Ohio House Bill 537: Proposed Regulations for Midwives and Birthing Centers

Smiling midwife consulting with a pregnant woman during a prenatal checkup, illustrating midwifery regulations under Ohio House Bill 537

The Ohio Board of Nursing (“BON”) and the Ohio Department of Commerce may soon regulate midwifery in Ohio. House Bill 537 was introduced in the Ohio House of Representatives on October 21, 2025. The Bill seeks to add or amend sections in the Ohio Revised Code (“ORC”) relating to certified nurse-midwives, certified midwives, licensed midwives, and traditional midwives. In doing so, the proposed Bill accounts for full regulation of these practice areas and defines roles for individual midwife designations. The following highlights key changes that are proposed in H.B. 537:

Certified Nurse-Midwives:

Allows a certified nurse-midwife (“CNM”) to, “in collaboration with one or more physicians, attend births in hospitals, homes, medical offices, and freestanding birthing centers and provide care for normal newborns during the period consistent with the scope of practice for certified nurse-midwives established by the American college of nurse-midwives.”[1]
Prohibits CNMs from treating “abnormal condition[s] that are outside of the scope of practice for certified nurse-midwives established by the American college of nurse-midwives, except in emergencies.” [2]
Prohibits CNMs from “delivering breech or face presentation except in an emergency or as provided in section 4723.581 of the Revised Code.” [3]

Certified Midwives:

Establishes that the BON “shall adopt rules establishing standards and procedures for the licensure and regulation of certified midwives.” [4]
States that a certified midwife (“CM”) is an individual who may practice only in accordance with a standard care arrangement (“SCA”) and adds “certified midwife” to all applicable SCA provisions. [5]
Establishes what activities a CM may engage in when in collaboration with one or more physicians.[6]

Licensed Midwives:

Establishes what is within the scope of a licensed midwife (“LM”) and what activities LMs may engage in.[7]

Traditional Midwives:

Establishes what is within the scope of a traditional midwife (“TM”) and what activities TMs may engage in.[8]

Free Standing Birthing Centers:

Requires free standing birthing centers to have one of the following attend each birth:
- “A physician licensed under Chapter 4731 of the Revised Code to practice medicine and surgery or osteopathic medicine and surgery;
- A certified nurse-midwife licensed under Chapter 4723 of the Revised Code;
- A certified midwife licensed under Chapter 4723 of the Revised Code;
- A licensed midwife licensed under Chapter 4724 of the Revised Code.”[9]

Each freestanding birthing center must have a director of patient services who is one of the following:
- “A physician licensed under Chapter 4731 of the Revised Code to practice medicine and surgery or osteopathic medicine and surgery;
- A certified nurse-midwife licensed under Chapter 4723 of the Revised Code who has contracted with a collaborating physician;
- A certified midwife licensed under Chapter 4723. of the Revised Code who has contracted with a collaborating physician.”[10]

Proposes that a hospital that is a “Medicaid provider and that operates a maternity unit shall agree to a written transfer agreement with any freestanding birthing center if both of the following apply”:[11]
- The freestanding birthing center is located within a thirty-mile radius of the hospital.
- The freestanding birthing center has requested a transfer agreement.

States that a transfer agreement shall “specify an effective procedure for the safe and immediate transfer of patients from the freestanding birthing center to the hospital when medical care beyond the care that can be provided at the freestanding birthing center is necessary, including when emergency situations occur or medical complications arise.”[12]

Home Births:

A CNM or CM shall be allowed to attend a vaginal birth after caesarean (“VBAC”), birth of twins, or breech birth as a home birth only if the conditions described are satisfied:[13]
- The patient gives their written informed consent, including a description of risks associated with the procedure.
- The certified nurse-midwife or certified midwife consults with a physician about the patient and together with the physician determines whether referral is appropriate for the patient.
- The certified nurse-midwife or certified midwife satisfies any other conditions required in rules adopted by the BON.

A LM shall be allowed to attend a VBAC, birth of twins, or breech birth as a home birth only if the conditions described are satisfied:[14]
- The patient gives their written informed consent, including a description of risks associated with the procedure.
- The licensed midwife consults with a physician, certified nurse-midwife, or certified midwife, and together with the physician or midwife determines whether referral is appropriate for the patient.
- The LM satisfies any other conditions required in rules adopted by the BON.

Where a CNM or CM provides care for a planned homebirth, there must be an individualized transfer of care planned with each patient, and the CNM or CM must “assess the status of the patient, fetus, and newborn throughout the maternity care cycle and shall determine when or if a transfer to a hospital is necessary.”^[15]

To learn more about H.B. 537 and how the proposed regulations may impact your practice, please contact BMD Member Jeana Singleton at jmsingleton@bmdllc.com or 330-253-2001.

[1] H.B. 537, pg. 60-61, available at https://search-prod.lis.state.oh.us/api/v2/general_assembly_136/legislation/hb537/00_IN/pdf/ (amending ORC Sec. 4723.43).

[2] Id. at 60.

[3] Id.

[4] H.B. 537, pg. 95, available at https://search-prod.lis.state.oh.us/api/v2/general_assembly_136/legislation/hb537/00_IN/pdf/ (adding ORC Sec. 4723.59).

[5] H.B. 537, pg. 63, available at https://search-prod.lis.state.oh.us/api/v2/general_assembly_136/legislation/hb537/00_IN/pdf/ (amending ORC Sec. 4723.431).

[6] H.B. 537, pg. 86-87, available at https://search-prod.lis.state.oh.us/api/v2/general_assembly_136/legislation/hb537/00_IN/pdf/ (adding ORC Sec. 4723.57).

[7] H.B. 537, pg. 102, available at https://search-prod.lis.state.oh.us/api/v2/general_assembly_136/legislation/hb537/00_IN/pdf/ (adding ORC Sec. 4724.05).

[8] H.B. 537, pg. 116, available at https://search-prod.lis.state.oh.us/api/v2/general_assembly_136/legislation/hb537/00_IN/pdf/ (adding ORC Sec. 4724.14).

[9] H.B. 537, pg. 5-6, available at https://search-prod.lis.state.oh.us/api/v2/general_assembly_136/legislation/hb537/00_IN/pdf/ (amends ORC Sec. 3702.30).

[10] H.B. 537, pg. 6, available at https://search-prod.lis.state.oh.us/api/v2/general_assembly_136/legislation/hb537/00_IN/pdf/ (amends ORC Sec. 3702.30).

[11] H.B. 537, pg. 8-9, available at https://search-prod.lis.state.oh.us/api/v2/general_assembly_136/legislation/hb537/00_IN/pdf/ (adding ORC Sec. 3722.15).

[12] H.B. 537, pg. 8-9, available at https://search-prod.lis.state.oh.us/api/v2/general_assembly_136/legislation/hb537/00_IN/pdf/ (adding ORC Sec. 3722.15).