The latest iteration of a bill that involves just 16 Utah midwives but has had the attention and often the aggravation of lawmakers for three years in a row was approved Tuesday morning in the Senate.

SB93, which was passed by the Senate 24-4, now moves to the House and likely faces a rocky reception.

The bill adds regulation to the state licensing granted to 16 direct-entry midwives, who have uncompromisingly argued that it is a veiled effort by the state licensing division, with tacit approval of the medical establishment, to get rid of them altogether.

Opponents say because they are following the pioneer-era tradition of apprenticing rather than undergoing certified teaching courses to become midwives, they have put under suspicion anything that would be written into law by the bill.

Legitimacy through licensing was the goal three years ago when the Direct-Entry Midwife Act was approved. The process of writing the bill into Utah Code became problematic because the act used the term "normal birth" when the phrase is not defined.

That has led to direct-entry midwives practicing beyond the scope of their training and increasing risk to mothers and infants in their care, say proponents of the bill.

"I wish they hadn't asked for licensing," Sen. Margaret Dayton, R-Provo and SB93 sponsor, said Tuesday during the bill's third reading in the Senate. "But with licensing comes regulation, as with a group or business in the state."

The bill in no way affects certified midwives — those who have been through a certified education program — and only clarifies the terms of practice for those who enter the profession directly as apprentices, she said.

Two complaints of midwives practicing beyond their scope have been filed, according to the state Division of Occupational and Professional Licensing. Although one of the complaints involved a hospital transfer, both of the complaints were dismissed as unfounded.

Sen. Scott McCoy, D-Salt Lake, said in explaining why he voted against the measure that it was the process more than the content that he found objective.

"What's happening here is we're being asked to legislate the details that should have but weren't worked out in the normal rules process" of writing the original act into state code," McCoy said. "There should have been more good-faith negotiation and collaboration."

McCoy and other lawmakers say that representatives in the medical establishment weren't on hand although they were notified of the rule-making. Now, three years later, they realize the midwives might have too much leeway and the state might face liability it doesn't want.

Dayton, who used to be a nurse and whose husband is an OB/GYN, said midwives must realize that with state license comes practice parameters, just like any other state-licensed occupation.

"Hospitals and doctors do not want the patients that do not want to be there," she said. "They acknowledge that people have other choices. There has never bee a move by the hospitals or this Legislature to go after the in-home birthing community."