California College of Midwives
State chapter ~ American College of Community Midwives

Section One



e The Midwife provides accurate information regarding the standards and scope of midwifery practice, fees, medical consultation arrangements and the rights and responsibilities of the client.



A. The Client shall receive complete, relevant, objective and, where appropriate, evidence-based information regarding community-based midwifery, including but not limited to:


1.      the risks and benefits associated with midwifery services provided in the Client’s home or freestanding birth center

2.      the right of the Client to change her mind and seek out obstetrical services or hospitalization

3.      a description of the responsibilities for the Client and her family, relative to choosing community-based maternity care

4.      the Client’s right to receive full information (including risks, benefits, options, and alternatives) and to provide permission or informed consent prior to the performance of routine procedures of midwifery care or other treatments, procedures or administration of any drug to mother or newborn

5.      the Client’s right to decline standard or recommended midwifery care. The Client’s decision to decline recommended care will be made in writing and signed or initialed by the client and kept in the Client’s chart;

6.      birth-related legal requirements for California residents which include newborn screening for inborn errors of metabolism (PKU), eye prophylaxis, registration of birth and death certificates, and reporting requirements for emergency transports involving mortality or serious complications

7.      information regarding the Client’s medical conditions and other concerns for which a Midwife may need to consult with a physician, refer Client to a physician, and/or transfer the Client to a physician’s care;

8.      information and referral of the Client to other providers and services whenever requested  or if the care required by the Client is outside the scope of practice for midwifery or the protocols of the individual Midwife

9.      the grievance process for Client complaints to the Medical Board of California regarding unsatisfactory or unethical care; (Medical Interface form per SB 1479)

10.  the client’s right to have pertinent records in her chart forwarded to other professionals when requested; to obtain copies of her midwifery records and those of her baby

11.  the Midwife’s expectations of the Client and the Midwife’s right to discontinue care; 


e The principle objective of the midwifery profession is to render service to healthy woman and their infants with full respect for human dignity. Midwives should merit the confidence of patients entrusted to their care, rendering to each a full measure of service and devotion. Each midwife should uphold the dignity and honor of the profession and accept its self-imposed disciplines. Such disciplines include a responsibility to uphold professional standards, to avoid compromise based on personal or institutional expediency and to adhere to professional rather than commercial standards in making known the availability of their services.

Client Disclosure and Informed Consent for Community-based Midwifery Services


B. The midwife shall provide a brief description, either orally or written, of the following:


1.      the Midwife’s practice standards, guidelines, protocols and policies

2.      the Midwife’s training & years of experience

3.      the Midwife’s compliance with adult and infant cardiopulmonary resuscitation and neonatal resuscitation certification, continuing and/or special education

4.      the Midwife's practice statistics, noting the number of clients served annually and the percentage of NSVD at home, of hospital transfers and subsequent operative or instrumental deliveries and the perinatal mortality rate for her practice

5.      any limitations on the skill, practice or other special requirements specific to the Midwife

6.      care and equipment available and supplies provided

7.      how to contact the Midwife for routine communication

8.      how to reach the Midwife in an emergency, including phone numbers for a second-call midwife or backup arrangements if the Midwife cannot be reached 


C. There shall be a place on the form for the client to attest, by signing her full name, that she has received complete, relevant, objective information on Client Rights and Responsibilities and Midwife’s Responsibilities as listed above. 


D. The Disclosure and Consent form shall include the date, name and signature of the client and if appropriate, her partner and become an official part of the Client’s records.

E.  Medical Interface Community-Based Maternity Services & Plans for Emergency Services ~ disclosure statement as required by LMPA / SB 1479


e Each Midwife shall disclose to a Client, in oral and written form:


1.      the legal scope of practice for Licensed Midwives under the LMPA

2.      the specific arrangements for her to access medical services including consultation and transfer of care during the prenatal period, hospital transfer during labor, birth and the immediate postpartum

3.      how to obtain appropriate emergency medical services for mother and baby when necessary

4.      the professional liability insurance status of the Licensed Midwife

5.      methods to inquire about the Midwife’s licensure status the Medical Board of California

6.      methods report unsatisfactory or unethical care to the Medical Board of California


The Medical Interface “Plan for Emergency Care” form shall include the date, name and signature of the client and, if appropriate, her partner and become an official part of the Client’s records.


The Medical Interface Form, as developed by the California College of Midwives, is accepted by the MBC as satisfying the requirements the 2000 amendment of the LMPA.


However, any California Licensed Midwife may develop her own version as long as it includes the same 6 areas of required information.


F. Midwife Responsibilities & Client Informed Consent Documents ~ Sample forms


1. Sample forms as developed by California midwives are available on line ~ Midwives may use or develop their own version for each form as long as each one includes the necessary information.


a.       Initial Client Disclosure & Informed Consent

b.      Medical Interface & Plans for Emergency Care per SB 1479

c.       Information on GBS & Consent/Decline of prenatal GBS cultures

d.      Information and Consent /Decline ~ Routine Newborn Ophthalmic Prophylaxis

e.       Information and Consent /Decline ~ Routine Administration of Vitamin K

f.        Consent for OOH Intrapartum Care

g.       Special Circumstances-Moderate-Risk Waiver // Informed Decline of Standardized Care

Sample form are available on the College of Midwives’ web site @ the following URL: