AL
Alabama House Bill HB257

Alabama 2025 Regular Session

Alabama House Bill HB257 Compare Versions

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55 By Representatives Harrison, Butler, Whorton, Wood (D),
66 Wilcox, Treadaway, Kirkland, Yarbrough, Stadthagen, Ingram,
77 Gidley, Lamb, Brown, Bolton, Starnes, Fincher, Sells, Estes,
88 Fidler
99 RFD: Health
1010 First Read: 11-Feb-25
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1818 8 3CF6EVV-1 12/12/2024 PMG (L)bm 2024-3192
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2020 First Read: 11-Feb-25
2121 SYNOPSIS:
2222 Existing law authorizes the State Board of
2323 Midwifery to administer the practice of midwifery.
2424 This bill would authorize the board to accept
2525 gifts and grants.
2626 This bill would authorize licensed midwives to
2727 provide midwifery care in freestanding birth centers
2828 and to administer certain newborn screening tests.
2929 A BILL
3030 TO BE ENTITLED
3131 AN ACT
3232 Relating to midwifery; to amend Sections 34-19-12,
3333 34-19-14, and 34-19-16, Code of Alabama 1975, to provide
3434 further for the powers of the State Board of Midwifery and the
3535 practice of midwifery; and to repeal Section 34-19-21, Code of
3636 Alabama 1975, relating to coverage or reimbursement for
3737 midwifery care.
3838 BE IT ENACTED BY THE LEGISLATURE OF ALABAMA:
3939 Section 1. Sections 34-19-12, 34-19-14, and 34-19-16,
4040 Code of Alabama 1975, are amended to read as follows:
4141 "§34-19-12
4242 (a) There is created and established a State Board of
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7272 (a) There is created and established a State Board of
7373 Midwifery to implement and administer this chapter.
7474 (b) The board shall pay all of its expenses from its
7575 own funds, and no expenses shall be borne by the State of
7676 Alabama from the State General Fund.
7777 (c) The board shall consist of seven members appointed
7878 by the Governor and , subject to confirmation by the Senate,
7979 from a list of qualified individuals nominated by the
8080 designated organization. Each list shall contain the names of
8181 at least two individuals for each position to be filled.
8282 (d) The members of the board shall be appointed for
8383 staggered initial terms and subsequent terms shall be for a
8484 minimum of four years or until his or her successor has been
8585 appointed and qualified.
8686 (e) The board shall meet at least twice each year,
8787 conducting its business in person or by electronic methods.
8888 (f) The board shall elect one of its members to serve
8989 as chair for a two-year term. The chair may not serve
9090 consecutive terms.
9191 (g) The composition of the board shall be as follows:
9292 (1) Four members shall hold a valid certified
9393 professional midwife credential from the North American
9494 Registry of Midwives. These members shall be appointed from a
9595 list of names submitted by the Alabama Birth CoalitionMidwives
9696 Alliance or its successor professional midwifery organization.
9797 One of these members shall be appointed to an initial term of
9898 four years, one to a term of three years, and two to a term of
9999 two years.
100100 (2) One member shall be a nurse practitioner. This
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130130 (2) One member shall be a nurse practitioner. This
131131 member shall be appointed to an initial term of four years.
132132 (3) One member shall be a licensed certified nurse
133133 midwife or registered nurse licensed under Article 5 of
134134 Chapter 21. This member shall be appointed from a list
135135 submitted by the Alabama Board of Nursing. This member shall
136136 be appointed to an initial term of three years.
137137 (4) One member shall have used midwifery services in
138138 the state. This member shall be appointed from a list of names
139139 submitted by the Alabama Birth Coalition. This member shall be
140140 appointed to an initial term of three years.
141141 (h) When choosing individuals to be considered by the
142142 Governor for appointment to the board, the nominating
143143 authorities shall strive to assure membership is inclusive and
144144 reflects the racial, gender, geographic, urban, rural, and
145145 economic diversity of the state.
146146 (i) All members of the board shall be immune from
147147 individual civil liability while acting within the scope of
148148 their duties as board members, unless conduct is unreasonable.
149149 (j) Vacancies shall be filled by the Governor and
150150 confirmed by the Senate in the same manner as other
151151 appointments are made. In the case of a vacancy, the new
152152 appointee shall serve for the remainder of the unexpired term.
153153 (k) Members of the board shall serve without
154154 compensation but shall be allowed travel and per diem expenses
155155 at the same rate paid to state employees, to be paid from the
156156 funds collected for the administration of this chapter, as
157157 funds are available.
158158 (l) The board may employ, subject to the Statestate
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188188 (l) The board may employ, subject to the Statestate
189189 Merit System, investigators, inspectors, attorneys, and any
190190 other agents, employees, and assistants as may from time to
191191 time be necessary, and may use any other means necessary to
192192 enforce the provisions of this chapter.
193193 (m) Pursuant to any terms and conditions adopted by the
194194 board by official resolution, the board may accept gifts and
195195 grants.
196196 (m)(n)(1) A licensed midwife shall file annually with
197197 the board the following information on a form prepared by the
198198 board and accessible on its website:
199199 a. The total number of births attended by the licensed
200200 midwife in the previous year, including births where the
201201 licensed midwife was assisting another licensed midwife.
202202 b. The number of maternal transfers to a health care
203203 facility from births attended by the licensed midwife,
204204 including instances where the licensed midwife was assisting
205205 another licensed midwife.
206206 c. The number of infant transfers to a health care
207207 facility from births attended by the licensed midwife,
208208 including instances where the licensed midwife was assisting
209209 another licensed midwife.
210210 d. The total number of maternal deaths from births
211211 attended by the licensed midwife, including instances where
212212 the licensed midwife was assisting another licensed midwife.
213213 e. The total number of infant deaths from births
214214 attended by the licensed midwife, including instances where
215215 the licensed midwife was assisting another licensed midwife.
216216 (2) The board shall make the information collected
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246246 (2) The board shall make the information collected
247247 under this subsection available to the public in accordance
248248 with federal law.
249249 (n)(o) The board shall be subject to the Alabama Sunset
250250 Law, Chapter 20, Title 41, as an enumerated agency as provided
251251 in Section 41-20-3, and shall have a termination date of
252252 October 1, 2021, and every four years thereafter, unless
253253 continued pursuant to the Alabama Sunset Law."
254254 "§34-19-14
255255 (a) The board shall do all of the following consistent
256256 with this chapter:
257257 (1) Approve, renew, suspend, or revoke licenses for the
258258 practice of midwifery.
259259 (2) Investigate and conduct hearings regarding
260260 complaints against a licensed midwife in order to determine if
261261 disciplinary action is warranted.
262262 (3) Establish reasonable licensure fees, including, but
263263 not limited to, initial application, renewal, and
264264 reinstatement fees.
265265 (4) Develop standardized forms , including, but not
266266 limited to, a midwife disclosure form, informed consent form,
267267 emergency care form, and applications for licensure and
268268 renewal.
269269 (5) Impose administrative fines, not to exceed one
270270 thousand dollars ($1,000) per violation, for violating this
271271 chapter, a board rule, or a condition of a license.
272272 (6) Establish levels of professional liability
273273 insurance that must be maintained by a licensed midwife at a
274274 limit of no less than one hundred thousand dollars ($100,000)
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304304 limit of no less than one hundred thousand dollars ($100,000)
305305 per occurrence and three hundred thousand dollars ($300,000)
306306 aggregate.
307307 (b)(1) The board shall adopt rules pursuant to the
308308 Administrative Procedure Act to implement this chapter in a
309309 manner consistent with the most current North American
310310 Registry of Midwives Job Analysis and with essential documents
311311 developed and published by the Midwives Alliance of North
312312 America. The rules shall include, but not be limited to,
313313 provision for all of the following:
314314 a. Licensing procedures and requirements.
315315 b. Minimum initial and continuing education
316316 requirements for licensure.
317317 c. Standards by which a licensed midwife shall conduct
318318 risk assessment.
319319 d. Standards for professional conduct.
320320 e. A standard procedure for investigating complaints.
321321 f. Requirements for clinical internships for
322322 individuals seeking midwifery training.
323323 (2) The rules shall ensure independent practice.
324324 (c) A licensed midwife may not administer or perform
325325 any of the following obstetric procedures which are outside of
326326 the scope of the licensed practice of midwifery:
327327 (1) An epidural, spinal, or caudal anesthetic.
328328 (2) Any type of narcotic analgesia.
329329 (3) Forceps or a vacuum extractor-assisted delivery.
330330 (4) Abortion.
331331 (5) Cesarean section or any surgery or surgical
332332 deliverdelivery except minimal episiotomies.
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362362 deliverdelivery except minimal episiotomies.
363363 (6) Pharmacological induction or augmentation of labor
364364 or artificial rupture of membranes prior to the onset of
365365 labor.
366366 (7) Except for the administration of local anesthetic,
367367 administration of an anesthetic.
368368 (8) Administration of any prescription medication in a
369369 manner that violates the Alabama Uniform Controlled
370370 SubstanceSubstances Act.
371371 (9) Vaginal birth after a cesarean.
372372 (d) A licensed midwife may not perform either of the
373373 following:
374374 (1) Delivery of a diagnosed multiple pregnancy.
375375 (2) Delivery of a baby whose position is diagnosed as
376376 non-cephalic at the onset of labor."
377377 "§34-19-16
378378 (a) A licensed midwife may provide midwifery care in
379379 the setting of the client's choice, exceptincluding a
380380 freestanding birth center, provided a licensed midwife may not
381381 provide midwifery care in a hospital.
382382 (b) A licensed midwife shall ensure that the client has
383383 signed a midwife disclosure form provided by the board
384384 indicating receipt of a written statement that includes all of
385385 the following information:
386386 (1) A description of the licensed midwife's education,
387387 training, and experience in midwifery.
388388 (2) Antepartum, intrapartum, and postpartum conditions
389389 requiring medical referral, transfer of care, and transport to
390390 a hospital.
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420420 a hospital.
421421 (3) A plan for medical referral, transfer of care, and
422422 transport of the client or newborn or both when indicated by
423423 specific antepartum, intrapartum, or postpartum conditions.
424424 (4) Instructions for filing a complaint against a
425425 licensed midwife.
426426 (5) A statement that the licensed midwife must comply
427427 with the federal Health Insurance Portability and
428428 Accountability Act.
429429 (6) The status of a licensed midwife's professional
430430 liability insurance coverage.
431431 (7) References to current evidence regarding the safety
432432 of midwifery care in out-of-hospital settings, including a
433433 copy of the most recent statement by the American Congress of
434434 Obstetricians and Gynecologists on home birth.
435435 (c) A licensed midwife shall ensure that the client has
436436 signed an informed consent form provided by the board.
437437 (d) For screening purposes only, a licensed midwife may
438438 order routine antepartum and postpartum laboratory analyses to
439439 be performed by a licensed laboratory.
440440 (e) After a client has secured the services of a
441441 licensed midwife, the licensed midwife shall document an
442442 emergency care plan on a form provided by the board.
443443 (f) A licensed midwife shall determine the progress of
444444 labor and, when birth is imminent, shall be available until
445445 delivery is accomplished.
446446 (g) A licensed midwife shall remain with the client
447447 during the postpartalpostpartum period until the conditions of
448448 the client and newborn are stabilized.
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478478 the client and newborn are stabilized.
479479 (h) A licensed midwife shall instruct the client
480480 regarding the requirements of the administration of eye
481481 ointment ordered by the Department of Public Health pursuant
482482 to Section 22-20-2.
483483 (i) A licensed midwife shall instruct the client
484484 regarding the requirements of administration of newborn health
485485 screening ordered by the Department of Public Health pursuant
486486 to Section 22-20-3.
487487 (j) A licensed midwife shall file a birth certificate
488488 for each birth in accordance with the requirements of Section
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490490 (k) A licensed midwife shall collect clinical data
491491 under the Midwives Alliance of North America Statistics
492492 Project for each client who initiates care and shall submit a
493493 copy of the clinical data collected for each consenting client
494494 to the board upon request.
495495 (l)(k) A licensed midwife shall report to the Alabama
496496 Department of Public Health pursuant to Chapter 11A , of Title
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498498 report to the Alabama Department of Public Health.
499499 (m)(l) A licensed midwife shall provide all information
500500 required to be provided to new mothers pursuant to Section
501501 22-20-3.1, and all information required to be provided to new
502502 mothers before discharge by hospitals, as defined in Section
503503 22-21-20.
504504 (n)(m) A licensed midwife shall order and administer
505505 those tests provided in Section 22-20-3 , and any rule adopted
506506 by the State Board of Health pursuant to that section relating
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536536 by the State Board of Health pursuant to that section relating
537537 to the newborn screening program, to all neonates in his or
538538 her care.
539539 (o)(n) A licensed midwife may order and administer a
540540 urinalysis or blood glucose test as indicated."
541541 Section 2. Section 34-19-21, Code of Alabama 1975,
542542 relating to coverage or reimbursement for midwifery care, is
543543 repealed.
544544 Section 3. This act shall become effective on October
545545 1, 2025.
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