Section R9-16-111. Prohibited Practice; Transfer of Care

A.      A midwife shall not provide midwifery services in a location that has the potential to cause harm to the client or the client’s child.

B.       A midwife shall not accept for midwifery services or continue midwifery services for a client who has or develops any of the following:

1.        A previous surgery that involved:

a.         An incision in the uterus, except as provided in R9- 16-108(B)(1); or

b.        A previous uterine surgery that enters the myome- trium;

2.        Multiple fetuses;

3.        Placenta previa or placenta accreta;

4.        A history of severe postpartum bleeding, of unknown cause, which required transfusion;

5.        Deep vein thrombosis or pulmonary embolism;

6.        Uncontrolled gestational diabetes;

7.        Insulin-dependent diabetes;

8.        Hypertension;

9.        Rh disease with positive titers;

10.     Active:

a.         Tuberculosis;

b.        Syphilis;

c.         Genital herpes at the onset of labor;

d.        Hepatitis  until  treated  and  recovered,  following which midwifery services may resume; or

e.         Gonorrhea  until  treated  and  recovered,  following which midwifery services may resume;

11.     Preeclampsia or eclampsia persisting after the second tri- mester;

12.     A blood pressure of 140/90 or an increase of 30 millime- ters of Mercury systolic or 15 millimeters of Mercury dia- stolic over the client's lowest baseline blood pressure for two consecutive readings taken at least six hours apart;

13.     A persistent hemoglobin level below 10 grams or a hema- tocrit below 30 during the third trimester;

14.     A pelvis that will not safely allow a baby to pass through during labor;

15.     A serious mental illness;

16.     Evidence of substance abuse, including six months prior to pregnancy, to one of the following, evident during an assessment of a client:

a.         Alcohol,

b.        Narcotics, or

c.         Other drugs;

17.     Except as provided in R9-16-108(B)(2), a fetus with an abnormal presentation;

18.     Labor beginning before the beginning of 36 weeks gesta- tion;

19.     A progression of labor that does not meet the require- ments of R9-16-108(J)(4), if applicable;

20.     Gestational age greater than 34 weeks with no prior pre- natal care;

21.     A gestation beyond 42 weeks;

22.     Presence of ruptured membranes without onset of labor within 24 hours;

23.     Abnormal fetal heart rate consistently less than 120 beats per minute or more than 160 beats per minute;

24.     Presence  of  thick  meconium,  blood-stained   amniotic fluid, or abnormal fetal heart tones;

25.     A postpartum hemorrhage of greater than 500 milliliters in the current pregnancy; or

26.     A non-bleeding placenta retained for more than 60 min- utes.

C.      A midwife shall not perform a vaginal delivery after prior Cesarean section for a client who:

1.        Had:

a.         More than one previous Cesarean section;

b.        A previous Cesarean section:

i.         With a classical, vertical, or unknown uterine incision;

ii.        Within 18 months before the expected delivery;

iii.      With   complications,  including  uterine  infec- tion; or

iv.       Due to failure to progress as a result of cephalo- pelvic insufficiency; or

c.         Complications during a previous vaginal delivery after a Cesarean section; or

2.        Has a fetus:

a.         With fetal anomalies, confirmed by an ultrasound; or

b.        In a breech presentation.

D.      A midwife shall not perform a vaginal delivery of a fetus in a breech presentation for a client who:

1.        Had a previous:

a.         Unsuccessful vaginal delivery or other demonstra- tion of an inadequate maternal pelvis, or

b.        Cesarean section; or

2.        Has a fetus:

a.         With fetal anomalies, confirmed by an ultrasound;

b.        With an estimated fetal weight less than 2500 grams or more than 3800 grams; or

c.         In an incomplete breech presentation.

E.       If the client has any of the conditions in subsections (B) through (D), a midwife shall:

1.        Document the condition in the client record, and

2.        Initiate transfer of care.

F.       A midwife shall not perform any operative procedures except as provided in R9-16-113.

G.      A midwife shall not:

1.        Use any artificial, forcible, or mechanical means to assist birth; or

2.        Attempt to correct fetal presentations by external or inter- nal movement of the fetus.

H.      A midwife shall not administer drugs or medications except as provided in R9-16-108(I)(5)(f), (K)(1)(g), (K)(2)(c), or R9-16- 113.

I.        Except as provided in R9-16-113, a midwife shall:

1.        Discontinue midwifery services and transfer care of a newborn in which any of the following conditions are present:

a.         Birth weight less than 2000 grams;

b.        Pale, blue, or gray color after 10 minutes;

c.         Excessive edema;

d.        Major congenital anomalies; or

e.         Respiratory distress; and

2.        Document the condition in subsection (I)(1) in the new- born record.

Historical Note

Adopted effective March 14, 1994 (Supp. 94-1). R9-16- 111 renumbered to R9-16-116; new Section R9-16-111 renumbered from R9-16-108 and amended by exempt rulemaking at 19 A.A.R. 1805, effective July 1, 2013

(Supp. 13-2).