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SENATE DOCKET, NO. 1327 FILED ON: 1/19/2023
SENATE . . . . . . . . . . . . . . No. 1457
The Commonwealth of Massachusetts
_________________
PRESENTED BY:
Rebecca L. Rausch
_________________
To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
Court assembled:
The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:
An Act promoting access to midwifery care and out-of-hospital birth options.
_______________
PETITION OF:
NAME:DISTRICT/ADDRESS :Rebecca L. RauschNorfolk, Worcester and MiddlesexJack Patrick Lewis7th Middlesex1/30/2023Hannah Kane11th Worcester1/31/2023Jason M. LewisFifth Middlesex2/1/2023Joanne M. ComerfordHampshire, Franklin and Worcester2/1/2023Lydia EdwardsThird Suffolk2/3/2023Patrick M. O'ConnorFirst Plymouth and Norfolk2/7/2023Thomas M. Stanley9th Middlesex2/8/2023Walter F. TimiltyNorfolk, Plymouth and Bristol2/8/2023Vanna Howard17th Middlesex2/9/2023Anne M. GobiWorcester and Hampshire2/9/2023James B. EldridgeMiddlesex and Worcester2/10/2023John F. KeenanNorfolk and Plymouth2/28/2023 1 of 13
SENATE DOCKET, NO. 1327 FILED ON: 1/19/2023
SENATE . . . . . . . . . . . . . . No. 1457
By Ms. Rausch, a petition (accompanied by bill, Senate, No. 1457) of Rebecca L. Rausch, Jack
Patrick Lewis, Hannah Kane, Jason M. Lewis and other members of the General Court for
legislation to promote access to midwifery care and out-of-hospital birth options. Public Health.
The Commonwealth of Massachusetts
_______________
In the One Hundred and Ninety-Third General Court
(2023-2024)
_______________
An Act promoting access to midwifery care and out-of-hospital birth options.
Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
of the same, as follows:
1 SECTION 1. Section 9 of chapter 13 of the General Laws, as appearing in the 2020
2Official Edition, is hereby amended by inserting, in line 7, after the word “counselors” the
3following words:- , the board of registration in midwifery.
4 SECTION 2. Said chapter 13, as so appearing, is hereby further amended by adding the
5following section:-
6 Section 110. (a) There shall be within the department of public health a board of
7registration in midwifery. The board shall consist of 8 members to be appointed by the governor,
85 of whom shall be midwives with not less than 5 years of experience in the practice of
9midwifery and who shall be licensed under sections 276 to 289, inclusive, of chapter 112, 1 of
10whom shall be a physician licensed to practice medicine under section 2 of said chapter 112 with
11experience working with midwives, 1 of whom shall be a certified nurse-midwife licensed to
12practice midwifery under section 80B of said chapter 112 and 1 of whom shall be a member of 2 of 13
13the public. Four of the members of the board of registration in midwifery shall have experience
14working on the issue of racial disparities in maternal health or be a member of a population that
15is underrepresented in the midwifery profession. When making the appointments, the governor
16shall consider the recommendations of organizations representing certified professional
17midwives in the commonwealth. The appointed members shall serve for terms of 3 years. Upon
18the expiration of a term of office, a member shall continue to serve until a successor has been
19appointed and qualified. A member shall not serve for more than 2 consecutive terms; provided,
20however, that a person who is chosen to fill a vacancy in an unexpired term of a prior board
21member may serve for 2 consecutive terms in addition to the remainder of that unexpired term. A
22member may be removed by the governor for neglect of duty, misconduct, malfeasance or
23misfeasance in the office after a written notice of the charges against the member and sufficient
24opportunity to be heard thereon. Upon the death or removal for cause of a member of the board,
25the governor shall fill the vacancy for the remainder of that member’s term after considering
26suggestions from a list of nominees provided by organizations representing certified professional
27midwives in the commonwealth. For the initial appointment of the board, the 5 members
28required to be licensed midwives shall be persons with at least 5 years of experience in the
29practice of midwifery who meet the eligibility requirements set forth in subsection (a) of section
30281 of chapter 112. Members of the board shall be residents of the commonwealth.
31 (b) Annually, the board shall elect from its membership a chair and a secretary who shall
32serve until their successors have been elected and qualified. The board shall meet not less than 4
33times annually and may hold additional meetings at the call of the chair or upon the request of
34not less than 4 members. A quorum for the conduct of official business shall be a majority of
35those appointed. Board members shall serve without compensation but shall be reimbursed for 3 of 13
36actual and reasonable expenses incurred in the performance of their duties. The members shall be
37public employees for the purposes of chapter 258 for all acts or omissions within the scope of
38their duties as board members.
39 SECTION 3. Section 1E of chapter 46 of the General Laws, as appearing in the 2020
40Official Edition, is hereby amended by inserting after the definition of “Physician” the following
41definition:-
42 “Licensed midwife,” a midwife licensed to practice by the board of registration in
43midwifery as provided in sections 276 to 289 of chapter 112.
44 SECTION 4. Section 3B of said chapter 46, as so appearing, is hereby amended by
45inserting after the word “physician”, in line 1, the following words:- or licensed midwife.
46 SECTION 5. Section 1 of chapter 94C of the general laws, as appearing in the 2020
47Official Edition, is hereby amended by inserting after the definition of “Isomer” the following
48definition:-
49 “Licensed midwife,” a midwife licensed to practice by the board of registration in
50midwifery as provided in sections 276 to 289 of chapter 112.
51 SECTION 6. Section 7 of said chapter 94C, as so appearing, is hereby amended by
52adding the following new subsection:-
53 (j) The commissioner shall promulgate regulations which provide for the automatic
54registration of licensed midwives, upon the receipt of the fee as herein provided, to issue written
55prescriptions in accordance with the provisions of sections 279 of chapter 112 and the
56regulations issued by the board of registration in midwifery under said section 279 of chapter 4 of 13
57112, unless the registration of such licensed midwife has been suspended or revoked pursuant to
58the provisions of section 13 or section 14 or unless such registration is denied for cause by the
59commissioner pursuant to the provisions of chapter 30A. Prior to promulgating such regulations,
60the commissioner shall consult with the board of registration in midwifery.
61 SECTION 7. Section 9 of said chapter 94C, as so appearing, is hereby amended by
62inserting in paragraph (a), after the words “certified nurse midwife as provided in section 80C of
63said chapter 112” the following words:- , licensed midwife as limited by subsection (j) of said
64section 7 and section 279 of said chapter 112.
65 SECTION 8. Section 9 of said chapter 94C, as so appearing, is hereby further amended in
66paragraph (b), by inserting after the words “midwife” in each place that they appear, the
67following words:- , licensed midwife.
68 SECTION 9. Said section 9 of said chapter 94C, as so appearing, is hereby further
69amended in paragraph (b), by inserting after the words “nurse-midwifery” in each place that they
70appear, the following words:- , midwifery.
71 SECTION 10. Section 9 of said chapter 94C is further amended in paragraph (c), by
72inserting after the words “certified nurse midwife” in each place that they appear, the following
73words:- , licensed midwife.
74 SECTION 11. The definition of “medical peer review committee” in section 1 of chapter
75111 of the General Laws, as appearing in the 2020 official edition, is hereby amended by adding
76the following sentence:- “Medical peer review committee” shall include a committee or
77association that is authorized by a midwifery society or association to evaluate the quality of 5 of 13
78midwifery services or the competence of midwives and suggest improvements in midwifery
79practices to improve patient care.
80 SECTION 12. Section 202 of said chapter 111, as so appearing, is hereby amended by
81inserting, in the second and third paragraphs, after the word “attendance”, in each instance, the
82following words:- or midwife in attendance.
83 SECTION 13. Said section 202, as so appearing, is hereby further amended by inserting,
84in the fourth paragraph, after the word “attendance” the following words:- or without the
85attendance of a midwife,.
86 SECTION 14. Section 204 of said chapter 111, as so appearing, is hereby amended by
87inserting, in lines 7, 12 and 28, after the word “medicine”, in each instance, the following word:-
88, midwifery.
89 SECTION 15. Chapter 112 of the General Laws, as appearing in the 2020 Official
90Edition, is hereby amended by adding the following new sections:-
91 Section 276. As used in sections 276 to 288, inclusive, of this chapter, the following
92words shall have the following meanings unless the context clearly requires otherwise:
93 “Board”, the board of registration in midwifery, established under section 110 of chapter
9413.
95 “Certified nurse-midwife”, a nurse with advanced training and who has obtained
96certification by the American Midwifery Certification Board.
97 “Certified professional midwife”, a professional independent midwifery practitioner who
98has obtained certification by the NARM." 6 of 13
99 “Client”, a person under the care of a licensed midwife, as described by a written
100statement pursuant to section 284 of this chapter.
101 “Licensed midwife”, a person registered by the board to practice midwifery in the
102commonwealth under sections 276 to 288, inclusive, of this chapter.
103 “MBC”, the midwifery bridge certificate issued by the NARM or its successor credential.
104 “MEAC”, the Midwifery Education Accreditation Council or its successor organization.
105 “Midwifery”, the practice of providing primary care to a client and newborn during the
106preconception, antepartum, intrapartum and postpartum periods.
107 “NARM”, the North American Registry of Midwives or its successor organization.
108 Section 277. Nothing in sections 276 to 288, inclusive, of this chapter shall limit or
109regulate the practice of a licensed physician, certified nurse-midwife, or licensed basic or
110advanced emergency medical technician. The practice of midwifery shall not constitute the
111practice of medicine, certified nurse-midwifery or emergency medical care.
112 Section 278. (a) The board shall:
113 (i) adopt rules and promulgate regulations governing licensed midwives and the practice
114of midwifery to promote public health, welfare and safety, consistent with the essential
115competencies identified by the NARM;
116 (ii) administer the licensing process, including, but not limited to:
117 (A) receiving, reviewing, approving, rejecting and issuing applications for licensure; 7 of 13
118 (B) renewing, suspending, revoking and reinstating licenses;
119 (C) investigating complaints against persons licensed under sections 276 to 288,
120inclusive, of this chapter;
121 (D) holding hearings and ordering the disciplinary sanction of a person who violates
122sections 276 to 288, inclusive, of this chapter or a regulation of the board;
123 (iii) establish administrative procedures for processing applications and renewals;
124 (iv) have the authority to adopt and provide a uniform, proctored examination for
125applicants to measure the qualifications necessary for licensure;
126 (v) develop practice standards for licensed midwives that shall include, but not be limited
127to:
128 (A) adoption of ethical standards for licensed midwives and apprentice midwives;
129 (B) maintenance of records of care, including client charts;
130 (C) participation in peer review; and
131 (D) development of standardized informed consent, reporting and written emergency
132transport plan forms;
133 (vi) establish and maintain records of its actions and proceedings in accordance with
134public records laws; and
135 (vii) adopt professional continuing education requirements for licensed midwives seeking
136renewal consistent with those maintained by the NARM. 8 of 13
137 (b) Nothing in this section shall limit the board’s authority to impose sanctions that are
138considered reasonable and appropriate by the board. A person subject to any disciplinary action
139taken by the board under this section or taken due to a violation of any other law, rule or
140regulation may file a petition for judicial review pursuant to section 64 of this chapter.
141 (c) A licensed midwife shall accept and provide care to clients only in accordance with
142the scope and standards of practice identified in the rules adopted pursuant to this section.
143 (d) Notwithstanding any other provision in this section, the board shall not issue any
144regulations that require a licensed midwife to practice under the supervision of or in
145collaboration with another healthcare provider or to enter into an agreement, written or
146otherwise, with another healthcare provider.
147 Section 279. A licensed midwife duly registered to issue written prescriptions in
148accordance with the provisions of subsection (j) of section 7 of chapter 94C may order, possess,
149purchase, and administer pharmaceutical agents consistent with the scope of midwifery practice,
150including without limitation antihemorrhagic agents including but not limited to oxytocin,
151misoprostol and methergine; intravenous fluids for stabilization; vitamin K; eye prophylaxes;
152oxygen; antibiotics for Group B Streptococcal antibiotic prophylaxes; Rho (D) immune globulin;
153local anesthetic; epinephrine; and other pharmaceutical agents identified by the board, however,
154that nothing in this section shall be construed to permit a licensed midwife’s use of
155pharmaceutical agents which are (a) controlled substances as described by Title 21 U.S.C.
156Section 812 or in chapter 94C, except for those listed in schedule VI; or (b) not identified by
157rules and regulations promulgated by the board of registration in midwifery as consistent with
158the scope of midwifery practice. 9 of 13
159 Section 280. A person who desires to be licensed and registered as a licensed midwife
160shall apply to the board in writing on an application form prescribed and furnished by the board.
161The applicant shall include in the application statements under oath satisfactory to the board
162showing that the applicant possesses the qualifications described under section 281 prior to any
163examination which may be required under section 278. The secretary of administration and
164finance, pursuant to section 3B of chapter 7, shall establish a license application fee, a license
165renewal fee and any other fee applicable under sections 276 to 288, inclusive, of this chapter;
166provided, however, that such license applicant and license renewal fees shall not exceed $200
167biennially. The board, in consultation with the secretary of administration and finance, shall
168institute a process for applicants to apply for a financial hardship waiver, which may reduce or
169fully exempt an applicant from paying the fee pursuant to this section. Fees collected by the
170board shall be deposited into the Quality in Health Professions Trust Fund pursuant to section
17135X of chapter 10 to support board operations and administration and to reimburse board
172members for actual and necessary expenses incurred in the performance of their official duties.
173 Section 281. (a) To be eligible for registration and licensure by the board as a licensed
174midwife, an applicant shall: (i) be of good moral character; (ii) be a graduate of a high school or
175its equivalent; and (iii) possess a valid certified professional midwife credential from the NARM.
176 (b) An applicant for a license to practice midwifery as a certified professional midwife
177shall submit to the board proof of successful completion of a formal midwifery education and
178training program as follows:
179 (i) a certificate of completion or equivalent from an educational program or institution
180accredited by the MEAC; or 10 of 13
181 (ii) an MBC, provided that an applicant: (1) is certified as a certified professional
182midwife within 5 years after the effective date of this section and completed a midwifery
183education and training program from an educational program or institution that is not accredited
184by the MEAC; or (2) is licensed as a professional midwife in a state that does not require
185completion of a midwifery education and training program from an educational program or
186institution that is accredited by the MEAC.
187 Section 282. The board may license in a like manner, without examination, any
188midwife who has been licensed in another state under laws which, in the opinion of the board,
189require qualifications and maintain standards substantially the same as those of this
190commonwealth for licensed midwives, provided, however, that such midwife applies and remits
191fees as provided for in section 279.
192 Section 283. (a) The board may, after a hearing pursuant to chapter 30A, revoke, suspend
193or cancel the license of a licensed midwife, or reprimand or censure a licensed midwife, for any
194of the reasons set forth in section 61.
195 (b) No person filing a complaint or reporting information pursuant to this section or
196assisting the board at its request in any manner in discharging its duties and functions shall be
197liable in any cause of action arising out of providing such information or assistance; provided,
198however, that the person making the complaint or reporting or providing such information or
199assistance does so in good faith and without malice. Section 284. When accepting a client for
200care, a licensed midwife shall obtain the client’s informed consent, which shall be evidenced by
201a written statement in a form prescribed by the board and signed by both the licensed midwife
202and the client. 11 of 13
203 Section 285. A licensed midwife shall prepare, in a form prescribed by the board, a
204written plan for the appropriate delivery of emergency care. The plan shall include, but not be
205limited to: (i) consultation with other health care providers; (ii) emergency transfer; and (iii)
206access to neonatal intensive care units and obstetrical units or other patient care areas.
207 Section 286. A health care provider that consults with or accepts a transport, transfer or
208referral from a licensed midwife, or that provides care to a client of a licensed midwife or such
209client’s newborn, shall not be liable in a civil action for personal injury or death resulting from
210an act or omission by the licensed midwife, unless the professional negligence or malpractice of
211the health care provider was a proximate cause of the injury or death.
212 Section 287. (a) The board may petition any court of competent jurisdiction for an
213injunction against any person practicing midwifery or any branch thereof without a license
214granted pursuant to sections 276 to 288, inclusive, of this chapter. Proof of damage or harm
215sustained by any person shall not be required for issuance of such injunction. Nothing in this
216section shall relieve a person from criminal prosecution for practicing without a license.
217 (b) Nothing in this section shall prevent or restrict the practice, service or activities of:
218 (i) a person licensed in the commonwealth from engaging in activities within the scope of
219practice of the profession or occupation for which such person is licensed; provided, however,
220that such person does not represent to the public, directly or indirectly, that such person is
221licensed under sections 276 to 289, inclusive, and that such person does not use any name, title
222or designation indicating that such person is licensed under said sections 276 to 289, inclusive; or 12 of 13
223 (ii) a person employed as a midwife by the federal government or an agency thereof if
224that person provides midwifery services solely under the direction and control of the
225organization by which such person is employed;
226 (iii) a traditional birth attendant who provides midwifery services if no fee is
227contemplated, charged or received, and such person has cultural or religious traditions that have
228historically included the attendance of traditional birth attendants at birth, and the birth attendant
229serves only individuals and families in that distinct cultural or religious group;
230 (iv) persons who are members of Native American communities and provide traditional
231midwife services to their communities; or
232 (v) any person rendering aid in an emergency.
233 Section 288. A licensed midwife, registered by the board of registration in midwifery
234pursuant to sections 276 to 288, inclusive, of this chapter, who provides services to any person or
235beneficiary covered by Title XIX of the Social Security Act or MassHealth pursuant to section
2369A of chapter 118E, may accept the Medicaid or MassHealth approved rate as payment in full
237for such services; provided, that a licensed midwife who accepts the Medicaid or MassHealth
238approved rate pursuant to this section shall be reimbursed at said rate for such services
239 SECTION 16. Chapter 118E of the General Laws, as appearing in the 2020 Official
240Edition, is hereby amended in section 10A by adding the words “licensed midwife,” after the
241word “physician,” in line 15 and after the word “pediatrician,” in line 20, and by inserting at the
242end of the section the following sentence:- The division shall provide coverage for midwifery
243services including prenatal care, childbirth and postpartum care provided by a licensed midwife
244regardless of the site of services. 13 of 13
245 SECTION 17. The board established pursuant to section 110 of chapter 13 of the General
246Laws shall adopt rules and promulgate regulations pursuant to this act within 1 year from the
247effective date of this act.
248 SECTION 18. The board established pursuant to section 110 of chapter 13 of the General
249Laws shall promulgate regulations for the licensure of individuals practicing midwifery prior to
250the date on which the board commences issuing licenses; provided, however, that individuals
251practicing midwifery in the commonwealth as of the date on which the board commences issuing
252licenses shall have 2 years from that date to complete the requirements necessary for licensure.
253 SECTION 19. Nothing in this act shall preclude a person who was practicing midwifery
254before the effective date of this act from practicing midwifery in the commonwealth until the
255board establishes procedures for the licensure of midwives pursuant to this act.
256 SECTION 20. The department of public health shall promulgate regulations within 1 year
257from the effective date of this act governing birth centers, consistent with standards set forth by
258the American Association of Birth Centers, including without limitation authorizing licensed
259professional midwives to practice in birth centers as primary birth attendants, director of birth
260centers, and director of clinical affairs. Licensed professional midwives practicing in licensed
261birth centers shall not be required to enter into any agreement for supervision or collaboration
262with any other healthcare provider or hospital.