Section R9-16-113. Emergency Measures

A.      In an emergency situation in which the health or safety of the client or newborn are determined to be at risk, a midwife:

1.        Shall ensure that an emergency medical services provider is called; and

2.        May perform the following procedures as necessary:

a.         Cardiopulmonary resuscitation of the client or new- born with a bag and mask;

b.        Administration of oxygen at no more than 8 liters per minute via mask for the client and 5 liters per minute for the newborn via neonatal mask;

c.         Episiotomy to expedite the delivery during fetal dis- tress;

d.        Suturing of episiotomy or tearing of the perineum to stop active bleeding, following administration of local anesthetic, contingent upon consultation with a physician or certified nurse midwife, or physician’s written orders;

e.         Release of shoulder dystocia by utilizing:

i.         Hyperflexion of the client's legs to the abdo- men,

ii.        Application  of  external  pressure  suprapubi- cally,

iii.      Rotation of the nonimpacted shoulder until the impacted shoulder is released,

iv.       Delivery of the posterior shoulder,

v.        Application of posterior pressure on the ante- rior shoulder, or

vi.       Positioning of the client on all fours with the back arched;

f.         Manual  exploration   of  the  uterus  for   control  of severe bleeding; or

g.        Manual removal of placenta.

B.       A licensed midwife may administer a maximum dose of 20 units of pitocin intramuscularly, in 10-unit dosages each, 30 minutes apart, to a client for the control of postpartum hemor- rhage, contingent upon physician or certified nurse midwife consultation and written orders by a physician, and arrange- ments for immediate transport of the client to a hospital.

C.      A midwife shall document in the client’s record any medica- tions taken by a client for the control of postpartum hemor- rhage.

Historical Note

New Section R9-16-113 renumbered from R9-16-110 and amended by exempt rulemaking at 19 A.A.R. 1805, effective July 1, 2013 (Supp. 13-2).