Amended in Senate June 13, 2013

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 to amend Sections 2507 and 2508 of the Business and Professions Code, begin insert and to amend Section 1204.3 of the Health and Safety 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. Under the act, a licensed midwife is required to make certain oral and written disclosures to prospective clients. A violation of the act is a crime.

This bill would additionally authorize a licensed midwife to directly obtain supplies begin insert and devices end insert begin insert , obtain and administer drugs and diagnostic tests end insert , 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.

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.

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.

begin insert

Existing law requires a licensed alternative birth center, and a licensed primary care clinic that provides services as an alternative birth center, to meet specified requirements, including requiring the presence of at least 2 attendants during birth, one of whom shall be either a physician and surgeon or a certified nurse-midwife.

end insert begin insert

This bill would provide that a licensed midwife may also satisfy that requirement.

end insert

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.

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.

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

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: yes.

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

SECTION 1.  

The Legislature finds and declares the following:

(a) 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.

(b) 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.

SEC. 2.  

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

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.

(f) A midwife is authorized to directly obtain supplies begin insert and
devices end insert begin insert , obtain and administer drugs and diagnostic tests end insert , order
testing, and receive reports that are necessary to his or her practice
of midwifery and consistent with his or her scope of practice.

(g) The board shall, not later than July 1, 2015, revise and 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 midwifery and identifying complications necessitating referral
to a physician and surgeon.

SEC. 3.  

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

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.

(3) The specific arrangements for the referral of complications
to a physician and surgeon begin insert for consultation. The licensed midwife
shall not be required to identify a specific physician and surgeon end insert .

(4) 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.

(5) 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.

begin insert

begin insert SEC. 4. end insert   

end insert

begin insert Section 1204.3 of the end insert begin insert Health and Safety Code end insert begin insert is
amended to read: end insert

1204.3.  

(a) An alternative birth center that is licensed as an
alternative birth center specialty clinic pursuant to paragraph (4)
of subdivision (b) of Section 1204 shall, as a condition of licensure,
and a primary care clinic licensed pursuant to subdivision (a) of
Section 1204 that provides services as an alternative birth center
shall, meet all of the following requirements:

(1) Be a provider of comprehensive perinatal services as defined
in Section 14134.5 of the Welfare and Institutions Code.

(2) Maintain a quality assurance program.

(3) Meet the standards for certification established by the
begin delete National Association of Childbearing Centers end delete begin insert American
Association of Birth Centers end insert , or at least equivalent standards as
determined by the state department.

(4) In addition to standards of the begin delete National Association of
Childbearing Centers end delete begin insert American Association of Birth Centers end insert
regarding proximity to hospitals and presence of attendants at
births, meet both of the following conditions:

(A) Be located in proximity, in time and distance, to a facility
with the capacity for management of obstetrical and neonatal
emergencies, including the ability to provide cesarean section
delivery, within 30 minutes from time of diagnosis of the
emergency.

(B) Require the presence of at least two attendants at all times
during birth, one of whom shall be begin delete either end delete a physician and begin delete surgeon end delete
begin insert surgeon, a licensed midwife, end insert or a certified nurse-midwife.

(5) Have a written policy relating to the dissemination of the
following information to patients:

(A) A summary of current state laws requiring child passenger
restraint systems to be used when transporting children in motor
vehicles.

(B) A listing of child passenger restraint system programs
located within the county, as required by begin delete Section 27360 of the
Vehicle Code or end delete Section 27362 of begin delete that code end delete begin insert the Vehicle Code end insert .

(C) Information describing the risks of death or serious injury
associated with the failure to utilize a child passenger restraint
system.

(b) The state department shall issue a permit to a primary care
clinic licensed pursuant to subdivision (a) of Section 1204
certifying that the primary care clinic has met the requirements of
this section and may provide services as an alternative birth center.
Nothing in this section shall be construed to require that a licensed
primary care clinic obtain an additional license in order to provide
services as an alternative birth center.

(c) (1) Notwithstanding subdivision (a) of Section 1206, no
place or establishment owned or leased and operated as a clinic or
office by one or more licensed health care practitioners and used
as an office for the practice of their profession, within the scope
of their license, shall be represented or otherwise held out to be
an alternative birth center licensed by the state unless it meets the
requirements of this section.

(2) Nothing in this subdivision shall be construed to prohibit
licensed health care practitioners from providing birth related
services, within the scope of their license, in a place or
establishment described in paragraph (1).

begin delete SEC. 4. end delete
begin insert SEC. 5. end insert   

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.