SB87ENGROSSED
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SB87
NRRE98T-2
By Senator Orr
RFD: Healthcare
First Read: 04-Feb-25
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First Read: 04-Feb-25
A BILL
TO BE ENTITLED
AN ACT
Relating to midwifery; to amend Sections 34-19-12,
34-19-14, and 34-19-16, Code of Alabama 1975, to provide
further for the powers of the State Board of Midwifery and the
practice of midwifery.
BE IT ENACTED BY THE LEGISLATURE OF ALABAMA:
Section 1. Sections 34-19-12, 34-19-14, and 34-19-16,
Code of Alabama 1975, are amended to read as follows:
"§34-19-12
(a) There is created and established a State Board of
Midwifery to implement and administer this chapter.
(b) The board shall pay all of its expenses from its
own funds and no expenses shall be borne by the State of
Alabama from the State General Fund.
(c) The board shall consist of seven members appointed
by the Governor and subject to confirmation by the Senate,
from a list of qualified individuals nominated by the
designated organization. Each list shall contain the names of
at least two individuals for each position to be filled.
(d) The members of the board shall be appointed for
staggered initial terms and subsequent terms shall be for a
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staggered initial terms and subsequent terms shall be for a
minimum of four years or until his or her successor has been
appointed and qualified.
(e) The board shall meet at least twice each year,
conducting its business in person or by electronic methods.
(f) The board shall elect one of its members to serve
as chair for a two-year term. The chair may not serve
consecutive terms.
(g) The composition of the board shall be as follows:
(1) Four members shall hold a valid certified
professional midwife credential from the North American
Registry of Midwives. These members shall be appointed from a
list of names submitted by the Alabama Birth CoalitionMidwives
Alliance or its successor professional midwifery organization.
One of these members shall be appointed to an initial term of
four years, one to a term of three years, and two to a term of
two years.
(2) One member shall be a nurse practitioner. This
member shall be appointed to an initial term of four years.
(3) One member shall be a licensed certified nurse
midwife or registered nurse licensed under Article 5 of
Chapter 21. This member shall be appointed from a list
submitted by the Alabama Board of Nursing. This member shall
be appointed to an initial term of three years.
(4) One member shall have used midwifery services in
the state. This member shall be appointed from a list of names
submitted by the Alabama Birth Coalition. This member shall be
appointed to an initial term of three years.
(h) When choosing individuals to be considered by the
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(h) When choosing individuals to be considered by the
Governor for appointment to the board, the nominating
authorities shall strive to assure membership is inclusive and
reflects the racial, gender, geographic, urban, rural, and
economic diversity of the state.
(i) All members of the board shall be immune from
individual civil liability while acting within the scope of
their duties as board members, unless conduct is unreasonable.
(j) Vacancies shall be filled by the Governor and
confirmed by the Senate in the same manner as other
appointments are made. In the case of a vacancy, the new
appointee shall serve for the remainder of the unexpired term.
(k) Members of the board shall serve without
compensation but shall be allowed travel and per diem expenses
at the same rate paid to state employees, to be paid from the
funds collected for the administration of this chapter, as
funds are available.
(l) The board may employ, subject to the Statestate
Merit System, investigators, inspectors, attorneys, and any
other agents, employees, and assistants as may from time to
time be necessary, and may use any other means necessary to
enforce the provisions of this chapter.
(m) Pursuant to any terms and conditions adopted by the
board by official resolution, the board may accept gifts and
grants.
(m)(n)(1) A licensed midwife shall file annually with
the board the following information on a form prepared by the
board and accessible on its website:
a. The total number of births attended by the licensed
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a. The total number of births attended by the licensed
midwife in the previous year, including births where the
licensed midwife was assisting another licensed midwife.
b. The number of maternal transfers to a health care
facility from births attended by the licensed midwife,
including instances where the licensed midwife was assisting
another licensed midwife.
c. The number of infant transfers to a health care
facility from births attended by the licensed midwife,
including instances where the licensed midwife was assisting
another licensed midwife.
d. The total number of maternal deaths from births
attended by the licensed midwife, including instances where
the licensed midwife was assisting another licensed midwife.
e. The total number of infant deaths from births
attended by the licensed midwife, including instances where
the licensed midwife was assisting another licensed midwife.
(2) The board shall make the information collected
under this subsection available to the public in accordance
with federal law.
(n)(o) The board shall be subject to the Alabama Sunset
Law, Chapter 20, Title 41, as an enumerated agency as provided
in Section 41-20-3, and shall have a termination date of
October 1, 2021, and every four years thereafter, unless
continued pursuant to the Alabama Sunset Law."
"§34-19-14
(a) The board shall do all of the following consistent
with this chapter:
(1) Approve, renew, suspend, or revoke licenses for the
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(1) Approve, renew, suspend, or revoke licenses for the
practice of midwifery.
(2) Investigate and conduct hearings regarding
complaints against a licensed midwife in order to determine if
disciplinary action is warranted.
(3) Establish reasonable licensure fees, including, but
not limited to, initial application, renewal, and
reinstatement fees.
(4) Develop standardized forms including, but not
limited to, a midwife disclosure form, informed consent form,
emergency care form, and applications for licensure and
renewal.
(5) Impose administrative fines, not to exceed one
thousand dollars ($1,000) per violation, for violating this
chapter, a board rule, or a condition of a license.
(6) Establish levels of professional liability
insurance that must be maintained by a licensed midwife at a
limit of no less than one hundred thousand dollars ($100,000)
per occurrence and three hundred thousand dollars ($300,000)
aggregate.
(b)(1) The board shall adopt rules pursuant to the
Administrative Procedure Act to implement this chapter in a
manner consistent with the most current North American
Registry of Midwives Job Analysis and with essential documents
developed and published by the Midwives Alliance of North
America. The rules shall include, but not be limited to,
provision for all of the following:
a. Licensing procedures and requirements.
b. Minimum initial and continuing education
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b. Minimum initial and continuing education
requirements for licensure.
c. Standards by which a licensed midwife shall conduct
risk assessment.
d. Standards for professional conduct.
e. A standard procedure for investigating complaints.
f. Requirements for clinical internships for
individuals seeking midwifery training.
(2) The rules shall ensure independent practice.
(c) A licensed midwife may not administer or perform
any of the following obstetric procedures which are outside of
the scope of the licensed practice of midwifery:
(1) An epidural, spinal, or caudal anesthetic.
(2) Any type of narcotic analgesia.
(3) Forceps or a vacuum extractor-assisted delivery.
(4) Abortion.
(5) Cesarean section or any surgery or surgical
deliverdelivery except minimal episiotomies.
(6) Pharmacological induction or augmentation of labor
or artificial rupture of membranes prior to the onset of
labor.
(7) Except for the administration of local anesthetic,
administration of an anesthetic.
(8) Administration of any prescription medication in a
manner that violates the Alabama Uniform Controlled
SubstanceSubstances Act.
(9) Vaginal birth after a cesarean.
(d) A licensed midwife may not perform either of the
following:
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following:
(1) Delivery of a diagnosed multiple pregnancy.
(2) Delivery of a baby whose position is diagnosed as
non-cephalic at the onset of labor."
"§34-19-16
(a) A licensed midwife may provide midwifery care in
the setting of the client's choice, except a hospital.
(b) A licensed midwife shall ensure that the client has
signed a midwife disclosure form provided by the board
indicating receipt of a written statement that includes all of
the following information:
(1) A description of the licensed midwife's education,
training, and experience in midwifery.
(2) Antepartum, intrapartum, and postpartum conditions
requiring medical referral, transfer of care, and transport to
a hospital.
(3) A plan for medical referral, transfer of care, and
transport of the client or newborn or both when indicated by
specific antepartum, intrapartum, or postpartum conditions.
(4) Instructions for filing a complaint against a
licensed midwife.
(5) A statement that the licensed midwife must comply
with the federal Health Insurance Portability and
Accountability Act.
(6) The status of a licensed midwife's professional
liability insurance coverage.
(7) References to current evidence regarding the safety
of midwifery care in out-of-hospital settings, including a
copy of the most recent statement by the American Congress of
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copy of the most recent statement by the American Congress of
Obstetricians and Gynecologists on home birth.
(c) A licensed midwife shall ensure that the client has
signed an informed consent form provided by the board.
(d) For screening purposes only, a licensed midwife may
order routine antepartum and postpartum laboratory analyses to
be performed by a licensed laboratory.
(e) After a client has secured the services of a
licensed midwife, the licensed midwife shall document an
emergency care plan on a form provided by the board.
(f) A licensed midwife shall determine the progress of
labor and, when birth is imminent, shall be available until
delivery is accomplished.
(g) A licensed midwife shall remain with the client
during the postpartalpostpartum period until the conditions of
the client and newborn are stabilized.
(h) A licensed midwife shall instruct the client
regarding the requirements of the administration of eye
ointment ordered by the Department of Public Health pursuant
to Section 22-20-2.
(i) A licensed midwife shall instruct the client
regarding the requirements of administration of newborn health
screening ordered by the Department of Public Health pursuant
to Section 22-20-3.
(j) A licensed midwife shall file a birth certificate
for each birth in accordance with the requirements of Section
22-9A-7.
(k) A licensed midwife shall collect clinical data
under the Midwives Alliance of North America Statistics
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under the Midwives Alliance of North America Statistics
Project for each client who initiates care and shall submit a
copy of the clinical data collected for each consenting client
to the board upon request.
(l)(k) A licensed midwife shall report to the Alabama
Department of Public Health pursuant to Chapter 11A , of Title
22, and any other law that requires hospitals or physicians to
report to the Alabama Department of Public Health.
(m)(l) A licensed midwife shall provide all information
required to be provided to new mothers pursuant to Section
22-20-3.1, and all information required to be provided to new
mothers before discharge by hospitals, as defined in Section
22-21-20.
(n)(m) A licensed midwife shall order those tests
provided in Section 22-20-3 and any rule adopted by the State
Board of Health pursuant to that section relating to the
newborn screening program, to all neonates in his or her care.
However, a licensed midwife may order and administer a heel
lance within 72 hours after birth but is prohibited from
interpreting any tests or screens under this subsection and
shall cause any results to be referred to a physician of the
mother's choosing who is licensed to practice medicine. A
licensed midwife is prohibited from providing any care to
newborns except as otherwise provided in this chapter or in an
emergency.
(o)(n) A licensed midwife may order and administer a
urinalysis or blood glucose test for the mother as indicated."
Section 2. This act shall become effective on October
1, 2025.
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1, 2025.
Senate
Read for the first time and referred
to the Senate committee on
Healthcare
................04-Feb-25
Read for the second time and placed
on the calendar:
1 amendment
................01-Apr-25
Read for the third time and passed
as amended
Yeas 32
Nays 0
Abstains 0
................08-Apr-25
Patrick Harris,
Secretary.
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