California Association of Midwives Foundation - Licensed Midwives Practice Act

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Licensed Midwives Practice Act

Licensed Midwives Practice Act

In California, Licensed Midwives are regulated by the Licensed Midwifery Practice Act (LMPA).

Currently, the LMPA is in transition. After the passage of AB1308, there is on-going work refining a revised set of regulations for midwives. CAM continues to collaborate with other stakeholders in the changing regulations. AB1308 removed our previous Standards of Care, now put into place by the MBC as non-binding Guidelines. CAM/CALM and CCM plan to put our own professional Standard of Care in place.

See the Guidelines, as posted on the Medical Board of California's website.

AB1308 also requires specific disclosures. CAMs lawyer drafted this one for your use. The MBC also has a version they put forward.

Summary of the Licensed Midwifery Practice Act

The Midwifery Practice Act specifies the requirements for licensure and the scope of practice for a licensed midwife.

Assembly Bill 1308 (Bonilla, Chapter 665, Statutes of 2013) made significant amendments to various Business and Professions Code sections governing the practice of midwifery in California. The changes become effective January 1, 2014.

The law provides that:

The holder of a midwifery license may attend cases of normal pregnancy and childbirth (see definition below) and provide prenatal, intrapartum, and postpartum care, including family-planning care, for the mother, and immediate care for the newborn.
The practice of midwifery does not include the assisting of childbirth by any artificial, forcible, or mechanical means, nor the performance of any version of these means.
Midwives are not authorized to practice medicine or to perform surgery.
Licensed midwives are authorized to directly obtain supplies and devices, obtain and administer drugs and diagnostic tests, order testing, and receive reports that are necessary to the practice of midwifery and consistent with his or her scope of practice.
No person, other than a licensed midwife, may hold himself/herself out as a licensed midwife or use any other term which may indicate or imply that he/she is a licensed midwife.

Normal Pregnancy / Required Referrals / Transfer of Care

The licensed midwife may assist a woman in childbirth as long as progress meets criteria accepted as normal.
Normal pregnancy and childbirth is defined as meeting all of the following conditions:

There is an absence of any preexisting maternal disease or condition likely to affect the pregnancy.
There is an absence of significant disease arising from the pregnancy.
There is a singleton fetus.
There is a cephalic presentation.
The gestational age of the fetus is greater than 37 0⁄7 weeks and less than 42 0⁄7 completed weeks of pregnancy.
Labor is spontaneous or induced in an outpatient setting.

If a potential client does not meet criteria #1 and #2 above, but does meet criteria #3-#6, and still wishes to be a client of the midwife, the midwife must provide the woman with a referral for an examination by a physician trained in obstetrics and gynecology. If the physician determines that the risk factors presented by the client's disease or condition are not likely to significantly affect the course of pregnancy and childbirth, then the midwife may assist the woman in pregnancy and childbirth.
If at any point during a pregnancy, childbirth, or postpartum care a client’s condition deviates from normal, the licensed midwife must immediately refer or transfer the client to a physician. The licensed midwife may consult and remain in consultation with the physician after the referral or transfer.
If the physician determines that the client’s condition or concern has been resolved such that the risk factors are not likely to significantly affect the course of pregnancy or childbirth, the licensed midwife may resume primary care of the client.
If, however, the physician determines that the client’s condition or concern has not been resolved, the licensed midwife may provide concurrent care with a physician and, if authorized by the client, be present during the labor and childbirth, and resume postpartum care, if appropriate. The licensed midwife may not resume primary care of the client under these circumstances.
A licensed midwife may not provide or continue to provide midwifery care to a woman with a risk factor that will significantly affect the course of pregnancy and childbirth, regardless of whether a woman has consented to this care or refused care by a physician.
If a client is transferred to a hospital, the licensed midwife must provide records, including prenatal records, and speak with the receiving physician and surgeon about labor up to the point of the transfer. The hospital shall report each transfer of a planned out-of-hospital birth to the Medical Board of California and the California Maternal Quality Care Collaborative using a standardized form developed by the board.

Photo Credit: Kelly M.