GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2025
H 1
HOUSE BILL 495
Short Title: Accessing Midwives Act. (Public)
Sponsors: Representatives Belk, Cunningham, Carney, and Ball (Primary Sponsors).
For a complete list of sponsors, refer to the North Carolina General Assembly web site.
Referred to: Rules, Calendar, and Operations of the House
March 25, 2025
*H495 -v-1*
A BILL TO BE ENTITLED 1
AN ACT TO ESTABLISH THE CERTIFIED PROFESSIONAL MIDWIVES LICENSING 2
ACT. 3
The General Assembly of North Carolina enacts: 4
SECTION 1. Chapter 90 of the General Statutes is amended by adding a new Article 5
to read: 6
"Article 10B. 7
"Certified Professional Midwives. 8
"§ 90-178.10. Title. 9
This Article may be cited as the "Accessing Midwives Act." 10
"§ 90-178.11. Definitions. 11
The following definitions apply in this Article: 12
(1) AMCB. – The American Midwifery Certification Board. 13
(2) Antepartal. – Occurring during pregnancy. 14
(3) Certified Midwife (CM). – A person who has obtained national certification 15
from the American Midwifery Certification Board (AMCB). 16
(4) Certified Nurse-Midwife (CNM). – A person approved to practice 17
Nurse-Midwifery under Article 10A of this Chapter. 18
(5) Certified Professional Midwife (CPM). – A person who has obtained national 19
certification from the North American Registry of Midwives (NARM). 20
(6) Collaboration. – The process by which a licensed midwife and a physician or 21
other appropriate health care provider jointly manage the care of a client, as 22
defined by Council rule. 23
(7) Consultation. – The exchange of information and advice regarding the client's 24
condition and indicated treatment with a licensed physician or certified nurse 25
midwife. 26
(8) Council. – The North Carolina Council of Midwives, a subcommittee of the 27
Division of Health Service Regulation. 28
(9) Department. – The North Carolina Department of Health and Human 29
Services. 30
(10) Division. – The Division of Health Service Regulation within the Department 31
of Health and Human Services to which the North Carolina Council of 32
Midwives reports. 33
(11) Health care provider. – As defined in G.S. 90-21.11. 34
(12) ICM. – The International Confederation of Midwives. 35 General Assembly Of North Carolina Session 2025
Page 2 House Bill 495-First Edition
(13) Intrapartal. – Occurring during the process of giving birth. 1
(14) Licensed physician. – A physician duly licensed in this State to practice 2
medicine under Article 1 of this Chapter. 3
(15) Licensee. – A Certified Professional Midwife who holds the CPM credential 4
or a Certified Midwife who holds the CM credential and is licensed to practice 5
midwifery under this Article. 6
(16) Midwife. – A person who is trained to (i) give the necessary care and advice 7
to women during pregnancy, labor, and the post-birth period, (ii) conduct 8
normal deliveries as the midwife's own responsibility, (iii) care for the newly 9
born infant, and (iv) recognize the warning signs of abnormal conditions 10
requiring referral to or collaboration with a licensed physician or other 11
licensed health care provider. 12
(17) Midwifery. – The provision of primary health or maternity care to 13
childbearing people and infants. 14
(18) NACPM. – The National Association of Certified Professional Midwives. 15
(19) NARM. – The North American Registry of Midwives. 16
(20) Postpartal. – Occurring subsequent to birth. 17
(21) US MERA. – The United States Midwifery Education, Regulation, and 18
Association. 19
"§ 90-178.12. License required; exemptions. 20
(a) No person shall practice or offer to practice midwifery as defined in this Article or 21
otherwise indicate or imply that the person is a licensed Certified Professional Midwife or 22
Certified Midwife unless the person is currently licensed as provided in this Article. 23
(b) The provisions of this Article do not apply to any of the following: 24
(1) An individual approved to practice midwifery under Article 10A of this 25
Chapter. 26
(2) A physician licensed to practice medicine under Article 1 of this Chapter when 27
engaged in the practice of medicine as defined by law. 28
(3) The performance of medical acts by a physician assistant or nurse practitioner 29
when performed in accordance with the rules of the North Carolina Medical 30
Board. 31
(4) The practice of nursing by a registered nurse engaged in the practice of nursing 32
under Article 9A of this Chapter. 33
(5) The rendering of childbirth assistance in an emergency situation. 34
(6) Individuals who are present during the birth process or assisting the Certified 35
Professional Midwife in the birth process, including family members, birth 36
workers, or other caregivers invited by the birthing person, midwifery 37
students, and assistants who are under the supervision of a midwife licensed 38
under the provisions of this Article. 39
(7) A traditional birth attendant practicing midwifery without a license if the 40
traditional birth attendant has cultural or religious traditions that have 41
historically included the attendance of traditional birth attendants at births and 42
that birth attendant serves only the families in that distinct cultural or religious 43
group. 44
"§ 90-178.13. The North Carolina Council of Midwives. 45
(a) Composition and Terms. – The North Carolina Council of Midwives is created. The 46
Council shall consist of seven members who shall serve staggered terms. The Council members 47
shall be appointed by the Secretary of the Department of Health and Human Services, and the 48
initial Council members shall be appointed on or before October 1, 2025, or within three months 49
of this Article becoming law, whichever is later, as follows: 50 General Assembly Of North Carolina Session 2025
House Bill 495-First Edition Page 3
(1) Four Certified Professional Midwives, one of whom shall serve for a term of 1
four years, two of whom shall serve for terms of three years, and one of whom 2
shall serve for a term of two years. 3
(2) One licensed physician who is knowledgeable in midwifery care who shall 4
serve for a term of four years. 5
(3) One community birth consumer who shall serve for a term of two years. 6
(4) One Certified Nurse-Midwife experienced in community birth who shall serve 7
a term of two years. 8
Upon the expiration of the terms of the initial Council members, members shall be appointed 9
for terms of four years and shall serve until their successors are appointed. No member may serve 10
more than two consecutive terms. 11
(b) Qualifications. – Each Council member shall be a resident of this State. The members 12
who are health care providers shall hold current licenses from the Council and remain in good 13
standing with the Council during their terms. 14
(c) Vacancies. – Any vacancy shall be filled by the Secretary of the Department of Health 15
and Human Services. Appointees to fill vacancies shall serve the remainder of the unexpired term 16
and until their successors have been duly appointed. 17
(d) Removal. – The Council may remove any of its members for neglect of duty, 18
incompetence, or unprofessional conduct. If a Council member is absent from three consecutive 19
Council meetings without excuse, that member shall be removed from office and a new member 20
shall be appointed by the Secretary of the Department of Health and Human Services. An absence 21
shall be deemed excused if caused (i) by a health problem or condition verified in writing by a 22
licensed physician or (ii) by an accident or similar unforeseeable tragedy or event, on or before 23
the next Council meeting. A member subject to disciplinary proceedings in the member's capacity 24
as a health care provider shall be disqualified from participating in the official business of the 25
Council until the charges have been resolved. 26
(e) Compensation. – Each member of the Council shall receive per diem and 27
reimbursement for travel and subsistence as provided in G.S. 93B-5. 28
(f) Officers. – The officers of the Council shall be a chair, a vice-chair, and other officers 29
deemed necessary by the Council to carry out the purposes of this Article. All officers shall be 30
elected annually by the Council for two-year terms and shall serve until their successors are 31
elected and qualified. No person may serve as chair for more than six consecutive years. 32
(g) Meetings. – The Council shall hold its first meeting within 45 days after the 33
appointment of its members and shall hold at least two meetings each year to conduct business 34
and to review the standards and rules previously adopted by the Council. The Council shall 35
establish the procedures for calling, holding, and conducting regular and special meetings. A 36
majority of Council members shall constitute a quorum. The Council shall hold such meetings 37
during the year as it deems necessary, one of which shall be an annual meeting. The Department, 38
the chairperson, or a majority of the Council shall have the authority to call additional meetings. 39
(h) Notice of Meeting; Records. – Public notice shall be given for all meetings, and all 40
meetings are open to the public. All records are available to the public. Persons wishing to obtain 41
copies of records may request copies, in writing, from the Council. 42
(i) The Council shall adopt rules within one year of the initial meeting to implement the 43
provisions of this Article. 44
"§ 90-178.14. Powers and duties of the Council. 45
In consultation with the Division and with guidance from the National Association of 46
Certified Professional Midwives Standards of Practice, the Council shall have the following 47
powers and duties: 48
(1) Administer this Article. 49
(2) Issue interpretations of this Article. 50 General Assembly Of North Carolina Session 2025
Page 4 House Bill 495-First Edition
(3) Adopt, amend, or repeal rules as may be necessary to carry out the provisions 1
of this Article, including rules relating to the administration of medications 2
consistent with a licensed midwife's training and scope of practice. 3
(4) Verify the credentials and qualifications of applicants for licensure, license 4
renewal, and reciprocal licensure. 5
(5) Issue, renew, deny, suspend, or revoke licensure and carry out any disciplinary 6
actions authorized by this Article. 7
(6) Set fees for licensure, license renewal, and other services deemed necessary 8
to carry out the purposes of this Article, not to exceed five hundred dollars 9
($500.00) over a two-year period. 10
(7) Maintain a current list of all persons who have been licensed as midwives 11
under this Article and, using a statistically validated data collection tool, 12
collect and review annual practice reports. 13
(8) Address problems and concerns of licensed midwives in order to promote 14
safety for the citizens of this State. 15
(9) Conduct investigations for the purpose of determining whether violations of 16
this Article or grounds for disciplining midwives exist. 17
(10) Maintain a record of all proceedings and make available to all licensed 18
midwives and other concerned parties an annual report of all Council action. 19
(11) Adopt a seal containing the name of the Council for use on all official 20
documents and reports issued by the Council. 21
(12) Educate the public and other providers of maternity care about the role of the 22
licensed midwife. 23
"§ 90-178.15. Requirements for licensure. 24
An applicant shall be licensed to practice as a midwife under this Article if the applicant 25
meets all of the following requirements: 26
(1) Completes an application on a form approved by the Council. 27
(2) Has completed all required educational and clinical training, including 28
education in emergency skills for pregnancy, birth, and newborn care and 29
other midwifery topics addressing all ICM Core Competencies, as determined 30
by US MERA, and has earned the national midwifery certification credential 31
awarded by a national midwifery certification agency accredited by the 32
National Commission on Certifying Agencies (NCCA), the accrediting body 33
of the Institute of Credentialing Excellence. 34
(3) Submits proof to the Council of current cardiopulmonary resuscitation (CPR) 35
certification and neonatal resuscitation program (NRP) certification. 36
(4) Has read, understands, and agrees to practice under the guidelines set forth in 37
this Article and any rules adopted pursuant to this Article. 38
(5) Pays the required fees in accordance with G.S. 90-178.19. 39
"§ 90-178.16. Responsibilities of a licensed midwife; display of license. 40
(a) A Certified Professional Midwife licensed under this Article shall practice according 41
to the National Association of Certified Professional Midwives (NACPM) Standards of Practice 42
and shall have the following responsibilities: 43
(1) Provide care for the healthy client who is expected to have a normal 44
pregnancy, labor, birth, and postpartal phase in the setting of their choice. 45
(2) Ensure that the client has signed an informed consent form. This form shall 46
include information to inform the client of the qualifications of the licensee 47
and the process of shared decision making and refusal. 48
(3) Order routine antepartal or postpartal screening or laboratory analysis to be 49
performed by a licensed laboratory or testing facility, when necessary. 50 General Assembly Of North Carolina Session 2025
House Bill 495-First Edition Page 5
(4) Develop an emergency plan in collaboration with the client that shall include 1
transfer plans for the client in the event of an emergency. 2
(5) Determine the progress of labor, monitor fetal and maternal status, and when 3
labor is well-established, be available until delivery is accomplished. 4
(6) Remain with the mother during the postpartal period until the conditions of 5
the mother and newborn are stabilized. 6
(7) Instruct the parents regarding the requirements of newborn screening. 7
(8) Instruct the parents regarding the requirement of newborn hearing screening. 8
(9) Submit and maintain a birth certificate of live birth in accordance with the 9
requirements of Article 4 of Chapter 130A of the General Statutes. 10
(10) Practice in compliance with the requirements of this Article and any rules 11
adopted pursuant to this Article. 12
(b) A midwife licensed pursuant to this Article shall display the license at all times in a 13
conspicuous place where the licensed midwife is practicing, when applicable. 14
"§ 90-178.17. License renewal; inactive status; lapsed license. 15
(a) An initial license to practice as a midwife shall be valid for two years. After the initial 16
license expires, a license shall be renewed every two years. All applications for renewal shall be 17
filed with the Council and shall be accompanied by the renewal fee in accordance with 18
G.S. 90-178.19 and proof of current certification from NARM or AMCB. Compliance with 19
NARM or AMCB recertification requirements shall include (i) remaining in good standing with 20
NARM or AMCB, (ii) maintaining current cardiopulmonary resuscitation (CPR) and neonatal 21
resuscitation program (NRP) certifications, and (iii) completing any continuing education 22
requirements. 23
(b) A license that has expired for failure to renew may be reinstated after the applicant 24
pays any late and renewal fees as required by G.S. 90-178.19 and complies with any other rules 25
adopted pursuant to this Article. 26
(c) Upon written request to the Council, the Council may grant a licensed midwife 27
inactive status. While inactive, the midwife shall not practice midwifery in this State and shall 28
not be subject to license renewal requirements established by the Council. A midwife may change 29
the midwife's status from inactive to active by (i) submitting a written request to the Council and 30
(ii) fulfilling the requirements for renewal described under subsection (a) of this section. 31
(d) A midwife who does not seek inactive status and allows the license to expire after a 32
90-day grace period shall apply for a new license as prescribed in this Article. 33
"§ 90-178.18. Reciprocity. 34
The Council may, upon application and payment of proper fees, grant a license to an 35
individual who resides in this State and has been licensed, certified, or registered to practice as a 36
midwife in another jurisdiction if that jurisdiction's standards of competency are substantially 37
equivalent to those provided in this Article in accordance with rules adopted by the Council. 38
"§ 90-178.19. Fees. 39
(a) All fees shall be set by the Council, in consultation with the Division, pursuant to 40
rules adopted under this Article. All fees payable to the Council shall be deposited in the name 41
of the Council in financial institutions designated by the Council as official depositories and shall 42
be used to pay all expenses incurred in carrying out the purposes of this Article. 43
(b) All salaries, compensation, and expenses incurred or allowed to carry out the purposes 44
of this Article shall be paid by the Council exclusively out of the fees received by the Council as 45
authorized by this Article or funds received from other sources. 46
"§ 90-178.20. Midwifery formulary. 47
The Council shall establish a formulary of drugs and devices that are appropriate to midwifery 48
care. Licensed midwifes shall dispense only those drugs and devices in accordance with the 49
current formulary defined by the Council. Licensed midwives shall comply with applicable State 50
and federal laws and rules relating to prescribing and administering of drugs. Licensed midwives 51 General Assembly Of North Carolina Session 2025
Page 6 House Bill 495-First Edition
shall maintain proper records of obtaining, storing, and administering drugs and devices. Nothing 1
in this section shall be construed to preclude a midwife from carrying out the prescribed medical 2
orders of a licensed health care provider authorized to prescribe. 3
"§ 90-178.21. Suspension, revocation, and refusal to renew license. 4
(a) The Council may issue a letter of reprimand, deny, refuse to renew, suspend, or revoke 5
an application for licensure or a license if the applicant or licensee does any of the following: 6
(1) Gives false information or withholds material information from the Council 7
in procuring or attempting to procure a license. 8
(2) Gives false information or withholds material information from the Council 9
during the course of an investigation conducted by the Council. 10
(3) Has been convicted of or pled guilty or no contest to a crime that indicates the 11
person is unfit or incompetent to practice midwifery as defined in this Article 12
or that indicates the person has deceived, defrauded, or endangered the public. 13
(4) Has a habitual substance abuse problem or mental impairment that interferes 14
with his or her ability to provide appropriate care as established by this Article 15
or rules adopted by the Council. 16
(5) Has demonstrated gross negligence, incompetency, or misconduct in the 17
practice of midwifery as defined in this Article. 18
(6) Has had an application for licensure or a license to practice midwifery in 19
another jurisdiction denied, suspended, or revoked for reasons that would be 20
grounds for similar action in this State. 21
(7) Has willfully violated any provision of this Article or rules adopted by the 22
Council. 23
(b) The taking of any action authorized under subsection (a) of this section may be 24
ordered by the Council after a hearing is held in accordance with Article 3A of Chapter 150B of 25
the General Statutes. The Council may reinstate a revoked license if it finds that the reasons for 26
revocation no longer exist and that the person can reasonably be expected to perform the services 27
authorized under this Article in a safe manner. 28
"§ 90-178.22. Enjoining illegal practices; vicarious liability. 29
(a) The Council may apply to the superior court for an order enjoining violations of this 30
Article. Upon a showing by the Council that any person has violated this Article, the court may 31
grant injunctive relief. 32
(b) No health care provider or medical facility shall be liable for an injury to a woman or 33
infant arising during childbirth and resulting from an act or omission by a midwife licensed under 34
this Article, regardless of whether the health care provider has consulted with or accepted a 35
referral from the licensee." 36
SECTION 2. This act becomes effective October 1, 2025. 37