DEPARTMENT OF HEALTH AND SOCIAL SERVICES
Statutory Authority: 16 Delaware Code, Section 122(3)h (16 Del.C. §122(3)h)
These regulations, “The State of Delaware Rules and Regulations Pertaining to the Practice of Non-Nurse Midwifery,” replace by recision the current "State of Delaware Rules and Regulations Pertaining to the Practice of Certified Midwifery" previously adopted on April 17, 1978 and most recently amended May 15, 1985.
The new regulations establish and define conditions under which individuals may be granted permits to practice direct entry/non-nurse midwifery in the State of Delaware. The Department of Health and Social Services, through the Division of Public Health, will recognize and issue a permit to practice midwifery for direct entry/non-nurse midwives.
Notice Of Public Hearing
The Community Health Care Access Section, Division of Public Health, Department of Health & Social Services, will hold a public hearing to discuss the proposed adoption of new “State of Delaware Rules and Regulations Pertaining to the Practice of Non-Nurse Midwifery.” The public hearing will be held on November 28, 2001, at 3:00 PM, in Room 400B, Delaware Technical and Community College, Terry Campus, Route 13 & Denny's Road, Dover, Delaware.
Information concerning the proposed regulation is available at the following location:
Community Health Care Access Section
Jesse Cooper Building
Federal and Water Streets
Dover, Delaware 19901
Telephone: (302) 739-4735
Anyone wishing to present his or her oral comments at this public hearing should contact Dave Walton at (302) 739-4700 by November 27, 2001. Anyone wishing to submit written comments as a supplement to, or in lieu of, oral testimony should submit such comments by December 3, 2001, to:
Dave Walton, Hearing Officer
Division of Public Health
P.O. Box 637
Dover, Delaware 19903-0637
Delaware State Board Of Health
Rules And Regulations Pertaining To The
Practice Of Midwifery
Adopted by the State Board of Health on April 17, 1978, amended September 19, 1978, and December 22, 1982, and amended to be effective 5/15/85.
Under the authority granted to the State Board of Health under 16 Del. C. §122 (3) (h), the Board of Health of the State of Delaware hereby adopts the following regulations pertaining to the practice of midwifery in the State of Delaware.
Section I - Definitions
a. Midwifery is the management of the woman throughout an essentially uncomplicated maternity cycle and includes the immediate care of the newborn. Management may include but is not limited to the following acts: physical examination during the maternity cycle; history taking; prenatal, postpartum and family planning education and counseling; preparation for childbirth; physical and emotional monitoring during labor and delivery including diagnostic tests; attending spontaneous vaginal births; routine inspection of the vagina and cervix throughout the maternity cycle; providing local anesthesia for perineal repair; performing and repairing episiotomies; resuscitating the newborn according to accepted procedures; documenting activities in appropriate maternity records; signing Birth Certificates: Provided, however, that these regulations shall not apply to a person assisting a licensed physician who may perform any of the above listed acts, or under emergency circumstances.
b. Essentially uncomplicated refers to periodic mutual determinations by the midwife and physician that the woman's physical and support needs can be met safely by a midwife.
c. Alliance is a relationship between a midwife and a physician(s) licensed to practice medicine or osteopathy in Delaware whereby medical consultation and referral, available on a 24-hour basis, is agreed upon in writing, signed by both parties, and filed with the State Board of Health.
Section II - Qualifications
No permit to practice midwifery in the State of Delaware shall be issued by the State Board of Health unless an applicant can demonstrate that said applicant has met the following qualifications:
a. Age of 21 years or older;
b. Licensed as a Registered Professional Nurse in the State of Delaware;
c. Possesses a valid certification by the American College of Nurse Midwives;
d. Submits a sworn statement that he/she has not been convicted of a felony; been professionally penalized or convicted of substance addiction; had a professional nursing license suspended or revoked in this or another state; been professionally penalized or convicted of fraud; is physically and mentally capable of engaging in the practice of midwifery; and
d. Has formed an alliance.
Section III - Application
Any person desiring to obtain a permit to practice midwifery shall make a written application to the Secretary of the State Board of Health. Such application shall be accompanied by the necessary documents setting forth the facts that the applicant possesses the qualifications in Section II. If after investigation of the application by the State Board of Health or its designee, it appears the applicant is qualified to practice midwifery, the State Board of Health shall issue a permit to practice midwifery in the State of Delaware.
Section IV - Maintenance of Permit
No person granted a permit under these regulations shall engage in active practice of midwifery without having an established alliance with a physician(s) licensed to practice medicine or osteopathy in the State of Delaware. Should the alliance be terminated during the permit period, the midwife must form a new alliance and submit the agreement to the State Board of Health before continuing to practice as a midwife. Failure to do so will result in automatic and immediate revocation of permit.
Loss of certification as a midwife from the American College of Nurse Midwives or suspension or revocation of the license to practice professional nursing in Delaware will result in automatic and immediate revocation of the permit to practice midwifery in Delaware.
Section V - Renewal of Permit
Any permit granted to practice midwifery in the State of Delaware shall terminate annually on December 31. The fee for such annual permit shall be $15.00. Said permit shall be renewable annually with the filing of an application and documentation setting forth continued qualification in items "b" through "e" of Section II. Should said permit not be renewed by January 31, the permit is considered lapsed and the midwife shall apply according to Section III.
Section VI - Exclusion
Any person who on September 19, 1978, held a valid permit issued by the State Board of Health to practice midwifery in the State of Delaware may be granted a permit to practice midwifery even though that person does not meet the qualifications specified in items "b" and "c" of Section II of these Rules and Regulations providing such midwife must continue to demonstrate to the State Board of Health full compliance with all other provisions of these Regulations and any special conditions as set forth by the State Board of Health to assure full compliance with all other provisions.
Section VII - Complaints
Any person may make a complaint in writing to the State Board of Health concerning incompetency, negligence, addiction to drugs and/or alcohol, physical or mental impairment, misrepresentation, willful breach of confidence, failure of a midwife to report a birth, or failure to otherwise comply with these regulations. Complaints shall be investigated by the State Board of Health or its designee and a determination made as to the need for a hearing. In the event a hearing is to be held, the midwife shall be notified by certified mail at least fifteen (15) days prior to the hearing as to the time and place of the hearing and any allegations which the Board intends to investigate. If such complaint is found to be justified, the permit of the midwife against whom the complaint has been lodged may, at the discretion of the State Board of Health, be revoked or suspended.
Section VIII - Illegal Practice
Any person who practices as a midwife as defined in item "a" of Section I in the State of Delaware without a permit issued by the State Board of Health shall be subject to a fine pursuant to 16 Del. C. § 107.
Section IX - Effective Date
These Regulations shall become effective January 14, 1983, and shall replace Rules and Regulations Pertaining to the Practice of Midwifery which were in effect until that date.
Section X - Severability
Should any section, sentence, clause, or phrase of these Rules and Regulations be legally declared unconstitutional or invalid for any reason, the remainder of said Rules and Regulations shall not be affected thereby.
Amendment To
Delaware State Board Of Health
Rules And Regulations Pertaining To The
Practice Of Midwifery
A waiver to the qualifications requirements may be approved by the State Board of Health to allow practice by a traditional midwife under the following circumstances and qualifications:
a. Evidence is submitted to the State Board of Health of a reasonable attempt to secure a licensed professional midwife.
b. An alliance has been formed with a physician licensed in Delaware and certified by the American Board of Obstetrics and Gynecology.
c. Evidence is submitted of acceptable training and experience as a midwife that meets criteria established by the Board.
d. Is at least 21 years of age.
e. Submits a sworn statement that he/she has not been convicted of a felony or charged with substance abuse, and is physically and mentally capable of engaging in such practice.
f. The area of practice shall be limited, by agreement with the allied physician, to a population which is medically underserved or has religious tenets opposed to medical practices.
g. Agrees to abide by all laws and regulations applicable to the care of newborn infants and registration of births.
If the above requirements are met, a limited license may be approved, to be renewed annually, and the license so designated.
Adopted by the State Board of Health to become effective May 15, 1985.
State Of Delaware
Rules And Regulations Pertaining To The
Practice Of Non-Nurse Midwifery
These regulations replace regulations previously adopted on April 17, 1978; amended September 19, 1978, December 22, 1982, and May 15, 1985, by the Delaware State Board of Health. Effective Date: Xxx xx, xxxx.
Section I – Purpose
The purpose of these Regulations is to establish and define conditions under which individuals may be granted permits to practice direct entry/non-nurse midwifery in the State of Delaware. The Department of Health and Social Services, through the Division of Public Health, will recognize and issue a permit to practice midwifery for direct entry/non-nurse midwives.
Section II – Authority
Title 16, Delaware Code, Chapter 1, Section 122 (3) h.
Section III – Definitions
a. Midwifery practice: is the management of women’s health care, focusing particularly on pregnancy, childbirth, the postpartum period, care of the newborn, and the family planning and gynecological needs of women, including the prescription of appropriate medications and devices within this defined scope of practice. The midwife practices within a health care system that provides for consultation, collaborative management or referral as indicated by the health status of the client.
b. Direct entry/non-nurse midwife: A person who has met the qualifications and received a permit from the Delaware Division of Public Health to practice midwifery in Delaware who is not licensed as an advanced practice nurse midwife.
c. Certified midwife: A person who has met the criteria stated in Section IVa (possesses a valid certification by national certification body).
d. Collaborative Agreement: Written verification of health care facility approved clinical privileges; or health care facility approved job description; or a written document that outlines the process for consultation and referral between a direct entry/non-nurse midwife and a physician.
e. Guidelines/Protocols: Suggested pathways to be followed by direct entry/non-nurse midwives for managing a particular medical problem. These guidelines/protocols shall be developed collaboratively by the midwife and a licensed physician.
f. Referral: The process whereby a direct entry/non-nurse midwife directs the client to a physician or another health care professional for management of a particular problem or aspect of the client’s care.
Section IV - Qualifications
To receive a permit to practice direct entry/non-nurse midwifery in the State of Delaware, an applicant must submit documentation to the Division of Public Health that they meet the following qualifications:
a. Possesses a valid certification by the American College of Nurse-Midwives Certification Council, Inc.; has completed a midwifery education program accredited by the ACNM’s Division of Accreditation; or has completed an equivalent program of studies as determined by the certification agency, including Certified Professional Midwives (CPM) and/or Certified Midwife (CM).
b. Submits a sworn statement that he/she has not been convicted of a felony; been professionally penalized or convicted of substance addiction; had a professional midwifery license suspended or revoked in this or another state; been professionally penalized or convicted of fraud; and is physically and mentally capable of engaging in the practice of midwifery.
c. Establishes a collaborative agreement with a medical provider which includes at a minimum:
• a minimum number of medical provider prenatal visits.
• guidelines and protocols that must include access and use of oxygen, medications (including Intravenous medications), emergency protocols for labor, delivery, and postpartum for both mother and neonate.
d. Possesses personal medical malpractice insurance.
e. Submits to the Division of Public Health a sample contract between the midwife and the pregnant women outlining the scope of practice and potential risk factors and complications.
Section V – Application
Any person who wishes to obtain a permit to practice direct entry/non-nurse midwifery shall make a written application to the Division of Public Health. Such application shall be accompanied by the necessary documents demonstrating that the applicant possesses the qualifications in Section IV. If, after investigation of the application by the Division of Public Health, it appears the applicant is qualified to practice direct entry/non-nurse midwifery, a permit to practice midwifery in the State of Delaware will be issued.
Section VI – Maintenance of Permit
No person granted a permit under these regulations shall engage in active practice of direct entry/non-nurse midwifery without continuously meeting the qualifications in Section IV. Changes that occur during the permit period (one year) must be reported to the Division of Public Health.
Section VII – Renewal of Permit
Any permit granted to practice direct entry/non-nurse midwifery in the State of Delaware shall terminate annually on December 31. The fee for such annual permit shall be determined annually (in July) by the Division of Public Health and not be less than $15.00. Permits shall be renewable annually with the filing of an application and documentation setting forth continued qualifications as specified in Section IV. Should a permit not be renewed by January 31, the permit is considered lapsed and the direct entry/non-nurse midwife shall apply according to Section V.
Section VIII – Complaints
The Division of Public Health may, upon receipt of a complaint or upon its own initiative, investigate allegations against a direct entry/non-nurse midwife of incompetence, negligence, substance abuse, misrepresentation, willful breach of confidence, failure to report a birth, or failure to comply with these regulations. Upon completion of the investigation, if the allegations are determined to be founded, the Division of Public Health may propose to suspend or revoke the permit of the direct entry/non-nurse midwife. The Division of Public Health shall notify the direct entry/non-nurse midwife of the proposed sanctions and offer the direct entry/non-nurse midwife the opportunity for a hearing. The direct entry/non-nurse midwife must request a hearing within 30 days of the date of the notification of the proposed sanctions. If the direct entry/non-nurse midwife does not request a hearing, the proposed sanctions shall become final.
Section IX – Illegal Practice
Any person who practices as a direct entry/non-nurse midwife, as defined in Section III, in the State of Delaware without a permit issued by the Division of Public Health shall be subject to a fine pursuant to 16 Del. C 107.
Section X - Severability
Should any section, sentence, clause, or phase of these Rules and Regulations be legally declared unconstitutional or invalid for any reason, the remainder of these Rules and Regulations shall not be affected.