(2) Advisory Board--The Midwives Advisory Board appointed by the presiding officer of the Commission with the approval of the Commission. CNMs are licensed as registered nurses authorized to practice as a category of advanced practice nurse (APN).Approximately 350 CNMs are authorized by the BNE to practice in Texas. (b) Using reasonable skill and knowledge, the midwife shall: (1) collect, assess and document maternal care data throughout the postpartum period including history, physical exam, laboratory testing; (2) develop and implement a plan of care; (3) evaluate the client's condition on an ongoing basis and modify the plan of care as necessary; and. (New Section adopted effective October 1, 2016, 41 TexReg 4477). Administrative Rules (3) Appropriate health care facility--The Department of State Health Services, a local health department, a public health district, a local health unit or a physician's office where specified tests can be administered and read, and where other medical/clinical procedures normally take place. … (New Section adopted effective October 1, 2016, 41 TexReg 4477; amended effective May 1, 2019, 44 TexReg 1849; amended effective August, 1, 2020, 45 TexReg 5184). The majority of CNM assisted births are in hospitals but they also deliver in birth centers and homes. 115.20. (d) If on any postpartum assessment one of the following conditions exists, the midwife shall initiate immediate emergency transfer, initiate emergency care as indicated by the situation, continue care as needed, and document that action in the midwifery record: (3) any hypertensive disorder, including preeclampsia/eclampsia; (4) signs of thrombophlebitis or pulmonary embolism; or. With a looming shortage of midwives, there is a pressing need to understand midwives' work environment and scope of practice. (4) be supervised and conducted by a course supervisor/administrator who shall: (A) be responsible for all aspects of the course; and, (B) have two years of experience in the independent practice of midwifery, nurse-midwifery or obstetrics; and, (C) have been primary care giver for at least 75 births including provision of prenatal, intrapartum, and postpartum care; and, (D) have met initial licensure requirements; or, (E) be a Certified Professional Midwife (CPM); or, (F) be American College of Nurse Midwives (ACNM) certified; or. Independent practice is not defined by the place of employment, the employer-employee relationship, requirements for physician co-signature, of the method of reimbursement for services. (E) continued approval of the course is not in the public interest. Be Certified by the North American Registry of Midwives (Certified Professional Midwife or C.P.M.) (7) Commission--The Texas Commission of Licensing and Regulation. (b) A retired midwife who has previously renewed under this subsection, and then subsequently seeks to return to employment in the active practice of midwifery in Texas, must either: (1) be currently licensed under this subsection but not due for renewal, and submit the following items to the department: (A) ten hours of continuing education, taken in the 12 months preceding the application; (B) the retired midwife reinstatement fee; and, (C) a written request to return his or her license to active status; or, (2) be currently licensed under this subsection and when billed for renewal, submit all the items required for renewal with a written request to return his or her license to active status; and. Enforcement Authority. Licensed Midwives work in a variety of settings such as clinics, midwifery offices, and their own private practices. (B) Course instructors shall have training and/or credentials appropriate for the course material they will teach. 115.2. (20) Retired midwife--A midwife licensed in Texas who is over the age of 55 and not currently employed in a health care field. (New Section adopted effective October 1, 2016, 41 TexReg 4477; amended effective August, 1, 2020, 45 TexReg 5184). (2) calling 911 and reporting the need for immediate transfer. (Effective August 1, 2020). Transfer of Care in an Emergency Situation. I will explain limitations of midwifery care as situations evolve and lay out options that are available within my scope of practice and explain options in a timely and thorough manner when outside or higher level care is needed. 115.13. (b) Course reciprocity. (4) Approved midwifery education courses--The basic midwifery education courses approved by the department. care for pregnancy, labor & birth. The ACC develops the certification exam and sets the requirements for ongoing certification. • Certified Nurse-Midwives are regulated by the BNE. Are you interested in midwifery school? Austin, TX 78711, (800) 803-9202 [in state only] Act--The Texas Midwifery Act, Texas Occupations Code, Chapter 203. continue to care for the client after discussing and documenting the risks in the midwifery record, which shall include informing the client that her condition may worsen and require transfer; manage the client in collaboration with an appropriate health care professional; or, terminate the midwife-client relationship; or. All fees must be made payable to the department and are nonrefundable. Meetings. • Licensed Midwife assisted births are in birth centers or homes. Jurisprudence Examination. Coordinating Care with Other Health Care Providers. (New Section adopted effective October 1, 2016, 41 TexReg 4477; amended effective May 1, 2019, 44 TexReg 1849). The jurisprudence examination must have been taken no more than one year prior to the date of application. (3) proof of current cardiopulmonary resuscitation (CPR) certification for health care providers by the American Heart Association; equivalent certification for the professional rescuer from the Red Cross; equivalent certification for healthcare and professional rescuer from the National Safety Council; or equivalent certification issued by any provider of CPR certification for health care providers currently accepted by the Department of State Health Service's Office of EMS/Trauma Systems Coordination; (4) proof of current certification for neonatal resuscitation, §§1 - 4, from the American Academy of Pediatrics; (5) proof of satisfactory completion of training in the collection of newborn screening specimens or an established relationship with another qualified and appropriately credentialed health care provider who has agreed to collect newborn screening specimens on behalf of the applicant; (6) a nonrefundable fee required under §115.80; and. The department shall obtain all relevant midwifery records and medical records necessary to conduct an investigation of a complaint without the necessity of consent of the midwife’s client. In addition, all licensing candidates must meet minimum clinical education requirements, be certified in healthcare provider CPR, and neonatal resuscitation. (5) any other condition or symptom which could threaten the life of the mother, as assessed by a midwife exercising reasonable skill and knowledge. There are two types of midwives who may legally practice in the state of Texas: Certified Nurse Midwives (CNM) and Licensed Midwives (LM). We advocate the practice of Texas nurse-midwives in the health care system as an ideal way of achieving safe, high quality, cost effective, and satisfying care for women and children. Acrobat Reader is necessary to view .pdf files. Termination of the Midwife-Client Relationship. (i) tuition schedule, other charges, and cancellation and refund policy, including the right of any prospective student to cancel his/her enrollment agreement within 72 hours after signing the agreement and receive a full refund of any money paid; (ii) student attendance, progress, and grievance policies; (iii) rules of operation and conduct of school personnel; (v) disclosure of approval status of course; (vii) reasonable access for non-English speakers and compliance with federal and state laws on accessibility. 115.14. (b) A midwife's initial license shall be valid from the date issued until March 1 of the following renewal period. • CNMs work in a wide variety of settings such as clinics, hospitals, medical offices, and their own private practices. 115.100. An on-site evaluation of the course shall be scheduled. (New Section adopted effective October 1, 2016, 41 TexReg 4477; amended effective May 1, 2019, 44 TexReg 1849). (b) Mandatory basic midwifery education shall: (1) be offered to ensure that only trained individuals practice midwifery in Texas; (2) be offered by any individual or organization meeting the requirements for course approval established by this subsection; (3) include a didactic component which shall: (A) be based upon and completely cover the most current Core Competencies and Standards of Practice of the Midwives Alliance of North America (MANA) and the current Texas Midwifery Basic Information Manual; (B) prepare the student to apply for certification by North American Registry of Midwives (NARM); and. (New Section adopted effective October 1, 2016, 41 TexReg 4477; new effective May 1, 2019, 44 TexReg 1849). An individual may apply for licensure as a midwife at any time during the year by submitting the following to the department: (1) a completed application on a department-approved form which shall contain: (A) specific information regarding personal data, social security number, birth date, other licenses held, and misdemeanor or felony convictions; (C) a statement that the applicant has read the Act and these rules and agrees to abide by them; (D) a statement that the information in the application is truthful and that the applicant understands that providing false and misleading information on items which are material in determining the applicant's qualifications may result in the voiding of the application, or denial or the revocation of any license issued; and. (b) The presiding officer of the advisory board shall preside at all board meetings at which he or she is in attendance. 115.100. Texas Midwifery Board Home Page Thank you for visiting the Department of State Health Services (DSHS) webpage. Our primary purpose is to promote and improve healthcare outcomes for the women and children of Texas. (New Section adopted effective October 1, 2016, 41 TexReg 4477). To describe the nature and scope of nurse‐midwifery practice in Texas and to determine legislative priorities and practice barriers. registered midwives (RM) St andards. (New Section adopted effective October 1, 2016, 41 TexReg 4477). Scope of Practice: The midwife is recognised as a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labour and the postpartum period, to conduct births on the midwife’s own responsibility and to provide care for the newborn and the infant. We do not tolerate violence, manipulation or coercion of any kind by any source. (d) Pursuant to Texas Occupations Code, Chapters 51 and 203, the commission or the executive director may deny the application for violation of the Act. If the midwife performs the tests, then she or he must have been appropriately trained. (c) The administration and possession of prophylaxis by a midwife is not a violation of the provisions of the Health and Safety Code, Chapter 483, concerning dangerous drugs. Obtain Complaint Information without Consent of Client. A midwife must obtain a completed and signed Newborn Screening Test Objection form from any parent who refuses to allow a midwife to perform the newborn screening tests. (17) Program--The department's midwifery program. (f) If on any newborn assessment after the immediate postpartum period, one of the following conditions exists, the midwife shall initiate immediate transfer to an appropriate health care professional and document that action in the midwifery record: (6) inability to urinate or pass meconium within 24 hours of birth; (13) any other abnormal newborn behavior or appearance which could threaten the life of the newborn, as assessed by a midwife exercising reasonable skill and knowledge. The midwife shall: (1) carry and use when needed, resuscitation equipment; and. (B) to the mother and/or newborn in other situations not listed above and deemed necessary according to generally accepted standards of midwifery practice to protect the health and well-being of the mother and/or newborn; (3) indications for administration of oxygen shall be clearly documented in the midwifery record. among providers. A basic midwifery education course which is currently accredited by the Midwifery Education Accreditation Council (MEAC) shall be deemed approved under this subsection upon submission of evidence of such accreditation. Newborn Care During the First Six Weeks After Birth. BACKGROUND: Across the globe, midwives are the largest group of maternity care providers despite little known about midwifery practice. (New Section adopted effective October 1, 2016, 41 TexReg 4477). (New Section adopted effective October 1, 2016, 41 TexReg 4477). Both direct entry and nurse midwives may practice and be licensed in the state of Arizona. (New Section adopted effective October 1, 2016, 41 TexReg 4477). (b) The midwife shall monitor the client's progress in labor by monitoring vital signs, contractions, fetal heart tones, cervical dilation, effacement, station, presentation, membrane status, input/output and subjective status as indicated. The written informed choice and disclosure statement which has been approved by the department shall include: (1) an informed choice statement containing: (A) statistics of the midwife's experience as a midwife; (B) the date of expiration of the midwife's license; (C) the date of expiration of the midwife's adult and infant cardiopulmonary resuscitation and neonatal resuscitation certification; (D) the midwife's compliance with continuing education requirements; and. Across the globe, midwives are the largest group of maternity care providers despite little known about midwifery practice. (c) If on any newborn assessment in the immediate postpartum period (first six hours of life), one of the following conditions exists, the midwife shall recommend referral and document that recommendation in the midwifery record: (2) gestational age assessment less than 36 weeks; (4) larger than 97th percentile for gestational age; or. (a) In order to renew every two years, a midwife's application for license renewal must include the following: (1) a completed license renewal application form which shall require the provision of the preferred mailing address and telephone number, and a statement of all misdemeanor and felony offenses for which the licensee has been convicted, along with any other information required by the department; (2) proof of completion of at least 20 contact hours of approved midwifery education since March 1 of the previous two-year renewal period; (3) proof of a current CPR certification for health care providers from one of the following: (B) equivalent certification for the professional rescuer from the Red Cross; (C) equivalent certification for healthcare and professional rescuer from the National Safety Council; or. CNM educational programs are accredited by the American College of Nurse-Midwives (ACNM) and recognized by the U.S. Department of Education. Cnáimhseachas’ refers to the modern Irish term for midwifery. The site visit will include the following: (A) an inspection of the course's facilities; (B) a review of its teaching plan, protocols, and teaching materials; (C) a review of didactic and preceptorship instruction; (D) interviews with staff and students; and. (a) Members of the advisory board serve staggered six-year terms. (5) any other abnormal newborn behavior or appearance which could adversely affect the newborn, as assessed by a midwife exercising reasonable skill and knowledge. If a person or entity violates any provision of Texas Occupations Code, Chapters 51 or 203, this chapter, or any rule or order of the executive director or commission, proceedings may be instituted to impose administrative penalties, administrative sanctions, or both in accordance with the provisions of Texas Occupations Code, Chapter 51 and 203 and any associated rules. 115.21. Obtain Complaint Information without Consent of Client. The midwife shall call 911 and provide further care as indicated by the situation. 115.114. Postpartum Care. 115.117. Late license renewal. (C) satisfactory completion of a basic midwifery education course accredited by the Midwifery Education Accreditation Council (MEAC), and the North American Registry of Midwives (NARM) exam, or any other comprehensive exam approved by the department. (b) As long as the midwife has been approved to perform the newborn screening test, the act of collecting this specimen will not constitute "practicing medicine" as defined by the Medical Practice Act. The following words and terms when used in this chapter shall have the following meaning unless the context clearly indicates otherwise. Instruction will be based upon the procedure for newborn screening developed by the Department of State Health Service's Newborn Screening Program under authority of the Health and Safety Code, Chapter 33. (1) The commission or executive director may deny an application for initial licensure or license renewal and may take disciplinary action against any person based upon proof of the following: (A) violation of the Act or rules adopted under the Act; (B) submission of false or misleading information to the department; (C) intemperate use of alcohol or drugs while engaged in the practice of midwifery; (D) unprofessional or dishonorable conduct that may reasonably be determined to deceive or defraud the public; (E) inability to practice midwifery with reasonable skill and safety because of illness, disability, or psychological impairment; (F) judgment by a court of competent jurisdiction that the individual is mentally impaired; (G) disciplinary action taken by another jurisdiction affecting the applicant's legal authority to practice midwifery; (H) submission of a birth or death certificate known by the individual to be false or fraudulent, or other noncompliance with Health and Safety Code, Chapter 191, or 25 Texas Administrative Code (TAC), Chapter 181 (relating to Vital Statistics); (I) noncompliance with Health and Safety Code, Chapter 244, or 25 TAC, Chapter 137 (relating to Birthing Centers); (J) failure to practice midwifery in a manner consistent with the public health and safety; (K) failure to submit midwifery records in connection with the investigation of a complaint; (L) a lack of personal or professional character in the practice of midwifery; (M) failure to use generally accepted standards of midwifery care; (N) failure to exercise ordinary diligence in the provision of midwifery care; (O) failure to act competently in the provision of midwifery care; or. Aims and objectives: To describe the nature and scope of nurse-midwifery practice in Texas and to determine legislative priorities and practice barriers. (c) The department shall review and update the examination as needed. (12) Local health unit--A division of a municipality or county government that provides limited public health services as provided by the Health and Safety Code, §121.004. • The BNE requires that nurse midwives be certified, and recognizes the ACNM Certification Council, Inc. (ACC) as the certification body for CNMs. The terms of three members expiring on January 31st of each odd-numbered year. (Cal. cover scope of practice. (1) Once the midwife has accepted a client, the relationship is ongoing and the midwife cannot refuse to continue to provide midwifery care to the client unless: (A) the client has no need of further care; (B) the client terminates the relationship; or. (5) include didactic curriculum instructors who: (A) have training and credentials for the course material they will teach; and. A midwife’s scope of practice may change depending on the nature of their roles and the learning they have undertaken. Texas Midwifery Board Rules, Subchapter D covers scope of practice. They also provide normal newborn care for up to six weeks of age. (2) The department may refuse to renew the license of a person who fails to pay an administrative penalty imposed under the Act, unless enforcement of the penalty is stayed or a court has ordered that the administrative penalty is not owed. A CPM must also have a Texas license or CNM credential to practice legally in Texas. (a) The advisory board shall meet at the call of the presiding officer of the commission or the executive director. (B) are approved by the course supervisor/administrator. (a) The department shall consider for approval only courses which have a course supervisor/administrator and site in Texas. • Licensed Midwives in Texas are regulated by Texas Department of Licensing and RegulationThere are approximately 200 Licensed Midwives in Texas. (21) Standing delegation orders--Written instructions, orders, rules, regulations or procedures prepared by a physician and designated for a patient population, and delineating under what set of conditions and circumstances actions should be instituted, as described in the rules of the Texas Medical Board in Chapter 193 (relating to Standing Delegation Orders) and §115.111 of this title (relating to Coordinating Care with Other Health Care Providers). See the Texas Midwifery School website. Each BCCNM designation has its own set of Standards of Practice. Background. The Midwifery Scope of Practice. (New Section adopted effective October 1, 2016, 41 TexReg 4477). The midwife shall not provide any further care after the arrival of emergency medical service (EMS) personnel but may do so if requested by EMS personnel. (New Section adopted effective October 1, 2016, 41 TexReg 4477; amended effective May 1, 2019, 44 TexReg 1849). (13) Newborn care--The care of a child for the first six weeks of the child's life. (a) Prior to delivery, the midwife shall establish a plan with the client for continuing care of the newborn. Labor and Delivery. Regulation of Birth Attendants in Texas. 115.23. (3) be documented in the midwifery record. 115.115. (New Section adopted effective October 1, 2016, 41 TexReg 4477; amended effective May 1, 2019, 44 TexReg 1849). They may also provide normal newborn care and primary health care for women. (10) Dishonored/returned check or payment fee is the fee prescribed under §60.82 of this title (relating to Dishonored Payment Device). Today, just about 10 percent of US births are … 115.5. The Texas Midwifery Board creates Standards of Practice for Licensed Midwives. Informed Choice and Disclosure Statement. (6) The department shall evaluate the application and all other pertinent information, including any complaints received and the site visit report. (2) Student files shall be maintained for a minimum of five years and shall include: (A) evidence that the entrance requirements have been met; (B) documentation demonstrating completion of didactic and clinical course work; and. Certified Nurse-Midwives (CNMs) are health care providers who care for women of all ages and stages of life. I will work within the scope of practice as set forth by the Texas Midwifery Board to bring you the highest standard of care in a safe and respectful manner. Officers. (512) 463-6599 A midwife shall terminate care of a client only in accordance with this section unless a transfer of care results from an emergency situation. scope of practice. Prenatal Care. (10) Executive director--The executive director of the department. The evaluation shall be conducted by a member of the department staff and a licensed midwife within the provisional year. (New Section adopted effective October 1, 2016, 41 TexReg 4477). 3.1.2 The scope of practice of midwives. (E) any other information required by the department. Yes, with referral required, except that transfer is mandatory for prior classical or vertical incision or prior uterine surgery with incision in uterine fundus. The enforcement authority granted under Texas Occupations Code, Chapters 51 and 203 and any associated rules may be used to enforce Texas Occupations Code, Chapters 51, 203 and this chapter. (C) the midwife formally terminates the relationship. (23) Voluntary charity care--Midwifery care provided without compensation and with no expectation of compensation. 16 Texas Administrative Code, Chapter 115 (16) Postpartum care--The care of a woman for the first six weeks after the woman has given birth. The presiding officer of the advisory board may vote on any matter before the advisory board. (D) shall provide reasonable access for non-English speakers and comply with federal and state laws on accessibility. (a) Using reasonable skill and knowledge, the midwife shall evaluate the client when the midwife arrives for labor and delivery, by obtaining a history, performing a physical exam, and collecting laboratory specimens. (22) Transfer--The process by which a midwife relinquishes care of the client for pregnancy, labor, delivery, or postpartum care or care of the newborn to a physician or another licensed health care professional who has current obstetric or pediatric knowledge and who is working under the supervision and delegation of a physician. Licensed midwives are midwives that have met all the requirements set forth by the state of Texas. Midwives The midwife in attendance at childbirth shall ensure that the administration of eye prophylaxis, or the objection of the parent, managing conservator, or guardian, is entered into the medical record of the child. Midwives Advisory Board Duties. What is the Career Outlook for a Nurse-Midwife? (9) Department--The Texas Department of Licensing and Regulation. Background: Across the globe, midwives are the largest group of maternity care providers despite little known about midwifery practice. 115.16. 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