or giving any false statement or information in
connection with the application for issuance of a license.
   (g) Impersonating any applicant or acting as proxy for an
applicant in any examination required under this chapter for the
issuance of a license or a certificate.
   (h) Impersonating another licensed practitioner, or permitting or
allowing another person to use his or her license or certificate for
the purpose of providing midwifery services.
   (i) Aiding or assisting, or agreeing to aid or assist any person
or persons, whether a licensed physician or not, in the performance
of or arranging for a violation of any of the provisions of Article
12 (commencing with Section 2221) of Chapter 5.




2520.  (a) (1) The fee to be paid upon the filing of a license
application shall be fixed by the board at not less than seventy-five
dollars ($75) nor more than three hundred dollars ($300).
   (2) The fee for renewal of the midwife license shall be fixed by
the board at not less than fifty dollars ($50) nor more than two
hundred dollars ($200).
   (3) The delinquency fee for renewal of the midwife license shall
be 50 percent of the renewal fee in effect on the date of the renewal
of the license, but not less than twenty-five dollars ($25) nor more
than fifty dollars ($50).
   (4) The fee to be paid for the licensing examination shall be
fixed by the board at not less than two hundred dollars ($200) nor
more than three hundred fifty dollars ($350).
   (b) The fees prescribed by this article shall be deposited in the
Licensed Midwifery Fund, which is hereby established, and shall be
available, upon appropriation, to the board for the purposes of this
article.




2521.  Any person who violates this article is guilty of a
misdemeanor.




 For answers to your questions about the midwifery licensing challenge program established by Seattle Midwifery School and California Association of Midwives, please contact Carrie Sparrevohn, LM at 530-750-2220 or e-mail her at:  


If you are a licensed midwife who is having problems with barriers to practice, please contact Karen Ehrich, LM, CPM in Northern California at 408-425-3326, or Paula Tipton-Healy, LM in Southern California at 760-944-3987. 


If you are an aspiring midwife desiring information on entering the profession, please go to: socalbirth.org/pathways/

2746.  The board shall issue a certificate to practice
nurse-midwifery to any person who qualifies under this article and is
licensed pursuant to the provisions of this chapter.




2746.1.  Every applicant for a certificate to practice
nurse-midwifery shall comply with all the provisions of this article
in addition to the provisions of this chapter.




2746.2.  Each applicant shall show by evidence satisfactory to the
board that he has met the educational standards established by the
board or has at least the equivalent thereof.  The board is
authorized to appoint a committee of qualified physicians and nurses,
including, but not limited to, obstetricians and nurse-midwives, to
develop the necessary standards relating to educational requirements,
ratios of nurse-midwives to supervising physicians, and associated
matters.



2746.3.  Midwife's certificates issued by the Medical Board of
California prior to the effective date of this article shall be
renewable only by such board.



2746.4.  Nothing in this article shall be construed to prevent the
practice of midwifery by a person possessing a midwife's certificate
issued by the Medical Board of California on the effective date of
this article.



2746.5.  The certificate to practice nurse-midwifery authorizes the
holder, under the supervision of a licensed physician and surgeon, to
attend cases of normal childbirth and to provide prenatal,
intrapartum, and postpartum care, including family-planning care, for
the mother, and immediate care for the newborn.
   As used in this chapter, the practice of nurse-midwifery
constitutes the furthering or undertaking by any certified person,
under the supervision of a licensed physician and surgeon who has
current practice or training in obstetrics, to assist a woman in
childbirth so long as progress meets criteria accepted as normal.
All complications shall be referred to a physician immediately.  The
practice of nurse-midwifery does not include the assisting of
childbirth by any artificial, forcible, or mechanical means, nor the
performance of any version.
   As used in this article, "supervision" shall not be construed to
require the physical presence of the supervising physician.
   A nurse-midwife is not authorized to practice medicine and surgery
by the provisions of this chapter.



2746.51.  Neither this chapter nor any other provision of law shall
be construed to prohibit a certified nurse-midwife from furnishing
drugs or devices when all of the following apply:
   (a) The drugs or devices are furnished incidentally to the
provision of family planning services, as defined in Section 14503 of
the Welfare and Institutions Code, or are furnished incidental to
the provision of routine health care or perinatal care, as defined in
subdivision (d) of Section 284 of the Health and Safety Code,
rendered to essentially healthy persons within a facility specified
in subdivision (a), except in the case of sole practitioners, and
subdivision (b), (c), (d), (i), or (j) of Section 1206 of, a clinic
as specified in Section 1204 of, a general acute care hospital as
defined in subdivision (a) of Section 1250 of, or a special hospital
specified as a maternity hospital in subdivision (f) of Section 1250
of, the Health and Safety Code.
   (b) The certified nurse-midwife is functioning pursuant to a
standardized procedure, as defined by current law in Section 2725.
The standardized procedure shall be developed and approved by the
supervising physician and surgeon, the certified nurse-midwife, and
the facility administrator or his or her designee.
   (c) The standardized procedure covering the furnishing of drugs or
devices shall specify which certified nurse-midwife may furnish
drugs or devices, which drugs or devices may be furnished, under what
circumstances, the extent of physician and surgeon supervision, the
method of periodic review of the certified nurse-midwife's
competence, including peer review, and  review of the provisions of
the standardized procedure.
   (d) The furnishing of drugs or devices by a certified
nurse-midwife occurs under physician and surgeon supervision.
Physician and surgeon supervision shall not be construed to require
the physical presence of the physician, but does include (1)
collaboration on the development of the standardized procedure, (2)
approval of the standardized procedure, and (3) availability by
telephonic contact at the time of patient examination by the
certified nurse-midwife.
   (e) For purposes of this section, no physician and surgeon shall
supervise more than four certified nurse-midwives at one time.
   (f) Drugs or devices furnished by a certified nurse-midwife shall
not include controlled substances under the California Uniform
Controlled Substances Act, (Division 10 (commencing with Section
11000) of the Health and Safety Code) and shall be further limited to
those drugs agreed upon by the certified nurse-midwife and physician
and surgeon and specified in the standardized procedure.
   (g) The board has certified in accordance with subdivision (h)
that the certified nurse-midwife has satisfactorily completed (1) at
least six month's physician and surgeon supervised experience in the
furnishing of drugs or devices and (2) a course in pharmacology
covering the drugs or devices to be furnished under this section.
The board shall establish the requirements for satisfactory
completion of this subdivision.
   (h) The furnishing of drugs or devices by certified nurse-midwives
is conditional on the issuance by the board of a number to the
applicant who has successfully completed the requirements of
subdivision (g).  The number shall be included on all transmittals of
orders for drugs or devices by the certified nurse-midwife.  The
board shall make the list available to the California State Board of
Pharmacy.  The board shall charge the applicant fees for application,
renewal, and penalty for failure to timely renew that are equal to
the fees charged to nurse practitioners pursuant to Section 2836.3.
   (i) Furnishing of drugs or devices by a certified nurse-midwife
means the act of making a pharmaceutical agent or agents available to
the patient in strict accordance with a standardized procedure.





2746.52.  Notwithstanding Section 2746.5, the certificate to
practice nurse-midwifery authorizes the holder to perform and repair
episiotomies, and to repair first-degree and second-degree
lacerations of the perineum, in a licensed acute care hospital, as
defined in subdivision (a) of Section 1250 of the Health and Safety
Code, and a licensed alternate birth center, as defined in paragraph
(4) of subdivision (b) of Section 1204 of the Health and Safety Code,
but only if all of the following conditions are met:
   (a) The supervising physician and surgeon and any backup physician
and surgeon is credentialed to perform obstetrical care in the
facility.
   (b) The episiotomies are performed pursuant to protocols developed
and approved by all of the following:
   (1) The supervising physician and surgeon.
   (2) The certified nurse-midwife.
   (3) The director of the obstetrics department or the director of
the family practice department, or both, if a physician and surgeon
in the obstetrics department or the family practice department is a
supervising physician and surgeon, or an equivalent person if there
is no specifically identified obstetrics department or family
practice department.
   (4) The interdisciplinary practices committee, if applicable.
   (5) The facility administrator or his or her designee.
   (c) The protocols, and the procedures which shall be developed
pursuant to the protocols, shall relate to the performance and repair
of episiotomies and the repair of first-degree and second-degree
lacerations of the perineum, and shall do all of the following:
   (1) Ensure that all complications are referred to a physician and
surgeon immediately.
   (2) Ensure immediate care of patients who are in need of care
beyond the scope of practice of the certified nurse midwife, or
emergency care for times when the supervising physician and surgeon
is not on the premises.
   (3) Establish the number of certified nurse-midwives that a
supervising physician and surgeon may supervise.




2746.7.  An applicant for certification pursuant to this article
shall submit a written application in the form prescribed by the
board, accompanied by the fee prescribed by Section 2815.5.




2746.8.  Each certificate issued pursuant to this article shall be
renewable biennially, and each person holding a certificate under
this article shall apply for a renewal of his certificate and pay the
biennial renewal fee required by Section 2815.5 every two years on
or before the last day of the month following the month in which his
birthday occurs, beginning with the second birthday following the
date on which the certificate was issued, whereupon the board shall
renew the certificate.
   Each such certificate not renewed in accordance with this section
shall expire but may within a period of eight years thereafter be
reinstated upon payment of the biennial renewal fee and penalty fee
required by Section 2815.5 and upon submission of such proof of the
applicant's qualifications as may be required by the board, except
that during such eight-year period no examination shall be required
as a condition for the reinstatement of any such expired certificate
which has lapsed solely by reason of nonpayment of the renewal fee.
After the expiration of such eight-year period the board may require
as a condition of reinstatement that the applicant pass such
examination as it deems necessary to determine his present fitness to
resume the practice of nurse-midwifery.