Amended in Assembly March 21, 2013

California Legislature—2013–14 Regular Session

Assembly Bill No. 1308

Introduced by Assembly Member Bonilla

February 22, 2013

An act begin insert to amend Sections 2507 and 2508 of the Business and Professions Code, end insert relating to professions and vocations.

LEGISLATIVE COUNSEL’S DIGEST

AB 1308, as amended, Bonilla. Midwifery.

Existing law, the Licensed Midwifery Practice Act of 1993, provides for the licensing and regulation of midwives by the Board of Licensing of the Medical Board of California. The license to practice midwifery authorizes the holder, under the supervision of a licensed physician and surgeon, as specified, 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. begin insert Under the act, a licensed midwife is required to make certain oral and written disclosures to prospective clients. end insert A violation of the act is a crime.

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This bill would additionally authorize a licensed midwife to directly obtain supplies, order testing, and receive reports that are necessary to his or her practice of midwifery and consistent with his or her scope of practice and would require a licensed midwife to disclose to prospective clients the specific arrangements for referral of complications to a physician and surgeon.

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This bill would state the intent of the Legislature to enact legislation to remove barriers to care in order to provide a more efficient and safer delivery method for mother and infant by allowing licensed midwives to practice in a manner originally intended in prior legislation.

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Existing law requires the board, by July 1, 2003, to adopt regulations defining the appropriate standard of care and level of supervision required for the practice of midwifery.

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This bill would require the board, by July 1, 2015, to revise and adopt regulations defining the appropriate standard of care and level of supervision required for the practice of midwifery and identifying complications necessitating referral to a physician and surgeon.

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By expanding the disclosures a licensed midwife is required to make to prospective clients, this bill would expand the scope of a crime thereby imposing a state-mandated local program.

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The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

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This bill would provide that no reimbursement is required by this act for a specified reason.

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Vote: majority. Appropriation: no. Fiscal committee:  begin delete no end delete begin insert yes end insert . State-mandated local program:  begin delete no end delete begin insert yes end insert .

The people of the State of California do enact as follows:

SECTION 1.  

begin delete (a) end delete begin delete   end delete The Legislature finds and declares the
following:

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(1)

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begin insert ( end insert begin insert a) end insert  Licensed midwives have been authorized to practice since
1993 under Senate Bill 350 (Chapter 1280 of the Statutes of 1993),
which was authored by Senator Killea. Additional legislation,
Senate Bill 1950 (Chapter 1085 of the Statutes of 2002), which
was authored by Senator Figueroa, was needed in 2002 to clarify
certain practice issues. While the midwifery license does not
specify or limit the practice setting in which licensed midwives
may provide care, the reality is that the majority of births delivered
by licensed midwives are planned as home births.

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(2)

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begin insert ( end insert begin insert b) end insert  Planned home births are safer when care is provided as part
of an integrated delivery model. For a variety of reasons, this
integration rarely occurs, and creates a barrier to the best and safest
care possible. This is due, in part, to the attempt to fit a midwifery
model of care into a medical model of care.

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(b) It is the intent of the Legislature to enact legislation that
would systematically remove unnecessary barriers to care in order
to provide a more efficient and safer delivery for mother and infant
by allowing licensed midwives to practice in a manner originally
intended in the authorizing legislation.

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begin insert SEC. 2. end insert   

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begin insert Section 2507 of the end insert begin insert Business and Professions Code end insert begin insert is
amended to read: end insert

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 and surgeon
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 and
surgeon.

(d) The ratio of licensed midwives to supervising physicians
and surgeons shall not be greater than four individual licensed
midwives to one individual supervising physician and surgeon.

(e) A midwife is not authorized to practice medicine and surgery
by this article.

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(f) A midwife is authorized to directly obtain supplies, order
testing, and receive reports that are necessary to his or her practice
of midwifery and consistent with his or her scope of practice.

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(f)

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begin insert ( end insert begin insert g) end insert  The board shall, not later than July 1, begin delete 2003, end delete begin insert 2015, revise
and end insert adopt in accordance with the Administrative Procedure Act
(Chapter 3.5 (commencing with Section 11340) of Part 1 of
Division 3 of Title 2 of the Government Code), regulations defining
the appropriate standard of care and level of supervision required
for the practice of begin delete midwifery. end delete begin insert midwifery and identifying
complications necessitating referral to a physician and surgeon. end insert

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begin insert SEC. 3. end insert   

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begin insert Section 2508 of the end insert begin insert Business and Professions Code end insert begin insert is
amended to read: end insert

2508.  

(a) A licensed midwife shall disclose in oral and written
form to a prospective client all of the following:

(1) All of the provisions of Section 2507.

(2) If the licensed midwife does not have liability coverage for
the practice of midwifery, he or she shall disclose that fact.

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(3) The specific arrangements for the referral of complications
to a physician and surgeon.

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(3)

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begin insert ( end insert begin insert 4) end insert  The specific arrangements for the transfer of care during the
prenatal period, hospital transfer during the intrapartum and
postpartum periods, and access to appropriate emergency medical
services for mother and baby if necessary.

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(4)

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begin insert ( end insert begin insert 5) end insert  The procedure for reporting complaints to the Medical Board
of California.

(b) The disclosure shall be signed by both the licensed midwife
and the client and a copy of the disclosure shall be placed in the
client’s medical record.

(c) The Medical Board of California may prescribe the form for
the written disclosure statement required to be used by a licensed
midwife under this section.

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begin insert SEC. 4. end insert   

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No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of
the Government Code, or changes the definition of a crime within
the meaning of Section 6 of Article XIII B of the California
Constitution.

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