Amends and adds to existing law to provide for a licensed midwife to obtain and administer medication indicated for maternal care or neonatal care if a midwife possesses requisite education, training, and experience.

LEGISLATURE OF THE STATE OF IDAHO Sixty-eighth Legislature Second Regular Session - 2026 IN THE HOUSE OF REPRESENTATIVES HOUSE BILL NO. 550 BY HEALTH AND WELFARE COMMITTEE AN ACT1 RELATING TO MIDWIFERY; AMENDING SECTION 54-5504, IDAHO CODE, TO REVISE CER-2 TAIN RULEMAKING AUTHORITY; AMENDING CHAPTER 55, TITLE 54, IDAHO CODE,3 BY THE ADDITION OF A NEW SECTION 54-5504A, IDAHO CODE, TO PROVIDE THAT A4 LICENSED MIDWIFE MAY OBTAIN AND ADMINISTER ANY MEDICATION INDICATED FOR5 MATERNAL CARE OR NEONATAL CARE FOR WHICH THE MIDWIFE POSSESSES THE REQ-6 UISITE EDUCATION, TRAINING, AND EXPERIENCE; AMENDING SECTION 54-5510,7 IDAHO CODE, TO PROVIDE CORRECT CODE REFERENCES; PROVIDING THAT CERTAIN8 ADMINISTRATIVE RULES CONTAINED IN IDAPA 24.26.01. SHALL BE NULL, VOID,9 AND OF NO FORCE AND EFFECT; AND DECLARING AN EMERGENCY AND PROVIDING AN10 EFFECTIVE DATE.11

Be It Enacted by the Legislature of the State of Idaho:12

SECTION 1. That Section 54-5504, Idaho Code, be, and the same is hereby13 amended to read as follows:14 54-5504. RULEMAKING. (1) The rules adopted by the board shall:15 (a) Allow a midwife to obtain and administer, during the practice of16 midwifery, the following:17 (i) Oxygen;18 (ii) Oxytocin, misoprostol, and methylergonovine as postpartum19 antihemorrhagic agents;20 (iii) Injectable local anesthetic for the repair of lacerations21 that are no more extensive than second degree;22 (iv) Antibiotics to the mother for group b streptococcus prophy-23 laxis consistent with guidelines of the United States centers for24 disease control and prevention;25 (v) Epinephrine to the mother administered for anaphylactic26 shock;27 (vi) Intravenous fluids for stabilization of the mother;28 (vii) Rho (D) immune globulin;29 (viii) Phytonadione; and30 (ix) Eye prophylactics to the child.31 (b) Prohibit the use of other legend drugs, except those of a similar32 nature and character as determined by the board to be consistent with33 the practice of midwifery; provided that at least one hundred twenty34 (120) days' advance notice of the proposal to allow the use of such drugs35 is given to the board of pharmacy and the board of medicine and neither36 board objects to the addition of such drugs to the midwifery formulary;37 (c) (a) Define a protocol for use by licensed midwives of drugs approved38 in paragraphs (a) and (b) of this subsection indicated for maternal39 care or neonatal care, as provided for in section 54-5504A, Idaho Code,40 that shall include methods of obtaining, storing, and disposing of such41

2 drugs and an indication for use, dosage, route of administration, and1 duration of treatment;2 (d) (b) Define a protocol for medical waste disposal; and3 (e) (c) Establish scope and practice standards for antepartum, intra-4 partum, postpartum, and newborn care that shall, at a minimum:5 (i) Prohibit a licensed midwife from providing care for a client6 with a history of disorders, diagnoses, conditions, or symptoms7 that include:8 1. Placental abnormality;9 2. Multiple gestation, except that midwives may provide an-10 tepartum care that is supplementary to the medical care of11 the physician overseeing the pregnancy, as long as it does12 not interfere with the physician's recommended schedule of13 care;14 3. Noncephalic presentation at the onset of labor or rupture15 of membranes, whichever occurs first;16 4. Birth under thirty-seven and zero-sevenths (37 0/7)17 weeks and beyond forty-two and zero-sevenths (42 0/7) weeks18 gestational age;19 5. A history of more than one (1) prior cesarean section,20 a cesarean section within eighteen (18) months of the esti-21 mated due date or any cesarean section that was surgically22 closed with a classical or vertical uterine incision;23 6. Platelet sensitization, hematological, or coagulation24 disorders;25 7. A body mass index of forty (40.0) or higher at the time of26 conception;27 8. Prior chemotherapy and/or radiation treatment for a ma-28 lignancy;29 9. Previous preeclampsia resulting in premature delivery;30 10. Cervical insufficiency;31 11. HIV positive status; or32 12. Opiate use that places the infant at risk of neonatal ab-33 stinence syndrome.34 (ii) Prohibit a licensed midwife from providing care for a client35 with a history of the following disorders, diagnoses, conditions,36 or symptoms, unless such disorders, diagnoses, conditions, or37 symptoms are being treated, monitored, or managed by a licensed38 health care provider:39 1. Diabetes;40 2. Thyroid disease;41 3. Epilepsy;42 4. Hypertension;43 5. Cardiac disease;44 6. Pulmonary disease;45 7. Renal disease;46 8. Gastrointestinal disorders;47 9. Previous major surgery of the pulmonary system, cardio-48 vascular system, urinary tract, or gastrointestinal tract;49 10. Abnormal cervical cytology;50

3 11. Sleep apnea;1 12. Previous bariatric surgery;2 13. Hepatitis;3 14. History of illegal drug use or excessive prescription4 drug use; or5 15. Rh or other blood group disorders and a physician deter-6 mines the pregnancy can safely be attended by a midwife.7 (iii) Require a licensed midwife to recommend that a client see8 a physician licensed pursuant to chapter 18, title 54, Idaho9 Code, or an equivalent provision of the law of a state bordering10 Idaho and to document and maintain a record as required by section11 54-5510, Idaho Code, if such client has a history of disorders,12 diagnoses, conditions, or symptoms that include:13 1. Previous complicated pregnancy;14 2. Previous cesarean section;15 3. Previous pregnancy loss in second or third trimester;16 4. Previous spontaneous premature labor;17 5. Previous preterm rupture of membranes;18 6. Previous preeclampsia;19 7. Previous hypertensive disease of pregnancy;20 8. Parvo;21 9. Toxo;22 10. CMV;23 11. HSV;24 12. Previous maternal/newborn group b streptococcus infec-25 tion;26 13. A body mass index of at least thirty-five (35.0) but less27 than forty (40.0) at the time of conception;28 14. Underlying family genetic disorders with potential for29 transmission; or30 15. Psychosocial situations that may complicate pregnancy.31 (iv) Require that a licensed midwife facilitate the immediate32 transfer to a hospital for emergency care for disorders, diag-33 noses, conditions, or symptoms that include:34 1. Maternal fever in labor;35 2. Suggestion of fetal jeopardy, such as bleeding or meco-36 nium or abnormal fetal heart tones;37 3. Noncephalic presentation at the onset of labor or rup-38 ture of membranes, whichever occurs first, unless imminent39 delivery is safer than transfer;40 4. Second-stage labor after two (2) hours of initiation of41 pushing when the mother has had a previous cesarean section;42 5. Current spontaneous premature labor;43 6. Current preterm premature rupture of membranes;44 7. Current preeclampsia;45 8. Current hypertensive disease of pregnancy;46 9. Continuous uncontrolled bleeding;47 10. Bleeding that necessitates the administration of more48 than two (2) doses of oxytocin or other antihemorrhagic49

4 agent does not respond to the administration of antihemor-1 rhagic agents;2 11. Delivery injuries to the bladder or bowel;3 12. Grand mal seizure;4 13. Uncontrolled vomiting;5 14. Coughing or vomiting of blood;6 15. Severe chest pain; or7 16. Sudden onset of shortness of breath and associated la-8 bored breathing.9 A transfer of care shall be accompanied by the client's medical10 record, the licensed midwife's assessment of the client's current11 condition, and a description of the care provided by the licensed12 midwife prior to transfer;13 (v) Establish a written plan for the emergency transfer and14 transport required in subparagraph (iv) of this paragraph and for15 notifying the hospital to which a client will be transferred in16 the case of an emergency. If a client is transferred in an emer-17 gency, the licensed midwife shall notify the hospital when the18 transfer is initiated and accompany the client to the hospital if19 feasible, or communicate by telephone with the hospital if unable20 to be present personally, and shall provide the client's medi-21 cal record. The record shall include the client's name, address,22 list of diagnosed medical conditions, list of prescription or23 over-the-counter medications regularly taken, history of previ-24 ous allergic reactions to medications, if feasible, the client's25 current medical condition and description of the care provided by26 the midwife, and next-of-kin contact information. A midwife who27 deems it necessary to transfer or terminate care pursuant to this28 section and any rules promulgated pursuant to this section or for29 any other reason shall transfer or terminate care and shall not be30 regarded as having abandoned care or wrongfully terminated ser-31 vices. Before nonemergent discontinuing of services, the midwife32 shall notify the client in writing, provide the client with names33 of licensed physicians and contact information for the nearest34 hospital emergency room, and offer to provide copies of medical35 records regardless of whether copying costs have been paid by the36 client.37 (f) (d) Establish and operate a system of peer review for licensed38 midwives that shall include but not be limited to the appropriateness,39 quality, utilization, and ethical performance of midwifery care.40 (2) The rules adopted by the board may not:41 (a) Require a licensed midwife to have a nursing degree or diploma;42 (b) Except as a condition imposed by disciplinary proceedings by the43 board, require a licensed midwife to practice midwifery under the su-44 pervision of another health care provider;45 (c) Except as a condition imposed by disciplinary proceedings by the46 board, require a licensed midwife to enter into an agreement, written or47 otherwise, with another health care provider;48 (d) Limit the location where a licensed midwife may practice midwifery;49

5 (e) Allow a licensed midwife to use vacuum extraction or forceps as an1 aid in the delivery of a newborn;2 (f) Grant a licensed midwife prescriptive privilege; or3 (g) Allow a licensed midwife to perform abortions.4

SECTION 2. That Chapter 55, Title 54, Idaho Code, be, and the same is5 hereby amended by the addition thereto of a NEW SECTION, to be known and des-6 ignated as Section 54-5504A, Idaho Code, and to read as follows:7 54-5504A. MEDICATIONS. A licensed midwife may obtain and administer8 any medication indicated for maternal care or neonatal care for which the9 midwife possesses the requisite education, training, and experience. Ad-10 ministration of such medication shall be performed within the acceptable11 community standard of care.12

SECTION 3. That Section 54-5510, Idaho Code, be, and the same is hereby13 amended to read as follows:14 54-5510. DISCLOSURE AND RECORDKEEPING -- LICENSE RENEWAL. (1) Before15 initiating care, a licensed midwife shall obtain a signed informed consent16 agreement from each client, acknowledging receipt, at a minimum, of the fol-17 lowing:18 (a) The licensed midwife's training and experience;19 (b) Instructions for obtaining a copy of the rules adopted by the board20 pursuant to this chapter;21 (c) Instructions for obtaining a copy of the NACPM essential documents22 and NARM job description;23 (d) Instructions for filing complaints with the board;24 (e) Notice of whether or not the licensed midwife has professional lia-25 bility insurance coverage;26 (f) A written protocol for emergencies, including hospital transport,27 that is specific to each individual client;28 (g) A description of the procedures, benefits, and risks of home birth,29 primarily those conditions that may arise during delivery; and30 (h) Any other information required by board rule.31 (2) All licensed midwives shall maintain a record of all signed in-32 formed consent agreements for each client for a minimum of nine (9) years33 after the last day of care for such client.34 (3) Before providing care for a client who has a history of disorders,35 diagnoses, conditions, or symptoms identified in section 54-5504(1)(e)(ii)36 54-5504(1)(c)(ii), Idaho Code, the licensed midwife shall provide writ-37 ten notice to the client that the client must obtain care from a physician38 licensed pursuant to chapter 18, title 54, Idaho Code, as a condition39 to her eligibility to obtain maternity care from the licensed midwife.40 Before providing care for a client who has a history of disorders, diag-41 noses, conditions, or symptoms identified in section 54-5504(1)(e)(iii)42 54-5504(1)(c)(iii), Idaho Code, or who has had a previous cesarean section,43 the licensed midwife shall provide written notice to the client that the44 client is advised to consult with a physician licensed pursuant to chapter45 18, title 54, Idaho Code, during her pregnancy. The midwife shall obtain the46 client's signed acknowledgment of receipt of said notice.47

6 (4) Any licensed midwife submitting an application to renew a license1 shall compile and submit to the board complete practice data for the calendar2 year preceding the date of the application. Such information shall be pro-3 vided in form and content as prescribed by rule of the board and shall include4 but not be limited to:5 (a) The number of clients to whom care has been provided by the licensed6 midwife;7 (b) The number of deliveries performed by the licensed midwife;8 (c) The apgar scores of the infants delivered by the licensed midwife;9 (d) The number of prenatal transfers;10 (e) The number of transfers during labor, during delivery, and immedi-11 ately following birth;12 (f) Any perinatal deaths; and13 (g) Other morbidity statistics as required by the board.14

SECTION 4. The rules contained in IDAPA 24.26.01., Idaho Board of Mid-15 wifery, relating to Protocols for the Use of Formulary Drugs, Section 200.,16 Subsection 01., shall be null, void, and of no force and effect on and after17 July 1, 2026.18

SECTION 5. An emergency existing therefor, which emergency is hereby19 declared to exist, this act shall be in full force and effect on and after20 July 1, 2026.21