23 LC 33 9252
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Senate Bill 81
By: Senators Anderson of the 43rd, Butler of the 55th, Jones II of the 22nd, Jackson of the
41st, Islam of the 7th and others
A BILL TO BE ENTITLED
AN ACT
To amend Title 31 of the Official Code of Georgia Annotated, relating to health, so as to
1
repeal in its entirety Chapter 26, relating to the practice of midwifery; to amend Title 43 of2
the Official Code of Georgia Annotated, relating to professions and businesses, so as to3
provide for the licensure and regulation of community midwives; to provide for a short title;4
to provide for legislative findings; to provide for definitions; to provide for the creation of5
the State Board of Community Midwifery; to provide for its membership and duties; to6
provide for the Secretary of State to consult with such board; to provide for regulation by the7
Secretary of State; to provide for licensure requirements; to provide for informed consent and8
written disclosures to clients; to provide for standards of liability in certain situations; to9
authorize the filing of birth certificates; to provide for prohibited acts; to provide for statutory10
construction; to amend Code Section 43-26-12 of the Official Code of Georgia Annotated,11
relating to exceptions to the operation of the "Georgia Registered Professional Nurse Practice12
Act," so as to provide for an exception relating to the practice of midwifery; to provide for13
related matters; to provide for an effective date; to repeal conflicting laws; and for other14
purposes.15
BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:16
SECTION 1.17 23 LC 33 9252
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Title 31 of the Official Code of Georgia Annotated, relating to health, is amended by
18
repealing in its entirety Chapter 26, relating to the practice of midwifery, and designating19
said chapter as reserved.20
SECTION 2.21
Title 43 of the Official Code of Georgia Annotated, relating to professions and businesses,22
is amended by adding a new chapter to read as follows:23
"CHAPTER 24B
24
43-24B-1.25
This chapter shall be known and may be cited as the 'Georgia Community Midwife Act.'26
43-24B-2.27
(a) The General Assembly finds that:28
(1) Parents are entitled to freedom in choosing their provider and setting for childbirth;29
(2) Some potential parents in this state desire alternatives to currently available hospital30
based maternity care;31
(3) Safe, planned out-of-hospital childbirth requires assistance by trained and competent32
professionals;33
(4) Community midwives are trained in managing normal physiological birth in the34
community setting;35
(5) Numerous counties in this state are underserved by obstetricians;36
(6) Community midwives can assist women and their families with safe and effective37
childbirth while guiding the health, safety, and welfare of women and their offspring38
through the childbearing year; and39 23 LC 33 9252
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(7) Regulating community midwifery promotes access to safe and effective antepartum,40
intrapartum, and postpartum care.41
(b) The General Assembly, therefore, declares it to be the purpose of this chapter to protect42
the health, safety, and welfare of the public by providing for the licensure and regulation43
of the activities of community midwives.44
43-24B-3.45
As used in this chapter, the term:46
(1) 'Board' means the State Board of Community Midwifery created pursuant to Code47
Section 43-24B-4.48
(2) 'Certified nurse midwife' means a midwife who is an advanced practice registered49
nurse.50
(3) 'Community midwife' means:51
(A) A skilled practitioner who provides specialized care to women and their infants52
during antenatal, childbirth, and postpartum periods in out-of-hospital community birth53
settings; or54
(B) An individual licensed under this chapter who is engaging in the practice of55
community midwifery.56
(4) 'Consultation' means a communication between a community midwife and a57
physician, a certified nurse midwife, or another licensed healthcare provider with58
expertise in providing medical services to women during the prenatal, childbirth, and59
postpartum periods when assessing a condition during such periods.60
(5) 'Informed consent' means a written certification by the client consenting to61
procedures, protocols, and treatments or recommended diagnostic tests after full62
disclosure of the current standard of care and its purpose, benefits, known risks,63
contraindications, and associated risks, as well as any alternative options.64 23 LC 33 9252
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(6) 'License' means a license issued pursuant to this chapter to engage in the practice of65
community midwifery.66
(7) 'Practice of community midwifery' means assistance given, in exchange for67
compensation, to women during the prenatal, childbirth, and postpartum periods,68
including well-woman screening and education. Midwifery services may be provided in69
out-of-hospital settings, such as a private home. Such services, which are provided70
within a network of relationships with other maternity care providers who may provide71
consultation and collaboration when needed, include:72
(A) Providing care, education, counseling, and support to women and their families73
throughout pregnancy, birth, and the postpartum period; identifying unique physical74
social and emotional needs; recognizing abnormal conditions requiring the services of75
a healthcare provider such as a physician, physician assistant, or advanced practice76
registered nurse and developing a plan for consultation and referral when such77
conditions arise; and providing emergency care and support for women and babies until78
additional assistance is available;79
(B) Ordering prenatal, postpartum, and well-woman laboratory analyses performed by80
a licensed laboratory for screening purposes; ordering obstetric ultrasounds; obtaining81
and using appropriate equipment and devices such as a Doppler ultrasound, blood82
pressure cuff, and phlebotomy supplies, instruments, and sutures; ordering obstetric83
ultrasounds; obtaining and administering antihemorrhagic agents including but not84
limited to Pitocin (oxytocin), misoprostol and methergine, intravenous fluids for85
stabilization of the laboring person, magnesium sulfate, terbutaline, neonatal injectable86
vitamin K, newborn antibiotic eye prophylaxis, oxygen, intravenous antibiotics for87
Group B Streptococcal antibiotic prophylaxis, Rho(D) immune globulin, local88
anesthetic, epinephrine, and other drugs or supplies approved by the Secretary; and89
administering a specific drug prescribed by a physician or other authorized healthcare90
provider for a client of a community midwife;91 23 LC 33 9252
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(C) Managing the postpartum period, including the suturing of an episiotomy and the92
suturing of first and second degree natural perineal and labial lacerations, including the93
administration of a local anesthetic;94
(D) Managing the newborn period, including:95
(i) Providing care for a newborn baby, including performing a normal newborn baby96
examination;97
(ii) Resuscitating a newborn baby; and98
(iii) Performing newborn screenings;99
(E) Providing limited interconceptual services in order to provide continuity of care,100
including:101
(i) Breastfeeding support and counseling;102
(ii) Family planning, limited to natural family planning, cervical caps, and103
diaphragms; and104
(iii) Pap smears, where each client with an abnormal result is to be referred to an105
appropriate licensed healthcare provider; and106
(F) Executing the orders of a physician, if the orders are within the education,107
knowledge, and skill of the community midwife.108
(8) 'Referral' means a request made by a community midwife to a physician or other109
healthcare provider for an assessment of a client or her offspring in order to determine110
appropriate care.111
(9) 'Secretary' means the Secretary of State or his or her designee.112
43-24B-4.113
(a) There is created within the division the State Board of Community Midwifery which114
shall consist of five members.115
(b) The Governor shall appoint all members of the board as follows:116
(1) Four community midwives; and117 23 LC 33 9252
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(2) One member of the general public.118
(c) The members of the board shall serve for terms of two years and may succeed119
themselves.120
(d) Any vacancy on the board shall be filled in the same manner as the regular121
appointments.122
(e) The Governor may remove members of the board for incompetence, neglect of duty,123
unprofessional conduct, conviction of any felony, failure to meet the qualifications of this124
chapter, or committing any act prohibited by this chapter.125
(f) Each member of the board shall serve without compensation and at no cost to the state.126
(g) The board shall elect a chairperson from among its membership, and may elect other127
officers at the discretion of the board, who shall each serve for one year.128
(h) The board shall meet at least once per year or as otherwise called by the chairperson.129
43-24B-5.130
The board shall issue a license to engage in the practice of community midwifery to any131
individual who meets the requirements of this chapter.132
43-24B-6.133
(a) Each applicant for a license under this chapter shall meet the following requirements:134
(1) Submit an application in a form prescribed by the division;135
(2) Pay a fee as determined by the board;136
(3) Have satisfactory results from a criminal background check conducted by the137
Georgia Crime Information Center and the Federal Bureau of Investigation, as138
determined by the board. Application for a license under this Code section shall139
constitute express consent and authorization for the board to perform such criminal140
background check. Each applicant who submits an application for licensure agrees to141
provide the board with any and all information necessary to run such criminal142 23 LC 33 9252
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background check, including, but not limited to, classifiable sets of fingerprints. The143
applicant shall be responsible for all fees associated with the performance of such144
background check;145
(4) Hold a current certification as a certified community midwife or a certified146
professional midwife, including having passed the examination required for certification147
or an equivalent certification, from a midwifery organization recognized by the board;148
(5) Hold current certification in adult cardiopulmonary resuscitation from an149
organization recognized by the board; and150
(6) Provide documentation of successful completion of an approved pharmacology151
course as defined by board rule.152
(b) The board, in its discretion, may issue a license to an applicant who does not meet all153
of the requirements of subsection (a) of this Code section but who has been engaged in the154
practice of community midwifery for at least ten years and has at least 50 documented155
births.156
43-24B-7.157
(a) A license issued by the board shall be renewed every three years if the licensee is not158
in violation of this chapter at the time of application for renewal.159
(b) Each individual licensed under this chapter is responsible for renewing his or her160
license before the expiration date.161
43-24B-8.162
(a) The Secretary shall seek the advice of the board regarding the establishment of rules163
and regulations and the implementation of requirements relating to licensure, license164
renewal, discipline, continuing education, and other issues related to the practice of165
midwifery in accordance with this chapter.166 23 LC 33 9252
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(b) The Secretary shall consult with the board prior to setting or changing fees as provided167
for in this chapter.168
(c) The board may act as a facilitator of state-wide dissemination of information169
concerning professional midwifery services.170
(d) The board shall provide analysis of disciplinary actions taken, appeals and denials, and171
revocation of licenses at least once per year.172
43-24B-9.173
(a) Prior to engaging in the practice of community midwifery with a client, a community174
midwife shall obtain informed consent from such client.175
(b) Such informed consent shall include:176
(1) The name and license number of the community midwife;177
(2) The client's name, address, telephone number, and primary care provider, if the client178
has one;179
(3) A description of the community midwife's education, training, continuing education,180
and experience in midwifery;181
(4) A description of the community midwife's peer review process;182
(5) The community midwife's philosophy of practice;183
(6) A promise to provide the client, upon request, with separate documents describing184
the rules governing the practice of community midwifery, including a list of conditions185
indicating the need for consultation, collaboration, referral, transfer, or mandatory186
transfer, and the community midwife's personal written practice guidelines;187
(7) A medical emergency transfer plan;188
(8) A description of the services provided to the client by the community midwife;189
(9) The availability of a grievance process;190
(10) The signatures of the client and community midwife and the dates of signature; and191 23 LC 33 9252
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(11) Whether the community midwife is covered by a professional liability insurance192
policy.193
(c) The community midwife shall retain a copy of such informed consents for at least four194
years.195
(d) A community midwife shall be authorized to file a birth certificate for each birth in196
accordance with the laws of this state.197
43-24B-10.198
(a) If a community midwife seeks consultation with or refers or transfers a client to a199
licensed healthcare provider or facility, the responsibility of the provider or facility for the200
client shall not begin until the client is physically within the care of such provider or201
facility.202
(b) A licensed healthcare provider who examines a community midwife's client shall only203
be liable for the actual examination and shall not be held accountable for the client's204
decision to pursue an out-of-hospital birth or the services of a community midwife.205
(c)(1) A licensed healthcare provider may, upon receiving a briefing or data from a206
community midwife, issue a medical order for the community midwife's client, without207
that client being an explicit patient of such provider.208
(2) Regardless of the advice given or order issued, the responsibility and liability for209
caring for the client shall be that of the community midwife.210
(3) The provider giving the order shall be responsible and liable only for the211
appropriateness of the order, given the briefing or data received.212
(4) The issuing of an order for a community midwife's client shall not constitute a213
delegation of duties from the other provider to the community midwife.214
(d) A licensed healthcare provider shall not be held civilly liable for rendering emergency215
medical services that arise from prohibited conduct or from care rendered under a waiver216 23 LC 33 9252
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as specified, unless the emergency medical services constitute gross negligence or reckless217
disregard for the client.218
(e) A community midwife shall be solely responsible for the use of medications under this219
chapter.220
43-24B-11.221
A community midwife shall not be authorized to:222
(1) Administer a prescription drug to a client in a manner that violates this chapter;223
(2) Effect any type of surgical delivery except for the cutting of an emergency224
episiotomy;225
(3) Administer any type of epidural, spinal, or caudal anesthetic, or any type of narcotic226
analgesia;227
(4) Use forceps or a vacuum extractor; or228
(5) Manually remove the placenta, except in an emergency that presents an immediate229
threat to the life of the woman.230
43-24B-12.231
Nothing in this chapter shall be construed to abridge, limit, or change in any way the right232
of a parent or parents to deliver a fetus where, when, how, and with whom they choose.233
43-24B-13.234
Nothing in this chapter shall be construed to prevent:235
(1) Any licensed healthcare professional from engaging in the authorized scope of236
practice of his or her profession;237
(2) Members of a pregnant woman's family from providing incidental care;238
(3) Representatives of a pregnant woman's culture from providing care consistent with239
the tenets or practices of such culture or representatives of a pregnant woman's religion240 23 LC 33 9252
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from providing care consistent with practices of such religion; provided, however, that241
such representatives shall not hold themselves out as community midwives; or242
(4) Precepted apprentices, student midwives, and midwifery assistants from providing243
midwifery services under the supervision and in the physical presence of a community244
midwife."245
SECTION 3.246
Code Section 43-26-12 of the Official Code of Georgia Annotated, relating to exceptions to247
the operation of the "Georgia Registered Professional Nurse Practice Act," is amended in248
subsection (a) by deleting "and" at the end of paragraph (9), by replacing the period at the249
end of paragraph (10) with "; and", and by adding a new paragraph to read as follows:250
"(11) The practice of community midwifery by a community midwife pursuant to251
Chapter 24B of this title."252
SECTION 4.253
This Act shall become effective upon its approval by the Governor or upon its becoming law254
without such approval.255
SECTION 5.256
All laws and parts of laws in conflict with this Act are repealed.257