Out-of-Hospital Childbirths: physicians and surgeons: licensed midwives: certified nurse-midwives.

(1) Existing law, the Medical Practice Act, provides for the licensure and regulation of physicians and surgeons by the Medical Board of California. Existing law, the Licensed Midwifery Practice Act of 1993, provides for the licensure and regulation of midwives by the Medical Board of California. A violation of the act is a crime. Existing law authorizes a licensed midwife to attend cases of normal pregnancy and childbirth, but requires a midwife to immediately refer or transfer a client to a physician and surgeon if there are complications. Under the act, if a client of a licensed midwife is transferred to a hospital, the licensed midwife is required to provide records and speak with the receiving physician and surgeon about labor up to the point of the transfer. The act requires a hospital to 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. Under existing law, a midwife is authorized to directly obtain supplies and devices, obtain and administer drugs and diagnostic tests, order testing, and receive reports that are necessary to his or her practice of midwifery and consistent with his or her scope of practice. Existing law, the Nursing Practice Act, provides for the licensure and regulation of certified nurse-midwives by the Board of Registered Nursing. A violation of the act is a crime. Existing law authorizes a certified nurse-midwife, 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, and provides that the practice of nurse-midwifery constitutes the furthering or undertaking by a certified person, 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. Existing law authorizes a certified nurse-midwife to furnish and order drugs or devices incidentally to the provision of family planning services, routine health care or perinatal care, and care rendered consistent with the certified nurse-midwife's educational preparation or clinical competence to specified persons, and only in accordance with standardized procedures and protocols developed and approved by, among others, the supervising physician and surgeon. Existing law establishes the Office of Statewide Health Planning and Development in state government and it has jurisdiction over health planning and research development. This bill would revise and recast these provisions by requiring that a licensed physician and surgeon, a licensed midwife, and a certified nurse-midwife only attend cases of pregnancy and out-of-hospital childbirth, as defined, when specified conditions are met. For purposes of determining whether a patient or client satisfies these conditions, the bill would require the licensed physician and surgeon, licensed certified nurse midwife, or licensed midwife to use a self-screening form to identify patient or client risk factors for out-of-hospital childbirth. The bill would specify those circumstances when a medical examination by a licensed physician and surgeon is required, when a licensed physician and surgeon, a licensed midwife, and a certified nurse-midwife is prohibited from attending cases of pregnancy and out-of-hospital childbirth, and when a licensed physician and surgeon, a licensed midwife, and a certified nurse-midwife would be required to initiate appropriate interventions, including transfer to a hospital, when a patient or client's health status changes. The bill would make it unprofessional conduct for a licensed physician and surgeon, licensed midwife, or licensed certified nurse-midwife to attend to a case of out-of-hospital childbirth after a licensed physician and surgeon determines that the patient or client is at an increased risk due to her health status, as provided. This bill would require licensed physician and surgeon, licensed midwife, or a licensed certified nurse-midwife attending to cases of out-of-hospital childbirths to make specified disclosures to a prospective patient or client and obtain consent, as provided. The bill would also require these licensees to provide the patient or client with the most recent versions of specified documents concerning out-of-hospital childbirths. The bill would also require the Medical Board of California and the Board of Registered Nursing to make those same documents publicly available on their Internet Web sites. If a patient or client is transferred to a hospital, this bill would require the licensee to provide specified records and speak with the receiving physician and surgeon about the labor up to the point of the transfer. The bill would provide that the failure to comply with this requirement shall constitute unprofessional conduct. The bill would also require the hospital, within a specified period of time, to report to the Office of Statewide Health Planning and Development each transfer of a patient, as specified. The bill would require the Office of Statewide Health Planning and Development to develop a form, subject to specified criteria, including that patient identifying information is protected, for purposes of implementing the hospital reporting requirement. This bill would require each licensee caring for a patient or client planning an out-of-hospital birth to submit, within a specified period of time, a form to the Office of Statewide Health Planning and Development indicating the initiation of care. The bill would also require each licensee who attends an out-of-hospital childbirth to annually submit a specified report to the Office of Statewide Health Planning and Development. The bill would require the Office of Statewide Health Planning and Development to, among other things, maintain the confidentiality of this information. For consistency with the above provisions governing out-of-hospital childbirths, the bill would make conforming changes to the Licensed Midwifery Practice Act of 1993 and the Nursing Practice Act. The bill would specify that a certified nurse-midwife is authorized to attend cases of out-of-hospital childbirth without physician and surgeon supervision when the provisions governing out-of-hospital childbirths are complied with. The bill would also authorize a licensed midwife and a certified nurse-midwife to administer, order, or use certain drugs and equipment. Because a violation of these requirements by a licensed midwife or certified nurse-midwife would be a crime under their respective acts, the bill would impose a state-mandated local program. (2) Under existing law, an alternative birth center that is licensed as an alternative birth center specialty clinic is required to, as a condition of licensure, and a primary care clinic providing services as an alternative birth center is required to, meet specified certain requirements including requiring the presence of at least 2 attendants at all times during birth, one of whom is required to be a licensed physician and surgeon, licensed midwife, or a certified nurse-midwife. This bill would require the client to be informed orally and in writing when no licensed physician and surgeon is present. (3) Existing constitutional provisions require that a statute that limits the right of access to the meetings of public bodies or the writings of public officials and agencies be adopted with findings demonstrating the interest protected by the limitation and the need for protecting that interest. This bill would make legislative findings to that effect. (4) 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.