** UPDATE 03/23/2021 for the latest wording click here to be directed to SB271 on the NELIS website. (it is not viewable on mobile devices) **
An ANNOTATED VERSION with friendly suggestions by some parents, friends, and midwives from Nevada Friends of Midwives is attached below in both PDF and DOCX format. You can find us and join the conversation here on NFoM.org or facebook.com/nevadafriendsofmidwives.
** for the latest wording and for public meeting info, please go to the Nevada Legislature website. https://www.leg.state.nv.us/Session/81st2021/ **
BDR 54-114 requested by Senator Scott Hammond.
Occupational and Professional Licensing of Certified Professional Midwives
Issuing Agency: Nevada Division of Public and Behavioral Health
Scope: Certified Professional Midwives provide on-going care throughout pregnancy and
continuous, hands on care during labor, birth and immediate postpartum period, as well as
maternal and well-baby care through the 8 weeks postpartum period. CPMs provide initial and
ongoing comprehensive assessment, diagnosis and treatment. Most CPMs own or work in
private home or birth centered based practices throughout the United States, Canada and
Mexico.
Duration: Permanent.
Effective Date:
Objective: The regulations establish policies, standards and criteria relating to the educational
and examination requirements, issuing of permits and licenses, practice, and continuing
education of persons who practice licensed midwifery.
Definitions:
A. “Apprentice” means a person who 1) wishes to make application for basic education in
the art and science of midwifery by apprenticeship, 2) has a formal preceptor
relationship defined in writing with a midwifery instructor who is in good standing with
the Board.
B. “Apprenticeship” the instructional period of a certified professional midwifery training
composed of practical experience obtained under the direct supervision of a preceptor
approved by the North American Registry of Midwives (NARM).
C. “Birth Assistant” a person whose scope is limited to simple routine medical tasks and
procedures that may be safely performed by a midwife assistant who functions under the
direct supervision of a licensed midwife. A birth assistant will not assess clinical
information or make clinical decisions.
D. "Birthing Center" a place or facility at which a person is scheduled to give birth following
a normal, uncomplicated pregnancy, but does not include a hospital, medical or obstetric
center.
E. “Board” means the Board of Certified Professional Midwives established under these
regulations.
F. “Certified Nurse-Midwife” means a graduate of a midwifery education program
accredited by the American Midwifery Certification Board. Once a nurse-midwife is
awarded her certification, candidates obtain an APRN licensure through and are
managed by the Nevada State Board of Nursing.
G. “Certified Professional Midwife” means an autonomous practitioner who has met the
standards for certifications set forth by the North American Registry of Midwives
(NARM).
H. “Community Birth” birth that is planned to take place outside of a hospital setting in
homes or freestanding birth centers.
I. “Continuing Education” means participation in a formal learning experience presented by
an instructor who is approved by MANA, ACNM, the Board, or fulfills requirements as set
by the North American Registry of Midwives.
J. “Directly Assisted”- the act where a student midwife is learning the skills of a midwife
through hands-on clinical experience with gradually increasing degrees of responsibility
while under the supervision of a certified or licensed midwife.
K. “Licensed Midwife” means a person who has successfully completed all the
requirements in this chapter and is in good standing with the Board of Certified
Professional Midwives and has the ability to practice to the full extent of their scope.
L. “Licensed Midwifery” means the provision of health care and management of persons in
the antepartum, intrapartum, postpartum, and inter conceptual periods and newborn
care up to 8 weeks of age. This care occurs within a health care system which provides
midwifery protocols, medical consultation, co-management or referral.
M. “Licensing Period” means a two-year period for which permits, or licenses are issued.
N. MEAC stands for Midwifery Education and Accreditation Counsel and is a non-profit
organization approved by the US Secretary of Education as a nationally recognized
accrediting agency.
O. “Midwifery Bridge Certificate” NARM, in collaboration with the US Department of
Education (USDE) accredited education programs and US MERA professional
organizations will administer and award the Midwifery Bridge Certificate to CPMs based
on completion of 50 accredited approved continuing education contact hours
(CEUs/CMEs/CNEs) within the five-year period prior to application. Required continuing
education will be based upon identified areas to address emergency skills and midwifery
competencies.
P. “Other Midwives” Any midwife who is not certified under the North American Registry of
Midwives and does not carry the credentials "Certified Professional Midwife" or "CPM”.
Q. “Peer Review” means the review of the practice standards and outcomes of a licensed
midwife by a group of their peers.
R. “Permit” means documentation issued by Nevada Division of Public and Behavioral
Health to a person meeting the professional requirements described in these regulations
authorizing the practice of midwifery at the apprentice level.
S. “Physician” means a person who is currently practicing obstetrics and is licensed and in
good standing in their jurisdiction to practice medicine or osteopathy.
T. “Preceptor” means a licensed midwife or certified nurse-midwife who licensed by their
state or jurisdiction to provide maternity care who assumes responsibility for supervising
the practical (clinical obstetric) experience of a student midwife. To qualify as a
preceptor, a CPM must be a NARM registered preceptor which requires 3 years of active
practice beyond entry-level CPM requirements or 50 primary births, including 10
continuity of care as set forth in NARM preceptor handbook.
U. “Student Midwife”-must be currently enrolled in a midwifery educational program
accredited by MEAC or excepted by the North American Registry of Midwives for the
PEP (Portfolio Evaluation Process) under the direct supervision of a licensed midwifery
preceptor.
Exemptions: “Other Midwives” This bill is written for the Certified Professional Midwife and
does not include or affect any other midwife.
Parents rights: Nothing in this chapter abridges, limits, or changes in any way the right of
parents to deliver their baby where, when, how, and with whom they choose, regardless of
licensure under this chapter.
Permits and Licenses
A. General Provisions
1) A licensed midwife may provide any care or services allowed by these
regulations
2) An apprentice midwife may provide any care or service allowed by these
regulations only set out under the direct supervision of a preceptor. The preceptor reviews and
evaluates all care provided by and attends every appointment, labor and delivery managed by
the apprentice. The preceptor retains the responsibility for clients seen by apprentices.
3) Nevada Division of Public and Behavioral Health requires full disclosure of
past midwifery licensure, suspensions, and revocations which will be considered before granting
any license or permit.
B. Apprentice Midwife Permits:
1) Application for apprentice midwife permit must include all of the following:
a) a completed agreement with the preceptor
b) a completed apprentice application
c) payment of a hundred dollars to the Nevada Division of Public and
Behavioral Health
2) Upon proof of successful completion, the Nevada Division of Public and
Behavioral Health will supply to the qualifying apprentice applicants an apprentice
midwife permit and necessary regulatory information applicable to apprenticeship.
3) An apprentice must have successfully completed basic education
requirements in midwifery and completed the examination provided by the North American
Registry of Midwives, no later than the end of the fourth year after the initial apprentice permit is
issued. In the event of extenuating circumstance, applicant may file for an extension. An
apprentice must successfully complete the following:
a) a minimum of twenty four months of educational and clinical study
b) a copy of your Certified Professional Midwife Certificate
4) Renewal of Permits: An apprentice midwifery permit may be renewed once
after the initial two years permit period. An applicant for renewal shall submit to the Nevada
Division of Public and Behavioral Health:
a) A completed renewal application
b) Renewal payment of one hundred dollars
C. Midwife Licensure:
1) An applicant for midwifery licensure must meet the following requirements
a) Submit a current copy of CPM certificate; if through PEP process,
applicant must also submit a Midwifery Bridge Certificate.
b) Submit a complete application on the Nevada Division of Public and
Behavioral Health form which shall include the applicants licensing and disciplinary history.
c) Submit along with a fee of two hundred dollars for licensure
2) After reviewing and approving duly submitted applications, the Nevada
Division of Public and Behavioral Health shall issue to qualifying applicants a license.
3) Renewal of Licensure: A midwifery license must be renewed every two years
from the date the license was issued. An applicant for renewal must submit:
a) A completed renewal form
b) Submit proof of current CPM certification.
c) Proof of 20 Continuing Education Credits
d) Renewal payment of two hundred dollars
4) Reinstatement of licenses lapsed longer than 4 years will need to repeat the
initials step of licensing.
D. Credentialing By Endorsement: An applicant holding a midwifery credential in another
state may be credentialed to practice in this state so long as MEAC education requirements
have been met or with PEP and mandatory bridge program completion if non-MEAC accredited
school or program.
Disciplinary Action: The Governor and Board of Certified Professional Midwives will decide
whether or not the actions of any reported grievance or incident was grievous enough for a
Midwife license to be revoked.
Education: the candidate shall meet the following condition:
A) A minimum of two years of midwifery training, either through a MEAC school or PEP
process accompanied by the completion of the Midwifery Bridge Certificate.
B) Meeting minimum educational requirements which shall include general health care
skills, cultural humility, studying basic sciences, reproductive anatomy and physiology,
behavioral sciences, childbirth education, community care, family planning, the legal aspects of
midwifery, nutrition during pregnancy and lactation, breastfeeding, clinical skills, aseptic
technique; and any other requirements that may come up.
C) The midwifery preceptor will support the above courses of education for the
apprentice as well as offer clinical experience.
Responsibilities and Scope of Practice:
A) Scope of Practice: The licensed midwife may provide care to low-risk, healthy
persons during the childbearing years including the preconception, pregnant and postpartum
period including well-person and reproductive care in a community-based setting, including
home or birth centers. The licensed midwife will also administer limited legend of medication as
noted in Drug Legend and care for a healthy newborn up to 8 weeks of age.
B) The Responsibility to Consult: The licensed midwife shall be responsible for
developing a means of consultation and referral/transfer to a physician or hospital when
obstetrical complications present for the client and/or infant, deviating from normal and low risk.
If every effort is made to consult, and it is documented in client records, and no physician is
willing to consult, this requirement will be considered met.
C) Limitation of Physician Liability: any relationship with a physician shall not by itself
provide the basis for finding a physician liable for any acts or omissions by a licensed midwife.
D) Informed Consent: The licensed midwife must obtain written, informed consent
regarding the care to be provided by the licensed midwife from the individual upon accepting
them for care. At a minimum the licensed midwife must first explain the following to any
individual seeking midwifery care to ensure that their choices are comprehensive and informed.
1) Midwives educational back ground
2) The risks and benefits of midwifery care
3) The nature and scope of the care to be given
4) The nature and terms of the financial agreement
E) Birth Assistants: In the event of a precipitous or emergency situation, if a
midwife assistant, student midwife, or Good Samaritan, feels they have a duty to
intervene, this shall not be interpreted as intention to practice midwifery without a
license.
F) Birth Registration: the licensed midwife must complete a Nevada certificate of live
birth registration and file it within 10 days of the birth of any child in the state of Nevada. No
licensed midwife shall register nor enable any other party to register as a Nevada birth any child
not born in the state.
G) Records: the licensed midwife will document and maintain clients records for no less
than ten years.
H) Mortality: immediate recording: a licensed midwife must report within forty eight hours
to the Office of Vital Statistics any neonatal or maternal mortality in patients for whom they have
cared in the perinatal period.
I) Reportable Diseases: The licensed midwife must report any reportable contagious
disease to the local health department.
J) Changes of address or phone number: A Licensed midwife must report a change of
their address or phone number within thirty days of the change.
Drug Legend- Acquire/procure, carry/transport, and administer medications for safe care
of pregnancy, labor and birth, and postpartum, and the newborn including but not limited
to: (See drug legend chart)
Medicaid Reimbursement
Reimbursement for Certified Professional Midwives
A) A health benefit plan or health insurance provided through Medicaid shall provide
coverage for services rendered by a certified professional midwife for services within the scope
of the practice of certified professional midwifery, regardless of the location where such services
are provided.
B) Coverage for services provided by a CPM shall not be subject to any greater copayment,
deductible, or coinsurance than is applicable to any other similar benefits provided by the health
benefit plan or health insurance coverage provided through Medicaid.
C) A health benefit plan may require that maternity services be provided by a CPM under
contract with the health benefit plan.
Midwifery Board: The Governor of the state of Nevada shall appoint a Licensed Midwifery
Board named Board of Certified Professional Midwives.
A) The board activities will be:
1) Review complaints against licensed midwives as requested by the Governor of
the state of Nevada and make recommendations to the Governor.
2) Remain current in clinical practice and professional issues and advise the
Governor accordingly
3) Conduct other relevant business as requested by the Governor
B) Advisory Board Membership: The Board of Certified Professional Midwives shall be
composed of five members and three ex-officio members; the membership shall be as follows:
1) Four state licensed midwives, at least two of whom shall be actively practicing.
2) One state licensed certified nurse midwife actively practicing, will be an ex-
officio member of the board.
3) One consumer member
4) One state licensed physician actively practicing obstetrics, will be an ex-officio
member of the board.
5) A representative from the Nevada Maternal and Child Health Coalition will be
an ex-officio member of the board.
C) Advisory Board procedures: Board members shall be appointed for staggered three-
year terms and not more than two consecutive terms.
1) Board members shall serve without compensation.
2) Any member failing to attend two consecutive meetings without good cause
and an excused absence prior to the meetings shall be deemed to have resigned from the
board.
Severability: If any part of application of the regulations governing the practice of licensed
midwifery is held invalid, the remainder or its application to other situations or persons shall not
be affected.
