On September 21, 2017, the Medical Board of California adopted new regulations related to the training of midwife assistants, the administration of midwife assistant training, and the requirements for approved, midwife assistant certifying organizations. The Board took this action to implement and interpret Senate Bill 408 (2015), which added new requirements and prohibitions to the Licensed Midwifery Practice Act of 1993 under Business & Professions Code § 2516.5.
SCOPE OF PRACTICE
Business and Professions Code § 2516.5(a)(1) defines “midwife assistant” as:
A person, who may be unlicensed, who performs basic administrative, clerical, and midwife technical supportive services in accordance with this chapter for a licensed midwife or certified nurse-midwife, is at least 18 years of age, and has had at least the minimum amount of hours of appropriate training pursuant to standards established by the board for a medical assistant pursuant to Section 2069. The midwife assistant shall be issued a certificate by the training institution or instructor indicating satisfactory completion of the required training. Each employer of the midwife assistant or the midwife assistant shall retain a copy of the certificate as a record.
Section 2516.5 authorizes a midwife assistant to perform certain assistive activities under the supervision of a licensed midwife or certified nurse-midwife, including the administration of medicine, withdrawing of blood, and midwife technical support services. Midwife assistants are permitted to perform the following midwife technical support services under § 2516.5(b)(3):
(A) Administer medications orally, sublingually, topically, or rectally, or by providing a single dose to a patient for immediate self-administration, and administer oxygen at the direction of the supervising licensed midwife or certified nurse-midwife. The licensed midwife or certified nurse-midwife shall verify the correct medication and dosage before the midwife assistant administers medication.
(B) Assist in immediate newborn care when the licensed midwife or certified nurse-midwife is engaged in a concurrent activity that precludes the licensed midwife or certified nurse-midwife from doing so.
(C) Assist in placement of the device used for auscultation of fetal heart tones when a licensed midwife or certified nurse-midwife is engaged in a concurrent activity that precludes the licensed midwife or certified nurse-midwife from doing so.
(D) Collect by noninvasive techniques and preserve specimens for testing, including, but not limited to, urine.
(E) Assist patients to and from a patient examination room, bed, or bathroom.
(F) Assist patients in activities of daily living, such as assisting with bathing or clothing.
(G) As authorized by the licensed midwife or certified nurse-midwife, provide patient information and instructions.
(H) Collect and record patient data, including height, weight, temperature, pulse, respiration rate, blood pressure, and basic information about the presenting and previous conditions.
(I) Perform simple laboratory and screening tests customarily performed in a medical or midwife office.
Section 2516.5(c) specifically prohibits midwife assistants from administering local anesthetic agents or performing any clinical laboratory test or examination for which the assistant is not authorized. Finally, section 2516.5(d) prohibits a midwife assistant from being employed for inpatient care in a licensed general acute care hospital as defined in Health and Safety Code § 1250(a).
CERTIFICATION AND TRAINING REQUIREMENTS
Among the new regulatory requirements, midwife assistants must maintain current certification in Neonatal Resuscitation from the American Academy of Pediatrics (Bus. & Prof. Code § 1379.02) and Basic Life Support from the American Heart Association or the American Safety and Health Institute (Bus. & Prof. Code § 1379.03), as well as training in infection control from the CDC (Bus. & Prof. Code § 1379.04).
Specific minimum hourly training requirements under § 1379(a) include:
(1) Five (5) clock hours of midwifery didactic training.
(2) Two (2) clock hours of training in administering oxygen by inhalation.
(3) Ten (10) clock hours of satisfactory demonstration of immediate newborn care.
In order to perform certain services, the following minimum training hours are required under § 1379(b):
(1) Five (5) clock hours of training on the device used for auscultation of fetal heart tones and ten (10) demonstrations of satisfactory placement of the device used for auscultation of fetal heart tones during labor or by stimulation.
(2) Ten (10) clock hours of training administering injections and performing skin tests, and satisfactory performance of ten (10) each intramuscular, subcutaneous, and intradermal injections, and skin tests.
(3) Ten (10) clock hours of training in venipuncture and skin puncture for the purpose of withdrawing blood, and satisfactory performance of ten (10) each of venipunctures and skin punctures for the purpose of withdrawing blood.
Organizations that certify midwife assistants must obtain Board approval, be not-for-profit, and meet specific standards listed under § § 1379.07-1379.09.