Idaho Bill H 639 (2026) – Midwifery: Medication Authority and Related Reforms
Primary purpose and intent
- To revise and expand the regulatory framework for midwives in Idaho, specifically by authorizing licensed midwives to obtain and administer medications indicated for maternal and neonatal care, provided the midwife has the requisite education, training, and experience.
- To streamline formulary rules and remove outdated or unnecessary language related to midwifery drug formularies.
- To ensure safer, standardized emergency transfer practices and documentation when complications arise.
Key provisions and changes
1) Rulemaking and clinical scope (Section 54-5504)
- The Idaho Board of Midwifery would be authorized to allow licensed midwives to obtain and administer a defined set of medications during midwifery care, including:
- Oxygen
- Postpartum antihemorrhagic agents: oxytocin, misoprostol, and methylergonovine
- Injectable local anesthetic for limited laceration repair (up to second-degree)
- Antibiotics for maternal Group B Streptococcus prophylaxis (per CDC guidelines)
- Epinephrine for maternal anaphylaxis
- Intravenous fluids for maternal stabilization
- Rho (D) immune globulin
- Phytonadione (Vitamin K)
- Eye prophylaxis for the newborn
- Rules may prohibit use of other legend drugs unless they are of a similar nature and character and require 120 days’ notice to the Board of Pharmacy and Board of Medicine, with neither board objecting.
2) Formulary, protocols, and practice standards
- The board would define:
- A formulary and protocol for drugs listed above (maternal/neonatal indications) including procurement, storage, disposal, dosage, route, and duration.
- Protocols for medical waste disposal.
- Scope and standards for antepartum, intrapartum, postpartum, and newborn care, including:
- Restrictions on midwifery care for clients with certain high-risk conditions (e.g., placental abnormalities, multiple gestations beyond specified limits, non-cephalic presentation, certain obstetric histories, high BMI, prior cesareans, infectious statuses, etc.).
- Prohibitions on providing care to clients with listed disorders unless managed by a licensed healthcare provider.
- Requisites to refer to a physician in specified scenarios and to document referrals/monitoring.
- Requirements for immediate transfer to hospital emergency care for a list of acute conditions and complications, with detailed transfer procedures and documentation.
3) Medication administration authority (New Section 54-5504A)
- A licensed midwife may obtain and administer any medication indicated for maternal or neonatal care that is included in the formulary and for which the midwife has the necessary education, training, and experience.
- Administration must meet the applicable community standard of care.
4) Disclosure, recordkeeping, and license renewal (Section 54-5510)
- Before initiating care, midwives must obtain signed informed consent detailing training/experience, access to rule documents, essential professional documents, complaint procedures, liability insurance status, emergency protocols, home birth procedures, and other information as required by rule.
- Records of signed informed consent must be kept for at least nine years after the last care.
- For clients with high-risk histories or prior cesareans, midwives must provide written notices directing care to licensed physicians and require acknowledgment from the client.
- License renewal requires practice data submission from the prior calendar year (number of clients, deliveries, Apgar scores, prenatal and labor transfers, perinatal deaths, and other morbidity statistics as required).
5) Sunset/implementation and rule status
- The current Midwifery Protocols for Formulary Drugs (IDAPA 24.26.01, Section 200) would be null, void, and of no force after July 1, 2026.
- The act is effective July 1, 2026, with an emergency declaration facilitating immediate effect upon passage.
Who would be affected
- Licensed midwives in Idaho, who would gain authority to obtain and administer certain medications and implement formulary protocols.
- Clients/patients receiving midwifery care, particularly those seeking home or community-based births, who would benefit from expanded treatment options and standardized emergency transfer procedures.
- Hospitals, physicians, and pharmacist boards (Board of Pharmacy and Board of Medicine) due to new collaboration, notification, and referral requirements.
- The Board of Midwifery, which would establish formulary protocols, transfer procedures, and peer-review processes, and collect practice data for renewals.
Procedural and timeline aspects
- Emergency status declared; the act becomes effective on July 1, 2026.
- Section 4 of the bill nullifies a specific existing rule set (IDAPA 24.26.01) as of July 1, 2026.
- The bill requires advance notice (120 days) to relevant boards for introducing additional drugs into the formulary, subject to board approval.
- License renewal data collection and recordkeeping changes would apply starting with the renewal cycle following implementation.
Summary
H 639 expands the clinical toolkit of Idaho-licensed midwives by authorizing the acquisition and administration of selected maternal and neonatal medications, contingent on adequate education and training. It creates formal formulary and protocol requirements, strengthens emergency transfer planning, and enhances disclosure and recordkeeping. It also repeals certain outdated formulary rules and aligns practice with updated standards, with a July 1, 2026 effective date.
