SHB 2329
In CommitteeHouse
Midwife supervision
Concerning midwife supervision of medical assistants and lactation consultants.
This status may be delayed. See Action History below for the latest updates.
How does a bill become law?
- Introduced: The bill is filed and assigned a number.
- Committee: A subject-matter committee holds hearings, takes public testimony, and decides whether to advance the bill.
- Floor Vote: The full chamber (House or Senate) debates and votes on the bill.
- Opposite Chamber: The bill repeats the committee and floor vote process in the other chamber.
- Governor: The Governor reviews the bill and decides whether to sign or veto it.
- Signed: The bill has been signed into law.
AI Analysis
This bill clarifies and expands the authority of licensed midwives in Washington to delegate clinical tasks to qualified support staff—including nurses, medical assistants, and lactation consultants—and updates definitions around supervision to allow for more flexible models like telemedicine. It also adds a sunset date for certain delegation rules and a future effective date for updated definitions.
- Allows licensed midwives to delegate specific midwifery tasks—including medication administration and specimen collection—to registered nurses, licensed practical nurses, medical assistants, and international board certified lactation consultants, as long as the tasks match the delegate’s training and scope of practice.
- Clarifies the definition of 'supervision' to include physical presence with immediate availability, or in some cases (e.g., blood draws, vaccines, telemedicine, or syphilis treatment), supervision via telemedicine or remote availability.
- Expands the list of health care practitioners authorized to delegate tasks to medical assistants to explicitly include midwives.
- Adds a new provision allowing midwives to supervise medical assistants during telemedicine visits using interactive audio and video technology.
- Includes a sunset clause for certain delegation rules (Section 2) that expire on June 30, 2027, while new definitions and supervision rules (Section 3) take effect on June 30, 2027.
Who is affected
- Licensed midwives — Midwives gain clearer authority to delegate specific clinical tasks—like medication administration or specimen collection—to qualified support staff, improving workflow and care capacity in midwifery practices.
- Medical assistants, registered nurses, and international board certified lactation consultants — Medical assistants, registered nurses, and lactation consultants may perform more tasks under midwife supervision, expanding their roles in maternal and newborn care settings.
- Patients receiving midwifery care — Patients may benefit from increased access to care, as midwives can more efficiently use trained support staff to provide routine services like vaccinations or blood draws during prenatal or postpartum visits.
- Clinics and birth centers using midwifery services — Health care clinics and birth centers that employ midwives and support staff may see changes in staffing models and supervision requirements.
Pro/Con Analysis
Stronger case for benefits
Potential Benefits (5)
Allowing midwives to delegate tasks like medication administration and specimen collection to qualified support staff (e.g., nurses, lactation consultants) increases care capacity—especially in rural or underserved areas—where midwifery-led clinics are often the primary maternal care source.
HealthcarePeopleRef: Section 1Explicitly permitting telemedicine supervision during virtual visits expands access to prenatal/postpartum care for patients in transportation-challenged or remote areas, reducing travel burden and time off work.
HealthcarePeopleRef: Section 3, (c)(i)Expanding the list of providers authorized to delegate to medical assistants to include midwives formalizes and legitimizes existing practice patterns, improving care coordination and reducing administrative friction in integrated clinics.
HealthcarePeopleRef: Section 1Allowing telemedicine supervision for syphilis treatment injections supports timely public health interventions—especially in rural areas—where specialists may not be on-site but can supervise via telehealth during outreach clinics.
Public SafetyPeopleRef: Section 3, (c)(ii)Support staff (e.g., medical assistants, nurses, lactation consultants) gain expanded roles and potential career advancement opportunities under clearer delegation pathways, which may improve job satisfaction and retention in maternal health settings.
Business & EmploymentPeopleRef: Section 1
Potential Concerns (5)
Allowing telemedicine supervision for intramuscular syphilis treatment may reduce real-time oversight, potentially increasing risk of medication errors or missed contraindications—though the procedure is low-risk and protocols exist, the shift from in-person to remote supervision lacks robust evidence of safety in community settings.
Public SafetyRef: Section 2, (c)(ii)Expanding telemedicine supervision to medical assistants during telehealth visits may dilute accountability if supervision is not meaningfully interactive or verifiable, especially in high-volume or low-resource clinics with limited technical infrastructure.
Public SafetyRef: Section 2, (c)(i)Permitting supervision via 'immediate availability' (rather than physical presence) for blood draws, vaccines, and specimen collection may reduce on-site oversight, increasing risk if support staff encounter unexpected complications without direct clinician access.
Public SafetyRef: Section 2, (b)The sunset and staggered effective dates create regulatory uncertainty for clinics and the Department of Health, requiring repeated rulemaking and potentially disrupting staffing models during transition periods.
Local GovernmentRef: Section 2 (sunset clause) and Section 3 (effective date)While midwives gain delegation authority, the bill does not mandate training, competency assessment, or liability coverage for delegated tasks—leaving clinics and support staff vulnerable to liability gaps if errors occur.
Business & EmploymentRef: Section 1
Who Is Most Affected
Midwives gain formal authority to delegate tasks to qualified support staff, improving workflow efficiency and care capacity—especially in small clinics or rural settings. This aligns with their scope of practice and reduces clinical bottlenecks.
Support staff (nurses, medical assistants, lactation consultants) gain expanded clinical responsibilities under supervision, potentially increasing job scope, compensation, and retention—but without new training mandates, skill gaps may persist in practice.
Patients—especially low-income, rural, or Medicaid-enrolled individuals—benefit from increased access to routine services (e.g., vaccines, blood draws) during prenatal visits, reducing missed appointments and travel burden.
Clinics and birth centers may reduce overhead by using support staff more efficiently, but face new administrative burdens in documenting delegation and supervision compliance—especially during the 2027 transition window.
The Department of Health faces minimal fiscal impact but must update licensing guidance and monitor delegation practices—particularly around telemedicine supervision standards—before the 2027 sunset review.