Additional Resources for Midwifery

• Statutes & Rules

  Indiana Statutes

  Title 25 Article 1  - Professions and Occupations

  Title 25 Article 1 Chapter 9 - Health Professions Standards of Practice

  Title 25 Article 23.4 - Certified Direct Entry Midwives

  Indiana Administrative Rules

  Title 844 Article 1 - General Provisions

• Informed Disclosure of Practice

  IC 25-23.4-4 lays out the requirements for informed consent and disclosure of practice.  The Committee cannot provide specific guidance.  If you have questions regarding these requirements please consult with private counsel.

  IC 25-23.4-4-1 Requirements to accept a client

  Sec. 1. (a) All the following must occur before a certified direct entry midwife may accept a client for midwifery care:

  (1) The certified direct entry midwife must provide the potential client with an informed disclosure of practice form.

  (2) The potential client must sign and date the form.

  (3) The certified direct entry midwife must sign and date the form.

  (4) If the potential client refuses a procedure or treatment required by law, the potential client must so indicate on a separate procedure or treatment form.

  (5) The certified direct entry midwife must have an emergency plan for the care of the client if an emergency arises. As part of the emergency plan, the client must sign a release of the client's medical records that allows the certified direct entry midwife to provide the client's medical records to a physician if an emergency arises.

  (6) Subject to rules adopted under IC 25-23.4-2-6(b)(5), the certified direct entry midwife must have a collaborative agreement with a physician to provide for consultation and care for the client. The physician shall examine the client at least one (1) time during the client's first trimester and one (1) time during the client's third trimester. The collaborating physician should be located in an area close to where the delivery will occur.

  (7) The certified direct entry midwife must provide the client with a list of options for additional screening and assessments, including visits to a physician.

  (8) The certified direct entry midwife must maintain medical records on the client through the entire course of care and transfer the medical records to a treating physician if an emergency arises. The medical records must contain all the forms that are required under this subsection.

  (b) A certified direct entry midwife may not have a minor as a client unless the minor's parent or guardian has agreed in writing to use the certified direct entry midwife and all other requirements of this article have been met.

  IC 25-23.4-4-2 Disclosure of procedures and treatment

  Sec. 2. (a) A certified direct entry midwife may not perform on a client a specific procedure or treatment that is not described on the informed disclosure of practice form described in section 1 of this chapter until both of the following occur:

  (1) The specific procedure or treatment is disclosed to the client in writing on a form that is separate from the informed disclosure of practice form.

  (2) The client agrees to the procedure or treatment by signing the procedure or treatment form.

  (b) If the potential client refuses a procedure or treatment required by law, the client must so indicate on a separate procedure or treatment form, which must be maintained in the client's medical records.

  IC 25-23.4-4-3 Informed disclosure of practice

  Sec. 3. The informed disclosure of practice form must be in writing and must contain the following information:

  (1) A description of the certified direct entry midwife's education and training in midwifery, including completion of continuing education courses and participation in the peer review process.

  (2) The certified direct entry midwife's experience level in the field of midwifery.

  (3) The certified direct entry midwife's philosophy of practice.

  (4) Antepartum, intrapartum, and postpartum period conditions requiring consultation, transfer of care, and transport to a hospital.

  (5) The emergency medical backup plan, including the emergency plan and the collaborative agreement with a physician for backup care required under section 1 of this chapter.

  (6) The services to be provided to the client by the certified direct entry midwife and that a physician is required to examine the client at least one (1) time during the client's first trimester and one (1) time during the client's third trimester.

  (7) The certified direct entry midwife's current status of certification under this article.

  (8) A detailed explanation of treatments and procedures.

  (9) A detailed description of the risks and expected benefits of midwifery care.

  (10) The availability of a grievance process in a case in which a client is dissatisfied with the performance of the certified direct entry midwife.

  (11) A statement that if the client is advised by the certified direct entry midwife or a collaborating physician that the client is or has become at risk (as described in IC 25-23.4-6), the certified direct entry midwife:

  (A) shall refer the client to a physician for consultation;

  (B) may refuse to provide or continue care; and

  (C) may transfer care of the client to a physician.

  (12) A statement disclosing whether or not the certified direct entry midwife maintains liability insurance.

  (13) That state certification of a certified direct entry midwife does not ensure that a home setting for delivery of a child is safe.

  (14) A statement that the client understands that the client is waiving the right to sue a physician or health care provider for the following:

  (A) The acts or omissions of the client's certified direct entry midwife.

  (B) For collaboration or work with a certified direct entry midwife except for in cases of gross negligence or willful or wanton misconduct by the physician or health care provider.

  IC 25-23.4-4-5 Prescription drugs

  Sec. 5. (a) Except as provided in subsection (b), a certified direct entry midwife may not dispense or administer prescription drugs.

  (b) A certified direct entry midwife may carry and administer the following medications under a protocol issued and agreed to by a physician licensed under IC 25-22.5:

  (1) Postpartum antihemorrhagic drugs in emergency situations.

  (2) Local anesthetics by infiltration or topical application, only for postpartum repair of lacerations, tears, and episiotomy.

  (3) Oxygen.

  (4) Prophylactic antibiotics for Group B Strep (also known as Beta Strep).

  (c) A certified direct entry midwife may not administer a drug intravenously and may, with a physician's order, administer the following:

  (1) Vitamin K, either orally or through intramuscular injection.

  (2) Rhogam.

  (3) Prophylactic ophthalmic antibiotics.

  specifying the circumstances under which a certified direct entry midwife may administer the substances listed in this subsection.

• Emergency Care Plans

  844 IAC 17-1-11 requires a certified direct entry midwife to develope a written emergency care plan for each client.

  The emergency care plan must:

  • Be signed by the client and midwife;
  • Be maintained in the client's record;
  • Specify the planned location of delivery;
  • Designate a hospital(s), including directions from the planned location of deliver, where the client can receive emergency care;
  • Include the name, address, and telephone number of the collaborating physician, midwife, infant's physician, and other designated providers;
  • Include the name, address, and telephone number of an emergency contact for the client;
  • Include a signed release of the client's records in accordance with IC 25-23.4-4-1(a)(5); and,
  • Be filed with the designated hospital(s).

  Sample Emergency Care Plan - This is provided for illustrative purposes only.

• Post-Birth Information

  Certified Direct Entry Midwives have certain duties after a client has given birth, pursuant to IC 25-23.4-4-6.

  After a client has given birth, the certified direct entry midwife shall:

  • Provide the client with a statement indicating that the newborn infant should be examined by a pediatrician or family practice physician for checkups beginning within two (2) weeks after birth; and,
  • Identify with the client a pediatrician or family practice physician for the care of the infant.
• Peer Review Requirements

  Pursuant to 844 IAC 17-1-7, all certified direct entry midwives must participate in peer review sessions at least twice a year.

  Approved peer review sessions must be sponsored by one of the following organizations:

  • North American Registry of Midwives
  • Indiana Midwives Association
  • Association of Indiana Midwives
  • Other organization approved by the Committee

  All peer review sessions must have at least 4 participants who hold one of the following licenses/credentials:

  • Certified Professional Midwife
  • Certified Direct Entry Midwife
  • Certfied Nurse Midwife

  In addition, all certified direct entry midwives must submit the following cases for peer review within six months:

  • Death of a client or client's child;
  • Intrapartum or post-partum transport of a client from the planned delivery location to a hospital, urgent care center, physician's office or similar facility for further care or treatment; or,
  • Significant adverse event or injury to the client or client's child, whether temporary or permanent in nature
• Annual Reporting Requirements

  Before March 31 of each year, a certified direct entry midwife shall report to the Committee the following information from the previous calendar year.   All reports may be submitted to your account at MyLicense.IN.gov. Click here to access the form.

  Required Information:

  • Number of live births
  • Number of still births
  • Number of maternal deaths
  • Average number of weeks of pre-natal care provided
  • Average number of weeks of post-partum care provided
  • Number of emergency transports to the hospital or other emergency facility
  • Number of transfers of care pre-natal, intrapartum and post-partum
  • Number of referrals pursuant to 844 IAC 17-1-9 pre-natal, intrapartum and post-partum, including reasons for referrals
  • Number of mother breastfeeding 6 weeks post-partum
• Frequently Asked Questions

  Why must I provide my email address?

  • We require an email address as we send all correspondence regarding your license and application via email.  Please make sure you keep it current with us just as you would your mailing address.

  I am out of state, how do I get my criminal back ground check?

  • There are lengthy instructions on how to proceed with the criminal back ground check on our website.  Go to the Criminal Background Check page and select the out of state instructions.

  When can I get my criminal background check done?

  • You can only obtain your criminal background check once you have received your online application receipt or if you have been notified that your application has been received by our office. If you choose to complete the process prior to notification, your background check will not be accepted and you will have to repeat the process.

  I have submitted an application for licensure and am no longer taking the position and therefore no longer need an Indiana license.  What do I need to do and can you refund my application fee?

  • You will need to email us that you wish to withdraw your application.  All fees are non-refundable unless otherwise stated according to IC 25-1-8-2(e).

  How long will it take to obtain my license?

  • How long it takes, is really up to the applicant and how long the documentation takes to get to us. Please note that if you have a positive response on your application a delay will occur, as positive responses may be reviewed by the Committee.  The Committee may determine to request a personal appearance.  If an appearance is requested, a letter will be sent to you via email.

  When does my Direct Entry Midwifery license expire?

  • All  licenses expire March 31 of odd-numbered years. Renewal notifications will be sent approximately 90 days prior to the expiration date.  The renewal fee is $50.

  Do I need to obtain continuing education to renew my license?

  • Yes, see continuing education resources page.
• Scope of Practice Rulings

  Licensed practitioners that have a specific question or questions about the scope of practice of their licensed profession may request a "practice ruling" from the Indiana Professional Licensing Agency (PLA) and the Indiana Midwifery Committee (the Committee). The PLA and the Committee may provide a formal determination/interpretation based on the practitioner's factual situations/circumstances. Licensed practitioners may submit a "Request for Practice Ruling" through the web-based form provided on the PLA's "Request for Practice Ruling" web page. Additional information and instructions for submitting a "Request for Practice Ruling " are provided on the web page.

  All requests will be reviewed by the PLA's legal team, and PLA's legal team will draft a ruling for the Committee's consideration and potential adoption. All rulings adopted by the Committee will be posted to the Indiana Register as well as the comprehensive list provided on the the PLA's "Request for Practice Ruling" web page.