Summary of the Licensed Midwifery Practice Act
The Midwifery Practice Act specifies the requirements for licensure and the scope
of practice for a licensed midwife. Assembly Bill 1308 (Bonilla, Chapter 665, Statutes
of 2013) made significant amendments to various Business and Professions Code sections
governing the practice of midwifery in California. The changes become effective
January 1, 2014. The law provides that:
- The holder of a midwifery license may attend cases of normal pregnancy and childbirth
(see definition below) and provide prenatal, intrapartum, and postpartum care, including
family-planning care, for the mother, and immediate care for the newborn.
- The practice of midwifery does not include the assisting of childbirth by any artificial,
forcible, or mechanical means, nor the performance of any version of these means.
- Midwives are not authorized to practice medicine or to perform surgery.
- Licensed midwives are authorized to directly obtain supplies and devices, obtain
and administer drugs and diagnostic tests, order testing, and receive reports that
are necessary to the practice of midwifery and consistent with his or her scope
- No person, other than a licensed midwife, may hold himself/herself out as a licensed
midwife or use any other term which may indicate or imply that he/she is a licensed
Normal Pregnancy / Required Referrals / Transfer of Care
- The licensed midwife may assist a woman in childbirth as long as progress meets
criteria accepted as normal.
- Normal pregnancy and childbirth is defined as meeting all of the following conditions:
- There is an absence of any preexisting maternal disease or condition likely to affect
- There is an absence of significant disease arising from the pregnancy.
- There is a singleton fetus.
- There is a cephalic presentation.
- The gestational age of the fetus is greater than 37 0⁄7 weeks and less than 42 0⁄7
completed weeks of pregnancy.
- Labor is spontaneous or induced in an outpatient setting.
- If a potential client does not meet criteria #1 and #2 above, but does meet criteria
#3-#6, and still wishes to be a client of the midwife, the midwife must provide
the woman with a referral for an examination by a physician trained in obstetrics
and gynecology. If the physician determines that the risk factors presented by the
client's disease or condition are not likely to significantly affect the course
of pregnancy and childbirth, then the midwife may assist the woman in pregnancy
- If at any point during a pregnancy, childbirth, or postpartum care a client’s condition
deviates from normal, the licensed midwife must immediately refer or transfer the
client to a physician. The licensed midwife may consult and remain in consultation
with the physician after the referral or transfer.
- If the physician determines that the client’s condition or concern has been resolved
such that the risk factors are not likely to significantly affect the course of
pregnancy or childbirth, the licensed midwife may resume primary care of the client.
- If, however, the physician determines that the client’s condition or concern has
not been resolved, the licensed midwife may provide concurrent care with a physician
and, if authorized by the client, be present during the labor and childbirth, and
resume postpartum care, if appropriate. The licensed midwife may not resume primary
care of the client under these circumstances.
- A licensed midwife may not provide or continue to provide midwifery care to a woman
with a risk factor that will significantly affect the course of pregnancy and childbirth,
regardless of whether a woman has consented to this care or refused care by a physician.
- If a client is transferred to a hospital, the licensed midwife must provide records,
including prenatal records, and speak with the receiving physician and surgeon about
labor up to the point of the transfer. The hospital shall 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.
A licensed midwife must disclose to a prospective client, both orally and in writing,
and obtain the client's informed consent for all of the following:
- The client is retaining a licensed midwife, not a certified nurse-midwife, and the
licensed midwife is not supervised by a physician and surgeon.
- The midwife’s current licensure status and license number.
- The practice settings in which the licensed midwife practices.
- Whether or not he or she has liability coverage for the practice of midwifery.
- The fact that many physicians do not have liability insurance coverage for services
provided to someone having a planned out-of-hospital birth.
- Acknowledgement that if the client is advised to consult with a physician, failure
to do so may affect the client’s legal rights in any professional negligence actions
against a physician, licensed health care professional, or hospital.
- There are conditions that are outside the scope of practice of a licensed midwife
that will result in a referral for a consultation from, or transfer of care to,
- The specific arrangements for the transfer of care during the prenatal period, hospital
transfer during the intrapartum and postpartum periods, and access to appropriate
emergency medical services for mother and baby if necessary, and recommendations
for preregistration at a hospital that has obstetric emergency services and is most
likely to receive the transfer.
- If, during the course of care, the client is informed that she has or may have a
condition indicating the need for a mandatory transfer, the licensed midwife must
initiate the transfer.
- The laws regulating licensed midwifery practices and the procedure for reporting
complaints to the Medical Board of California, and that these are available on the
Medical Board of California’s Internet website.
- Consultation with a physician does not alone create a physician-patient relationship
or any other relationship with the physician. The informed consent must specifically
state that the licensed midwife and the consulting physician are not employees,
partners, associates, agents, or principals of one another. The licensed midwife
must inform the patient that he or she is independently licensed and practicing
midwifery and in that regard is solely responsible for the services he or she provides.
- The disclosure and consent must be signed by both the licensed midwife and the client
and a copy of the disclosure and consent must be placed in the client’s medical
View a sample disclosure and consent
form meeting these requirements.
In order to be issued a license to practice midwifery, applicants must pay the required
fee and have successfully completed one of the following:
- a three-year postsecondary midwifery educational program accredited by an accrediting
organization recognized by the United States Department of Education, Division of
- an approved midwifery education program that offers the opportunity for students
to obtain credit for previous midwifery education and clinical experiences and demonstrate,
by practical examination, the clinical competencies that reflect national standards
for the practice of midwifery. Completion of clinical experiences must be verified
by a licensed midwife or certified nurse-midwife and a physician and surgeon, all
of whom must be current in the knowledge and practice of obstetrics and midwifery.
Beginning January 1, 2015, new licensees may not substitute clinical experience
for formal didactic education.
- an educational program approved by the Board and is currently licensed as a midwife
by a state with equivalent licensing standards.
Applicants must also have successfully completed a written examination, which has
been adopted by the Board as equivalent to the American College of Nurse Midwives
exam (NARM Exam).
Licensed Midwife Annual Report
- Each midwife who assists, or supervises a student midwife in assisting, in childbirth
that occurs in an out-of-hospital setting must annually report to the Office of
Statewide Health Planning and Development (OSHPD). The report must be submitted
no later than March 30, for the prior calendar year.
Renewal and Fees
- Licensed midwives must renew their license every two years which requires payment
of the current fee and certification of 36 hours of approved continuing education.
- An expired license may be renewed within five years from the expiration date upon
payment of the current and accrued fees and certification of completing the continuing education
- The current licensing fee is $300.00, renewal fee is $200.00, and the delinquency
fee is $50.00.
The Board may suspend, revoke, or place on probation the license of a licensed midwife,
or take other appropriate disciplinary action for any of the following:
- Unprofessional conduct.
- Procuring a license by fraud or misrepresentation.
- Conviction of a crime substantially related to the qualifications, function and
duties of a licensed midwife.
- Procuring, aiding, abetting, attempting, agreeing to procure, offering to procure,
or assisting at, a criminal abortion.
- Violating or attempting to violate, directly or indirectly, or assisting in or abetting
the violation of, or conspiring to violate any provision or term of the laws regulating
- Making or giving false statements or information in connection with the application
for issuance of a license.
- Impersonating any applicant or acting as proxy for any applicant in an examination
required for licensure.
- Impersonating another licensed practitioner, or permitting or allowing another person
to use his or her license for the purpose of providing midwifery services.
- Aiding or assisting, or agreeing to aid or assist any person or persons, whether
a licensed physician or not, in the performance of, or arranging for, a violation
of any of the provisions of Article 12 of Chapter 5. Violators of this article are
guilty of a misdemeanor.
- Failing to do any of the following when required:
- Consult with a physician and surgeon.
- Refer a client to a physician and surgeon.
- Transfer a client to a hospital.