§ 33-46-108 — 33-46-103. Board of midwifery

(a) The board of midwifery is established. The board
shall regulate the practice of midwifery in the state to ensure
the safety of women and newborn children receiving care from
midwives.
(b) The board shall license as a midwife any person who
applies in the manner prescribed by the board in rules and
regulations and who:
(i) Pays the fees established by the board pursuant
to this act;
(ii) Has graduated from a midwifery education program
accredited by the midwifery education accreditation council, or
a similar successor organization, or has five (5) years
experience practicing as a licensed or certified midwife in
another state;
(iii) Provides proof of current certification as a
certified professional midwife by the North American registry of
midwives or its successor organization;
(iv) Has completed a practicum or course of practical
experience meeting the requirements established by rule and
regulation of the board;
(v) Has provided the board with evidence of
successful completion of board approved courses in the treatment
of respiratory distress in newborns, pharmacology, the treatment
of shock, intravenous therapy and suturing specific to midwives.
The board may accept graduation from an accredited program as
provided by paragraph (ii) of this subsection as satisfying this
requirement if those programs adequately cover these subjects;
(vi) Has provided the board fingerprints and other
information necessary for a criminal history record background
check as provided under W.S. 7-19-201;
(vii) Has successfully completed a personal interview
with the board, if the board deems an interview appropriate in
general or in a specific case;
(viii) Has not provided materially false or
misleading information to the board;
(ix) Has not been convicted of a crime which in the
judgment of the board renders the person unfit to practice
midwifery.
(c) The board may by endorsement license any person as a
midwife who applies in the manner prescribed by the board and
who:
(i) Pays the fees established by the board pursuant
to this act;
(ii) Is currently licensed or certified by any state
with requirements at least as stringent as this state and is in
good standing in that state;
(iii) Has successfully completed a personal interview
with the board if the board deems an interview appropriate in
general or in a specific case;
(iv) Has provided the board fingerprints and other
information necessary for a criminal history record background
check as provided under W.S. 7-19-201;
(v) Has not provided materially false or misleading
information to the board;
(vi) Has not been convicted of a crime which in the
judgment of the board renders the person unfit to practice
midwifery;
(vii) Has not been sanctioned in another state
without resolution satisfactory to the board.
(d) The period of licensure shall be two (2) years and the
board shall renew the license upon application, payment of fees
and completion of any required continuing education, absent
cause to take action pursuant to subsection (e) of this section.
(e) The board may revoke, suspend or condition the license
of a midwife or require the midwife to practice for a time under
the supervision of a person licensed under the Medical Practice
Act, a certified nurse midwife or another midwife as appropriate
if the board finds the midwife has committed any one (1) or more
of the following:
(i) Been convicted of a crime which renders the
person unfit to practice midwifery;
(ii) Violated this act;
(iii) Abused or neglected women or newborns under the
midwife's care;
(iv) Failed to refer women or newborn children in
need of care or at risk of needing care beyond the abilities of
the midwife to an appropriate health care professional in accord
with standards of the national association of certified
professional midwives or other national midwife certifying
agency established for such purpose which has been reviewed and
approved by the board;
(v) Provided a level or degree of care indicating a
need for additional training of the midwife or additional
professional supervision of the midwife.
(f) The board may authorize its chairman or executive
secretary, if any, to issue a provisional license allowing any
of the following:
(i) Any person eligible for licensure to practice
under the supervision of another midwife, a person licensed
under the Medical Practice Act or a certified nurse midwife
until the board has the opportunity to act on the person's
application for licensure, however this paragraph shall not
apply to any person whose license or certificate is under
revocation, suspension or disciplinary restriction in another
state;
(ii) Any person undertaking the practicum required
under this act to practice under the supervision of another
midwife, a certified nurse midwife or a person licensed under
the Medical Practice Act;
(iii) Any person licensed or certified in another
state with requirements at least as stringent as this state to
practice for not more than thirty (30) days to provide education
and instruction in midwifery or to act as a locum tenens for a
midwife licensed under this act. The board may define by rule
and regulation the number of times during a year a provisional
license pursuant to this paragraph may be issued.
(g) Unless otherwise provided in this act, hearing
procedures shall be promulgated in accordance with, and a person
aggrieved by a decision of the board may take an appeal pursuant
to, the Wyoming Administrative Procedure Act.
(h) The practice of midwifery in Wyoming prior to the
effective date of this act shall not constitute grounds for the
board to deny licensure to or to discipline any person who
otherwise qualifies for licensure under this act.
(j) The board shall make, adopt, amend, repeal and enforce
reasonable rules and regulations necessary for the proper
administration and enforcement of this act. The rules adopted
by the board shall:
(i) Develop uniform and reasonable scope of practice
standards for midwifery consistent with W.S. 33-46-102(a)(ii)
and (iii), which shall, at a minimum:
(A) Prohibit a licensed midwife from providing
care for a client with any one (1) or more of the following
pregnancy disorders, diagnoses, conditions or symptoms:
(I) Placental abnormality;
(II) Multiple gestation;
(III) Noncephalic presentation at the onset
of labor or rupture of membranes, whichever occurs first;
(IV) Birth under thirty-seven (37) weeks or
after forty-two (42) weeks gestational age;
(V) A history of more than one (1) prior
cesarean section with no prior vaginal delivery, a cesarean
section within eighteen (18) months of the current delivery or
any cesarean section that was surgically closed with a classical
or vertical incision;
(VI) Rhesus factor or other blood group or
platelet sensitization, hematological disorders or coagulation
disorders;
(VII) Preeclampsia;
(VIII) Cervical insufficiency or a history
of cervical insufficiency.
(B) Prohibit a licensed midwife from providing
care for a client with a history of any one (1) or more of the
following disorders, diagnoses, conditions or symptoms unless
the disorder, diagnosis, condition or symptom is being treated,
monitored and managed during the current pregnancy by a
physician licensed under the Medical Practice Act:
(I) Diabetes;
(II) Thyroid disease;
(III) Epilepsy;
(IV) Hypertension;
(V) Cardiac disease;
(VI) Pulmonary disease;
(VII) Renal disease;
(VIII) Previous major surgery of the
pulmonary system, cardiovascular system, urinary tract or
gastrointestinal tract;
(IX) Hepatitis.
(C) Require a licensed midwife to recommend that
a client see a physician licensed under the Medical Practice Act
and to document and maintain a record if the client has a
history of any one (1) or more of the following disorders,
diagnoses, conditions or symptoms:
(I) Previous complicated pregnancy;
(II) Previous cesarean section;
(III) Previous pregnancy loss in second or
third trimester;
(IV) Previous spontaneous premature labor;
(V) Previous preterm rupture of membranes;
(VI) Previous preeclampsia;
(VII) Previous hypertensive disease of
pregnancy;
(VIII) Prior infection with parvo virus,
toxoplasmosis, cytomegalovirus or herpes simplex virus;
(IX) Previous newborn group B streptococcus
infection;
(X) A body mass index of thirty-five (35)
or higher at the time of conception;
(XI) Underlying family genetic disorders
with potential for transmission;
(XII) Psychiatric illness.
(D) Require a licensed midwife to facilitate the
immediate transfer to a hospital for emergency care, a client
with any one (1) or more of the following disorders, diagnoses,
conditions or symptoms:
(I) Maternal fever in labor;
(II) Suggestion of fetal jeopardy such as
significant bleeding, thick meconium or abnormal fetal heart
tones without delivery imminent;
(III) Noncephalic presentation at the onset
of labor or rupture of membranes, whichever occurs first;
(IV) Second stage of labor longer than two
(2) hours without adequate progress;
(V) Current spontaneous premature labor;
(VI) Current preterm premature rupture of
membranes;
(VII) Current preeclampsia;
(VIII) Current hypertensive disease of
pregnancy;
(IX) Continuous uncontrolled bleeding;
(X) Bleeding which necessitates the
administration of more than two (2) doses of oxytocin or other
antihemorrhagic agent;
(XI) Delivery injuries to the bladder or
bowel;
(XII) Seizures;
(XIII) Uncontrolled vomiting;
(XIV) Coughing or vomiting of blood;
(XV) Severe chest pain;
(XVI) Sudden onset of shortness of breath
and associate labored breathing.
(E) Require that a licensed midwife recommend to
the client that two (2) providers trained in neonatal
resuscitation program be present at delivery;
(F) Require a licensed midwife to maintain
records of all care provided to clients.
(ii) Develop a protocol for written informed consent
to treatment, which shall include all of the following:
(A) The licensed midwife's experience and
training;
(B) Instructions for obtaining a copy of rules
adopted by the board pursuant to this act;
(C) Instructions for obtaining a copy of
documents adopted by the national association of certified
professional midwives that identify the nature of and standards
of practice for responsible midwifery practice;
(D) Instructions for filing complaints with the
board;
(E) Notice of the type and liability limits of
professional or personal liability insurance maintained by the
midwife or notice that the midwife does not carry liability
insurance;
(F) A written protocol for emergencies that is
specific for each individual client, including the following
provisions:
(I) Transport to a hospital in an
emergency;
(II) Notification of the hospital to which
a client will be transferred upon initiation of the transfer;
(III) Accompaniment of the client to the
hospital by the midwife, if feasible, or telephone notice to the
hospital if the midwife is unable to be present personally;
(IV) Transmission of the client's record to
the hospital, including the client's name, address, list of
known medical conditions, list of prescription or over the
counter medications regularly taken, history of previous
allergic reactions to medications, the client's current medical
condition and description of the care provided by the midwife;
(V) Next of kin contact information.
(G) A description of the procedures, benefits
and risks of home birth, primarily those conditions that may
arise during delivery;
(H) Any other information required by board
rule.
(iii) Define a protocol for the use of those drugs
approved by the board for administration to mothers and babies.
The protocol shall include amounts and methods of obtaining,
storing and disposing of approved drugs, indications and
contraindications for usage, dosage, route of administration and
duration of treatment;
(iv) Define a protocol for management of newborns
which shall at a minimum include immediate management of
respiratory distress or other serious or potentially serious
illness in the newborn, ensuring compliance with the newborn
screening requirements of W.S. 35-4-801 and ensuring compliance
with the relevant portions of vital records reporting pursuant
to W.S. 35-1-401 through 35-1-431;
(v) Define a protocol for medical waste disposal;
(vi) Require midwives to report outcomes of all
clients for which the midwife provided services at any point
during labor or delivery to the board after each birth.
(k) Rules adopted by the board shall not:
(i) Require a licensed midwife to have a nursing
degree or diploma;
(ii) Except as authorized by subsection (f) of this
section or as a condition imposed as a disciplinary measure
pursuant to W.S. 33-46-103(e), require a licensed midwife to
practice midwifery under the supervision of another health care
provider;
(iii) Except as a condition imposed as a disciplinary
measure pursuant to W.S. 33-46-103(e), require a licensed
midwife to enter into an agreement, written or otherwise, with
another health care provider;
(iv) Limit the location where a licensed midwife may
practice midwifery;
(v) Allow a licensed midwife to use vacuum extraction
or forceps as an aid in the delivery of a newborn;
(vi) Grant a licensed midwife prescriptive privilege,
except as provided in the protocol established pursuant to W.S.
33-46-103(j)(iii);
(vii) Allow a licensed midwife to perform abortions.
(m) At no less than five (5) year intervals, the board
shall examine the reports provided under paragraph (j)(vi) of
this section to assess the efficacy of the program.