ANALYSIS OF HOUSE BILL 2031

      Including midwives in women's health care services.

Health Care Committee                          January 31, 2000

Washington State House of Representatives

SPONSORS:  Representatives Ruderman and Dunn.

BACKGROUND:  The practice of midwifery is regulated by the Department of Health as a health care profession, and a midwife must pass an examination and hold a license in order to practice or advertise as a midwife.  However the Nursing Care Quality Assurance Commission regulates the practice of nurse midwives.

The practice of midwifery includes the rendering of medical aid for a fee or compensation to a woman during the prenatal, intrapartum, and postpartum stages of child birth.  It includes the acquisition and administration of prophylactic ophthalmic medication, postpartum oxytocic, vitamin K, Rho immune globulin (human), and local anesthetic, including other drugs or medications prescribed by a physician.  Midwives must consult physicians whenever there are significant deviations from normal in either the mother or infant, and have a written plan for consultation, emergency transfer and transport of the infant to neonatal intensive care, or the woman to obstetrical care.

Candidates must have at least three years of midwifery training, and meet minimum educational requirements including neonatal pediatrics, obstetrics, pharmacology, female reproductive anatomy, gynecology, and epidemiology.  Required training includes undertaking the care of at least 50 women in each stage of the delivery process.

Health carriers by law must assure that enrolled female patients have direct access to timely and appropriate covered women=s health care services from the health practitioner of their choice without the necessity of prior approval.  However carriers are not prevented from restricting women patients to seeing only health practitioners with participating agreements.

Health practitioners include, but are not limited to, physicians and osteopathic physicians, physicians= and osteopathic physicians= assistants, and advanced registered nurse practitioner specialists.

Licensed midwives are not included among the health practitioners that provide women's health care services.

SUMMARY:  Licensed midwives are included among the health practitioners with whom health carriers may contract for providing direct access to maternity services for their enrollees.