House committee substitute makes the following changes to the 1st edition.

Adds a whereas clause.

Amends GS 90-18.7, Limitations on nurse-midwives, making conforming changes, inserting "certified" before "nurse-midwife" throughout the section.

Amends GS 90-178.2, Definitions, to reinstate the term "interconceptional care" and delete "family planning" from the definition for interconceptional care. Expands the same definition, including gynecologic care and management of common health problems as types of interconceptional care. Amends the definitions for the terms intrapartum care, midwifery, newborn care, postpartum care, and prenatal care. Deletes the term and definition for primary care from the section.

Amends GS 90-178.3, Regulation of midwifery, providing that certified nurse-midwives (CNMs) must consult, collaborate with, or refer to other providers licensed under this Article if indicated by the health status of the patient (previously, section required CNMs to practice within a health care system that provided for consultation, collaborative management, or referral. Also required midwifery standards to be consistent with the standards of care established by the American College of Nurse-Midwives, as well as requiring certified nurse-midwives to provide each patient with information regarding or referral to other providers and services at the request of the patient or when required care is outside the scope of the midwife's practice). Also deletes provision that provided that individuals engaging in the practice of midwifery without a license are in violation of this Article and Article 1 of GS Chapter 90.

Amends GS 90-178.4(a), making technical and clarifying changes, replacing "pursuant" with "under" throughout the subsection.

Amends GS 90-178.4, deleting the provisions of the previous edition and adding two new subsections as follows. Deletes proposed language and provisions for GS 90-178.4(a1), found in the previous edition, replacing them with two new subsections, GS 90-178.4(a1) and (a2), requiring CNMs attending planned births outside a hospital setting to obtain written informed consent from the patient, which must include (1) risk information, (2) assumption of risk by the patient, (3) patient agreement to transfer to a health care facility if deemed necessary by the CNM, and (4) a disclosure if the CNM is not covered by liability insurance. Also requires a CNM attending a planned birth outside a hospital setting to provide the patient a specific, detailed transfer plan to a hospital.

Amends GS 90-178.4(b), making technical and clarifying changes and deleting the requirement that the joint subcommittee must adopt rules for establishing physician supervision of the CNM. Provides that rules will be adopted regarding the form and contents of applications, which will include information regarding the applicant's education and certification by the American Midwifery Certification Board (was, American College of Nurse Midwives).

Amends GS 90-178.5, making a technical change.

Amends GS 90-178.7(b) to provide that any person practicing midwifery without being approved and registered under Article 10A of GS Chapter 90 will not collect a fee for services provided. Any person practicing without being duly approved will be guilty of a Class 3 misdemeanor. Also establishes that any person practicing midwifery without proper approval and who holds himself or herself out as being approved as such will be guilty of a Class I felony.

Amends GS 90-178.8, making clarifying and technical changes, and providing that  physicians, physician assistants, or nurses will not be held liable for civil damages arising from any medical care or treatment in specified situations; however, each will remain liable for his or her own independent negligent acts. Similarly, provides that no health care facility licensed under GS 122C or 131E is liable for any civil damages arising from medical care or treatment it provides in specified situations; however, the facility will remain liable for its own independent negligent acts.