Chapter 18.50 RCW



18.50.010Practicing midwifery definedGratuitous servicesDuty to consult with physician.
18.50.020License required.
18.50.030ExemptionsPractice of religionTreatment by prayer.
18.50.032ExemptionsRegistered nurses and nurse midwives.
18.50.034ExemptionsPersons enrolled in midwifery programs.
18.50.040Candidates for examinationApplicationEligibilityStudent midwife permits.
18.50.045Midwifery education programsAccreditation.
18.50.050Compliance with secretary's determination.
18.50.060ExaminationsTimes and placesSubjectsIssuance of license.
18.50.065Credentialing by endorsement.
18.50.102License renewal.
18.50.105Inform patient of qualifications of midwifeForm.
18.50.108Written plan for consultation, emergency transfer, and transport.
18.50.115Administration of drugs and medicationsRules.
18.50.126Application of uniform disciplinary act.
18.50.130"Certificate" and "license" synonymous.
18.50.140Midwifery advisory committeeGenerally.
18.50.150Midwifery advisory committeeAdvice and recommendations.
18.50.160Delegation to nurse.
18.50.170Down syndromeParent information.
18.50.900Repeal and saving.


Abortion: Chapter 9.02 RCW.
Actions for injuries resulting from health care: Chapter 7.70 RCW.
Crimes relating to pregnancy and childbirth: RCW 9A.32.060.
Health professions accountFees creditedRequirements for biennial budget requestUnappropriated funds: RCW 43.70.320.
Registration of live birth: Chapter 70.58A RCW.
Secretary of health or designee ex officio member of health professional licensure and disciplinary boards: RCW 43.70.300.


Unless the context clearly requires otherwise, the definitions in this section apply throughout this chapter:
(1) "Department" means the department of health.
(2) "Secretary" means the secretary of health.
(3) "Midwife" means a midwife licensed under this chapter.
(4) "Physician" means a physician licensed under chapter 18.57 or 18.71 RCW.


Effective date1981 c 53: "Sections 1, 2, 5, 6, 8, 9, 10, 11, and 13 through 17 of this act shall take effect January 15, 1982." [ 1981 c 53 § 19.]

Practicing midwifery definedGratuitous servicesDuty to consult with physician.

Any person shall be regarded as practicing midwifery within the meaning of this chapter who shall render medical aid for a fee or compensation to a woman during prenatal, intrapartum, and postpartum stages or to her newborn up to two weeks of age or who shall advertise as a midwife by signs, printed cards, or otherwise. Nothing shall be construed in this chapter to prohibit gratuitous services. It shall be the duty of a midwife to consult with a physician whenever there are significant deviations from normal in either the mother or the newborn.


Effective date1981 c 53: See note following RCW 18.50.005.

License required.

Any person who shall practice midwifery in this state after July 1, 1917, shall first obtain from the secretary a license so to do, and the said secretary is authorized to grant such license after examination of the applicant as hereinafter provided.
[ 1991 c 3 § 104; 1917 c 160 § 1; RRS § 10174.]

ExemptionsPractice of religionTreatment by prayer.

This chapter shall not be construed to interfere in any way with the practice of religion, nor be held to apply to or regulate any kind of treatment by prayer.
[ 1917 c 160 § 12; RRS § 10185. FORMER PART OF SECTION: 1917 c 160 § 8, part; RRS § 10181, part, now codified in RCW 18.50.010.]


Gratuitous services exempted: RCW 18.50.010.

ExemptionsRegistered nurses and nurse midwives.

Registered nurses and nurse midwives certified by the nursing care quality assurance commission under chapter 18.79 RCW shall be exempt from the requirements and provisions of this chapter.


SeverabilityHeadings and captions not lawEffective date1994 sp.s. c 9: See RCW 18.79.900 through 18.79.902.
Effective date1981 c 53: See note following RCW 18.50.005.

ExemptionsPersons enrolled in midwifery programs.

Nothing in this chapter shall be construed to apply to or interfere in any way with the practice of midwifery by a person who is enrolled in a program of midwifery approved and accredited by the secretary: PROVIDED, That the performance of such services is only pursuant to a regular course of instruction or assignment from the student's instructor, and that such services are performed only under the supervision and control of a person licensed in the state of Washington to perform services encompassed under this chapter.


Effective date1981 c 53: See note following RCW 18.50.005.

Candidates for examinationApplicationEligibilityStudent midwife permits.

(1) Any person seeking to be examined shall present to the secretary, at least forty-five days before the commencement of the examination, a written application on a form or forms provided by the secretary setting forth under affidavit such information as the secretary may require and proof the candidate has received a high school degree or its equivalent; that the candidate is twenty-one years of age or older; that the candidate has received a certificate or diploma from a midwifery program accredited by the secretary and licensed under chapter 28C.10 RCW, when applicable, or a certificate or diploma in a foreign institution on midwifery of equal requirements conferring the full right to practice midwifery in the country in which it was issued. The diploma must bear the seal of the institution from which the applicant was graduated. Foreign candidates must present with the application a translation of the foreign certificate or diploma made by and under the seal of the consulate of the country in which the certificate or diploma was issued.
(2) The candidate shall meet the following conditions:
(a) Obtaining a minimum period of midwifery training for at least three years including the study of the basic nursing skills that the department shall prescribe by rule. However, if the applicant is a registered nurse or licensed practical nurse under chapter 18.79 RCW, or has had previous nursing education or practical midwifery experience, the required period of training may be reduced depending upon the extent of the candidate's qualifications as determined under rules adopted by the department. In no case shall the training be reduced to a period of less than two years.
(b) Meeting minimum educational requirements which shall include studying obstetrics; neonatal pediatrics; basic sciences; female reproductive anatomy and physiology; behavioral sciences; childbirth education; community care; obstetrical pharmacology; epidemiology; gynecology; family planning; genetics; embryology; neonatology; the medical and legal aspects of midwifery; nutrition during pregnancy and lactation; breastfeeding; nursing skills, including but not limited to injections, administering intravenous fluids, catheterization, and aseptic technique; and such other requirements prescribed by rule.
(c) For a student midwife during training, undertaking the care of not less than fifty women in each of the prenatal, intrapartum, and early postpartum periods, but the same women need not be seen through all three periods. A student midwife may be issued a permit upon the satisfactory completion of the requirements in (a), (b), and (c) of this subsection and the satisfactory completion of the licensure examination required by RCW 18.50.060. The permit permits the student midwife to practice under the supervision of a midwife licensed under this chapter, a physician or a certified nurse-midwife licensed under the authority of chapter 18.79 RCW. The permit shall expire within one year of issuance and may be extended as provided by rule.
(d) Observing an additional fifty women in the intrapartum period before the candidate qualifies for a license.
(3) Notwithstanding subsections (1) and (2) of this section, the department shall adopt rules to provide credit toward the educational requirements for licensure before July 1, 1988, of nonlicensed midwives, including rules to provide:
(a) Credit toward licensure for documented deliveries;
(b) The substitution of relevant experience for classroom time; and
(c) That experienced lay midwives may sit for the licensing examination without completing the required coursework.
The training required under this section shall include training in either hospitals or alternative birth settings or both with particular emphasis on learning the ability to differentiate between low-risk and high-risk pregnancies.


SeverabilityHeadings and captions not lawEffective date1994 sp.s. c 9: See RCW 18.79.900 through 18.79.902.
Effective date1986 c 299: See RCW 28C.10.902.
Effective date1981 c 53: See note following RCW 18.50.005.

Midwifery education programsAccreditation.

The secretary shall promulgate standards by rule under chapter 34.05 RCW for accrediting midwifery educational programs. The standards shall cover the provision of adequate clinical and didactic instruction in all subjects and noncurriculum matters under this section including, but not limited to, staffing and teacher qualifications. In developing the standards, the secretary shall be advised by and receive the recommendations of the midwifery advisory committee.

Compliance with secretary's determination.

Applicants shall comply with administrative procedures, administrative requirements, and fees determined by the secretary as provided by RCW 43.70.250 and 43.70.280.


Limitation on increases in midwifery fees: RCW 43.24.086.

ExaminationsTimes and placesSubjectsIssuance of license.

(1) The secretary is hereby authorized and empowered to execute the provisions of this chapter and shall offer examinations in midwifery at least twice a year at such times and places as the secretary may select. The examinations shall be written and shall be in the English language.
(2) The secretary, with the assistance of the midwifery advisory committee, shall develop or approve a licensure examination in the subjects that the secretary determines are within the scope of and commensurate with the work performed by a licensed midwife. The examination shall be sufficient to test the scientific and practical fitness of candidates to practice midwifery. All application papers shall be deposited with the secretary and there retained for at least one year, when they may be destroyed.
(3) If the examination is satisfactorily completed, the secretary shall issue to such candidate a license entitling the candidate to practice midwifery in the state of Washington.


Effective date1981 c 53: See note following RCW 18.50.005.

Credentialing by endorsement.

(1) An applicant holding a credential in another state may be credentialed to practice in this state without examination if the secretary determines that the other state's credentialing standards are substantially equivalent to the standards in this state.
(2) The secretary shall write rules to bridge the gap between requirements of national certification of certified professional midwives and state requirements for licensure for licensed midwives.


Application to scope of practiceCaptions not law1991 c 332: See notes following RCW 18.130.010.

License renewal.

(1) A licensed midwife must renew his or her license according to the following requirements:
(a) Completion of a minimum of thirty hours of continuing education, approved by the secretary, every three years;
(b) Proof of participation in a Washington state coordinated quality improvement program as detailed in rule;
(c) Proof of participation in data submission on perinatal outcomes to a national or state research organization, as detailed in rule; and
(d) Fees determined by the secretary as provided in RCW 43.70.250 and 43.70.280.
(2) The secretary shall write rules regarding the renewal requirements and the department's process for verification of the third-party data submission.


Effective date1981 c 53: See note following RCW 18.50.005.
Limitation on increases in midwifery fees: RCW 43.24.086.

Inform patient of qualifications of midwifeForm.

The secretary, with the advice of the midwifery advisory committee, shall develop a form to be used by a midwife to inform the patient of the qualifications of a licensed midwife.

Written plan for consultation, emergency transfer, and transport.

Every licensed midwife shall develop a written plan for consultation with other health care providers, emergency transfer, transport of an infant to a newborn nursery or neonatal intensive care nursery, and transport of a woman to an appropriate obstetrical department or patient care area. The written plan shall be submitted annually together with the license renewal fee to the department.


Effective date1981 c 53: See note following RCW 18.50.005.

Administration of drugs and medicationsRules.

A midwife licensed under this chapter may obtain and administer prophylactic ophthalmic medication, postpartum oxytocic, vitamin K, Rho immune globulin (human), and local anesthetic and may administer such other drugs or medications as prescribed by a physician. A pharmacist who dispenses such drugs to a licensed midwife shall not be liable for any adverse reactions caused by any method of use by the midwife.
The secretary, after consultation with representatives of the midwife advisory committee, the pharmacy quality assurance commission, and the Washington medical commission, may adopt rules that authorize licensed midwives to purchase and use legend drugs and devices in addition to the drugs authorized in this chapter.


SeverabilityHeadings and captions not lawEffective date1994 sp.s. c 9: See RCW 18.79.900 through 18.79.902.

Application of uniform disciplinary act.

The uniform disciplinary act, chapter 18.130 RCW, governs unlicensed practice, the issuance and denial of licenses, and the discipline of licensees under this chapter.


Severability1987 c 150: See RCW 18.122.901.
Severability1986 c 259: See note following RCW 18.130.010.

"Certificate" and "license" synonymous.

The words "certificate" and "license" shall be known as interchangeable terms in this chapter.
[ 1917 c 160 § 11; RRS § 10184.]


The secretary shall promulgate rules under chapter 34.05 RCW as are necessary to carry out the purposes of this chapter.


Effective date1981 c 53: See note following RCW 18.50.005.

Midwifery advisory committeeGenerally.

The midwifery advisory committee is created.
The committee shall be composed of one physician who is a practicing obstetrician; one practicing physician; one certified nurse midwife licensed under chapter 18.79 RCW; three midwives licensed under this chapter; and one public member, who shall have no financial interest in the rendering of health services. The committee may seek other consultants as appropriate, including persons trained in childbirth education and perinatology or neonatology.
The members are appointed by the secretary and serve at the pleasure of the secretary but may not serve more than five years consecutively. The terms of office shall be staggered. Members of the committee shall be reimbursed for travel expenses as provided in RCW 43.03.050 and 43.03.060.


SeverabilityHeadings and captions not lawEffective date1994 sp.s. c 9: See RCW 18.79.900 through 18.79.902.

Midwifery advisory committeeAdvice and recommendations.

The midwifery advisory committee shall advise and make recommendations to the secretary on issues including, but not limited to, continuing education, mandatory reexamination, and peer review.

Delegation to nurse.

A licensed midwife may delegate to a registered nurse or a licensed practical nurse selected acts, tasks, or procedures that constitute the practice of midwifery but do not exceed the education of the nurse.

Down syndromeParent information.

A midwife who provides a parent with a positive prenatal or postnatal diagnosis of Down syndrome shall provide the parent with the information prepared by the department under RCW 43.70.738 at the time the midwife provides the parent with the Down syndrome diagnosis.

Repeal and saving.

All acts or parts of acts inconsistent with the provisions of this chapter may be and the same are hereby repealed: PROVIDED, This chapter shall not repeal the provisions of the vital statistics laws of the state, but shall be deemed as additional and cumulative provisions.