TITLE XXX
OCCUPATIONS AND PROFESSIONS

Chapter 326-D
MIDWIFERY

Section 326-D:1

    326-D:1 Purpose. –
I. The general court finds that the practice of midwifery has been a part of the culture and tradition of New Hampshire since colonial days and that it is in the public interest to remove impediments to the practice of midwifery.
II. For personal and economic reasons some New Hampshire citizens will have home births. It is the intent of the general court to preserve the rights of women to deliver children at home, to remove obstacles to safe out-of-hospital deliveries, and to assure quality care.
III. The general court further finds that childbirth is a culmination of pregnancy and is a natural process rather than an illness.
IV. The general court acknowledges that the services of a certified midwife are a reasonable alternative for healthy pregnant women.
V. The general court hereby intends that the scope of practice of midwifery shall be modeled on The International Definition of Midwifery as accepted by the World Health Organization and the International Confederation of Midwives. However, in no event shall the scope of midwifery practice exceed the parameters of the definition of "midwifery" under RSA 326-D:2, V.

Source. 1999, 213:8, eff. July 6, 1999.

Section 326-D:2

    326-D:2 Definitions. –
In this chapter:
I. "Client" means a woman who has retained the services of a midwife for the duration of her pregnancy, labor and the postpartum period and as defined in the scope of practice adopted by the council pursuant to RSA 541-A.
II. "Council" means the midwifery council established in RSA 326-D:3.
III. [Repealed.]
IV. "Midwife" means one who is certified to practice midwifery pursuant to this chapter.
V. "Midwifery" means the practice, by persons other than physicians or surgeons licensed under RSA 329, nurses registered under RSA 326-B, or physician's assistants licensed under RSA 328-D, of:
(a) Providing the necessary supervision, care and advice to women during pregnancy, labor and the postpartum period;
(b) Conducting vaginal deliveries on the midwife's own responsibility, and caring for the newborn and the infant; such care to mother and child to include preventive measures, the detection of abnormal conditions, the procurement of medical assistance, and the execution of emergency measures in the absence of medical help; and
(c) Consulting with a physician whenever there are significant deviations from normal or whenever there is a medical emergency in either the mother or the infant.

Source. 1999, 213:8, eff. July 6, 1999. 2021, 197:89, I, eff. July 1, 2021.

Section 326-D:3

    326-D:3 Council Established. –
I. There shall be a midwifery council consisting of 6 members to be appointed by the governor with the advice and consent of the executive council. Members shall be appointed for 4-year terms. No member shall be appointed to more than 2 consecutive terms. All members of the council shall have been residents of this state for at least 5 years preceding appointment and shall include:
(a) An obstetrician licensed to practice medicine under RSA 329 with experience in working with midwives certified pursuant to this chapter.
(b) A pediatrician licensed to practice medicine under RSA 329 with experience in working with midwives certified pursuant to this chapter.
(c) Three midwives certified under this chapter, who have each attended at least 50 deliveries as midwives.
(d) One member of the general public who has familiarity with the practice of midwifery. The public member shall be a resident of the state of New Hampshire who is not, and never has been, a member of the midwifery profession or the spouse of any such person. The public member shall not have, and shall never have had, a material financial interest in either the provision of midwifery services or an activity directly related to midwifery, including the representation of the council or its predecessor or the profession for a fee at any time during the 5 years preceding the date of appointment.
II. Members appointed to the council shall serve without compensation.
III. [Repealed.]
IV. Members of the council shall elect a chairperson annually from among their members. The council shall meet at least quarterly and may hold additional meetings at such times as it may deem necessary. A quorum of the council shall consist of a majority of the members of the council who have been approved by the governor and council.

Source. 1999, 213:8. 2010, 118:8. 2015, 276:108, XXVIII, eff. July 1, 2015. 2021, 197:87, eff. July 1, 2021. 2023, 212:22, eff. Oct. 3, 2023.

Section 326-D:4

    326-D:4 Powers and Duties of the Council. –
I. The powers and duties of the council shall include:
(a) Certifying eligible applicants for certification under this chapter.
(b) [Repealed.]
(c) [Repealed.]
II. The council shall have the power to subpoena witnesses and administer oaths in any hearing or disciplinary proceedings, and to compel, by subpoena duces tecum, the production of papers and records.

Source. 1999, 213:8. 2014, 167:24, eff. July 1, 2014. 2019, 346:155, eff. July 1, 2019. 2021, 197:85, eff. July 1, 2021. 2023, 212:23, I, eff. Oct. 2, 2023.

Section 326-D:5

    326-D:5 Rulemaking. –
I. The council shall adopt rules, pursuant to RSA 541-A, relative to:
(a) Qualifications for the practice of midwifery.
(b) The teaching of midwifery.
(c) The scope of practice and procedures in the practice of midwifery, including policies for professional direction and supervision.
(d) Eligibility requirements for the certification of midwives and the issuance of certificates of midwifery, including procedures for provisional certification and recertification after certification has lapsed.
(e) Renewal eligibility requirements, including requirements for continuing education and peer review.
(f) Diagnostic and laboratory tests midwives may administer and perform and the proper administration of RSA 326-D:12.
(g) Standards for reciprocity.
(h) Establishing all administrative fines authorized under RSA 326-D:8, III(a)(4).
(i) Reporting requirements relative to client information and notification of transfers.
II. No rule relative to the scope of midwifery practice shall exceed the parameters of the definition of "midwifery" under RSA 326-D:2, V.
III. [Repealed.]

Source. 1999, 213:8. 2014, 167:25, eff. July 1, 2014. 2021, 197:86, eff. July 1, 2021. 2023, 212:23, II, eff. Oct. 3, 2023.

Section 326-D:6

    326-D:6 Certification. –
I. No person shall practice midwifery in this state without first obtaining certification from the council. The council shall certify for the practice of midwifery any person applying for such certification who meets the qualifications adopted under RSA 326-D:5, I(a) and who submits a $110 certification fee.
II. Certification issued under this chapter shall be subject to renewal every 2 years and shall expire unless renewed in accordance with rules adopted by the council and upon payment of a $110 renewal fee.
III. The title "certified midwife" shall be used only by persons certified under this chapter. No person shall continue to represent himself or herself as a certified midwife after certification has been suspended under this chapter. Any person whose certification under this chapter has been suspended or revoked by the council for disciplinary action under RSA 326-D:8, shall not engage in the practice of midwifery unless and until the suspension or revocation of certification has been lifted.
IV. Any person who shall practice or attempt to practice as a certified midwife in this state without certification shall be guilty of a class A misdemeanor if a natural person or guilty of a felony if any other person. Any person violating any other provision of this chapter shall be guilty of a violation.

Source. 1999, 213:8. 2006, 76:9. 2014, 167:26, eff. July 1, 2014.

Section 326-D:7

    326-D:7 Qualifications. –
In order to be certified as a midwife by the council, a person shall:
I. Have completed high school or its equivalent.
II. Complete one college-level course in human anatomy and physiology, or pass a college-level equivalency program or credit by exam.
III. Express an intent to engage in the active practice of midwifery in the state.
IV. Submit an affidavit disclosing any criminal convictions. If the council determines that such conviction has a direct bearing on the applicant's ability to serve as a midwife, such conviction may serve as a basis for denial of certification.
V. Meet practical experience requirements prescribed by the council, including specific numbers of prenatal visits, post-partum follow-up exams, attendance at live births as an observer and primary birth attendant under supervision, performance of newborn examinations, performance of laceration repairs, performance of postpartum visits, and observation of in-hospital births.
VI. Present evidence of technical skills as prescribed by the council.
VII. Present evidence of a passing grade on a certification examination approved by the council.
VIII. Pass both a written and an oral examination administered by the council. Such examinations shall include, but shall not be limited to, questions relative to New Hampshire laws and rules governing midwives.

Source. 1999, 213:8, eff. July 6, 1999.

Section 326-D:8

    326-D:8 Disciplinary Action. –
I. [Repealed.]
II. Misconduct sufficient to support disciplinary proceedings under this section shall include:
(a) The practice of fraud or deceit in procuring or attempting to procure certification to practice under this chapter.
(b) Conviction of any crime which demonstrates unfitness to practice midwifery.
(c) Demonstrable gross incompetence of the certificate holder.
(d) Addiction to the use of alcohol or other habit-forming drugs to a degree which renders the certificate holder unfit to practice under this chapter.
(e) A legal finding of mental incompetence.
(f) Willful or repeated violation of the provisions of this chapter.
(g) Suspension or revocation without subsequent reinstatement of certification, similar to one issued under this chapter, in another jurisdiction.
III. [Repealed.]

Source. 1999, 213:8, eff. July 6, 1999. 2023, 212:23, III, eff. Oct. 3, 2023.

Section 326-D:9

    326-D:9 Repealed by 2021, 197:89, II, eff. July 1, 2021. –

Section 326-D:10

    326-D:10 Repealed by 2021, 197:89, III, eff. July 1, 2021. –

Section 326-D:11

    326-D:11 Certificate Renewal; Continuing Education. – Every person certified under this chapter shall apply to the council for certificate renewal every 2 years. Renewals of certificates shall be contingent upon presentation of satisfactory evidence to the council of having met the continuing education requirements established by the council pursuant to RSA 326-D:5, I(e) and shall be accompanied by the renewal fee established by the office of professional licensure and certification. All certificates shall automatically lapse 2 years after the date of issuance unless a timely and complete renewal application has been filed with the council. In no event shall a certificate, for which a timely and complete application for renewal has been submitted, expire before the council has taken final action upon the application.

Source. 1999, 213:8, eff. July 6, 1999. 2021, 197:88, eff. July 1, 2021.

Section 326-D:12

    326-D:12 Administration of Drugs and Medications. –
I. A midwife certified under this chapter may obtain, possess, and administer the following medications under the conditions indicated:
(a) Rh immune globin (Rhogam), if indicated.
(b) Eye prophylaxis in accordance with RSA 132:6.
(c) Oxygen for fetal distress and infant resuscitation.
(d) Lidocaine Hydrochloride by infiltration and suture material, but only for the purpose of postpartum repair of tears, lacerations, or episiotomy.
(e) Vitamin K by injection or oral vitamin K for control and prevention of acute and late onset hemorrhagic disease in the newborn.
(f) Oxytocins such as pitocin, ergotrate, and methergine, by injection or orally, only for postpartum control of maternal hemorrhage.
(g) Intravenous fluids such as Ringer's Lactate with or without D5W and Normosol-R with or without D5W, with no additional medications unless specifically ordered by physician.
(h) Other drugs or medications as prescribed by a physician, consistent with the scope of midwifery practice as defined by the council.
II. A midwife certified pursuant to this chapter may lawfully purchase and have possession of the medications named in RSA 326-D:12, I, and the equipment normally required for administration. The labels attached to such medications and equipment shall indicate that they are for administrative use only.
III. A pharmacist who dispenses such medications to a certified midwife shall not be liable for any adverse reactions caused by any method of use by the midwife.

Source. 1999, 213:8, eff. July 6, 1999.

Section 326-D:12-a

    326-D:12-a Telemedicine. – A midwife certified under this chapter shall be permitted to provide services through the use of telemedicine. "Telemedicine" means the use of audio, video, or other electronic media for the purpose of diagnosis, consultation, or treatment.

Source. 2020, 27:19, eff. July 21, 2020.

Section 326-D:13

    326-D:13 Reciprocity. – The council may certify any applicant who is licensed in any other state, provided the other state's licensing or certification requirements are substantially equivalent to or higher than those of this state.

Source. 1999, 213:8, eff. July 6, 1999.

Section 326-D:14

    326-D:14 Exceptions. –
I. Any person who was certified as a lay-midwife under the previous provisions of RSA 326-D shall be immediately eligible for certification as a midwife upon the effective date of this section.
II. Residents of this state who held themselves out as midwives prior to July 1, 1999, may continue to practice in this state without certification until June 30, 2001. Such midwives, however, shall obtain certification under this chapter by July 1, 2001 in order to practice midwifery. Such midwives may be certified under this chapter, if they meet all of the qualifications under RSA 326-D:7, except that experience requirements under RSA 326-D:7, V, shall be waived if the applicant can document at least 50 successful home births.

Source. 1999, 213:8, eff. July 6, 1999.