Licensed Midwives.
Licensed midwives are one of two types of midwives in Washington, in addition to certified nurse-midwives. Licensed midwives are licensed by the Department of Health (DOH) and they must generally have completed an accredited midwifery program and three years of midwifery training before licensure. Applicants must also pass the national and state midwifery licensure examinations.
Licensed midwives are required to consult with physicians whenever there are significant deviations from normal in either the gestational parent or the newborn. A licensed midwife may delegate to a registered nurse or a licensed practical nurse selected acts, tasks, or procedures that constitute the practice of midwifery but do not exceed the education of the nurse.
Medical Assistants.
The DOH issues certifications for several different types of medical assistants (MAs), including certified MAs and registered MAs. The Secretary of Health adopts minimum qualifications and requirements for each type of MA.
An MA may perform specific authorized duties when delegated by, and under the supervision of, a health care practitioner, but the required level of supervision may vary for different types of MAs and the specific task. A "health care practitioner" that may supervise an MA is defined to include:
Lactation Consultants.
Lactation consultants offer expertise and resources to new parents regarding lactation. Lactation consultants are not licensed by the DOH, but they may be certified by the International Board of Lactation Consultant Examiners, which is an international credentialing body for lactation consultants.
A licensed midwife may delegate to an MA selected tasks that constitute the practice of midwifery but do not exceed the education and scope of practice of the MA. A licensed midwife is not prohibited from coordinating with an international board-certified lactation consultant.
Licensed midwives, acting within the scope of their licensure, are added to the list of "health care practitioners" that may supervise MAs.
The substitute bill:
As part of a pilot project, testimony in this section of the bill report was summarized by generative artificial intelligence and reviewed for accuracy by non-partisan legislative staff. Generative artificial intelligence was used only in this section of the bill report; all other sections were prepared by non-partisan legislative staff without the use of any generative artificial intelligence.
(In support) The testimony in support of the bill emphasized the importance of preserving and strengthening access to midwifery and community-based birthing care in Washington, particularly as these services face increasing financial and regulatory pressures. Testimony described the bill as a targeted, corrective measure intended to remove unnecessary barriers and address statutory oversights affecting licensed midwives. Supporters explained that the bill would allow licensed midwives to more effectively delegate appropriate tasks to medical assistants, aligning midwifery practice with other health care settings and improving operational flexibility. This change was characterized as especially important given recent reimbursement reductions and workforce challenges, which have made it difficult for birth centers to sustain staffing levels and meet community demand, particularly in rural and underserved areas. Testimony further noted that allowing the use of medical assistants as birth assistants would reduce costs while maintaining safe and competent care, thereby supporting the financial stability of birth centers and helping ensure continued access to midwifery-led birthing and postpartum services. Overall, the testimony framed the bill as a practical fix that supports licensed midwives, strengthens the maternal health care workforce, and helps preserve patient choice in birthing options across the state.
(Opposed) None.
Representative Stephanie Barnard, prime sponsor; Cynthia Flynn, Washington Association of Birth Centers; and Lynette Pettibone, MAWS WABC Tye Bridge Birth Center.