BP BHEAD INT S

AN ACT Relating to midwifery; amending RCW 18.50.010, 18.50.040, 18.50.105, and 18.50.108; creating a new section; and declaring an emergency.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

Sec. 1. RCW 18.50.010 and 1991 c 3 s 103 are each amended to read as follows:

Any person shall be regarded as practicing midwifery within the meaning of this chapter who shall render medical aid for a fee or compensation to a woman during prenatal, intrapartum, and postpartum stages or who shall advertise as a midwife by signs, printed cards, or otherwise. Nothing shall be construed in this chapter to prohibit gratuitous services. It shall be the duty of a midwife to consult with a physician whenever there are significant deviations from normal in either the mother or the infant.

A person licensed under this chapter shall not undertake the care of any woman who is at high risk for complications during the prenatal, intrapartum, or postpartum period, as the term "high risk" is defined pursuant to section 5 of this act. A woman who presents evidence of such high risk shall be expeditiously referred to a physician licensed under chapter 18.57 or 18.71 RCW. Nothing in this section shall prohibit a physician from returning the patient to the midwife, if the problem is appropriately managed and relieved or not confirmed, nor shall the physician be prohibited from agreeing to a comanage arrangement.

The physician shall not be liable for complications that occur in, or are caused by, the pregnancy when the woman was not directly under the physician's care.

Sec. 2. RCW 18.50.040 and 1994 sp.s. c 9 s 705 are each amended to read as follows:

(1) Any person seeking to be examined shall present to the secretary, at least forty-five days before the commencement of the examination, a written application on a form or forms provided by the secretary setting forth under affidavit such information as the secretary may require and proof the candidate has received a high school degree or its equivalent; that the candidate is twenty-one years of age or older; that the candidate has received a certificate or diploma from a midwifery program accredited by the secretary and licensed under chapter 28C.10 RCW, when applicable, or a certificate or diploma in a foreign institution on midwifery of equal requirements conferring the full right to practice midwifery in the country in which it was issued. The diploma must bear the seal of the institution from which the applicant was graduated. Foreign candidates must present with the application a translation of the foreign certificate or diploma made by and under the seal of the consulate of the country in which the certificate or diploma was issued.

(2) The candidate shall meet the following conditions:

(a) Obtaining a minimum period of midwifery training for at least three years including the study of the basic nursing skills that the department shall prescribe by rule. However, if the applicant is a registered nurse or licensed practical nurse under chapter 18.79 RCW, or has had previous nursing education or practical midwifery experience, the required period of training may be reduced depending upon the extent of the candidate's qualifications as determined under rules adopted by the department. In no case shall the training be reduced to a period of less than two years.

(b) Meeting minimum educational requirements which shall include studying obstetrics; neonatal pediatrics; basic sciences; female reproductive anatomy and physiology; behavioral sciences; childbirth education; community care; obstetrical pharmacology; epidemiology; gynecology; family planning; genetics; embryology; neonatology; the medical and legal aspects of midwifery, including the identification of patients presenting high risk for complications during the prenatal, intrapartum, or postpartum period, as the term "high risk" is defined pursuant to section 5 of this act, and the legal requirements relating to such patients in RCW 18.50.010; nutrition during pregnancy and lactation; breast feeding; nursing skills, including but not limited to injections, administering intravenous fluids, catheterization, and aseptic technique; and such other requirements prescribed by rule.

(c) For a student midwife during training, undertaking the care of not less than fifty women in each of the prenatal, intrapartum, and early postpartum periods, but the same women need not be seen through all three periods. A student midwife may be issued a permit upon the satisfactory completion of the requirements in (a), (b), and (c) of this subsection and the satisfactory completion of the licensure examination required by RCW 18.50.060. The permit permits the student midwife to practice under the supervision of a midwife licensed under this chapter, a physician or a certified nurse-midwife licensed under the authority of chapter 18.79 RCW. The permit shall expire within one year of issuance and may be extended as provided by rule.

(d) Observing an additional fifty women in the intrapartum period before the candidate qualifies for a license.

(3) Notwithstanding subsections (1) and (2) of this section, the department shall adopt rules to provide credit toward the educational requirements for licensure before July 1, 1988, of nonlicensed midwives, including rules to provide:

(a) Credit toward licensure for documented deliveries;

(b) The substitution of relevant experience for classroom time; and

The training required under this section shall include training in either hospitals or alternative birth settings or both with particular emphasis on learning the ability to differentiate between low-risk and high-risk pregnancies.

Sec. 3. RCW 18.50.105 and 1991 c 3 s 111 are each amended to read as follows:

The secretary, with the advice of the midwifery advisory committee, shall develop a form to be used by a midwife to inform the patient of the qualifications of a licensed midwife and the requirements relating to treating patients who are at high risk for complications during the prenatal, intrapartum, or postpartum period, as the term "high risk" is defined pursuant to section 5 of this act, and the legal requirements relating to such patients in RCW 18.50.010.

Sec. 4. RCW 18.50.108 and 1981 c 53 s 14 are each amended to read as follows:

Every licensed midwife shall develop a written plan for consultation with other ((~~health care providers~~)) physicians, emergency transfer, transport of an infant to a newborn nursery or neonatal intensive care nursery, and transport of a woman to an appropriate obstetrical department or patient care area. The written plan shall be submitted annually together with the license renewal fee to the department.

A plan shall also be submitted indicating how the licensee will identify patients presenting high risk for complications during the prenatal, intrapartum, or postpartum period, as the term "high risk" is defined pursuant to section 5 of this act, and how the licensee will implement compliance with the requirements of this chapter relating to such patients. A signed statement from the consultant agreeing to provide backup shall be appended to the plan application.

NEW SECTION. Sec. 5. The medical quality assurance commission with the advice of the midwifery advisory committee shall develop a definition of high risk for the purposes of this act.

NEW SECTION. Sec. 6. This act is necessary for the immediate preservation of the public peace, health, or safety, or support of the state government and its existing public institutions, and shall take effect immediately.