Informed Consent Information & Waiver
for Clients of California Licensed Midwives ~ 2014
Licensed Midwifery Practice Act as modified by AB 1308 ~ September 12, 2013
This bill would, among other things, no longer require a physician and surgeon to supervise a licensed midwife.
The bill would require, if a potential midwife client fails to meet the conditions of a normal pregnancy or childbirth, as defined, but still desires to be a client, that the licensed midwife refer the woman to a physician and surgeon for examination. The bill would require the board to adopt regulations specifying certain of those conditions.
The bill would authorize the licensed midwife to assist the woman only if the physician and surgeon determines, after examination, that the risk factors presented by the woman’s disease or condition are not likely to significantly affect the course of pregnancy and childbirth.
The bill would require a licensed midwife to immediately refer or transfer the client to a physician and surgeon if at any point during pregnancy, childbirth, or postpartum care a client’s condition deviates from normal.
The bill would authorize the licensed midwife to resume primary care of the client if the physician and surgeon determines that the client’s condition or concern has been resolved, and to provide concurrent care if the client’s condition or concern has not been resolved, as specified.
Amended language of the LMPA under AB 1308
2508. (a) A licensed midwife shall disclose in oral and written form to a prospective client as part of a client care plan, and obtain informed consent for, all of the following (1) All of the provisions of Section 2507:
SEC. 2. Section 2507 of the Business and Professions Code is amended to read:
2507. (a) The license to practice midwifery authorizes the holder to attend cases of normal pregnancy and childbirth, as defined in paragraph (1) of subdivision (b), and to provide prenatal, intrapartum, and postpartum care, including family-planning care, for the mother, and immediate care for the newborn.
(b) As used in this article, the practice of midwifery constitutes the furthering or undertaking by any licensed midwife to assist a woman in childbirth so as long as progress meets criteria accepted as normal.
(1) Except as provided in paragraph (2), a licensed midwife shall only assist a woman in normal pregnancy and childbirth, which is defined as meeting all of the following conditions:
(A) There is an absence of both of the following [NO evidence of the following]
(i) Any preexisting maternal disease or condition likely to affect the pregnancy
(ii) Significant disease arising from the pregnancy
(B) There is a singleton fetus
(C) There is a cephalic (i.e., head down or “vertex”) presentation
(D) The gestational age of the fetus is greater than 37 0⁄7 weeks and less than 42 0⁄7 completed weeks of pregnancy
(E) Labor is spontaneous or induced in an outpatient setting
(2) If a potential midwife client meets the conditions specified in subparagraphs (B) to (E), inclusive, of paragraph (1), but fails to meet the conditions specified in subparagraph (A) of paragraph (1), and the woman still desires to be a client of the licensed midwife, …..
….. the licensed midwife shall provide the woman with a referral for an examination by a physician and surgeon trained in obstetrics and gynecology.
A licensed midwife may assist the woman in pregnancy and childbirth only if an examination by a physician and surgeon trained in obstetrics and gynecology is obtained and the physician and surgeon who examined the woman determines that the risk factors presented by her disease or condition are not likely to significantly affect the course of pregnancy and childbirth.
(3)The board shall adopt regulations … specifying the conditions described in subparagraph (A) of paragraph (1).
(c) (1) If at any point during a pregnancy, childbirth, or postpartum care a client’s condition deviates from normal, the licensed midwife shall immediately refer or transfer the client to a physician and surgeon.
The licensed midwife may consult and remain in consultation with the physician and surgeon after the referral or transfer.
(2) If a physician and surgeon determines that the client’s condition or concern has been resolved such that the risk factors presented by a woman’s disease or condition are not likely to significantly affect the course of pregnancy or childbirth, the licensed midwife may resume primary care of the client and resume assisting the client during her pregnancy, childbirth, or postpartum care.
(3) If a physician and surgeon determines the client’s condition or concern has not been resolved as specified in paragraph (2), the licensed midwife may provide concurrent care with a physician and surgeon and, if authorized by the client, be present during the labor and childbirth, and resume postpartum care, if appropriate.
A licensed midwife shall not resume primary care of the client.
(d) A licensed midwife shall not provide or continue to provide midwifery care to a woman with a risk factor that will significantly affect the course of pregnancy and childbirth, regardless of whether the woman has consented to this care or refused care by a physician or surgeon, except as provided in paragraph (3) of subdivision (c).
2508. (a) A licensed midwife shall disclose in oral and written form to a prospective client as part of a client care plan, and obtain informed consent for, all of the following:
(1) All of the provisions of Section 2507 (as above)
(2) The client is retaining a licensed midwife, not a certified nurse midwife, and the licensed midwife is not supervised by a physician and surgeon.
(3) The licensed midwife’s current licensure status and license number.
(4) The practice settings in which the licensed midwife practices.
(5) If the licensed midwife does not have liability coverage for the practice of midwifery, he or she shall disclose that fact. The licensed midwife shall disclose to the client that many physicians and surgeons do not have liability insurance coverage for services provided to someone having a planned out-of-hospital birth.
(6) The acknowledgment that if the client is advised to consult with a physician and surgeon, failure to do so may affect the client’s legal rights in any professional negligence actions against a physician and surgeon, licensed health care professional, or hospital.
(7) There are conditions that are outside of the scope of practice of a licensed midwife that will result in a referral for a consultation from, or transfer of care to, a physician and surgeon.
(8) The specific arrangements for the referral of complications to a physician and surgeon for consultation. The licensed midwife shall not be required to identify a specific physician and surgeon.
(9) The specific arrangements for the transfer of care during the prenatal period, hospital transfer during the intrapartum and postpartum periods, and access to appropriate emergency medical services for mother and baby if necessary, and recommendations for pre-registration at a hospital that has obstetric emergency services and is most likely to receive the transfer.
(10) If, during the course of care, the client is informed that she has, or may have, a condition indicating the need for a mandatory transfer, the licensed midwife shall initiate the transfer.
(11) The availability of the text of laws regulating licensed midwifery practices and the procedure for reporting complaints to the Medical Board of California, which may be found on the Medical Board of California’s Internet Web site.
(12) Consultation with a physician and surgeon does not alone create a physician-patient relationship or any other relationship with the physician and surgeon.
The informed consent shall specifically state that the licensed midwife and the consulting physician and surgeon are not employees, partners, associates, agents, or principals of one another. The licensed midwife shall inform the patient that he or she is independently licensed and practicing midwifery, and in that regard, is solely responsible for the services he or she provides.
(b) The disclosure and consent shall be signed by both the licensed midwife and the client and a copy of the disclosure and consent shall be placed in the client’s medical record.
(c) The Medical Board of California may prescribe the form for the written disclosure and informed consent statement required to be used by a licensed midwife under this section.
SEC. 4. Section 2510 is added to the Business and Professions Code, to read:
If a client is transferred to a hospital, the licensed midwife shall provide records, including prenatal records, and speak with the receiving physician and surgeon about labor up to the point of the transfer. The hospital shall report each transfer of a planned out-of-hospital birth to the Medical Board of California and the California Maternal Quality Care Collaborative using a standardized form developed by the board.
Client Acknowledgment of Relevant Midwifery Laws
Section 2508 of the Business and Professions Code requires that a licensed midwife shall make the following disclosures in oral and written form.
According to the above section of law, clients of California licensed midwives are required to be informed about the pertinent laws regulating the community-based Out-of-Hospital practice of midwifery under the Licensed Midwifery Practice Act (LMPA) of 1993 and its subsequent amendments. This includes AB 1308, which went into effect on January 1, 2014.
As your midwife, I, _____________________________, Ca LM# ____, am required to communicate the following information to you:
CLIENT NAME: I, ____________________________________________, understand or state that my midwife:
- provided relevant provisions of Section 2507 and 2508 to me earlier in this document
- answered my questions about Sections 2507 & 2508 to the best of her ability
- made the following statements about herself and the midwifery law available to me:
PRACTICE STATUS ~ {LM’s full name & title}
- is independently licensed by the Medical Board of California
- her license status (number #041 ) is current and unrestricted
- is not a certified nurse midwife
- does not practice under the supervision of a physician and surgeon
LOCATION OF SERVICES:
- my midwife practices in out-of-hospital settings, including homes, birth centers and clinics
- does not have hospital admitting or hospital practice privileges
PHYSICIAN REFFERAL &/OR TRANSFER OF CARE:
- medical conditions identified during pregnancy that are outside the scope of practice for a licensed midwife will require my midwife to refer me to a physician and surgeon for consultation or transfer-of-care
- if a medical condition develops during labor, birth, postpartum or neonatal period, indicating the need for a mandatory hospital transfer of myself or my baby, my midwife will initiate the transfer of care
- to facilitate the hospital transfer process, my midwife recommends that I pre-register at a hospital that provides obstetric emergency services and is the one to which I am most likely to transfer
PROFESSIONL LIABILITY ISSUES:
- as an independent practitioner of midwifery, my midwife is solely responsible for the services she provides
- does/does not carry liability coverage for the practice of midwifery
- my midwife, and any physician and surgeon with whom he/she consults, are not employees, partners, associates, agents, or principals of one another
- many physicians and surgeons do not have liability insurance coverage for services provided to someone having a planned out-of-hospital birth
- consultation with a physician and surgeon does not alone create a physician/ patient relationship or any other relationship with the physician and surgeon
- if advised to consult with a physician and surgeon, my failure to do so may affect my legal rights in any professional negligence actions against a physician and surgeon, licensed healthcare professional, or hospital.
As a midwifery client of Ca LM #____ {client name} _____________________________________, I read and understand all the above statements to the best of my ability and understand that a copy of this signed Disclosure Form shall be placed in my midwifery chart. Date _______________
Please continue to page #7. Fill in the pertinent information AND sign the “Record of Medical Interface Arrangements for clients of California Licensed Midwives” as required by the Licensed Midwives Practice Act of 1993
Medical Interface Arrangements relative to pregnancy & childbirth
for clients of California Licensed Midwives
Client Name _________________________________________ Date ________
Licensed Midwife ______________________________________ License #_____
(1) My plans/arrangements for medical/obstetrical consultation and/or non-urgent transfer of care during my pregnancy are as follows: ___________________________________________________________________________
(2) If elective obstetrical care during my labor, birth and the immediate postpartum becomes necessary, I’ve identified the following hospital and physician to provide such services: ___________________________________________________________________________
(3) My midwife and I have together identified arrangements specific to my geographical location for emergency care for myself, or my newborn baby during or after the birth: ___________________________________________________________________________
I have been informed of my right to check on the licensure status of any health care practitioner licensed in California. Physicians, Licensed Midwives and 18 allied health professions are licensed and regulated by the Medical Board of California (MBC). For information on Medical Board licentiates, call 1- 916 / 263-2382 or visit their web site at www.medbd.ca.gov/.
I’ve also been advised that I can report complaints about medical or midwifery care to the MBC by calling 1- 800 / 633-2322. Instructions and a complaint form are available on-line by visiting the MBC Internet site @ www.medbd.ca.gov/.
If the above named licensed midwife does not carry professional liability insurance (i.e. medical malpractice coverage), I have been informed of that fact.
Client Signature _________________________________ Date ____________
Midwife Signature ______________________________ Date__________
www.CollegeofMidwives.org 2000 Medical Interface Form ~ updated 2014