Subchapter A. LICENSURE AND REGULATION OF MIDWIFE ACTIVITIES

 The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:

   ACNM—The American College of Nurse-Midwives.

   Collaborating physician—A medical or osteopathic medical doctor who has hospital privileges in obstetrics, gynecology or pediatrics and who has entered into a collaborative agreement with a midwife.

   Collaborative agreement—A signed written agreement between a midwife and a collaborating physician in which they agree to the details of the collaborative arrangement between them with respect to the care of midwifery clients.

   Midwife—A person licensed by the Board to practice midwifery.

   Midwife examination—An examination offered or recognized by the Board to test whether an individual has accumulated sufficient academic knowledge with respect to the practice of midwifery to qualify for a midwife license. The Board recognizes the certifying examination of the ACNM as a midwife examination.

   Midwifery practice—anagement of the care of essentially normal women and their normal neonates—initial 28-day period. This includes antepartum, intrapartum, postpartum and nonsurgically related gynecological care.

   Midwife program—An academic and clinical program of study in midwifery which has been approved by the Board or by an accrediting body recognized by the Board. The Board recognizes the ACNM as an accrediting body of programs of study in midwifery.

   Midwife protocol—A written document developed by the midwife setting forth, in detail, the scope and limitations of the midwife’s intended practice.

   The provisions of this §  18.1 amended under section 2 of the act of April 4, 1929 (P. L. 160, No. 155) (63 P. S. §  172); and sections 8 and 35(a) of the Medical Practice Act of 1985 (63 P. S. § §  422.8 and 422.35(a)).

   The provisions of this §  18.1 adopted January 2, 1987, effective immediately and applies retroactively to December 31, 1986, 17 Pa.B. 24; amended May 19, 1989, effective May 20, 1989, 19 Pa.B. 2161. Immediately preceding text appears at serial page (119272).

 The Board will grant a midwife license to an applicant who meets the following requirements. The applicant shall:

   (1)  Be licensed as a registered nurse in this Commonwealth.

   (2)  Satisfy the licensure requirements in §  16.12 (relating to general qualifications for licenses and certificates).

   (3)  Have successfully completed a midwife progam.

   (4)  Have obtained one of the following:

     (i)   A passing grade on a midwife examination. The Board accepts the passing grade on the certifying examination of the ACNM as determined by the ACNM.

     (ii)   ACNM certification as a midwife before the ACNM certification examination was first administered in 1971.

   (5)  Submit an application for a midwife license accompanied by the required fee. For the fee amount, see §  16.13 (relating to licensure, certification, examination and registration fees).

   The provisions of this §  18.2 amended under section 2 of the act of April 4, 1929 (P. L. 160, No. 155) (63 P. S. §  172); and sections 8 and 35(a) of the Medical Practice Act of 1985 (63 P. S. § §  422.8 and 422.35(a)).

 (a)  A midwife license shall be registered biennially. The procedure for the biennial registration of a midwife license is in §  16.15 (relating to biennial registration; inactive status and unregistered status).

 (b)  The fee for the biennial registration of a midwife license is set forth in §  16.13 (relating to licensure, certification, examination and registration fees).

   The provisions of this §  18.3 amended under section 2 of the act of April 4, 1929 (P. L. 160, No. 155) (63 P. S. §  172); and sections 8 and 35(a) of the Medical Practice Act of 1985 (63 P. S. § §  422.8 and 422.35(a)).

 At a minimum, the midwife protocol shall identify the following:

   (1)  The procedures and routines of care, including specific treatment regimens to be provided by the midwife, by practice area—for example, antepartum, intrapartum, postpartum and nonsurgically related gynecological care.

   (2)  The circumstances under which consultation, co-management, referral and transfer of care of women and newborns are to take place, and the mechanics by which each are to occur.

   (3)  Procedures and routines of care of newborns, including specific treatment regimens, if the midwife manages the care of newborns beyond the time of delivery.

   The provisions of this §  18.4 amended under section 2 of the act of April 4, 1929 (P. L. 160, No. 155) (63 P. S. §  172); and sections 8 and 35(a) of the Medical Practice Act of 1985 (63 P. S. § §  422.8 and 422.35(a)).

 (a)  A midwife may not engage in midwifery practice without having entered into a collaborative agreement.

 (b)  A midwife shall only engage in midwifery practice in accordance with a midwife protocol and collaborative agreements.

 (c)  A collaborative agreement shall contain either an acknowledgment that the midwife shall practice under the midwife protocol, or that the midwife shall practice under the midwife protocol as expanded or modified in the collaborative agreement.

 (d)  Expansions and modifications of the midwife protocol agreed to by the midwife and the collaborating physician shall be set forth, in detail, in the collaborative agreement.

 (e)  If the collaborating physician intends to authorize the midwife to relay to other health care providers medical regimens prescribed by that physician, including drug regimens, that authority, as well as the prescribed regimens, shall be set forth in the collaborative agreement.

   The provisions of this §  18.5 amended under section 2 of the act of April 4, 1929 (P. L. 160, No. 155) (63 P. S. §  172); and sections 8 and 35(a) of the Medical Practice Act of 1985 (63 P. S. § §  422.8 and 422.35(a)).

 The midwife is authorized and required to do the following:

   (1)  Engage in midwifery practice as defined in §  18.1 (relating to definitions), as further provided for in this subchapter and in accordance with the ethical and quality standards of the profession as required in section 41(8) of the act (63 P. S. §  422.41(8)).

   (2)  Maintain a midwife protocol and collaborative agreements, and make them available for inspection by clients and the Board upon request.

   (3)  Prescribe medical, therapeutic and diagnostic measures for essentially normal women and their normal neonates in accordance with the midwife protocol or a collaborative agreement, or both.

   (4)  Administer specified drugs as provided in collaborative agreements or as directed by a collaborating physician for a specific patient and, if specifically authorized to do so in a collaborative agreement, relay to other health care providers medical regimens prescribed by the collaborating physician, including drug regimens.

   (5)  Perform medical services in the care of women and newborns that may be beyond the scope of midwifery, if the authority to perform those services is delegated by the collaborating physician in the collaborative agreement, the delegation is consistent with standards of practice embraced by the midwife and the relevant physician communities in this Commonwealth, and the delegated medical services do not involve the prescribing or dispensing of drugs.

   (6)  Refer and transfer to the care of a physician, as provided for in the midwife protocol or a collaborative agreement, or both, those women and newborns whose medical problems are outside the scope of midwifery practice and who require medical services which have not been delegated to the midwife in a collaborative agreement.

   (7)  Review and revise the midwife protocol and collaborative agreements as needed.

   (8)  Carry out responsibilities placed by law or regulation upon a person performing the functions that are performed by the midwife.

   The provisions of this §  18.6 amended under section 2 of the act of April 4, 1929 (P. L. 160, No. 155) (63 P. S. §  172); and sections 8 and 35(a) of the Medical Practice Act of 1985 (63 P. S. § §  422.8 and 422.35(a)).

 (a)  The Board may refuse, revoke, suspend, limit or attach conditions to the license of a midwife for engaging in conduct prohibited by section 41 of the act (63 P. S. §  422.41(8)) for Board-regulated practitioners.

 (b)  The Board will order the emergency suspension of the license of a midwife who presents an immediate and clear danger to the public health and safety, as required by section 40 of the act (63 P. S. §  422.40).

 (c)  The license of a midwife shall automatically be suspended, as required by section 40 of the act.

   The provisions of this §  18.7 amended under section 2 of the act of April 4, 1929 (P. L. 160, No. 155) (63 P. S. §  172); and sections 8 and 35(a) of the Medical Practice Act of 1985 (63 P. S. § §  422.8 and 422.35(a)).

   The provisions of this §  18.8 adopted January 2, 1987, effective immediately and applies retroactively to December 31, 1986, 17 Pa.B. 24; reserved May 19, 1989, effective May 20, 1989, 19 Pa.B. 2161. Immediately preceding text appears at serial page (114029).