North Carolina 2025-2026 Regular Session

North Carolina House Bill H495 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1	1		GENERAL ASSEMBLY OF NORTH CAROLINA
2	2		SESSION 2025
3		-	H 1
4		-	HOUSE BILL 495
	3	+	H D
	4	+	HOUSE BILL DRH40180-NBf-23
	5	+
5	6
6	7
7	8		Short Title: Accessing Midwives Act. (Public)
8		-	Sponsors: Representatives Belk, Cunningham, Carney, and Ball (Primary Sponsors).
9		-	For a complete list of sponsors, refer to the North Carolina General Assembly web site.
10		-	Referred to: Rules, Calendar, and Operations of the House
11		-	March 25, 2025
12		-	H495 -v-1
	9	+	Sponsors: Representative Belk.
	10	+	Referred to:
	11	+
	12	+	DRH40180 -NBf-23
13	13		A BILL TO BE ENTITLED 1
14	14		AN ACT TO ESTABLISH THE CERTIFIED PROFESSIONAL MIDWIVES LICENSING 2
15	15		ACT. 3
16	16		The General Assembly of North Carolina enacts: 4
17	17		SECTION 1. Chapter 90 of the General Statutes is amended by adding a new Article 5
18	18		to read: 6
19	19		"Article 10B. 7
20	20		"Certified Professional Midwives. 8
21	21		"§ 90-178.10. Title. 9
22	22		This Article may be cited as the "Accessing Midwives Act." 10
23	23		"§ 90-178.11. Definitions. 11
24	24		The following definitions apply in this Article: 12
25	25		(1) AMCB. – The American Midwifery Certification Board. 13
26	26		(2) Antepartal. – Occurring during pregnancy. 14
27	27		(3) Certified Midwife (CM). – A person who has obtained national certification 15
28	28		from the American Midwifery Certification Board (AMCB). 16
29	29		(4) Certified Nurse-Midwife (CNM). – A person approved to practice 17
30	30		Nurse-Midwifery under Article 10A of this Chapter. 18
31	31		(5) Certified Professional Midwife (CPM). – A person who has obtained national 19
32	32		certification from the North American Registry of Midwives (NARM). 20
33	33		(6) Collaboration. – The process by which a licensed midwife and a physician or 21
34	34		other appropriate health care provider jointly manage the care of a client, as 22
35	35		defined by Council rule. 23
36	36		(7) Consultation. – The exchange of information and advice regarding the client's 24
37	37		condition and indicated treatment with a licensed physician or certified nurse 25
38	38		midwife. 26
39	39		(8) Council. – The North Carolina Council of Midwives, a subcommittee of the 27
40	40		Division of Health Service Regulation. 28
41	41		(9) Department. – The North Carolina Department of Health and Human 29
42	42		Services. 30
43	43		(10) Division. – The Division of Health Service Regulation within the Department 31
44	44		of Health and Human Services to which the North Carolina Council of 32
45	45		Midwives reports. 33
46	46		(11) Health care provider. – As defined in G.S. 90-21.11. 34
47		-	(12) ICM. – The International Confederation of Midwives. 35 General Assembly Of North Carolina Session 2025
48		-	Page 2 House Bill 495-First Edition
49		-	(13) Intrapartal. – Occurring during the process of giving birth. 1
50		-	(14) Licensed physician. – A physician duly licensed in this State to practice 2
51		-	medicine under Article 1 of this Chapter. 3
52		-	(15) Licensee. – A Certified Professional Midwife who holds the CPM credential 4
53		-	or a Certified Midwife who holds the CM credential and is licensed to practice 5
54		-	midwifery under this Article. 6
55		-	(16) Midwife. – A person who is trained to (i) give the necessary care and advice 7
56		-	to women during pregnancy, labor, and the post-birth period, (ii) conduct 8
57		-	normal deliveries as the midwife's own responsibility, (iii) care for the newly 9
58		-	born infant, and (iv) recognize the warning signs of abnormal conditions 10
59		-	requiring referral to or collaboration with a licensed physician or other 11
60		-	licensed health care provider. 12
61		-	(17) Midwifery. – The provision of primary health or maternity care to 13
62		-	childbearing people and infants. 14
63		-	(18) NACPM. – The National Association of Certified Professional Midwives. 15
64		-	(19) NARM. – The North American Registry of Midwives. 16
65		-	(20) Postpartal. – Occurring subsequent to birth. 17
66		-	(21) US MERA. – The United States Midwifery Education, Regulation, and 18
67		-	Association. 19
68		-	"§ 90-178.12. License required; exemptions. 20
69		-	(a) No person shall practice or offer to practice midwifery as defined in this Article or 21
70		-	otherwise indicate or imply that the person is a licensed Certified Professional Midwife or 22
71		-	Certified Midwife unless the person is currently licensed as provided in this Article. 23
72		-	(b) The provisions of this Article do not apply to any of the following: 24
73		-	(1) An individual approved to practice midwifery under Article 10A of this 25
74		-	Chapter. 26
75		-	(2) A physician licensed to practice medicine under Article 1 of this Chapter when 27
76		-	engaged in the practice of medicine as defined by law. 28
77		-	(3) The performance of medical acts by a physician assistant or nurse practitioner 29
78		-	when performed in accordance with the rules of the North Carolina Medical 30
79		-	Board. 31
80		-	(4) The practice of nursing by a registered nurse engaged in the practice of nursing 32
81		-	under Article 9A of this Chapter. 33
82		-	(5) The rendering of childbirth assistance in an emergency situation. 34
83		-	(6) Individuals who are present during the birth process or assisting the Certified 35
84		-	Professional Midwife in the birth process, including family members, birth 36
85		-	workers, or other caregivers invited by the birthing person, midwifery 37
86		-	students, and assistants who are under the supervision of a midwife licensed 38
87		-	under the provisions of this Article. 39
88		-	(7) A traditional birth attendant practicing midwifery without a license if the 40
89		-	traditional birth attendant has cultural or religious traditions that have 41
90		-	historically included the attendance of traditional birth attendants at births and 42
91		-	that birth attendant serves only the families in that distinct cultural or religious 43
92		-	group. 44
93		-	"§ 90-178.13. The North Carolina Council of Midwives. 45
94		-	(a) Composition and Terms. – The North Carolina Council of Midwives is created. The 46
95		-	Council shall consist of seven members who shall serve staggered terms. The Council members 47
96		-	shall be appointed by the Secretary of the Department of Health and Human Services, and the 48
97		-	initial Council members shall be appointed on or before October 1, 2025, or within three months 49
98		-	of this Article becoming law, whichever is later, as follows: 50 General Assembly Of North Carolina Session 2025
99		-	House Bill 495-First Edition Page 3
	47	+	(12) ICM. – The International Confederation of Midwives. 35
	48	+	(13) Intrapartal. – Occurring during the process of giving birth. 36
	49	+	H.B. 495
	50	+	Mar 24, 2025
	51	+	HOUSE PRINCIPAL CLERK General Assembly Of North Carolina Session 2025
	52	+	Page 2 DRH40180-NBf-23
	53	+	(14) Licensed physician. – A physician duly licensed in this State to practice 1
	54	+	medicine under Article 1 of this Chapter. 2
	55	+	(15) Licensee. – A Certified Professional Midwife who holds the CPM credential 3
	56	+	or a Certified Midwife who holds the CM credential and is licensed to practice 4
	57	+	midwifery under this Article. 5
	58	+	(16) Midwife. – A person who is trained to (i) give the necessary care and advice 6
	59	+	to women during pregnancy, labor, and the post-birth period, (ii) conduct 7
	60	+	normal deliveries as the midwife's own responsibility, (iii) care for the newly 8
	61	+	born infant, and (iv) recognize the warning signs of abnormal conditions 9
	62	+	requiring referral to or collaboration with a licensed physician or other 10
	63	+	licensed health care provider. 11
	64	+	(17) Midwifery. – The provision of primary health or maternity care to 12
	65	+	childbearing people and infants. 13
	66	+	(18) NACPM. – The National Association of Certified Professional Midwives. 14
	67	+	(19) NARM. – The North American Registry of Midwives. 15
	68	+	(20) Postpartal. – Occurring subsequent to birth. 16
	69	+	(21) US MERA. – The United States Midwifery Education, Regulation, and 17
	70	+	Association. 18
	71	+	"§ 90-178.12. License required; exemptions. 19
	72	+	(a) No person shall practice or offer to practice midwifery as defined in this Article or 20
	73	+	otherwise indicate or imply that the person is a licensed Certified Professional Midwife or 21
	74	+	Certified Midwife unless the person is currently licensed as provided in this Article. 22
	75	+	(b) The provisions of this Article do not apply to any of the following: 23
	76	+	(1) An individual approved to practice midwifery under Article 10A of this 24
	77	+	Chapter. 25
	78	+	(2) A physician licensed to practice medicine under Article 1 of this Chapter when 26
	79	+	engaged in the practice of medicine as defined by law. 27
	80	+	(3) The performance of medical acts by a physician assistant or nurse practitioner 28
	81	+	when performed in accordance with the rules of the North Carolina Medical 29
	82	+	Board. 30
	83	+	(4) The practice of nursing by a registered nurse engaged in the practice of nursing 31
	84	+	under Article 9A of this Chapter. 32
	85	+	(5) The rendering of childbirth assistance in an emergency situation. 33
	86	+	(6) Individuals who are present during the birth process or assisting the Certified 34
	87	+	Professional Midwife in the birth process, including family members, birth 35
	88	+	workers, or other caregivers invited by the birthing person, midwifery 36
	89	+	students, and assistants who are under the supervision of a midwife licensed 37
	90	+	under the provisions of this Article. 38
	91	+	(7) A traditional birth attendant practicing midwifery without a license if the 39
	92	+	traditional birth attendant has cultural or religious traditions that have 40
	93	+	historically included the attendance of traditional birth attendants at births and 41
	94	+	that birth attendant serves only the families in that distinct cultural or religious 42
	95	+	group. 43
	96	+	"§ 90-178.13. The North Carolina Council of Midwives. 44
	97	+	(a) Composition and Terms. – The North Carolina Council of Midwives is created. The 45
	98	+	Council shall consist of seven members who shall serve staggered terms. The Council members 46
	99	+	shall be appointed by the Secretary of the Department of Health and Human Services, and the 47
	100	+	initial Council members shall be appointed on or before October 1, 2025, or within three months 48
	101	+	of this Article becoming law, whichever is later, as follows: 49 General Assembly Of North Carolina Session 2025
	102	+	DRH40180-NBf-23 Page 3
100	103		(1) Four Certified Professional Midwives, one of whom shall serve for a term of 1
101	104		four years, two of whom shall serve for terms of three years, and one of whom 2
102	105		shall serve for a term of two years. 3
103	106		(2) One licensed physician who is knowledgeable in midwifery care who shall 4
104	107		serve for a term of four years. 5
105	108		(3) One community birth consumer who shall serve for a term of two years. 6
106	109		(4) One Certified Nurse-Midwife experienced in community birth who shall serve 7
107	110		a term of two years. 8
108	111		Upon the expiration of the terms of the initial Council members, members shall be appointed 9
109	112		for terms of four years and shall serve until their successors are appointed. No member may serve 10
110	113		more than two consecutive terms. 11
111	114		(b) Qualifications. – Each Council member shall be a resident of this State. The members 12
112	115		who are health care providers shall hold current licenses from the Council and remain in good 13
113	116		standing with the Council during their terms. 14
114	117		(c) Vacancies. – Any vacancy shall be filled by the Secretary of the Department of Health 15
115	118		and Human Services. Appointees to fill vacancies shall serve the remainder of the unexpired term 16
116	119		and until their successors have been duly appointed. 17
117	120		(d) Removal. – The Council may remove any of its members for neglect of duty, 18
118	121		incompetence, or unprofessional conduct. If a Council member is absent from three consecutive 19
119	122		Council meetings without excuse, that member shall be removed from office and a new member 20
120	123		shall be appointed by the Secretary of the Department of Health and Human Services. An absence 21
121	124		shall be deemed excused if caused (i) by a health problem or condition verified in writing by a 22
122	125		licensed physician or (ii) by an accident or similar unforeseeable tragedy or event, on or before 23
123	126		the next Council meeting. A member subject to disciplinary proceedings in the member's capacity 24
124	127		as a health care provider shall be disqualified from participating in the official business of the 25
125	128		Council until the charges have been resolved. 26
126	129		(e) Compensation. – Each member of the Council shall receive per diem and 27
127	130		reimbursement for travel and subsistence as provided in G.S. 93B-5. 28
128	131		(f) Officers. – The officers of the Council shall be a chair, a vice-chair, and other officers 29
129	132		deemed necessary by the Council to carry out the purposes of this Article. All officers shall be 30
130	133		elected annually by the Council for two-year terms and shall serve until their successors are 31
131	134		elected and qualified. No person may serve as chair for more than six consecutive years. 32
132	135		(g) Meetings. – The Council shall hold its first meeting within 45 days after the 33
133	136		appointment of its members and shall hold at least two meetings each year to conduct business 34
134	137		and to review the standards and rules previously adopted by the Council. The Council shall 35
135	138		establish the procedures for calling, holding, and conducting regular and special meetings. A 36
136	139		majority of Council members shall constitute a quorum. The Council shall hold such meetings 37
137	140		during the year as it deems necessary, one of which shall be an annual meeting. The Department, 38
138	141		the chairperson, or a majority of the Council shall have the authority to call additional meetings. 39
139	142		(h) Notice of Meeting; Records. – Public notice shall be given for all meetings, and all 40
140	143		meetings are open to the public. All records are available to the public. Persons wishing to obtain 41
141	144		copies of records may request copies, in writing, from the Council. 42
142	145		(i) The Council shall adopt rules within one year of the initial meeting to implement the 43
143	146		provisions of this Article. 44
144	147		"§ 90-178.14. Powers and duties of the Council. 45
145	148		In consultation with the Division and with guidance from the National Association of 46
146	149		Certified Professional Midwives Standards of Practice, the Council shall have the following 47
147	150		powers and duties: 48
148	151		(1) Administer this Article. 49
149	152		(2) Issue interpretations of this Article. 50 General Assembly Of North Carolina Session 2025
150		-	Page 4 ~~House Bill 495-First Edition~~
	153	+	Page 4 DRH40180-NBf-23
151	154		(3) Adopt, amend, or repeal rules as may be necessary to carry out the provisions 1
152	155		of this Article, including rules relating to the administration of medications 2
153	156		consistent with a licensed midwife's training and scope of practice. 3
154	157		(4) Verify the credentials and qualifications of applicants for licensure, license 4
155	158		renewal, and reciprocal licensure. 5
156	159		(5) Issue, renew, deny, suspend, or revoke licensure and carry out any disciplinary 6
157	160		actions authorized by this Article. 7
158	161		(6) Set fees for licensure, license renewal, and other services deemed necessary 8
159	162		to carry out the purposes of this Article, not to exceed five hundred dollars 9
160	163		($500.00) over a two-year period. 10
161	164		(7) Maintain a current list of all persons who have been licensed as midwives 11
162	165		under this Article and, using a statistically validated data collection tool, 12
163	166		collect and review annual practice reports. 13
164	167		(8) Address problems and concerns of licensed midwives in order to promote 14
165	168		safety for the citizens of this State. 15
166	169		(9) Conduct investigations for the purpose of determining whether violations of 16
167	170		this Article or grounds for disciplining midwives exist. 17
168	171		(10) Maintain a record of all proceedings and make available to all licensed 18
169	172		midwives and other concerned parties an annual report of all Council action. 19
170	173		(11) Adopt a seal containing the name of the Council for use on all official 20
171	174		documents and reports issued by the Council. 21
172	175		(12) Educate the public and other providers of maternity care about the role of the 22
173	176		licensed midwife. 23
174	177		"§ 90-178.15. Requirements for licensure. 24
175	178		An applicant shall be licensed to practice as a midwife under this Article if the applicant 25
176	179		meets all of the following requirements: 26
177	180		(1) Completes an application on a form approved by the Council. 27
178	181		(2) Has completed all required educational and clinical training, including 28
179	182		education in emergency skills for pregnancy, birth, and newborn care and 29
180	183		other midwifery topics addressing all ICM Core Competencies, as determined 30
181	184		by US MERA, and has earned the national midwifery certification credential 31
182	185		awarded by a national midwifery certification agency accredited by the 32
183	186		National Commission on Certifying Agencies (NCCA), the accrediting body 33
184	187		of the Institute of Credentialing Excellence. 34
185	188		(3) Submits proof to the Council of current cardiopulmonary resuscitation (CPR) 35
186	189		certification and neonatal resuscitation program (NRP) certification. 36
187	190		(4) Has read, understands, and agrees to practice under the guidelines set forth in 37
188	191		this Article and any rules adopted pursuant to this Article. 38
189	192		(5) Pays the required fees in accordance with G.S. 90-178.19. 39
190	193		"§ 90-178.16. Responsibilities of a licensed midwife; display of license. 40
191	194		(a) A Certified Professional Midwife licensed under this Article shall practice according 41
192	195		to the National Association of Certified Professional Midwives (NACPM) Standards of Practice 42
193	196		and shall have the following responsibilities: 43
194	197		(1) Provide care for the healthy client who is expected to have a normal 44
195	198		pregnancy, labor, birth, and postpartal phase in the setting of their choice. 45
196	199		(2) Ensure that the client has signed an informed consent form. This form shall 46
197	200		include information to inform the client of the qualifications of the licensee 47
198	201		and the process of shared decision making and refusal. 48
199	202		(3) Order routine antepartal or postpartal screening or laboratory analysis to be 49
200	203		performed by a licensed laboratory or testing facility, when necessary. 50 General Assembly Of North Carolina Session 2025
201		-	~~House Bill 495-First Edition~~ Page 5
	204	+	DRH40180-NBf-23 Page 5
202	205		(4) Develop an emergency plan in collaboration with the client that shall include 1
203	206		transfer plans for the client in the event of an emergency. 2
204	207		(5) Determine the progress of labor, monitor fetal and maternal status, and when 3
205	208		labor is well-established, be available until delivery is accomplished. 4
206	209		(6) Remain with the mother during the postpartal period until the conditions of 5
207	210		the mother and newborn are stabilized. 6
208	211		(7) Instruct the parents regarding the requirements of newborn screening. 7
209	212		(8) Instruct the parents regarding the requirement of newborn hearing screening. 8
210	213		(9) Submit and maintain a birth certificate of live birth in accordance with the 9
211	214		requirements of Article 4 of Chapter 130A of the General Statutes. 10
212	215		(10) Practice in compliance with the requirements of this Article and any rules 11
213	216		adopted pursuant to this Article. 12
214	217		(b) A midwife licensed pursuant to this Article shall display the license at all times in a 13
215	218		conspicuous place where the licensed midwife is practicing, when applicable. 14
216	219		"§ 90-178.17. License renewal; inactive status; lapsed license. 15
217	220		(a) An initial license to practice as a midwife shall be valid for two years. After the initial 16
218	221		license expires, a license shall be renewed every two years. All applications for renewal shall be 17
219	222		filed with the Council and shall be accompanied by the renewal fee in accordance with 18
220	223		G.S. 90-178.19 and proof of current certification from NARM or AMCB. Compliance with 19
221	224		NARM or AMCB recertification requirements shall include (i) remaining in good standing with 20
222	225		NARM or AMCB, (ii) maintaining current cardiopulmonary resuscitation (CPR) and neonatal 21
223	226		resuscitation program (NRP) certifications, and (iii) completing any continuing education 22
224	227		requirements. 23
225	228		(b) A license that has expired for failure to renew may be reinstated after the applicant 24
226	229		pays any late and renewal fees as required by G.S. 90-178.19 and complies with any other rules 25
227	230		adopted pursuant to this Article. 26
228	231		(c) Upon written request to the Council, the Council may grant a licensed midwife 27
229	232		inactive status. While inactive, the midwife shall not practice midwifery in this State and shall 28
230	233		not be subject to license renewal requirements established by the Council. A midwife may change 29
231	234		the midwife's status from inactive to active by (i) submitting a written request to the Council and 30
232	235		(ii) fulfilling the requirements for renewal described under subsection (a) of this section. 31
233	236		(d) A midwife who does not seek inactive status and allows the license to expire after a 32
234	237		90-day grace period shall apply for a new license as prescribed in this Article. 33
235	238		"§ 90-178.18. Reciprocity. 34
236	239		The Council may, upon application and payment of proper fees, grant a license to an 35
237	240		individual who resides in this State and has been licensed, certified, or registered to practice as a 36
238	241		midwife in another jurisdiction if that jurisdiction's standards of competency are substantially 37
239	242		equivalent to those provided in this Article in accordance with rules adopted by the Council. 38
240	243		"§ 90-178.19. Fees. 39
241	244		(a) All fees shall be set by the Council, in consultation with the Division, pursuant to 40
242	245		rules adopted under this Article. All fees payable to the Council shall be deposited in the name 41
243	246		of the Council in financial institutions designated by the Council as official depositories and shall 42
244	247		be used to pay all expenses incurred in carrying out the purposes of this Article. 43
245	248		(b) All salaries, compensation, and expenses incurred or allowed to carry out the purposes 44
246	249		of this Article shall be paid by the Council exclusively out of the fees received by the Council as 45
247	250		authorized by this Article or funds received from other sources. 46
248	251		"§ 90-178.20. Midwifery formulary. 47
249	252		The Council shall establish a formulary of drugs and devices that are appropriate to midwifery 48
250	253		care. Licensed midwifes shall dispense only those drugs and devices in accordance with the 49
251	254		current formulary defined by the Council. Licensed midwives shall comply with applicable State 50
252	255		and federal laws and rules relating to prescribing and administering of drugs. Licensed midwives 51 General Assembly Of North Carolina Session 2025
253		-	Page 6 ~~House Bill 495-First Edition~~
	256	+	Page 6 DRH40180-NBf-23
254	257		shall maintain proper records of obtaining, storing, and administering drugs and devices. Nothing 1
255	258		in this section shall be construed to preclude a midwife from carrying out the prescribed medical 2
256	259		orders of a licensed health care provider authorized to prescribe. 3
257	260		"§ 90-178.21. Suspension, revocation, and refusal to renew license. 4
258	261		(a) The Council may issue a letter of reprimand, deny, refuse to renew, suspend, or revoke 5
259	262		an application for licensure or a license if the applicant or licensee does any of the following: 6
260	263		(1) Gives false information or withholds material information from the Council 7
261	264		in procuring or attempting to procure a license. 8
262	265		(2) Gives false information or withholds material information from the Council 9
263	266		during the course of an investigation conducted by the Council. 10
264	267		(3) Has been convicted of or pled guilty or no contest to a crime that indicates the 11
265	268		person is unfit or incompetent to practice midwifery as defined in this Article 12
266	269		or that indicates the person has deceived, defrauded, or endangered the public. 13
267	270		(4) Has a habitual substance abuse problem or mental impairment that interferes 14
268	271		with his or her ability to provide appropriate care as established by this Article 15
269	272		or rules adopted by the Council. 16
270	273		(5) Has demonstrated gross negligence, incompetency, or misconduct in the 17
271	274		practice of midwifery as defined in this Article. 18
272	275		(6) Has had an application for licensure or a license to practice midwifery in 19
273	276		another jurisdiction denied, suspended, or revoked for reasons that would be 20
274	277		grounds for similar action in this State. 21
275	278		(7) Has willfully violated any provision of this Article or rules adopted by the 22
276	279		Council. 23
277	280		(b) The taking of any action authorized under subsection (a) of this section may be 24
278	281		ordered by the Council after a hearing is held in accordance with Article 3A of Chapter 150B of 25
279	282		the General Statutes. The Council may reinstate a revoked license if it finds that the reasons for 26
280	283		revocation no longer exist and that the person can reasonably be expected to perform the services 27
281	284		authorized under this Article in a safe manner. 28
282	285		"§ 90-178.22. Enjoining illegal practices; vicarious liability. 29
283	286		(a) The Council may apply to the superior court for an order enjoining violations of this 30
284	287		Article. Upon a showing by the Council that any person has violated this Article, the court may 31
285	288		grant injunctive relief. 32
286	289		(b) No health care provider or medical facility shall be liable for an injury to a woman or 33
287	290		infant arising during childbirth and resulting from an act or omission by a midwife licensed under 34
288	291		this Article, regardless of whether the health care provider has consulted with or accepted a 35
289	292		referral from the licensee." 36
290	293		SECTION 2. This act becomes effective October 1, 2025. 37