No. 28294 (New Rule): R156-77. Direct-Entry Midwife Act Rules

DAR File No.: 28294
Filed: 10/17/2005, 03:15
Received by: NL

 

RULE ANALYSIS

Purpose of the rule or reason for the change:

The Division is establishing this rule to implement the Direct-Entry Midwife Act, Title 58, Chapter 77, that was enacted during the 2005 General Session of the Legislature in H.B. 25. (DAR NOTE: H.B. 25 (2005) is found at UT L 2005 Ch 299, and was effective 05/02/2005.)

 

Summary of the rule or change:

This new rule: 1) establishes definitions for terms used throughout the rule; 2) defines the organizations approved to provide adult and infant CPR and newborn or neonatal resuscitation; 3) defines an approved pharmacology course for licensure; 4) establishes renewal requirements to include current certificate as a Certified Professional Midwife and current certification in adult and infant CPR and newborn/neonatal resuscitation; 5) defines unprofessional conduct to include failure to practice in accordance with the Midwives Alliance of North America (MANA) Core Competencies and the MANA Standards and Qualifications for the Art and Practice of Midwifery; 6) establishes the standards and circumstances that require a licensed direct-entry midwife (LDEM) to recommend and facilitate consultation, collaboration, referral, transfer, and mandatory transfer; 7) establishes procedures for the termination of midwifery care when a client has or may have a condition requiring consultation, collaboration, referral, transfer, or mandatory transfer; and 8) requires the submission of outcome data electronically to the MANA's Division of Research on the form prescribed by MANA.

 

State statutory or constitutional authorization for this rule:

Subsections 58-1-106(1)(a), 58-1-202(1)(a), 58-77-202(4), and 58-77-601(2)

 

This rule or change incorporates by reference the following material:

Adds: The Midwives Alliance of North America (MANA) Core Competencies for Basic Midwifery Practice, 1994 edition; and the MANA Standards and Qualifications for the Art and Practice of Midwifery, 1997 edition

 

Anticipated cost or savings to:

the state budget:

The newly established rule will need to be printed and distributed to interested parties at an estimated cost of $75 which can be absorbed within the Division's current budget.

 

local governments:

No fiscal impact on local governments is anticipated because local governments would not need to seek direct-entry midwife licensure or the services of a licensed direct-entry midwife.

 

other persons:

Individuals who seek licensure as a direct-entry midwife will incur the cost of the certification examination, a pharmacology course, and licensure fees (initial application and renewal) as was addressed in the fiscal note the Division completed for H.B. 25. No additional costs will be incurred as a result of adoption of this proposed rule. For individuals who seek licensure as a direct-entry midwife, the following fees will apply: Initial application fee is $100 and the renewal fee is $63 every 2 years. The certification examination costs $700 and the pharmacology course may range in cost from $20 to $1,000 depending on the institution providing the class. The Division is unable to determine an aggregate amount due to the fact that the Division does not know how many persons will apply for licensure as a direct-entry midwife.

 

Compliance costs for affected persons:

For individuals who seek licensure as a direct-entry midwife, the following fees will apply: initial application fee is $100 and the renewal fee is $63 every 2 years. The certification examination costs $700 and the pharmacology course may range in cost from $20 to $1,000 depending on the institution providing the class.

 

Comments by the department head on the fiscal impact the rule may have on businesses:

This rule filing adopts standards to administer the Direct-Entry Midwife Act, which was adopted by H.B. 25 in the 2005 Legislative Session. The costs associated with this rule are indicated in the rule summary and have already become part of the fiscal impact statement to H.B. 25. No additional impact to businesses is anticipated as a result of this rule filing. Francine A. Giani, Executive Director

 

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Commerce
Occupational and Professional Licensing
HEBER M WELLS BLDG
160 E 300 S
SALT LAKE CITY UT 84111-2316

 

Direct questions regarding this rule to:

Laura Poe at the above address, by phone at 801-530-6789, by FAX at 801-530-6511, or by Internet E-mail at [e-mail]

 

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

12/15/2005

 

Interested persons may attend a public hearing regarding this rule:

12/09/2005 at 1:00 PM, Heber Wells Bldg, 160 E 300 S, Conference Room 4B (fourth floor), Salt Lake City, UT

 

This rule may become effective on:

12/16/2005

 

Authorized by:

J. Craig Jackson, Director

 

 

RULE TEXT

R156. Commerce, Occupational and Professional Licensing.

R156-77. Direct-Entry Midwife Act Rules.

R156-77-101. Title.

These rules are known as the "Direct-Entry Midwife Act Rules."

 

R156-77-102. Definitions.

In addition to the definitions in Title 58, Chapters 1 and 77, as used in Title 58, Chapter 77 or these rules:

(1) "Accredited school", as used in these rules, includes any midwifery school that has been granted pre-accredited status by MEAC.

(2) "Apgar score", as used in Section R156-77-601, means an index used to evaluate the condition of a newborn based on a rating of 0, 1, or 2 for each of the five characteristics of color, heart rate, response to stimulation of the sole of the foot, muscle tone, and respiration with 10 being a perfect score.

(3) "Collaborate", as used in Section R156-77-601, means the process by which an LDEM and another licensed health care provider jointly manage a specific condition of a client according to a mutually agreed-upon plan of care. The LDEM continues midwifery management of the client and may follow through with the medical management as agreed upon with the provider.

(4) "Consultation", as used in Section R156-77-601, means the process by which the LDEM discusses client status with an appropriate licensed health care provider by phone, written note, or in person. The provider may give a recommendation for management, but does not assume the management of the client.

(5) "CPR", as used in these rules, means cardiopulmonary resuscitation.

(6) "LDEM", as used in these rules, means a licensed direct entry midwife licensed under Title 58, Chapter 77.

(7) "MANA", as used in these rules, means the Midwives Alliance of North America.

(8) "MEAC", as used in these rules, means the Midwifery Education Accreditation Council.

(9) "Midwifery Care", as used in these rules, has the same meaning as the practice of direct-entry midwifery as defined in Subsection 58-77-102(7).

(10) "NARM", as used in these rules, means the North American Registry of Midwives.

(11) "Refer", as used in Section R156-77-601, means the process by which an LDEM directs the client to an appropriate licensed health care provider for management of a specific condition. The LDEM continues midwifery management of the client.

(12) "Transfer", as used in Section R156-77-601, means the process by which an LDEM relinquishes management of a client to an appropriate licensed health care provider. The LDEM may provide on-going support services as appropriate.

(13) "Unprofessional conduct," as defined in Title 58 Chapters 1 and 77, is further defined, in accordance with Subsection 58-1-203(5), in Section R156-77-502.

 

R156-77-103. Authority - Purpose.

These rules are adopted by the division under the authority of Subsection 58-1-106(1)(a) to enable the division to administer Title 58, Chapter 77.

 

R156-77-104. Organization - Relationship to Rule R156-1.

The organization of this rule and its relationship to Rule R156-1 is as described in Section R156-1-107.

 

R156-77-302a. Qualifications for licensure - Application Requirements.

In accordance with Subsections 58-1-203(1), 58-1-301(3), and 58-77-302(5), the application requirements for licensure in Section 58-77-302 are defined herein.

(1) An applicant for licensure as an LDEM must submit documentation of current CPR certification for health care providers, for both adults and infants, from one of the following organizations:

(a) American Heart Association;

(b) American Red Cross or its affiliates; or

(c) American Safety and Health Institute.

(2) An applicant for licensure as an LDEM must submit documentation of current newborn or neonatal resuscitation certification from one of the following organizations:

(a) American Academy of Pediatrics;

(b) American Heart Association; or

(c) a MEAC approved program or accredited school.

 

R156-77-302b. Qualifications for licensure - Education Requirements.

In accordance with Subsections 58-1-203(1), 58-1-301(3), and 58-77-302(6), the pharmacology course requirement for licensure in Subsection 58-77-302(6) is defined herein. The course must be:

(1) offered by a post-secondary educational institution that is accredited by an accrediting board recognized by the Council for Higher Education Accreditation of the American Council on Education, a MEAC approved midwifery program or accredited midwifery school, or be a MEAC approved program or course; and

(2) at least eight clock hours in length and include basic pharmacotherapeutic principles and administration of medications including the drugs listed in Subsections 58-77-102(7)(f)(i) through (ix); or

(3) a general pharmacology course of at least 20 clock hours in length from a health-related course of study.

 

R156-77-303. Renewal Cycle - Procedures.

(1) In accordance with Subsection 58-1-308(1), the renewal date for the two-year renewal cycle applicable to licensees under Title 58, Chapter 77 is established by rule in Subsection R156-1-308a(1).

(2) Renewal procedures shall be in accordance with Section R156-1-308c.

(3) Each applicant for renewal shall comply with the following:

(a) submit documentation of holding a current Certified Professional Midwife certificate in good standing with NARM; and

(b) submit documentation of current certifications in adult and infant CPR, and newborn resuscitation that meets the criteria established in R156-77-302a.

 

R156-77-502. Unprofessional Conduct.

"Unprofessional conduct" includes:

(1) failure to practice in accordance with the knowledge, clinical skills, and judgments described in the MANA Core Competencies for Basic Midwifery Practice (1994), which is hereby adopted and incorporated by reference; and

(2) failing as a midwife to follow the MANA Standards and Qualifications for the Art and Practice of Midwifery (1997), which is hereby adopted and incorporated by reference.

 

R156-77-601. Standards of Practice.

Except as provided in Subsection 58-77-601(3)(b), and in accordance with Subsection 58-77-601(2), the standards and circumstances that require an LDEM to recommend and facilitate consultation, collaboration, referral, transfer, or mandatory transfer of client care are established herein. These standards are at a minimum level and are hierarchical in nature. If the standard requires at least consultation for a condition, an LDEM may choose to collaborate, refer, or transfer the care of the client.

(1) Consultation:

(a) antepartum:

(i) suspected intrauterine growth retardation;

(ii) changes in the breasts not related to pregnancy;

(iii) significant vaginal bleeding inconsistent with normal pregnancy or miscarriage;

(iv) hyperemesis unresponsive to LDEM treatment;

(v) pain unrelated to common discomforts of pregnancy;

(vi) presence of condylomata that may obstruct delivery;

(vii) anemia unresponsive to LDEM treatment;

(viii) history of genital herpes;

(ix) suspected fetal demise;

(x) suspected multiple gestation;

(xi) confirmed chromosomal or genetic aberrations;

(xii) hepatitis C; and

(xiii) any other condition in the judgment of the LDEM requires consultation.

(2) Collaborate:

(a) antepartum:

(i) infection not responsive to LDEM treatment;

(ii) seizure disorder affecting the pregnancy;

(iii) history of cervical incompetence with surgical therapy;

(iv) third trimester genital herpes outbreak;

(v) moderate preeclampsia or pregnancy induced hypertension; and

(vi) any other condition in the judgment of the LDEM requires collaboration;

(b) postpartum:

(i) infection not responsive to LDEM treatment; and

(ii) any other condition in the judgment of the LDEM requires collaboration.

(3) Refer:

(a) antepartum:

(i) thyroid disease;

(ii) human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS);

(iii) severe psychiatric illness;

(iv) persistent oligohydramnios or polyhydramnios;

(v) heart disease that has been determined by a cardiologist to have potential to affect or to be affected by pregnancy, labor, or delivery; and

(vi) any other condition in the judgment of the LDEM requires referral;

(b) postpartum:

(i) bladder dysfunction;

(ii) severe depression; and

(iii) any other condition in the judgment of the LDEM requires referral;

(c) newborn:

(i) birth injury requiring on-going care;

(ii) minor congenital anomaly;

(iii) jaundice beyond physiologic levels;

(iv) failure to thrive;

(v) inability to suck or feed; and

(vi) any other condition in the judgment of the LDEM requires referral.

(4) Transfer, however may be waived in accordance to Subsection 58-77-601(3)(b):

(a) antepartum:

(i) current drug or alcohol abuse;

(ii) mono-amniotic multiple gestation;

(iii) twin-to-twin transfusion syndrome;

(iv) greater than a one and one-half pound estimated weight discrepancy between fetuses in a multiple gestation;

(v) current diagnosis of cancer;

(vi) Rh isoimmunization;

(vii) intrauterine growth retardation;

(viii) insulin-dependent diabetes; and

(ix) any other condition in the judgment of the LDEM may require transfer;

(b) intrapartum:

(i) suspected chorioamnionitis;

(ii) non-reassuring fetal heart rate pattern that does not respond to LDEM treatment;

(iii) visible genital lesions suspicious of herpes virus infection;

(iv) moderate hypertension; and

(v) any other condition in the judgment of the LDEM may require transfer;

(c) postpartum:

(i) retained placenta; and

(ii) any other condition in the judgment of the LDEM may require transfer;

(d) newborn:

(i) gestational age assessment less than thirty-six (36) weeks;

(ii) major congenital anomaly not diagnosed prenatally;

(iii) persistent hyperthermia or hypothermia unresponsive to LDEM treatment; and

(iv) any other condition in the judgment of the LDEM may require transfer.

(5) Mandatory transfer:

(a) antepartum:

(i) severe preeclampsia or pregnancy induced hypertension;

(ii) eclampsia or hemolysis, elevated liver enzymes, and low platelets syndrome (HELLP);

(iii) documented platelet count less than 75,000 platelets per mm³ of blood;

(iv) complete placenta previa at week 36 or greater; and

(v) any other condition in the judgment of the LDEM must be transferred;

(b) intrapartum:

(i) signs of uterine rupture;

(ii) presentation(s) not compatible with spontaneous vaginal delivery;

(iii) progressive labor prior to 36 weeks gestation except miscarriages, confirmed fetal death, or congenital anomalies incompatible with life;

(iv) prolapsed umbilical cord unless birth is imminent;

(v) clinically significant abdominal pain inconsistent with normal labor;

(vi) seizure;

(vii) complete placenta previa; and

(viii) any other condition in the judgment of the LDEM must be transferred;

(c) postpartum:

(i) uncontrolled hemorrhage;

(ii) maternal shock that is unresponsive to LDEM treatment;

(iii) postpartum psychosis;

(iv) signs of deep vein thrombosis or pulmonary embolism; and

(v) any other condition in the judgment of the LDEM must be transferred;

(d) newborn:

(i) non-transient respiratory distress;

(ii) non-transient pallor or central cyanosis;

(iii) Apgar score at ten minutes of less than six;

(iv) full CPR for greater than two minutes;

(v) hemorrhage;

(vi) seizure;

(vii) persistent hypertonia, lethargy, flaccidity or irritability, or jitteriness;

(viii) inability to urinate or pass meconium within the first 48 hours of life; and

(ix) any other condition in the judgment of the LDEM must be transferred.

 

R156-77-602. Procedures for the Termination of Midwifery Care.

(1) The procedure to terminate midwifery care for a client who has been informed that she has or may have a condition indicating the need for medical consultation, collaboration, referral, or transfer is established herein:

(a) provide no fewer than three business days written notice, unless an emergency, during which the LDEM shall continue to provide midwifery care, to enable the client to select another licensed health care provider;

(b) provide a referral; and

(c) document the termination of care in the client's records.

(2) The procedure to terminate midwifery care to a client who has been informed that she has or may have a condition indicating the need for mandatory transfer is established herein.

(a) have the client sign a release of care indicating the LDEM has terminated providing midwifery care as of a specific date and time; or

(b) verbally instruct the client of the termination of midwifery care and document said instruction in the client record.

 

R156-77-603. Submission of Outcome Data.

In accordance with Subsection 58-77-601(5), an individual licensed as an LDEM must submit outcome data electronically to the MANA's Division of Research on the form prescribed by MANA, and in accordance to the policies and procedures established by MANA.

 

KEY: licensing, midwife, direct-entry midwife

2005

58-1-106(1)(a)

58-1-202(1)(a)

58-77-202(4)

58-77-601(2)