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Chapter 246-834 WAC

Last Update: 4/30/24

MIDWIVES

WAC Sections

HTMLPDF246-834-010Definitions.
HTMLPDF246-834-020Secretary accredited midwifery programs.
HTMLPDF246-834-030Eligibility for state licensing examination.
HTMLPDF246-834-050Examination requirements for licensure as a midwife.
HTMLPDF246-834-055Examination failures.
HTMLPDF246-834-060Initial application requirements for licensure as a midwife.
HTMLPDF246-834-062Initial or reinstating application for individuals who have not been in the active practice of midwifery.
HTMLPDF246-834-065Application for examination—Foreign trained.
HTMLPDF246-834-066Certified professional midwife (CPM) licensure requirements.
HTMLPDF246-834-067Preceptor for certified professional midwife (CPM) licensure program.
HTMLPDF246-834-068Trainee permit for certified professional midwife (CPM) licensure program.
HTMLPDF246-834-160Student midwife permit.
HTMLPDF246-834-165Application requirements for a licensed midwife seeking a limited prescriptive license extension, a license extension for medical devices, or a license extension for implants.
HTMLPDF246-834-250Legend drugs and devices.
HTMLPDF246-834-255Elements of care for the newborn.
HTMLPDF246-834-345License renewal.
HTMLPDF246-834-355Continuing education.
HTMLPDF246-834-360Quality improvement program.
HTMLPDF246-834-370Data submission.
HTMLPDF246-834-400Expired license.
HTMLPDF246-834-450Inactive license.
HTMLPDF246-834-990Midwifery fees and renewal cycle.
DISPOSITION OF SECTIONS FORMERLY CODIFIED IN THIS TITLE
246-834-070Release of examination results. [Statutory Authority: RCW 18.50.060. WSR 99-03-064, § 246-834-070, filed 1/18/99, effective 2/18/99. Statutory Authority: RCW 43.70.040. WSR 91-02-049 (Order 121), recodified as § 246-834-070, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 18.50.135. WSR 82-19-079 (Order PL 406), § 308-115-070, filed 9/21/82.] Repealed by WSR 17-15-024, filed 7/7/17, effective 8/7/17. Statutory Authority: RCW 18.50.010, 18.50.040, 18.50.050, 18.50.135, and 2014 c 187.
246-834-080Examination failures. [Statutory Authority: RCW 18.50.010, 18.50.040, 18.50.050, 18.50.135, and 2014 c 187. WSR 17-15-024, § 246-834-080, filed 7/7/17, effective 8/7/17. Statutory Authority: RCW 18.50.060. WSR 99-03-064, § 246-834-080, filed 1/18/99, effective 2/18/99. Statutory Authority: RCW 18.50.135 and 18.50.045. WSR 92-02-018 (Order 224), § 246-834-080, filed 12/23/91, effective 1/23/92. Statutory Authority: RCW 43.70.040. WSR 91-02-049 (Order 121), recodified as § 246-834-080, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 18.50.135. WSR 82-19-079 (Order PL 406), § 308-115-080, filed 9/21/82.] Decodified by WSR 24-10-091, filed 4/30/24, effective 6/6/24. Statutory Authority: RCW 18.50.115, 18.50.135, 43.70.613, 2022 c 289, and 2021 c 276. Recodified as § 246-834-055.
246-834-090Purpose of accreditation of midwifery educational programs. [Statutory Authority: RCW 18.50.135 and 18.50.045. WSR 92-02-018 (Order 224), § 246-834-090, filed 12/23/91, effective 1/23/92. Statutory Authority: RCW 43.70.040. WSR 91-02-049 (Order 121), recodified as § 246-834-090, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 18.50.135. WSR 82-19-079 (Order PL 406), § 308-115-090, filed 9/21/82.] Repealed by WSR 17-15-024, filed 7/7/17, effective 8/7/17. Statutory Authority: RCW 18.50.010, 18.50.040, 18.50.050, 18.50.135, and 2014 c 187.
246-834-100Philosophy, purpose and objectives of an accredited midwifery educational program. [Statutory Authority: RCW 43.70.040. WSR 91-02-049 (Order 121), recodified as § 246-834-100, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 18.50.135. WSR 82-19-079 (Order PL 406), § 308-115-100, filed 9/21/82.] Repealed by WSR 17-15-024, filed 7/7/17, effective 8/7/17. Statutory Authority: RCW 18.50.010, 18.50.040, 18.50.050, 18.50.135, and 2014 c 187.
246-834-110Advisory body. [Statutory Authority: RCW 43.70.040. WSR 91-02-049 (Order 121), recodified as § 246-834-110, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 18.50.135. WSR 82-19-079 (Order PL 406), § 308-115-110, filed 9/21/82.] Repealed by WSR 17-15-024, filed 7/7/17, effective 8/7/17. Statutory Authority: RCW 18.50.010, 18.50.040, 18.50.050, 18.50.135, and 2014 c 187.
246-834-120Learning sites. [Statutory Authority: RCW 43.70.040. WSR 91-02-049 (Order 121), recodified as § 246-834-120, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 18.50.135. WSR 82-19-079 (Order PL 406), § 308-115-120, filed 9/21/82.] Repealed by WSR 17-15-024, filed 7/7/17, effective 8/7/17. Statutory Authority: RCW 18.50.010, 18.50.040, 18.50.050, 18.50.135, and 2014 c 187.
246-834-130Staffing and teacher qualifications. [Statutory Authority: RCW 18.50.135 and 18.50.045. WSR 92-02-018 (Order 224), § 246-834-130, filed 12/23/91, effective 1/23/92. Statutory Authority: RCW 43.70.040. WSR 91-02-049 (Order 121), recodified as § 246-834-130, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 18.50.045. WSR 86-16-012 (Order PM 608), § 308-115-130, filed 7/25/86. Statutory Authority: RCW 18.50.135. WSR 82-19-079 (Order PL 406), § 308-115-130, filed 9/21/82.] Repealed by WSR 17-15-024, filed 7/7/17, effective 8/7/17. Statutory Authority: RCW 18.50.010, 18.50.040, 18.50.050, 18.50.135, and 2014 c 187.
246-834-135Secretary accredited midwifery programs. [Statutory Authority: RCW 18.50.010, 18.50.040, 18.50.050, 18.50.135, and 2014 c 187. WSR 17-15-024, § 246-834-135, filed 7/7/17, effective 8/7/17.] Decodified by WSR 24-10-091, filed 4/30/24, effective 6/6/24. Statutory Authority: RCW 18.50.115, 18.50.135, 43.70.613, 2022 c 289, and 2021 c 276. Recodified as § 246-834-020.
246-834-140Eligibility for state licensing examination. [Statutory Authority: RCW 18.50.010, 18.50.040, 18.50.050, 18.50.135, and 2014 c 187. WSR 17-15-024, § 246-834-140, filed 7/7/17, effective 8/7/17. Statutory Authority: RCW 18.50.135 and 18.50.045. WSR 92-02-018 (Order 224), § 246-834-140, filed 12/23/91, effective 1/23/92. Statutory Authority: RCW 43.70.040. WSR 91-02-049 (Order 121), recodified as § 246-834-140, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 18.50.135. WSR 87-21-011 (Order PM 686), § 308-115-140, filed 10/9/87; WSR 85-23-044 (Order PL 566), § 308-115-140, filed 11/18/85; WSR 82-19-079 (Order PL 406), § 308-115-140, filed 9/21/82.] Decodified by WSR 24-10-091, filed 4/30/24, effective 6/6/24. Statutory Authority: RCW 18.50.115, 18.50.135, 43.70.613, 2022 c 289, and 2021 c 276. Recodified as § 246-834-030.
246-834-150Students. [Statutory Authority: RCW 18.50.135 and 18.50.045. WSR 92-02-018 (Order 224), § 246-834-150, filed 12/23/91, effective 1/23/92. Statutory Authority: RCW 43.70.040. WSR 91-02-049 (Order 121), recodified as § 246-834-150, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 18.50.135. WSR 85-23-044 (Order PL 566), § 308-115-150, filed 11/18/85; WSR 82-19-079 (Order PL 406), § 308-115-150, filed 9/21/82.] Repealed by WSR 17-15-024, filed 7/7/17, effective 8/7/17. Statutory Authority: RCW 18.50.010, 18.50.040, 18.50.050, 18.50.135, and 2014 c 187.
246-834-170Reports to the department of health by accredited midwifery educational programs. [Statutory Authority: RCW 43.70.280. WSR 98-05-060, § 246-834-170, filed 2/13/98, effective 3/16/98. Statutory Authority: RCW 18.50.135 and 18.50.045. WSR 92-02-018 (Order 224), § 246-834-170, filed 12/23/91, effective 1/23/92. Statutory Authority: RCW 43.70.040. WSR 91-02-049 (Order 121), recodified as § 246-834-170, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 18.50.135. WSR 82-19-079 (Order PL 406), § 308-115-170, filed 9/21/82.] Repealed by WSR 17-15-024, filed 7/7/17, effective 8/7/17. Statutory Authority: RCW 18.50.010, 18.50.040, 18.50.050, 18.50.135, and 2014 c 187.
246-834-180Application for accreditation. [Statutory Authority: RCW 18.50.135 and 18.50.045. WSR 92-02-018 (Order 224), § 246-834-180, filed 12/23/91, effective 1/23/92. Statutory Authority: RCW 43.70.040. WSR 91-02-049 (Order 121), recodified as § 246-834-180, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 18.50.045. WSR 86-16-012 (Order PM 608), § 308-115-180, filed 7/25/86. Statutory Authority: RCW 18.50.135. WSR 82-19-079 (Order PL 406), § 308-115-180, filed 9/21/82.] Repealed by WSR 17-15-024, filed 7/7/17, effective 8/7/17. Statutory Authority: RCW 18.50.010, 18.50.040, 18.50.050, 18.50.135, and 2014 c 187.
246-834-190School survey visits. [Statutory Authority: RCW 18.50.135 and 18.50.045. WSR 92-02-018 (Order 224), § 246-834-190, filed 12/23/91, effective 1/23/92. Statutory Authority: RCW 43.70.040. WSR 91-02-049 (Order 121), recodified as § 246-834-190, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 18.50.135. WSR 85-23-044 (Order PL 566), § 308-115-190, filed 11/18/85; WSR 82-19-079 (Order PL 406), § 308-115-190, filed 9/21/82.] Repealed by WSR 17-15-024, filed 7/7/17, effective 8/7/17. Statutory Authority: RCW 18.50.010, 18.50.040, 18.50.050, 18.50.135, and 2014 c 187.
246-834-200Appeal of department of health decisions. [Statutory Authority: RCW 43.70.280. WSR 98-05-060, § 246-834-200, filed 2/13/98, effective 3/16/98. Statutory Authority: RCW 18.50.135, 18.50.045 and 34.05.220. WSR 92-02-018 (Order 224), § 246-834-200, filed 12/23/91, effective 1/23/92. Statutory Authority: RCW 43.70.040. WSR 91-02-049 (Order 121), recodified as § 246-834-200, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 18.50.135. WSR 82-19-079 (Order PL 406), § 308-115-200, filed 9/21/82.] Repealed by WSR 17-15-024, filed 7/7/17, effective 8/7/17. Statutory Authority: RCW 18.50.010, 18.50.040, 18.50.050, 18.50.135, and 2014 c 187.
246-834-210Closure of an accredited school of midwifery. [Statutory Authority: RCW 18.50.135 and 18.50.045. WSR 92-02-018 (Order 224), § 246-834-210, filed 12/23/91, effective 1/23/92. Statutory Authority: RCW 43.70.040. WSR 91-02-049 (Order 121), recodified as § 246-834-210, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 18.50.135. WSR 82-19-079 (Order PL 406), § 308-115-210, filed 9/21/82.] Repealed by WSR 17-15-024, filed 7/7/17, effective 8/7/17. Statutory Authority: RCW 18.50.010, 18.50.040, 18.50.050, 18.50.135, and 2014 c 187.
246-834-220Midwife-in-training program, credit toward educational requirements for licensure. [Statutory Authority: RCW 18.50.065, 18.50.135, and 18.50.040. WSR 15-20-049, § 246-834-220, filed 9/30/15, effective 10/31/15. Statutory Authority: RCW 18.50.135 and 18.50.045. WSR 92-02-018 (Order 224), § 246-834-220, filed 12/23/91, effective 1/23/92. Statutory Authority: RCW 43.70.040. WSR 91-02-049 (Order 121), recodified as § 246-834-220, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 18.50.040(3) and 18.50.115. WSR 88-12-040 (Order PM 732), § 308-115-220, filed 5/27/88.] Repealed by WSR 17-15-024, filed 7/7/17, effective 8/7/17. Statutory Authority: RCW 18.50.010, 18.50.040, 18.50.050, 18.50.135, and 2014 c 187.
246-834-230Midwife-in-training (MIT) program—Preceptor qualifications. [Statutory Authority: RCW 18.50.065, 18.50.135, and 18.50.040. WSR 15-20-049, § 246-834-230, filed 9/30/15, effective 10/31/15. Statutory Authority: RCW 18.50.135 and 18.50.045. WSR 92-02-018 (Order 224), § 246-834-230, filed 12/23/91, effective 1/23/92. Statutory Authority: RCW 43.70.040. WSR 91-02-049 (Order 121), recodified as § 246-834-230, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 18.50.040(3) and 18.50.115. WSR 88-12-040 (Order PM 732), § 308-115-230, filed 5/27/88.] Repealed by WSR 17-15-024, filed 7/7/17, effective 8/7/17. Statutory Authority: RCW 18.50.010, 18.50.040, 18.50.050, 18.50.135, and 2014 c 187.
246-834-240Trainee permit for midwife-in-training program. [Statutory Authority: RCW 18.50.065, 18.50.135, and 18.50.040. WSR 15-20-049, § 246-834-240, filed 9/30/15, effective 10/31/15. Statutory Authority: RCW 18.50.135 and 18.50.045. WSR 92-02-018 (Order 224), § 246-834-240, filed 12/23/91, effective 1/23/92. Statutory Authority: RCW 43.70.040. WSR 91-02-049 (Order 121), recodified as § 246-834-240, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 18.50.040(3) and 18.50.115. WSR 88-12-040 (Order PM 732), § 308-115-240, filed 5/27/88.] Repealed by WSR 17-15-024, filed 7/7/17, effective 8/7/17. Statutory Authority: RCW 18.50.010, 18.50.040, 18.50.050, 18.50.135, and 2014 c 187.
246-834-260General provisions. [Statutory Authority: RCW 43.70.280. WSR 98-05-060, § 246-834-260, filed 2/13/98, effective 3/16/98. Statutory Authority: RCW 18.50.135, 18.50.045, 18.130.050 and 18.130.070. WSR 92-02-018 (Order 224), § 246-834-260, filed 12/23/91, effective 1/23/92. Statutory Authority: RCW 43.70.040. WSR 91-02-049 (Order 121), recodified as § 246-834-260, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 18.130.070. WSR 89-14-092 (Order PM 842), § 308-115-260, filed 6/30/89.] Repealed by WSR 17-15-024, filed 7/7/17, effective 8/7/17. Statutory Authority: RCW 18.50.010, 18.50.040, 18.50.050, 18.50.135, and 2014 c 187.
246-834-270Mandatory reporting. [Statutory Authority: RCW 43.70.040. WSR 91-02-049 (Order 121), recodified as § 246-834-270, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 18.130.070. WSR 89-14-092 (Order PM 842), § 308-115-270, filed 6/30/89.] Repealed by WSR 17-15-024, filed 7/7/17, effective 8/7/17. Statutory Authority: RCW 18.50.010, 18.50.040, 18.50.050, 18.50.135, and 2014 c 187.
246-834-280Health care institutions. [Statutory Authority: RCW 43.70.040. WSR 91-02-049 (Order 121), recodified as § 246-834-280, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 18.130.070. WSR 89-14-092 (Order PM 842), § 308-115-280, filed 6/30/89.] Repealed by WSR 17-15-024, filed 7/7/17, effective 8/7/17. Statutory Authority: RCW 18.50.010, 18.50.040, 18.50.050, 18.50.135, and 2014 c 187.
246-834-290Midwifery associations or societies. [Statutory Authority: RCW 43.70.040. WSR 91-02-049 (Order 121), recodified as § 246-834-290, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 18.130.070. WSR 89-14-092 (Order PM 842), § 308-115-290, filed 6/30/89.] Repealed by WSR 17-15-024, filed 7/7/17, effective 8/7/17. Statutory Authority: RCW 18.50.010, 18.50.040, 18.50.050, 18.50.135, and 2014 c 187.
246-834-310Health care service contractors and disability insurance carriers. [Statutory Authority: RCW 43.70.040. WSR 91-02-049 (Order 121), recodified as § 246-834-310, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 18.130.070. WSR 89-14-092 (Order PM 842), § 308-115-310, filed 6/30/89.] Repealed by WSR 17-15-024, filed 7/7/17, effective 8/7/17. Statutory Authority: RCW 18.50.010, 18.50.040, 18.50.050, 18.50.135, and 2014 c 187.
246-834-320Professional liability carriers. [Statutory Authority: RCW 43.70.040. WSR 91-02-049 (Order 121), recodified as § 246-834-320, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 18.130.070. WSR 89-14-092 (Order PM 842), § 308-115-320, filed 6/30/89.] Repealed by WSR 17-15-024, filed 7/7/17, effective 8/7/17. Statutory Authority: RCW 18.50.010, 18.50.040, 18.50.050, 18.50.135, and 2014 c 187.
246-834-330Courts. [Statutory Authority: RCW 43.70.040. WSR 91-02-049 (Order 121), recodified as § 246-834-330, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 18.130.070. WSR 89-14-092 (Order PM 842), § 308-115-330, filed 6/30/89.] Repealed by WSR 17-15-024, filed 7/7/17, effective 8/7/17. Statutory Authority: RCW 18.50.010, 18.50.040, 18.50.050, 18.50.135, and 2014 c 187.
246-834-340State and federal agencies. [Statutory Authority: RCW 43.70.040. WSR 91-02-049 (Order 121), recodified as § 246-834-340, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 18.130.070. WSR 89-14-092 (Order PM 842), § 308-115-340, filed 6/30/89.] Repealed by WSR 17-15-024, filed 7/7/17, effective 8/7/17. Statutory Authority: RCW 18.50.010, 18.50.040, 18.50.050, 18.50.135, and 2014 c 187.
246-834-350Cooperation with investigation. [Statutory Authority: RCW 18.50.135, 18.50.045, 18.130.050 and 18.130.070. WSR 92-02-018 (Order 224), § 246-834-350, filed 12/23/91, effective 1/23/92. Statutory Authority: RCW 43.70.040. WSR 91-02-049 (Order 121), recodified as § 246-834-350, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 18.130.070. WSR 89-14-092 (Order PM 842), § 308-115-350, filed 6/30/89.] Repealed by WSR 97-20-101, filed 9/29/97, effective 10/30/97. Statutory Authority: RCW 43.70.040.
246-834-500AIDS prevention and information education requirements. [Statutory Authority: RCW 18.50.135, 18.50.045 and 70.24.270. WSR 92-02-018 (Order 224), § 246-834-500, filed 12/23/91, effective 1/23/92. Statutory Authority: RCW 43.70.040. WSR 91-02-049 (Order 121), recodified as § 246-834-500, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 70.24.270. WSR 88-22-077 (Order PM 786), § 308-115-500, filed 11/2/88.] Repealed by WSR 98-05-060, filed 2/13/98, effective 3/16/98. Statutory Authority: RCW 43.70.280.

PDF246-834-010

Definitions.

The following definitions apply throughout this chapter unless the context clearly indicates otherwise:
(1) "Active practice" means 20 hours per month in prenatal and postpartum clinical care, or minimum of six births annually as the primary midwife;
(2) "Administer" means to dispense, apply, and manage drugs, medical devices, and implants;
(3) "Department" means the Washington state department of health;
(4) "Directly assisted" means the act where a student midwife is learning the skills of a midwife through hands-on clinical experience in gradually increasing degrees of responsibility while under supervision of a licensed midwife or other obstetric provider;
(5) "Lactation care and services" means evaluation, problem identification, treatment, education, and consultation regarding lactation and chest feeding to gestational parents and neonates;
(6) "Nursing education" means completion of courses for credit in a school that is approved to train persons for licensure as registered nurses or licensed practical nurses, or courses in other formal training programs which include instruction in basic nursing skills, excluding nursing assistant training;
(7) "Postpartum" means the 12-month period beginning on the last day of the pregnancy.
(8) "Practical midwifery experience" means performance of tasks within the midwifery scope of practice, that is verified by affidavit, testimony or other sworn written documentation that verifies that the experience and its documentation is equivalent to that required of students enrolled in an accepted midwifery education program;
(9) "Preceptor" means a licensed midwife or other obstetric practitioner licensed by their state or jurisdiction to provide maternity care who assumes responsibility for supervising the practical (clinical obstetric) experience of a student midwife;
(10) "Primary attendant" means a student midwife who acts as primary midwife making intrapartum clinical decisions while under supervision of a licensed midwife or other obstetric provider;
(11) "Secretary" means the secretary of the Washington state department of health;
(12) "Supervision" means the observation and evaluation of a student midwife's practical performance. A supervisor must be physically present on-site and available to intervene when a student midwife performs any clinical care task at births and prenatal and postpartum care exams.
[Statutory Authority: RCW 18.50.115, 18.50.135, 43.70.613, 2022 c 289, and 2021 c 276. WSR 24-10-091, § 246-834-010, filed 4/30/24, effective 6/6/24. Statutory Authority: RCW 18.50.010, 18.50.040, 18.50.050, 18.50.135, and 2014 c 187. WSR 17-15-024, § 246-834-010, filed 7/7/17, effective 8/7/17. Statutory Authority: RCW 18.50.135 and 18.50.045. WSR 92-02-018 (Order 224), § 246-834-010, filed 12/23/91, effective 1/23/92. Statutory Authority: RCW 43.70.040. WSR 91-02-049 (Order 121), recodified as § 246-834-010, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 18.50.135. WSR 85-23-044 (Order PL 566), § 308-115-050, filed 11/18/85; WSR 82-19-079 (Order PL 406), § 308-115-050, filed 9/21/82.]


PDF246-834-020

Secretary accredited midwifery programs.

The secretary accepts midwifery education programs that meet the Midwifery Education Accreditation Council (MEAC) standards and competencies established in 2014 as accredited and approved courses of instruction.
[Statutory Authority: RCW 18.50.115, 18.50.135, 43.70.613, 2022 c 289, and 2021 c 276. WSR 24-10-091, recodified as § 246-834-020, filed 4/30/24, effective 6/6/24. Statutory Authority: RCW 18.50.010, 18.50.040, 18.50.050, 18.50.135, and 2014 c 187. WSR 17-15-024, § 246-834-135, filed 7/7/17, effective 8/7/17.]


PDF246-834-030

Eligibility for state licensing examination.

Candidates for the state licensing examination shall meet the following conditions, unless applying under WAC 246-834-066 Certified professional midwife (CPM) licensure requirements:
(1) Midwifery training shall be at least three academic years, and shall consist of both didactic and clinical instruction sufficient to meet the educational standards of the school and this section. However, the length of required training may be shortened, but not to less than two academic years, after consideration of the student's documented education and experience in the required subjects, if the applicant is a registered nurse or practical nurse licensed under chapter 18.79 RCW, or has had previous nursing education or practical midwifery experience.
(2) The applicant must receive instruction in the following educational areas:
(a) Midwifery, basic sciences (including biology, physiology, microbiology, anatomy with emphasis on female reproductive anatomy, genetics and embryology), normal and abnormal obstetrics and gynecology, family planning techniques, childbirth education, nutrition both during pregnancy and lactation, chest feeding, neonatology, epidemiology, community care, and medicolegal aspects of midwifery; and
(b) Basic nursing skills and clinical skills including, but not limited to, vital signs, perineal prep, catheterization, aseptic techniques, administration of medications both orally and by injection, local infiltration for anesthesia, venipuncture, administration of intravenous fluids, infant and adult resuscitation, and charting.
(3) The applicant must undertake the care of not less than 100 individuals in the intrapartum period. No less than 15 of the 100 individuals must be cared for in the intrapartum period while the applicant was enrolled in the school from which the student graduates.
(a) The applicant shall submit to the department documentation of attendance at 100 births of which:
(i) At least 30 births where the applicant was the primary attendant under supervision of a qualified attendant;
(ii) At least 20 births where the applicant directly assisted;
(iii) At least 50 births that the applicant observed in addition to births counted in (d)(i) and (ii) of this subsection; and
(iv) Documentation for (a)(i) through (iii) of this subsection must include at least the date, client identifier, the applicants role at each birth, and the signature or initials of the qualified attendant at the birth of either: A licensed midwife, a CPM preceptor, a certified nurse midwife, or a practitioner licensed by their state or jurisdiction to provide maternity care. The applicant shall submit to the department the name and contact information of each signatory, if available. The department may approve exceptions to the required documentation in this subsection.
(b) The applicant shall submit to the department documentation of prenatal care examinations of 50 individuals and early postpartum care examinations of 50 individuals. The same individuals need not be seen for both examinations.
(i) No less than 15 individuals must be cared for in the prenatal and postpartum periods while enrolled in the school from which the student graduates.
(ii) Documentation must include at least the date, client identifier, and the signature or initials of the qualified attendant at the care examination of either: A licensed midwife, a CPM preceptor, a certified nurse midwife, or a practitioner licensed by their state or jurisdiction to provide maternity care. The applicant must submit to the department the name and contact information of each signatory, if available. The department may approve exceptions to the required documentation in this subsection.
(4) The applicant shall demonstrate competency in the use and administration of legend drugs and devices described in WAC 246-834-250. The applicant shall submit documentation of competency to the department on a department supplied form. A licensed health care professional who, within his or her scope of practice, is qualified in the use and administration of legend drugs and devices described in RCW 18.50.115 and WAC 246-834-250 must sign the form.
[Statutory Authority: RCW 18.50.115, 18.50.135, 43.70.613, 2022 c 289, and 2021 c 276. WSR 24-10-091, amended and recodified as § 246-834-030, filed 4/30/24, effective 6/6/24. Statutory Authority: RCW 18.50.010, 18.50.040, 18.50.050, 18.50.135, and 2014 c 187. WSR 17-15-024, § 246-834-140, filed 7/7/17, effective 8/7/17. Statutory Authority: RCW 18.50.135 and 18.50.045. WSR 92-02-018 (Order 224), § 246-834-140, filed 12/23/91, effective 1/23/92. Statutory Authority: RCW 43.70.040. WSR 91-02-049 (Order 121), recodified as § 246-834-140, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 18.50.135. WSR 87-21-011 (Order PM 686), § 308-115-140, filed 10/9/87; WSR 85-23-044 (Order PL 566), § 308-115-140, filed 11/18/85; WSR 82-19-079 (Order PL 406), § 308-115-140, filed 9/21/82.]


PDF246-834-050

Examination requirements for licensure as a midwife.

(1) An applicant for midwifery licensure shall successfully pass:
(a) The midwifery examination offered by the North American Registry of Midwives (NARM);
(b) The Washington state licensure examination with a minimum passing score of 80; and
(c) The midwifery jurisprudence examination with a passing score of 100 percent, as offered by the department.
(2) The secretary may, by rule, revise examination requirements if necessary, for good cause.
[Statutory Authority: RCW 18.50.135, 18.50.115, 18.50.060, and 2020 c 76. WSR 22-13-079, § 246-834-050, filed 6/10/22, effective 7/11/22. Statutory Authority: RCW 18.50.010, 18.50.040, 18.50.050, 18.50.135, and 2014 c 187. WSR 17-15-024, § 246-834-050, filed 7/7/17, effective 8/7/17. Statutory Authority: RCW 18.50.060. WSR 99-03-064, § 246-834-050, filed 1/18/99, effective 2/18/99.]


PDF246-834-055

Examination failures.

(1) An applicant who has failed the NARM examination or the Washington state licensing examination, or both, shall retake and pass the examination(s) which he or she failed.
(2) The applicant who fails the Washington state licensing examination may sit for the reexamination if the individual:
(a) Applies to the department at least 14 days prior to the next scheduled examination; and
(b) Pays the required fee as specified in WAC 246-834-990.
(3) An applicant who fails the NARM or Washington licensing examination three consecutive times shall submit evidence to the secretary of completion of an individualized program of study approved by the department prior to retaking the examination.
[Statutory Authority: RCW 18.50.115, 18.50.135, 43.70.613, 2022 c 289, and 2021 c 276. WSR 24-10-091, amended and recodified as § 246-834-055, filed 4/30/24, effective 6/6/24. Statutory Authority: RCW 18.50.010, 18.50.040, 18.50.050, 18.50.135, and 2014 c 187. WSR 17-15-024, § 246-834-080, filed 7/7/17, effective 8/7/17. Statutory Authority: RCW 18.50.060. WSR 99-03-064, § 246-834-080, filed 1/18/99, effective 2/18/99. Statutory Authority: RCW 18.50.135 and 18.50.045. WSR 92-02-018 (Order 224), § 246-834-080, filed 12/23/91, effective 1/23/92. Statutory Authority: RCW 43.70.040. WSR 91-02-049 (Order 121), recodified as § 246-834-080, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 18.50.135. WSR 82-19-079 (Order PL 406), § 308-115-080, filed 9/21/82.]


PDF246-834-060

Initial application requirements for licensure as a midwife.

(1) An applicant for a midwife license shall submit to the department the following:
(a) Initial application on forms provided by the department.
(b) Fees required in WAC 246-834-990.
(c) Proof of high school graduation, or its equivalent.
(d) Proof of at least three years of midwifery training, per RCW 18.50.040 (2)(a), unless the applicant qualifies for a reduced academic period.
(e) Proof of successful completion of the midwifery jurisprudence exam, as required in WAC 246-834-050.
(2) In addition to the requirements in subsection (1) of this section, an applicant for a midwife license shall also:
(a) Have transcripts sent directly to the department from the applicant's midwifery school demonstrating that the applicant has received a certificate or diploma in midwifery. An applicant applying under WAC 246-834-065 or 246-834-066 may be exempted from this requirement.
(b) Have verification of passing the North American Registry of Midwives (NARM) examination as required in WAC 246-834-050. Results must be sent directly to the department from NARM.
(3) Once all application requirements in this section are met, and additional requirements in WAC 246-834-065 or 246-834-066 if applicable, the department will schedule the applicant for the Washington state licensing exam as required in WAC 246-834-050.
[Statutory Authority: RCW 18.50.135, 18.50.115, 18.50.060, and 2020 c 76. WSR 22-13-079, § 246-834-060, filed 6/10/22, effective 7/11/22. Statutory Authority: RCW 18.50.135 and 18.50.115. WSR 19-15-005, § 246-834-060, filed 7/5/19, effective 8/5/19. Statutory Authority: RCW 18.50.065, 18.50.135, and 18.50.040. WSR 15-20-049, § 246-834-060, filed 9/30/15, effective 10/31/15. Statutory Authority: RCW 18.50.060. WSR 99-03-064, § 246-834-060, filed 1/18/99, effective 2/18/99. Statutory Authority: RCW 43.70.280. WSR 98-05-060, § 246-834-060, filed 2/13/98, effective 3/16/98. Statutory Authority: RCW 18.50.135 and 18.50.045. WSR 92-02-018 (Order 224), § 246-834-060, filed 12/23/91, effective 1/23/92. Statutory Authority: RCW 43.70.040. WSR 91-02-049 (Order 121), recodified as § 246-834-060, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 18.50.135. WSR 82-19-079 (Order PL 406), § 308-115-060, filed 9/21/82.]


PDF246-834-062

Initial or reinstating application for individuals who have not been in the active practice of midwifery.

This section applies to applicants for an initial license as a licensed midwife, or reinstatement of a midwifery license, who have not been in the active practice of midwifery prior to initial or reinstatement license application.
(1) Any applicant who has not been engaged in the active practice of midwifery for more than three years but less than five years prior to the date of application shall, in addition to the requirements for licensure as specified in WAC 246-834-030 and 246-834-060:
(a) Provide documentation of a minimum of 10 births while acting as a birth assistant under the supervision of a preceptor within the last 12 months; and
(b) Provide documentation of completion of continuing education for the three years prior to application that meets the requirements of WAC 246-834-355.
(2) Any initial or reinstating applicant who has not been engaged in the active practice of midwifery for five or more years prior to the date of application shall, in addition to the requirements for licensure as specified in WAC 246-834-030 and 246-834-060:
(a) Provide documentation of a minimum of 15 births while acting as a birth assistant under the supervision of a preceptor within the last 12 months;
(b) Provide documentation of completion of continuing education for the three years prior that meets the requirements of WAC 246-834-355; and
(c) If applying for reinstatement, retake and pass the current Washington state midwifery licensure examination.
(3) This section does not apply to any applicant who has been enrolled in a recognized educational program under WAC 246-834-020 or 246-834-065.
[Statutory Authority: RCW 18.50.115, 18.50.135, 43.70.613, 2022 c 289, and 2021 c 276. WSR 24-10-091, § 246-834-062, filed 4/30/24, effective 6/6/24. Statutory Authority: RCW 18.50.010, 18.50.040, 18.50.050, 18.50.135, and 2014 c 187. WSR 17-15-024, § 246-834-062, filed 7/7/17, effective 8/7/17.]


PDF246-834-065

Application for examination—Foreign trained.

An applicant for a midwife license who graduated from a foreign educational institution on midwifery outside of any U.S. jurisdiction may sit for the licensing examination provided the applicant completes all requirements in this section:
(1) Complete application requirements for licensure in WAC 246-834-060;
(2) Provide proof of a certificate or diploma from 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 graduated. If applicable, the candidates must, at the individual's own expense, present with the application a certified translation of the foreign certificate or diploma;
(3) Submit proof of completing at least three years of midwifery training including the study of basic nursing that meets the requirements under WAC 246-834-030(1);
(4) Submit proof of meeting minimum educational requirements under WAC 246-834-030 (2)(a) and (b);
(5) Submit to the department documentation of attendance at 100 births that meets the requirements of WAC 246-834-030 (3)(a);
(6) Submit to the department documentation of prenatal care examinations of 50 individuals and early postpartum care examinations of 50 individuals that meets the requirements of WAC 246-834-030 (3)(b); and
(7) Demonstrate competency in the use and administration of legend drugs and devices described in RCW 18.50.115 and WAC 246-834-250. The applicant shall submit documentation of competency to the department on a department supplied form. A licensed health care professional who, within the individual's scope of practice, is qualified in the use and administration of legend drugs and devices described in RCW 18.50.115 and WAC 246-834-250 must sign the form.
[Statutory Authority: RCW 18.50.115, 18.50.135, 43.70.613, 2022 c 289, and 2021 c 276. WSR 24-10-091, § 246-834-065, filed 4/30/24, effective 6/6/24. Statutory Authority: RCW 18.50.010, 18.50.040, 18.50.050, 18.50.135, and 2014 c 187. WSR 17-15-024, § 246-834-065, filed 7/7/17, effective 8/7/17. Statutory Authority: RCW 43.70.280. WSR 98-05-060, § 246-834-065, filed 2/13/98, effective 3/16/98. Statutory Authority: RCW 43.70.040. WSR 91-02-049 (Order 121), recodified as § 246-834-065, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 18.50.135. WSR 89-16-037 (Order PM 856), § 308-115-065, filed 7/25/89, effective 8/25/89.]


PDF246-834-066

Certified professional midwife (CPM) licensure requirements.

An applicant who holds a current North American Registry of Midwives (NARM) certified professional midwife (CPM) certification may apply for a Washington state midwife license by completing all requirements in this section.
(1) To be eligible for a midwife license an applicant holding a CPM shall:
(a) Complete all application requirements for licensure in WAC 246-834-060.
(b) Ensure that proof of the CPM certification is sent to the department directly from NARM.
(c) Submit to the department documentation of attendance at 100 births of which:
(i) At least 30 births where the applicant was the primary attendant under supervision of a qualified attendant;
(ii) At least 20 births where the applicant directly assisted;
(iii) At least 50 births that the applicant observed in addition to births counted in (c)(i) and (ii) of this subsection; and
(iv) Documentation for (c)(i) through (iii) of this subsection must include at least the date, client identifier, the applicant's role at each birth, and the signature or initials of the qualified attendant at the birth of either: A licensed midwife, a CPM preceptor, a certified nurse midwife, or a practitioner licensed by their state or jurisdiction to provide maternity care. The applicant shall submit to the department the name and contact information of each signatory, if available. The department may approve exceptions to the required documentation in this subsection.
(d) Submit to the department documentation of prenatal care examinations of 50 individuals and early postpartum care examinations of 50 individuals. The same individuals need not be seen for both examinations. Documentation must include at least the date, client identifier, and the signature or initials of the qualified attendant at the care examination of either: A licensed midwife, a CPM preceptor, a certified nurse midwife, or a practitioner licensed by their state or jurisdiction to provide maternity care. The applicant must submit to the department the name and contact information of each signatory, if available. The department may approve exceptions to the required documentation in this subsection.
(e) Demonstrate competency in the use and administration of legend drugs and devices described in RCW 18.50.115 and WAC 246-834-250. The applicant shall submit documentation of competency to the department on a department supplied form. A licensed health care professional who, within the individual's scope of practice, is qualified to use and administer legend drugs and devices described in RCW 18.50.115 and WAC 246-834-250 must sign the form.
(f) Successfully complete courses on epidemiology and obstetric pharmacology from:
(i) An institution that is accredited by an agency recognized by the Council for Higher Education Accreditation (CHEA) and included in their database of institutions on programs accredited by recognized United States accrediting organizations;
(ii) An institution that is accredited by an agency recognized by the United States Department of Education (USDOE) and included in their database of accredited postsecondary institutions and programs; or
(iii) A curriculum or program approved by the department.
(2) Applicants applying under this section who have a current CPM but do not meet all of the requirements listed in subsection (1)(c) through (f) of this section may apply to the department for a trainee permit under WAC 246-834-068. The trainee permit authorizes the applicant to complete subsection (1)(c) through (e) of this section, under the supervision of a preceptor as described in WAC 246-834-067.
[Statutory Authority: RCW 18.50.115, 18.50.135, 43.70.613, 2022 c 289, and 2021 c 276. WSR 24-10-091, § 246-834-066, filed 4/30/24, effective 6/6/24. Statutory Authority: RCW 18.50.065, 18.50.135, and 18.50.040. WSR 15-20-049, § 246-834-066, filed 9/30/15, effective 10/31/15.]


PDF246-834-067

Preceptor for certified professional midwife (CPM) licensure program.

This section defines the role of a preceptor as used in WAC 246-834-066. A certified professional midwife (CPM) applicant for licensure as a midwife may use more than one preceptor to meet the requirements for licensure under WAC 246-834-066.
(1) A preceptor for clinical requirements including observed, managed, and assisted births, and prenatal and postpartum examinations must:
(a) Have a current Washington state license as a midwife under chapter 18.50 RCW, physician under chapter 18.71 RCW, osteopathic physician under chapter 18.57 RCW, or certified nurse midwife under chapter 18.79 RCW; and
(b) Have actively practiced obstetrics for at least three consecutive years or attended at least 150 births.
(2) A preceptor for legend drugs and devices must have a current Washington state credential and be, within the individual's scope of practice, qualified to use and administer legend drugs and devices described in RCW 18.50.115 and WAC 246-834-250.
[Statutory Authority: RCW 18.50.115, 18.50.135, 43.70.613, 2022 c 289, and 2021 c 276. WSR 24-10-091, § 246-834-067, filed 4/30/24, effective 6/6/24. Statutory Authority: RCW 18.50.065, 18.50.135, and 18.50.040. WSR 15-20-049, § 246-834-067, filed 9/30/15, effective 10/31/15.]


PDF246-834-068

Trainee permit for certified professional midwife (CPM) licensure program.

(1) The department may issue a trainee permit to a certified professional midwife (CPM) who has submitted an initial application to the department accompanied by a nonrefundable fee as specified in WAC 246-834-990.
(2) The CPM trainee permit authorizes the CPM to complete the licensure requirements outlined in WAC 246-834-066 (1)(c) through (e).
(3) A CPM trainee permit expires one year from the date of issuance. The department may extend the permit upon request to accommodate extenuating circumstances.
(4) The department may deny, modify or revoke a CPM trainee permit at any time if the department determines that patient safety, health or welfare may be in jeopardy or the trainee fails to comply with the requirements of this section.
[Statutory Authority: RCW 18.50.065, 18.50.135, and 18.50.040. WSR 15-20-049, § 246-834-068, filed 9/30/15, effective 10/31/15.]


PDF246-834-160

Student midwife permit.

(1) A student midwife permit may be issued to any individual who has:
(a) Successfully completed an accredited midwifery program as specified in WAC 246-834-020, or is foreign trained as specified in WAC 246-834-065(1);
(b) Obtained a minimum period of midwifery training of at least three academic years as required by WAC 246-834-030;
(c) Met the minimum education requirements required in WAC 246-834-030 (2)(a) and (b);
(d) Documentation of undertaking the care of not less than 50 individuals in each of the prenatal, intrapartum and early postpartum periods as required by RCW 18.50.040 (2)(c);
(e) Satisfactorily completed the NARM examination required by WAC 246-834-050; and
(f) Filed a completed application for student midwife permit under WAC 246-834-060 and accompanied by a nonrefundable fee as specified in WAC 246-834-990.
(2) The student midwife permit authorizes the student to practice and observe individuals in the intrapartum period under the supervision of a licensed midwife under 18.50 RCW, an allopathic physician under chapter 18.71 RCW, an osteopathic physician under chapter 18.57 RCW or certified nurse midwife under chapter 18.79 RCW.
(3) Once all application requirements including clinical components are completed the applicant may be eligible to sit for the Washington state licensure examination as required in WAC 246-834-050.
[Statutory Authority: RCW 18.50.115, 18.50.135, 43.70.613, 2022 c 289, and 2021 c 276. WSR 24-10-091, § 246-834-160, filed 4/30/24, effective 6/6/24. Statutory Authority: RCW 18.50.135, 18.50.115, 18.50.060, and 2020 c 76. WSR 22-13-079, § 246-834-160, filed 6/10/22, effective 7/11/22. Statutory Authority: RCW 18.50.010, 18.50.040, 18.50.050, 18.50.135, and 2014 c 187. WSR 17-15-024, § 246-834-160, filed 7/7/17, effective 8/7/17. Statutory Authority: RCW 18.50.135 and 18.50.045. WSR 92-02-018 (Order 224), § 246-834-160, filed 12/23/91, effective 1/23/92. Statutory Authority: RCW 43.70.040. WSR 91-02-049 (Order 121), recodified as § 246-834-160, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 18.50.135. WSR 82-19-079 (Order PL 406), § 308-115-160, filed 9/21/82.]


PDF246-834-165

Application requirements for a licensed midwife seeking a limited prescriptive license extension, a license extension for medical devices, or a license extension for implants.

(1) A licensed midwife seeking a limited prescriptive license extension shall:
(a) Submit evidence of completion of 15 additional obstetrical pharmacology didactic training hours. The additional hours must include the prescription classifications listed in WAC 246-834-250(4) and provide skills and knowledge beyond entry-level skills or knowledge in antibiotics and contraceptives; and
(b) Submit evidence of completion of additional training on family planning and treating common, low risk prenatal and postpartum conditions. Such training must be either:
(i) A clinical experience of at least 20 cases reviewed in consultation with a licensed health care professional who, within their scope of practice, is qualified to use and administer legend drugs and devices described in RCW 18.50.115 and WAC 246-834-250. The licensed health care professional must attest to the applicant's knowledge and skills by signing a form provided by the department; or
(ii) A clinical training course or courses approved by the department.
(2) A licensed midwife seeking the license extension for medical devices or the license extension for implants shall:
(a) Submit completion of the requirements in subsection (1) of this section;
(b) Submit evidence of completion of training as required by the medical device manufacturers, or an equivalent. The training must include at least three simulated medical device insertions under direct supervision;
(c) Submit evidence of completion of training as required by the implant device manufacturers, or an equivalent. The training must include at least three simulated removals under direct supervision; and
(d) Submit evidence of completion of additional training on medical devices or implants, or both that includes:
(i) A clinical experience of four inserted medical devices and one medical device removal under direct supervision;
(ii) A clinical experience of one inserted implant and three implant removals under direct supervision;
(e) The clinical experience in (d) of this subsection must be supervised by a licensed health care professional who, within their scope of practice, is qualified to administer medical devices and implants and has at least two years of experience. The health care professional must attest to the applicant's knowledge and skills by signing a form provided by the department.
(f) A licensed midwife may pursue all three license extensions. The training on prescriptive, medical devices, and implants in subsections (1) and (2) must be completed within five years from the date of application.
(3) The license extensions referenced in this section do not apply to newborn care.
[Statutory Authority: RCW 18.50.115, 18.50.135, 43.70.613, 2022 c 289, and 2021 c 276. WSR 24-10-091, § 246-834-165, filed 4/30/24, effective 6/6/24.]


PDF246-834-250

Legend drugs and devices.

A licensed midwife shall have a procedure, policy or guideline for the use of each legend drug and device. A midwife may not administer or prescribe a legend drug or use a legend device for which they are not qualified by education, training, and experience.
(1) A licensed midwife may purchase and use legend drugs and devices as follows:
(a) Dopplers, syringes, needles, phlebotomy equipment, sutures, urinary catheters, intravenous equipment, amnihooks, airway suction devices, electronic fetal monitors, jada system, tocodynamometer monitors, oxygen and associated equipment, glucose monitoring systems and testing strips, neonatal pulse oximetry equipment, hearing screening equipment, centrifuges, and nasopharyngeal or nasal swabs for appropriate testing;
(b) Nitrous oxide as an analgesic, self-administered inhalant in a 50 percent blend with oxygen, and associated equipment, including a scavenging system;
(c) Ultrasound machine used in the real time ultrasound of pregnant uterus for the confirmation of viability, first trimester dating, third trimester presentation, placental location, and amniotic fluid assessment; and
(d) Neonatal and adult resuscitation equipment and medication, including airway devices and epinephrine for neonates.
(2) Pharmacies may issue the following as ordered by a licensed midwife: Lactation pumps, compression stockings and belts, maternity belts, diaphragms and cervical caps, glucometers and testing strips, iron supplements, prenatal vitamins, and recommended vaccines as specified in subsection (3)(e) through (j) of this section.
(3) In addition to prophylactic ophthalmic medication, postpartum oxytocic, vitamin K, Rho (D) immune globulin, and local anesthetic medications as listed in RCW 18.50.115, licensed midwives may obtain and administer the following medications:
(a) Intravenous fluids limited to Lactated Ringers, five percent Dextrose with Lactated Ringers, and 0.9% sodium chloride;
(b) Sterile water for intradermal injections for pain relief;
(c) Magnesium sulfate for prevention or treatment of peripartum seizures pending transport;
(d) Epinephrine for use in peripartum anaphylaxis and resuscitation and neonatal resuscitation, pending transport;
(e) Measles, Mumps, and Rubella (MMR) vaccine to nonimmune postpartum individuals;
(f) Tetanus, diphtheria, acellular pertussis (Tdap) vaccine for use in pregnancy;
(g) Hepatitis B (HBV) birth dose for any newborn administration;
(h) HBIG and HBV for any neonates born to a hepatitis B positive gestational parent;
(i) Influenza vaccine;
(j) Any vaccines recommended by the Centers for Disease Control and Prevention (CDC) advisory committee on immunization practices for infants in the first two weeks after birth or pregnant or postpartum people;
(k) Terbutaline to temporarily decrease contractions pending emergent intrapartum transport;
(l) Antibiotics for intrapartum prophylaxis of Group B Streptococcus (GBS) per current CDC guidelines;
(m) Antihemorrhagic drugs to treat postpartum hemorrhage including, but not limited to, intravenous tranexamic acid, oxytocins, misoprostol, methylergonovine maleate (oral or intramuscular), and prostaglandin F2 alpha; and
(n) Nifedipine for indication of preterm labor pending transport.
(4) A licensed midwife with a limited prescriptive license extension may prescribe, obtain, and administer the items in subsections (1) through (3) of this section, and the following medications and therapies for the prevention and treatment of outpatient conditions that do not constitute a significant deviation from normal per RCW 18.50.010 during pregnancy or postpartum based on current evidence and practice:
(a) Antibiotics;
(b) Antiemetics;
(c) Antivirals;
(d) Antifungals;
(e) Low-potency topical steroids;
(f) Antipruritic medications and therapies;
(g) Other medications and therapies including, but not limited to:
(i) Galactagogues;
(ii) Topical analgesia for anal, vulvar, and perineal pain;
(iii) Preterm labor preventatives;
(iv) Stool softeners;
(v) Vitamins and minerals for preventing and treating deficiencies;
(vi) Over-the-counter medications as needed;
(vii) Nonopioid medication for therapeutic rest;
(viii) Medications for miscarriage prevention and completion;
(ix) Smoking cessation;
(x) Prescription referrals for IV iron infusions; and
(h) Hormonal and nonhormonal family planning methods.
(5) Pursuant to RCW 18.50.010, a licensed midwife with a license extension that includes medical devices or implants, or both may prescribe, obtain, and administer hormonal and nonhormonal family planning method devices including, but not limited to, copper or other nonhormonal intrauterine devices (IUD), IUDs with levonorgestrel or other progestin, implants or as consistent with current evidence and practice so long as they have a license extension to perform the task.
(6) The client's records must contain documentation of all medications and devices prescribed, ordered, and administered.
[Statutory Authority: RCW 18.50.115, 18.50.135, 43.70.613, 2022 c 289, and 2021 c 276. WSR 24-10-091, § 246-834-250, filed 4/30/24, effective 6/6/24. Statutory Authority: RCW 18.50.135, 18.50.115, 18.50.060, and 2020 c 76. WSR 22-13-079, § 246-834-250, filed 6/10/22, effective 7/11/22. Statutory Authority: RCW 18.50.135 and 18.50.115. WSR 19-15-005, § 246-834-250, filed 7/5/19, effective 8/5/19. Statutory Authority: RCW 18.50.115. WSR 05-06-118, § 246-834-250, filed 3/2/05, effective 4/2/05. Statutory Authority: RCW 43.70.040. WSR 91-02-049 (Order 121), recodified as § 246-834-250, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 18.50.040(3) and 18.50.115. WSR 88-12-040 (Order PM 732), § 308-115-250, filed 5/27/88.]


PDF246-834-255

Elements of care for the newborn.

The customary scope of care of a newborn up to two weeks of age by a licensed midwife includes, but is not limited to, clinical assessment, treatment, education, support and referral as described in this section. Newborn care shall not go beyond the scope of the midwife's education, training and experience.
(1) Immediate newborn care includes, but is not limited to:
(a) Appearance, pulse, grimace, activity and respiration (APGAR) assessment;
(b) Stabilization and monitoring of the newborn for a minimum of two hours postpartum;
(c) Early initiation and facilitation of infant feeding;
(d) Complete physical examination;
(e) Education for parents regarding care and monitoring of the normal newborn; and
(f) Physician consultation, referral and/or transfer of care in the event of significant deviations from normal.
(2) Other support may include:
(a) Neonatal resuscitation; and
(b) Legend drugs and devices allowed in RCW 18.50.115 and WAC 246-834-250.
(3) Subsequent care may include, but is not limited to:
(a) Evaluating the newborn for well-being such as jaundice, weight loss, and adequate feeding and elimination patterns;
(b) Newborn metabolic screening per RCW 70.83.020;
(c) Critical congenital heart disease screening per RCW 70.83.090;
(d) Lactation care and services; and
(e) Consultation and possible referral to pediatric care for any significant deviation from normal.
[Statutory Authority: RCW 18.50.115, 18.50.135, 43.70.613, 2022 c 289, and 2021 c 276. WSR 24-10-091, § 246-834-255, filed 4/30/24, effective 6/6/24. Statutory Authority: RCW 18.50.010, 18.50.040, 18.50.050, 18.50.135, and 2014 c 187. WSR 17-15-024, § 246-834-255, filed 7/7/17, effective 8/7/17.]


PDF246-834-345

License renewal.

A licensed midwife must renew their license every year on the individual's birthday. To renew a license, a licensed midwife shall comply with the requirements in:
(1) RCW 18.50.102 License renewal;
(2) RCW 18.50.108 Written plan for consultation, emergency transfer, and transport;
(3) WAC 246-12-030 How to renew a credential;
(4) WAC 246-834-355 Continuing education;
(5) WAC 246-834-360 Quality improvement program;
(6) WAC 246-834-370 Data submission; and
(7) WAC 246-834-990 Midwifery fees and renewal cycle.
[Statutory Authority: RCW 18.50.115, 18.50.135, 43.70.613, 2022 c 289, and 2021 c 276. WSR 24-10-091, § 246-834-345, filed 4/30/24, effective 6/6/24. Statutory Authority: RCW 18.50.102 and 18.50.135. WSR 15-24-092, § 246-834-345, filed 11/30/15, effective 12/31/15.]


PDF246-834-355

Continuing education.

(1) A licensed midwife shall complete 30 hours of continuing education (CE) every three years and must comply with WAC 246-12-170 through 246-12-240. CE course work must contribute to the professional knowledge and development of the licensed midwife.
(a) A minimum of 25 hours must be directly related to the clinical practice of midwifery. A licensed midwife who has a license extension shall complete a minimum of three hours of CE relevant to the license extension or extensions they hold as part of the 25-hour requirement.
(b) In addition to the 25 hours of clinical practice CE in (a) of this subsection, a licensed midwife shall complete two hours of health equity CE every four years per chapter 43.70 RCW and in compliance with WAC 246-12-800 through 246-12-830.
(c) Any remaining hours may be in professional development activities that enhance the practice of the licensed midwife.
(2) A licensed midwife shall obtain CE hours through one or more of the categories listed below. Documentation for all activities must include licensee's name, date of activity, and number of hours. Additional specific documentation is defined below:
(a) Acceptable CE course work. A minimum of 10 hours is required per reporting period in acceptable CE course work. For the purposes of this section, acceptable CE course work means courses offered or authorized by industry recognized local, state, private, national and international organizations, agencies or institutions of higher learning. The department will not authorize or approve specific CE courses. The required documentation for this category is a certificate or documentation of attendance.
(b) Course work or classes offered by an accredited college or university. The course work must provide skills and knowledge beyond entry-level skills. The required documentation for this category is a transcript or documentation of attendance. A maximum of 10 hours is allowed per reporting period for this category.
(c) Research, writing, or teaching. The required documentation for this category is a two-page synopsis for each activity written by the licensee. A maximum of 15 hours is allowed per reporting period for this category.
(d) Documented self-study or life experience. The required documentation for this category is a two-page synopsis of each activity written by the licensee. A maximum of five hours is allowed per reporting period for this category.
(e) Serving on a professional board, committee, disciplinary panel, or association. The required documentation for this category is a letter or other documentation from the organization. A maximum of five hours is allowed per reporting period for this category.
(f) Professional manuscript review. The required documentation for this category is a letter from the publishing organization verifying review of the manuscript. A maximum of 10 hours is allowed per reporting period for this category.
(g) Professional conference or workshop. The required documentation for this category is a certificate or documentation of attendance. A maximum of 10 hours is allowed per reporting period for this category.
(3) Continuing education credit will not be given for the following:
(a) A cardiopulmonary resuscitation course;
(b) A neonatal resuscitation course; or
(c) Participation in data submission on perinatal outcomes.
(4) The department may verify completion of continuing competency hours.
[Statutory Authority: RCW 18.50.115, 18.50.135, 43.70.613, 2022 c 289, and 2021 c 276. WSR 24-10-091, § 246-834-355, filed 4/30/24, effective 6/6/24. Statutory Authority: RCW 18.50.102 and 18.50.135. WSR 15-24-092, § 246-834-355, filed 11/30/15, effective 12/31/15.]


PDF246-834-360

Quality improvement program.

(1) As a condition of renewing a license, a licensed midwife shall:
(a) Participate in a Washington state coordinated quality improvement program peer review process that complies with the requirements in RCW 43.70.510.
(b) Attest every two years that the midwife has completed peer review for a minimum of five of the midwife's clinical cases over the course of those two years.
(2) A midwife may be excused from or granted an extension of participation in a peer review process due to illness or other extenuating circumstances. The department, upon request, will determine if the requirements may be waived or if an extension may be granted.
(3) For auditing purposes, written confirmation of participation in a peer review process from the approved coordinated quality improvement program shall suffice. The midwife must keep their participation records; records must not be sent to the department.
(4) Verification of completion of participation in a peer review process will begin on January 1, 2018.
[Statutory Authority: RCW 18.50.115, 18.50.135, 43.70.613, 2022 c 289, and 2021 c 276. WSR 24-10-091, § 246-834-360, filed 4/30/24, effective 6/6/24. Statutory Authority: RCW 18.50.102 and 18.50.135. WSR 15-24-092, § 246-834-360, filed 11/30/15, effective 12/31/15.]


PDF246-834-370

Data submission.

(1) As a condition of renewing a license, a licensed midwife shall report data on all courses of care for every gestational parent and newborn under the midwife's care to a national or state research organization approved by the department. If the gestational parent declines to participate in the collection of data, the midwife shall follow the protocol of the approved national or state research organization.
(2) The licensed midwife shall verify compliance by submitting an attestation to the department annually with the license renewal. For good cause, the secretary may waive reporting requirements.
(3) For auditing purposes, written confirmation of full participation in data collection from the approved state or national research organization shall suffice.
(4) The midwife must keep their data and participation records; data and participation records will not be submitted directly to the department.
[Statutory Authority: RCW 18.50.115, 18.50.135, 43.70.613, 2022 c 289, and 2021 c 276. WSR 24-10-091, § 246-834-370, filed 4/30/24, effective 6/6/24. Statutory Authority: RCW 18.50.135, 18.50.115, 18.50.060, and 2020 c 76. WSR 22-13-079, § 246-834-370, filed 6/10/22, effective 7/11/22. Statutory Authority: RCW 18.50.102 and 18.50.135. WSR 15-24-092, § 246-834-370, filed 11/30/15, effective 12/31/15.]


PDF246-834-400

Expired license.

A midwife licensed under this chapter may reinstate an expired license or license extension.
(1) If a midwife's license has been expired for less than three years, the practitioner shall meet the requirements of WAC 246-12-040.
(2) If a midwife's license has expired and the practitioner has been engaged in the active practice of midwifery in another United States jurisdiction or territory, or other location approved by the department, the practitioner shall:
(a) Submit verification of active practice; and
(b) Meet the requirements of WAC 246-12-040.
(3) If a midwife's license has been expired for three years or more but less than five years at time of application, and the practitioner has not been actively engaged in midwifery, the practitioner shall:
(a) Work as a birth assistant under the supervision of a department-approved preceptor for a minimum of 10 births; and
(b) Meet the requirements of WAC 246-12-040.
(4) If a midwife's license has been expired for more than five years at time of application, and the practitioner has not been actively engaged in midwifery, the practitioner shall:
(a) Work as a birth assistant under the supervision of a department-approved preceptor for a minimum of 15 births;
(b) Retake and successfully pass the Washington state licensing examination; and
(c) Meet the requirements of WAC 246-12-040.
(5) A proposed preceptor shall:
(a) Hold an active license without restriction, current discipline, or conditions as a midwife under chapter 18.50 RCW, a certified nurse midwife under chapter 18.79 RCW, an allopathic physician under chapter 18.71 RCW, or an osteopathic physician under chapter 18.57 RCW;
(b) Have actively practiced at least three consecutive years or attended at least 150 births; and
(c) Have demonstrated ability and skill to provide safe, quality care.
(6) If a midwife's license extension has expired and the practitioner has been engaged in the active practice of midwifery prescriptive or medical devices and implant practice in another United States jurisdiction or territory, or other location approved by the department, the practitioner shall:
(a) Submit verification of active practice of prescriptive, devices, or implant practices; and
(b) Meet the requirements of WAC 246-12-040.
(7) If a licensed midwife at the time of reactivation has had an expired license extension for less than five years and has not been engaged in the active practice of midwifery prescriptive or medical devices and implant practice, the practitioner may submit their records for their initial training as required in WAC 246-834-165 and meet the requirements in WAC 246-12-040.
(8) If a licensed midwife at the time of reactivation has had an expired license extension for five years or more and has not been engaged in the active practice of midwifery prescriptive or medical devices and implant practice, the practitioner shall retake the required training in WAC 246-834-165.
[Statutory Authority: RCW 18.50.115, 18.50.135, 43.70.613, 2022 c 289, and 2021 c 276. WSR 24-10-091, § 246-834-400, filed 4/30/24, effective 6/6/24. Statutory Authority: RCW 18.50.135 and 18.50.115. WSR 19-15-005, § 246-834-400, filed 7/5/19, effective 8/5/19. Statutory Authority: RCW 18.50.010, 18.50.040, 18.50.050, 18.50.135, and 2014 c 187. WSR 17-15-024, § 246-834-400, filed 7/7/17, effective 8/7/17. Statutory Authority: RCW 43.70.280. WSR 98-05-060, § 246-834-400, filed 2/13/98, effective 3/16/98.]


PDF246-834-450

Inactive license.

(1) A licensed midwife may obtain an inactive license by meeting the requirements of WAC 246-12-090.
(2) An inactive license must be renewed every year on the midwife's birthday according to WAC 246-12-100 and by paying the fee required under WAC 246-834-990.
(3) A midwife with an inactive license may return to active status.
(a) A midwife with an inactive license for three years or less who wishes to return to active status must meet the requirements of WAC 246-12-110.
(b) A midwife with an inactive license for more than three years, who has been in active practice in another United States jurisdiction or territory or other location approved by the department and wishes to return to active status shall:
(i) Submit verification of active practice; and
(ii) Meet the requirements of WAC 246-12-110.
(c) A midwife with an inactive license for more than three years but less than five, who has not been in active practice and wishes to return to active status must:
(i) Work as a birth assistant under the supervision of a department-approved preceptor for a minimum of 10 births; and 
(ii) Meet the requirements of WAC 246-12-110.
(d) A midwife with an inactive license for more than five years who has not been in active practice and wishes to return to active status shall:
(i) Work as a birth assistant under the supervision of a department-approved preceptor for a minimum of 15 births;
(ii) Retake and successfully pass the Washington state licensing examination; and
(iii) Meet the requirements of WAC 246-12-110.
(4) A proposed preceptor shall:
(a) Hold an active license without restriction, current discipline, or conditions as a midwife under chapter 18.50 RCW, a certified nurse midwife under chapter 18.79 RCW, an allopathic physician under chapter 18.71 RCW, or an osteopathic physician under chapter 18.57 RCW;
(b) Have actively practiced at least three consecutive years or attended at least 150 births; and
(c) Have demonstrated ability and skill to provide safe, quality care.
(5) A licensed midwife with an inactive license extension who has been engaged in the active practice of midwifery prescriptive or medical devices and implant practice in another United States jurisdiction or territory, or other location approved by the department, and wishes to return to active practice shall:
(a) Submit verification of active practice of prescriptive, devices, or implant practices; and
(b) Meet the requirements of WAC 246-12-110.
(6) A licensed midwife with an inactive license extension for less than five years at the time of reactivation, and has not been actively practicing in midwifery prescriptive, medical devices, and implants practice, the individual may submit their records for their initial training as required in WAC 246-834-165 and meet the requirements in WAC 246-12-040.
(7) A licensed midwife with an inactive license extension for five years or more at the time of reactivation, and who has not been actively engaged in midwifery prescriptive or medical devices and implant practice, shall retake the required training in WAC 246-834-165.
[Statutory Authority: RCW 18.50.115, 18.50.135, 43.70.613, 2022 c 289, and 2021 c 276. WSR 24-10-091, § 246-834-450, filed 4/30/24, effective 6/6/24. Statutory Authority: RCW 18.50.135 and 18.50.115. WSR 19-15-005, § 246-834-450, filed 7/5/19, effective 8/5/19. Statutory Authority: RCW 18.50.010, 18.50.040, 18.50.050, 18.50.135, and 2014 c 187. WSR 17-15-024, § 246-834-450, filed 7/7/17, effective 8/7/17.]


PDF246-834-990

Midwifery fees and renewal cycle.

(1) Licenses must be renewed every year on the practitioner's birthday as provided in chapter 246-12 WAC, Part 2.
(2) The following fees are nonrefundable:
Title of Fee
Fee
Initial application
$525.00
State examination (initial/retake)
155.00
Renewal
525.00
Late renewal penalty
265.00
Duplicate license
10.00
Verification of license
25.00
Expired license reissuance
300.00
UW online access fee (HEAL-WA)
16.00
Student midwife permit
175.00
Inactive credential
250.00
[Statutory Authority: RCW 43.70.250 and 43.70.280. WSR 18-04-109, § 246-834-990, filed 2/6/18, effective 6/1/18. Statutory Authority: RCW 18.50.010, 18.50.040, 18.50.050, 18.50.135, and 2014 c 187. WSR 17-15-024, § 246-834-990, filed 7/7/17, effective 8/7/17. Statutory Authority: RCW 43.70.110 (3)(c) and 43.70.250. WSR 12-19-088, § 246-834-990, filed 9/18/12, effective 11/1/12. Statutory Authority: RCW 43.70.110 and 43.70.112. WSR 11-19-098, § 246-834-990, filed 9/20/11, effective 1/1/12. Statutory Authority: RCW 43.70.110, 43.70.250, and 2010 c 37. WSR 10-19-071, § 246-834-990, filed 9/16/10, effective 10/15/10. Statutory Authority: 2006 c 372, RCW 43.70.250 and 18.50.135. WSR 06-13-012, § 246-834-990, filed 6/9/06, effective 7/1/06. Statutory Authority: RCW 43.70.250, [43.70.]280 and 43.70.110. WSR 05-12-012, § 246-834-990, filed 5/20/05, effective 7/1/05. Statutory Authority: RCW 43.70.250 and 18.50.135. WSR 04-22-113, § 246-834-990, filed 11/3/04, effective 2/17/05. Statutory Authority: RCW 43.70.250, 2001 2nd sp.s. c 7 and RCW 18.50.102. WSR 01-23-101, § 246-834-990, filed 11/21/01, effective 1/21/02. Statutory Authority: RCW 18.50.102 and 43.70.250. WSR 98-11-069, § 246-834-990, filed 5/19/98, effective 7/13/98. Statutory Authority: RCW 43.70.250. WSR 91-13-002 (Order 173), § 246-834-990, filed 6/6/91, effective 7/7/91. Statutory Authority: RCW 43.70.040. WSR 91-02-049 (Order 121), recodified as § 246-834-990, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 43.70.250. WSR 90-04-094 (Order 029), § 308-115-405, filed 2/7/90, effective 3/10/90. Statutory Authority: RCW 18.50.135. WSR 89-08-008 (Order PM 827), § 308-115-405, filed 3/24/89. Statutory Authority: RCW 43.24.086. WSR 87-18-031 (Order PM 667), § 308-115-405, filed 8/27/87. Statutory Authority: 1983 c 168 § 12. WSR 83-17-031 (Order PL 442), § 308-115-405, filed 8/10/83. Formerly WAC 308-115-400.]