texas midwife scope of practice
(5) any other abnormal newborn behavior or appearance which could adversely affect the newborn, as assessed by a midwife exercising reasonable skill and knowledge. 115.119. For more information on the ATM Midwifery Training Program visit the Education page. 115.7. (d) The midwife shall engage in a periodic process of evaluation and quality assurance. 115.113. (c) The department shall review and update the examination as needed. Administration of Oxygen. CNM educational programs are accredited by the American College of Nurse-Midwives (ACNM) and recognized by the U.S. Department of Education. (b) It is an emergency if, during labor, delivery, or six hours immediately following placental delivery, the midwife determines that transfer is necessary and the client refuses transfer. (P) a material misrepresentation knowingly made to the department on any matter or to a client during the provision of midwifery care. Bus. (b) Meetings shall be announced and conducted under the provisions of the Open Meetings Act, Texas Government Code, Chapter 551. (d) Advisory board action shall require a majority vote of those members present and voting. (1) The course supervisor/administrator shall submit an application form and a non-refundable initial midwifery course application fee to the department with the following supporting documentation: (B) course curriculum with specific content references to: (iii) NARM Skills Assessment Test Specifications; (iv) Texas Midwifery Basic Information and Instructor Manual; and. (Effective August 1, 2020). (1) Midwife Training Certification Form for Newborn Screening Specimen Collection. Relay Texas-TDD: (800) 735-2989, Helping Small Business and Consumers Since 1909, For more information about obtaining a TDLR license or renewing a TDLR license that expired while serving on active duty, please go to the, Air Conditioning and Refrigeration Contractors, Hearing Instrument Fitters and Dispensers, Speech-Language Pathologists and Audiologists, download the entire Midwives Administrative Rules document, License Search, Frequently Asked Questions and Guidelines, Renew online, check license status, search for a license, or file a complaint. Obtain Complaint Information without Consent of Client. 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. (2) Course curriculum must provide an educational experience which: (A) covers new developments in the fields of midwifery or related disciplines; or, (B) reviews established knowledge in the fields of midwifery or related disciplines; and, (C) shall be presented in standard contact hour increments for continuing health education; and. For more information about Midwives, contact customer service. The Midwifery Scope of Practice. 115.20. Prenatal Care. A midwife’s scope of practice may change depending on the nature of their roles and the learning they have undertaken. Nurse-Midwifery practice is founded upon the principles of continuity of care, empowerment of women, family … (8) Consultation--The process by which a midwife, who maintains responsibility for the woman's care, seeks the advice of a physician or another licensed health care professional or member of the health care team of a different profession. Texas Midwifery Board Rules, Subchapter D covers scope of practice. 2. The Midwives Advisory Board consists of nine members appointed by the presiding officer of the commission, with the approval of the commission as follows: (1) five members each of whom has at least three years’ experience in the practice of midwifery; (2) two members who represent the public and who are not practicing or trained in a health care profession, one of whom is a parent with at least one child born with the assistance of a midwife; (3) one physician member who is certified by a national professional organization of physicians that certifies obstetricians and gynecologists; and. 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. (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). (17) Program--The department's midwifery program. (23) Voluntary charity care--Midwifery care provided without compensation and with no expectation of compensation. Should the midwife choose to do the newborn screening she or he will obtain training to perform this test from an appropriate health care facility. (3) act to resolve problems that are identified. (18) Public health district--A district created under the Health and Safety Code, Chapter 121, Subchapter E. (19) Referral--The process by which a midwife directs the client to a physician or another licensed health care professional who has current obstetric or pediatric knowledge and who is working under supervision and delegation of a physician. (a) Prior to delivery, the midwife shall establish a plan with the client for continuing care of the newborn. (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. Standards for the Practice of Midwifery in Texas (a) Using reasonable skill and knowledge, the midwife shall: (1) provide clients with a description of the scope of midwifery services and information regarding the client's rights and responsibilities in accordance with the Act; Texas Midwifery Board Home Page Thank you for visiting the Department of State Health Services (DSHS) webpage. (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. (a) Using reasonable skill and knowledge, the midwife shall collect, assess, and document maternal care data through a detailed obstetric, gynecologic, medical, social, and family history and a complete prenatal physical exam and appropriate laboratory testing, including antenatal testing if necessary; develop and implement a plan of care; thereafter evaluate the client's condition on an ongoing basis; and modify the plan of care as necessary. (e) If on any newborn assessment after the immediate postpartum period, one of the following conditions exists, the midwife shall recommend referral to an appropriate health care professional and document that recommendation in the midwifery record: (4) any other abnormal newborn behavior or appearance which could adversely affect the infant, as assessed by a midwife exercising reasonable skill and knowledge. Initial Application for Licensure. 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. (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. (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. (1) The department shall approve courses for a three year period. A licensed midwife with appropriate training and experience may also provide family planning and routine well-woman care according to her individual protocols. (New Section adopted effective October 1, 2016, 41 TexReg 4477). (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. (c) Midwives are authorized to purchase equipment and supplies listed in the American Heart Association Cardiopulmonary Resuscitation Guidelines and the American Academy of Pediatrics Neonatal Resuscitation Guidelines for the administration of oxygen. Labor and Delivery. Advisory Board Membership. • To become licensed in Texas, a midwife must: 1. (a) A retired midwife who is only providing voluntary charity care: (1) may renew his or her midwifery license by submitting all the items required for renewal, the retired midwife renewal fee, and only five hours of approved midwifery continuing education. Texas: Consortium of Texas Certified Nurse Midwives (CTCNM) 4000 Sunflower Lane Belton, TX 75613 firstname.lastname@example.org, National: American College of Nurse Midwives (ACNM) 8403 Colesville Rd, Suite 1550 Silver Spring, MD 20910 Phone 240-485-1800 Fax: 240-485-1818 www.midwife.org, Texas:Association of Texas Midwives P.O.Box 887Elmendorf, TX 78112 Phone: 432-664-8815 www.texasmidwives.com, National/International: The North American Registry of Midwives (NARM) 5257 Rosestone Dr. Lilburn, GA 30047 Phone: 1-888-842-4784 www.narm.org, "To advance the quality and accessibility of midwifery in Texas.". Midwifery in Texas: Safety, Regulation and Need, Find Local Represenative & State Legislators. • Licensed Midwives in Texas are regulated by Texas Department of Licensing and RegulationThere are approximately 200 Licensed Midwives in Texas. (d) If a client has reached 42.0 weeks gestation and is not yet in labor, the midwife shall immediately either: (1) collaborate with a physician and obtain appropriate antenatal testing, in order to continue midwifery care; or. Newborn Screening. (b) Course reciprocity. (5) include didactic curriculum instructors who: (A) have training and credentials for the course material they will teach; and. CNMs independently manage women's health care services relating to pregnancy, childbirth, the postpartum period, family planning, and routine gynecological needs. (E) 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 or fetus; (2) postpartum oxygen may be administered while monitoring according to the Midwifery Practice Standards and Principles: (A) to the newborn during the initial neonatal period at a rate concurrent with American Academy of Pediatrics Neonatal Resuscitation guidelines; or. 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). (6) "Midwife" means a person who practices midwifery and has met the licensing requirements established by this chapter and commission rules. (a) Initial licensure. In addition, all licensing candidates must meet minimum clinical education requirements, be certified in healthcare provider CPR, and neonatal resuscitation. 115.21. (e) If on initial or subsequent assessment during labor or delivery, one of the following conditions exists, the midwife shall initiate immediate emergency transfer in accordance with §115.113 and document that action in the midwifery record: (4) gestational hypertension/preeclampsia/eclampsia; (5) severe abdominal pain inconsistent with normal labor; (6) a non-reassuring fetal heart rate pattern; (8) thick meconium unless the birth is imminent; (9) visible genital lesions suspicious of herpes virus infection; (12) presentation(s) not compatible with spontaneous vaginal delivery; (13) laceration(s) requiring repair beyond the scope of practice of the midwife; (16) any other condition or symptom which could threaten the life of the mother or fetus, as assessed by a midwife exercising reasonable skill and knowledge. Transfer of Care in an Emergency Situation. (C) identification of didactic and preceptorship teaching sites; (D) a financial statement or balance sheet (within the last year) for the course supervisor/administrator or course owner and disclosure of any bankruptcy within the last five years; and. (c) The midwife shall document midwifery care in legible, complete health records. (New Section adopted effective October 1, 2016, 41 TexReg 4477; amended effective May 1, 2019, 44 TexReg 1849). • CNMs work in a wide variety of settings such as clinics, hospitals, medical offices, and their own private practices. (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. Monday to Friday 8:30 am to 4:30 pm (Closed statutory holidays) Due to the COVID-19 pandemic, our office is closed to walk-in traffic until further notice. (7) Commission--The Texas Commission of Licensing and Regulation. 115.111. 115.75. (New Section adopted effective October 1, 2016, 41 TexReg 4477). (2) calling 911 and reporting the need for immediate transfer. 115.15. (New Section adopted effective October 1, 2016, 41 TexReg 4477). A Certified Nurse Midwife is a licensed registered nurse who is approved by the Texas Board of Nursing as an advanced practice registered nurse in nurse-midwifery and who is also certified by the American College of Nurse-Midwives. The presiding officer of the advisory board may vote on any matter before the advisory board. (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. CNMs are registered nurses that have completed a graduate-level program in nurse-midwifery. (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. Newborn Care During the First Six Weeks After Birth. (5) The site visit written report shall recommend to the department approval or denial of the course. 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. (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. (New Section adopted effective October 1, 2016, 41 TexReg 4477). Texas Department of Licensing and Regulation Certified Nurse-Midwives (CNMs) are health care providers who care for women of all ages and stages of life. License Renewal. Scope of Nursing and Midwifery Practice Framework: definition of scope of midwifery practice. The Code requires midwives not to practise outside of their skills, knowledge or competence. According to ICM, 14 the scope of practice of midwives identifies the circumstances in which the midwife may make autonomous clinical decisions and in what circumstances the midwife must practice in collaboration with other health professionals such as doctors. (New Section adopted effective October 1, 2016, 41 TexReg 4477; amended effective August, 1, 2020, 45 TexReg 5184). Fax: (512) 463-9468 PO Box 12157 (d) Course changes. Rules Subch. Practice - Registered Nurse Scope of Practice. (b) The presiding officer of the advisory board shall preside at all board meetings at which he or she is in attendance. A minimum of 3 of the 20 births attended as primary midwife under supervision must be with women for whom the student has provided primary care during at least 4 prenatal visits, birth, newborn exam and one postpartum exam; (C) serving as the primary midwife, under supervision, in performing: (i) 75 prenatal exams, including at least 20 initial history and physical exams; (7) include preceptors who are approved by the course supervisor/administrator and shall be: (D) physicians licensed in the United States and actively engaged in the practice of obstetrics. (New Section adopted effective October 1, 2016, 41 TexReg 4477). (7) "Midwifery" means the practice of: (A) providing the necessary supervision, care, and advice to a woman during normal pregnancy, labor, and the postpartum period; Officers. 115.16. These standards must also be approved by the Texas Board of Health. Terms; Vacancies. 115.6. (D) shall provide reasonable access for non-English speakers and comply with federal and state laws on accessibility. Abstract. The physician, registered nurse, or any other person who instructs a midwife in the approved techniques for newborn screening on the orders of a physician is immune from liability arising out of the failure or refusal of a midwife to: (1) collect and submit the blood specimen in an approved manner; or. Many midwives focus on maternity care, i.e. Unless otherwise indicated, an applicant must submit all required information and documentation of credentials on official department-approved forms. Methodology / Rules. (4) practice in accordance with the knowledge, clinical skills, and judgments described in the most recently adopted version of the Midwives Alliance of North America (MANA) Core Competencies for Basic Midwifery Practice, within the bounds of the midwifery scope of practice as defined by the Act and Rules; (b) The midwife shall provide care in a safe and clean environment. (512) 463-6599 A midwife’s scope of practice can vary widely throughout the United States, depending on the classification of midwife and the limitations mandated by each state. (New Section adopted effective October 1, 2016, 41 TexReg 4477). Continuing Education. (2) The midwife may terminate care for any reason by: (A) providing a minimum of 14 days written notice, during which the midwife shall continue to provide midwifery care; (B) making an attempt to tell the client in person and in the presence of a witness of the midwife's wish to terminate care and the date that care will be terminated; (C) providing a list of alternate health care providers; and. (a) The advisory board shall meet at the call of the presiding officer of the commission or the executive director. (2) Newborn Screening Agreement for Newborn Babies of Midwife Clients. (b) If a vacancy occurs on the board, the presiding officer of the commission, with the commission’s approval, shall appoint a replacement who meets the qualifications for the vacant position to serve for the remainder of the term. (2) use universal precautions for infection control. In this case, the midwife must use the form Newborn Screening Agreement for Newborn Babies of Midwife Clients to attest to her responsibility for seeing that the screening is done and to designate a facility for such screening. Austin, TX 78711, (800) 803-9202 [in state only] 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. Nurse-midwives practice within a health care system that provides for consultation, collaboration or referral as indicated. (c) As long as one is available, a physician or an appropriately trained professional acting under standing delegation order from a physician at an appropriate health care facility shall instruct midwives in the proper procedure (newborn screening collection procedure of the Department of State Health Services’ Newborn Screening Program) for newborn screening blood specimen collection and submission. 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) collect, assess and document newborn care data by monitoring the vital signs, performing a physical exam, and obtaining the laboratory tests necessary for the infant during the postpartum period; (2) provide appropriate education and counseling to the mother; and. (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. • The BNE requires that nurse midwives be certified, and recognizes the ACNM Certification Council, Inc. (ACC) as the certification body for CNMs. (a) In an emergency situation, the midwife shall initiate emergency care as indicated by the situation and immediate transfer of care by making a reasonable effort to contact the health care professional or institution to whom the client will be transferred and to follow the health care professional's instructions; and continue emergency care as needed while: (1) transporting the client by private vehicle; or. scope of practice. Certified nurse-midwife (CNM) functions include: Taking a medical history, and doing a physical exam; Ordering laboratory tests and procedures; Managing therapy The Association of Texas Midwives recognizes the negative impacts of bullying and harassment upon the practice and profession of midwifery in Texas. D. § 831.60(d) states that in (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. The Certified Nurse-Midwife (CNM) is a Master's prepared advanced practice nurse who independently manages the health care of women focusing on common primary care issues, family planning, gynecologic needs, childbearing and care of newborns in a variety of settings. (3) observe the newborn for a minimum of two hours after he or she is stable with no signs of distress. (b) If a client who is at a low risk of developing complications elects not to accept a referral or a physician or associate's advice, the midwife shall: (c) If a midwife administers any prescription medication to a client or her newborn other than oxygen and eye prophylaxis, the midwife must do so in accordance with standing delegation orders from and under the supervision of a physician. Non-English speakers and comply with federal and state laws on accessibility Prescribe independently vs those Require! And provide further care as indicated by the Act or this Chapter shall have training credentials... The legal definition of midwifery in New Zealand collaboration or referral as indicated by the department of Licensing and (..., they comprise a small fraction of practicing midwives when compared to CNMs as indicated by department. And recognized by the TDLR the Texas midwifery Rules, Subchapter D covers scope of practice professional. 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