Action Needed: TDLR Informed Consent Proposed Revisions: Request for Comments
Fellow Texas Midwives,
We need your voice on the proposed revisions to the Informed Choice and Disclosure Statement. This form is being revised internally with TDLR and is not going through the traditional rule-making process, which involves input and approval from the Midwives Advisory Board.
First, we want to acknowledge that we appreciate TDLR’s attention to detail and its continued efforts to improve the Midwifery Program. We recognize that the intent behind these changes is to strengthen transparency and safety.
What’s Changing
The proposed additions include:
Professional liability insurance: Expanded this section with malpractice definition and informing clients they can sue regardless if a midwife carries malpractice or not and “may, at any time, ask their midwife about their financial responsibility arrangements…”
Informs clients that they can sue midwives for personal assets and “may, at any time, ask their midwife about their financial responsibility arrangements.”
State Medicaid/CHIP resources: Clients are directed to state programs for prenatal coverage.
Hospital preparation instructions: Clients are “strongly encouraged” to visit hospitals in advance, preregister, and pack a bag “in case of a transfer.”
Expanded prohibited acts: Frenotomies and abortion are newly included.
More detailed hospital contact information requirements.
Why This Matters
The proposed form raises serious concerns for midwives and the families they serve:
Exceeds statutory limits: While the legal disclosure section itself remains under the 500-word limit, the additions—including insurance education, hospital logistics, and state insurance resources—extend the document well beyond the statutory intent. This makes the form longer and more burdensome for clients.
No other licensed healthcare profession is treated this way: No other licensed healthcare profession in Texas is required to include language inviting clients to investigate their provider’s personal financial assets. This single requirement uniquely burdens midwives and risks misrepresenting their practice.
Malpractice and financial disclosure concerns: The expanded professional liability section requires discussion of personal financial responsibility, placing an undue burden on midwives without improving client safety.
Insurance framing is misleading: The insurance section frames midwifery practice as high-risk and financially precarious without evidence. This could create unnecessary fear for families and undermine trust in the provider-client relationship.
Hospital preparation language is paternalistic: Instructions to preregister, visit hospital units, and pack a hospital bag suggest that transfers are expected rather than exceptional. This over-medicalizes care and may intimidate families choosing midwifery.
New prohibited acts without legislative mandate: Adding frenotomies and abortion to the prohibited acts list changes how scope of practice is presented through a disclosure form rather than legislation or rulemaking.
Reduced transparency: Removing the Neonatal Resuscitation credential expiration date decreases client visibility into provider qualifications.
Below are sample public comments you may copy, paste, and adapt. These are written for submission as a private individual, Licensed Midwife, or consumer, not as a board or association representative.
How to Submit a Public Comment to TDLR
There are two templates available—one for midwives and one for consumers/supporters
Submit your public comment here: https://ga.tdlr.texas.gov:1443/form/gcerules
You only need to submit one comment, but more are always welcome.
TDLR Public Comment Templates for Licensed Midwives & Clients/Supporters
SAMPLE COMMENT FOR LICENSED MIDWIVES
Name
Private Individual, Licensed Midwife
Midwifery Program, TDLR
“I am writing in regard to the proposed revisions to the Informed Choice and Disclosure Statement. I appreciate TDLR’s continued efforts to update and improve the Informed Choice and Disclosure Statement.
The purpose of this document is to provide clear, relevant information that helps clients make informed decisions about their care. While I appreciate the Department’s efforts to improve the form, the proposed revisions significantly expand it in ways that go beyond what is mandated in statute.
As an informed choice disclosure for midwifery care, I do not see why this document must include information about state insurance resources and hospital logistics. While midwives may choose to share this information when appropriate, there is no statutory requirement for it to be included, and it does not directly support informed consent.
I am particularly concerned about the expanded professional liability section, which goes beyond identifying whether a midwife carries insurance and requires discussion of personal financial responsibility in the event of a claim. This creates pressure for midwives to disclose private financial information that is not relevant to client safety and may cause unnecessary fear or misunderstanding for families.
I respectfully ask the Department to reconsider these additions and ensure that revisions to this form remain concise, aligned with statute, and focused on providing clear, usable informed consent for clients of licensed midwives.”
We also want to encourage midwives to invite clients to participate.
Consumer voices matter. Please consider encouraging current and former clients to:
• Submit public comments
• Complete our consumer database. LINK HERE
Hearing directly from families strengthens the case that informed choice should be clear, respectful, and usable, not overwhelming or fear-based.
SAMPLE CONSUMER COMMENT
Name
Private Individual, Consumer
“I support transparency and informed choice in maternity care.
I am concerned about the proposed requirement for midwives to explain personal financial responsibility related to malpractice. As a consumer, this information would not help me make safer or better decisions about my care. Instead, it could create unnecessary fear or confusion at an already vulnerable time in pregnancy.
The proposed revisions significantly expand the Informed Choice and Disclosure Statement in ways that go beyond what is mandated in statute. I respectfully ask that this form remain focused on health, safety, and care options rather than on my provider’s personal financial situation.”
Every comment matters. Every voice helps shape the future of midwifery in Texas. By speaking up now, we protect informed choice, preserve the integrity of our care model, and ensure that future policies truly serve families and midwives alike.
Thank you for taking the time to participate and for the care you provide to Texas families every day.
In solidarity,
Association of Texas Midwives
