§ 4181. Definitions
The definitions contained in this section shall apply throughout this chapter unless the context clearly requires otherwise:
(1) "Director" means the director of the office of professional regulation.
(2) "Licensed Midwife (LM)" means anyone who has met the requirements set down by the North American Registry of Midwives and who meets the eligibility criteria set forth in this chapter.
(3) "Midwifery" means the provision of care, support, and education to healthy women during the childbearing cycle, including normal pregnancy, labor, childbirth, and the postpartum period. Such care occurs in collaboration and consultation with other health care providers, and can appropriately occur at home, in birthing centers, or in medical facilities. Such care, support, and education may relate to:
(A) appropriate measures that promote and maintain the health of the mother and baby;
(B) the availability of birthing alternatives;
(C) the prevention or reduction of risk to the mother and baby;
(D) the detection of abnormal conditions;
(E) the procurement of appropriate medical assistance;
(F) the execution of emergency measures;
(G) the provision of newborn care and appropriate screening; and
(H) the provision of wellwoman health care.
(4) "Midwifery educational process" means a course of study that includes a combination of apprenticeship, selfteaching, experience, formal instruction, correspondence work or at-distance learning, and practice in nonmedical settings, usually the home, but sometimes freestanding birth centers, approved or accredited, or both, by the Midwifery Education Accreditation Council.
(5) "NARM" means the North American Registry of Midwives.
(6) "VMA" means the Vermont midwives alliance. (Added 1999, No. 133 (Adj. Sess.), § 44, eff. Jan. 1, 2001.)
§ 4182. Exemptions
In recognition that, in Vermont, a variety of practitioners provides care to women during pregnancy and birth, this chapter does not apply to the following:
(1) Certified nursemidwives authorized under the board of nursing to practice in Vermont, unless they have chosen to become licensed midwives. Notwithstanding this subsection, certified nurse midwives who choose to become licensed midwives remain subject to the jurisdiction of the board of nursing as well as to the provisions of this chapter.
(2) Licensed physicians or other licensed health care providers authorized to provide midwifery care.
(3) Student midwives in training with licensed midwives. (Added 1999, No. 133 (Adj. Sess.), § 44, eff. Jan. 1, 2001.)
§ 4183. Eligibility
A person shall be eligible to be licensed as a midwife, if the person has:
(1) certification as a certified professional midwife (CPM) by the North American Registry of Midwives;
(2) earned a high school degree or its equivalent as a basis for entry into the study of midwifery; and
(3) agreed to practice according to the scope and standards of practice as required by rules adopted pursuant to section 4185 of this title. (Added 1999, No. 133 (Adj. Sess.), § 44, eff. Jan. 1, 2001.)
§ 4184. Application for and issuance of license
To become a licensed midwife, a person shall apply to the director on a form the director shall furnish. The application shall be accompanied by the specified fee and evidence that the person meets the eligibility requirements of section 4183 of this title. (Added 1999, No. 133 (Adj. Sess.), § 44, eff. Jan. 1, 2001.)
§ 4185. Director; duties
(a) The Director shall:
(1) provide general information to applicants for licensure as midwives;
(2) explain appeal procedures to licensed midwives and applicants, and complaint procedures to the public;
(3) administer fees as established by law;
(4) receive applications for licensure, administer examinations, provide licenses to applicants qualified under this chapter, renew, revoke, and reinstate licenses as ordered by an administrative law officer; and
(5) refer all disciplinary matters to an administrative law officer.
(b) The Director shall adopt general rules necessary to perform his or her duties under this chapter, maintain and make available a list of approved programs for continuing education, and by January 1, 2001, in consultation with the Commissioner of Health, the Vermont Medical Society, and the Vermont chapter of the American College of Nurse-Midwives, adopt specific rules defining the scope and practice standards, including risk-assessment criteria, based at a minimum, on the practice standards of the Vermont Midwives Alliance (VMA) and the Midwives Alliance of North America (MANA), and defining a protocol and formulary for drug use by licensed midwives, including anti-hemorrhagic drugs and oxygen. Once initially established by rule, the formulary for medication use by licensed midwives, including anti-hemorrhagic agents and oxygen, shall be updated by the Director as necessary, subject to the approval of the Commissioner of Health and notwithstanding the provisions of 3 V.S.A. chapter 25. The Director shall update the protocol and formulary, in consultation with the Commissioner of Health or his or her designee, the Vermont Medical Society, and the Vermont chapter of the American College of Nurse-Midwives to ensure licensed midwives have available those medications deemed necessary to maintain best practice standards and deemed necessary for licensed midwives to provide pre-natal and postpartum care consistent with accepted and prevailing standards of care for mothers and their babies.
(c)(1) The Director shall appoint an advisory committee to study and report to the Director and to the Commissioner of Health on matters relating to midwifery, including recommendations if necessary for revisions to the administrative rules. The Committee shall focus on improving communication and collaboration among birth providers.
(2) The Committee shall be composed of at least six members: three midwives licensed under this chapter, two physicians licensed by the Board of Medical Practice or the Board of Osteopathic Physicians and Surgeons, and one advanced practice registered nurse midwife licensed by the Board of Nursing.
(3) Members of the Committee shall be entitled to compensation at the rate provided in 32 V.S.A. § 1010. (Added 1999, No. 133 (Adj. Sess.), § 44, eff. Jan. 1, 2001; amended 2007, No. 29, § 68; 2013, No. 138 (Adj. Sess.), § 47.)
§ 4186. Advisor appointees
(a) The secretary of state shall appoint two licensed midwives and one physician, licensed under chapter 23 of this title and who has professional experience with home births, to serve as advisors in matters relating to licensed midwives. They shall be appointed for staggered five-year terms and shall serve at the pleasure of the secretary. One of the initial appointments may be for less than five years.
(b) The midwife appointees shall not have less than three years' experience as midwives qualified to be licensed under this chapter during the period immediately preceding appointment and shall be actively engaged in midwifery during their incumbency.
(c) The office of professional regulation shall investigate complaints regarding licensed midwives or applicants for licensing or renewal and, when appropriate, refer them to an administrative law officer established under 3 V.S.A. § 129(j).
(d) The director shall seek the advice of the persons appointed under this section in carrying out the provisions of this chapter. Such appointees shall be entitled to compensation and expenses as provided in 32 V.S.A. § 1010 for attendance at any meeting called by the director for this purpose. (Added 1999, No. 133 (Adj. Sess.), § 44, eff. Jan. 1, 2001.)
§ 4187. Renewals
(a)(1) Biennially, the director shall forward a renewal form to each licensed midwife. The completed form shall include verification that during the preceding two years, the licensed midwife has:
(A) completed 20 hours of continuing education approved by the director by rule;
(B) participated in at least four peer reviews;
(C) submitted individual practice data;
(D) maintained current cardiopulmonary resuscitation certification; and
(E) filed a timely certificate of birth for each birth at which he or she was the attending midwife, as required by law.
(2) Upon receipt of the completed form and of the renewal fee, the director shall issue a renewal license to applicants who qualify under this section.
(b) The director shall renew a license which has lapsed for a period of three years or less upon receipt of the renewal fee and late renewal penalty, the reinstatement fee, and an application for renewal which shows that the person still meets the eligibility requirements of this chapter and that all the requirements for renewal, including continuing education, have been satisfied. A person shall not be required to pay renewal fees for lapsed years.
(c) The director may adopt rules to assure that an applicant whose license has lapsed for a period greater than three years may be eligible for licensing, but such rules shall not establish requirements greater than the eligibility requirements of this chapter. (Added 1999, No. 133 (Adj. Sess.), § 44, eff. Jan. 1, 2001; amended 2011, No. 35, § 5, eff. May 18, 2011.)
§ 4188. Unprofessional conduct
(a) A licensed midwife or applicant for licensing, renewal or reinstatement shall not engage in unprofessional conduct.
(b) Unprofessional conduct shall include the conduct prohibited by 3 V.S.A. § 129a and by this section, whether or not taken by a license holder:
(1) failing to provide for informed consent, or exercising undue influence on or taking improper advantage of a person using midwifery services;
(2) willfully making or filing false reports or records in the practice of midwifery, obstructing that filing, or willfully failing to file required reports or records, including birth certificates;
(3) engaging in abusive behavior of any kind with clients.
(c) After a hearing, and upon a finding of unprofessional conduct, an administrative law officer may take disciplinary action against a licensed midwife or applicant. (Added 1999, No. 133 (Adj. Sess.), § 44, eff. Jan. 1, 2001.)
§ 4189. Prohibition; offenses
(a) No person shall use in connection with the person's name any letters, words, or insignia indicating or implying that the person is a licensed midwife, unless the person is licensed in accordance with this chapter. However, a person may use any designation issued by a state or nationally recognized organization, as long as the name of that organization is clearly used with the designation.
(b) No person shall practice midwifery in this state without a valid license issued in accordance with this chapter except as provided in section 4182 of this title.
(c) A person who violates this section shall be subject to the penalties provided in 3 V.S.A. § 127(c). (Added 1999, No. 133 (Adj. Sess.), § 44, eff. Jan. 1, 2001; amended 2007, No. 29, § 69.)
§ 4190. Written plan for consultation, emergency transfer, and transport
(a) Every licensed midwife shall develop a written plan for consultation with physicians licensed under chapter 23 of this title and other health care providers for emergency transfer, for transport of an infant to a newborn nursery or neonatal intensive care nursery, and for transport of a woman to an appropriate obstetrical department or patient care area. The written plan shall be submitted to the director on an approved form with the application required by section 4184 of this title and biennially thereafter with the renewal form required by section 4187 of this title. The written transport plan shall be reviewed and approved by the advisors appointed pursuant to section 4186 of this title and shall be provided to any health care facility or health care professional identified in the plan. The director, in consultation with the advisors, the commissioner of health, and other interested parties, shall develop a single, uniform form for use in all cases in which a transfer or transport occurs, which shall include the medical information needed by the facility or professional receiving the transferred or transported patient.
(b)(1) A licensed midwife shall, within 30 days of a birth or sentinel event, complete any peer review that is both required by rules governing licensed midwives and which is generated due to a death, significant morbidity to client or child, transfer to hospital, or to practice performed outside the standards for midwives as set forth in the rules governing licensed midwives. This peer review report shall be submitted to the office of professional regulation within 30 days of its completion.
(2) During the peer review process, other health care professionals engaged in the care or treatment of the client may provide written input to the peer review panel related to quality assurance and other matters within or related to the licensed midwife's scope of practice. The written comments shall be filed with the office of professional regulation and subject to the same confidentiality provisions as apply to other documents related to peer reviews. Upon completion of the peer review process, the director shall provide notice of the final disposition of the peer review to all health care professionals who submitted input pursuant to this subdivision. (Added 1999, No. 133 (Adj. Sess.), § 44, eff. Jan. 1, 2001; amended 2007, No. 29, § 70; 2011, No. 35, § 6, eff. May 18, 2011.)
§ 4191. Informed consent
A licensed midwife shall provide each client with and maintain a record of a signed informed consent form that describes the midwife's education and credentials, whether the midwife has professional liability insurance coverage, procedures and risks of home birth, a copy of the emergency plan required by section 4190 of this title, and the address and phone number of the office of professional regulation where complaints may be filed. (Added 1999, No. 133 (Adj. Sess.), § 44, eff. Jan. 1, 2001.)