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

DAR File No.: 28294
Filed: 07/10/2006, 04:59
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

Following an April 2006 public hearing and further review by the Division and Licensed Direct-Entry Midwife Board, further amendments are being proposed to the rule.

 

Summary of the rule or change:

In Section R156-77-601, amendments are made to the practice standards by including more symptoms/problems or moving a symptom/problem to a different category of a practice standard. For example, several problems were moved from transfer, which may be waived by the client, to mandatory transfer, such as a client with insulin-dependent diabetes. (DAR NOTE: This is the second change in proposed rule (CPR) for Rule R156-77. The original proposed new rule upon which the first CPR was based was published in the November 15, 2005, issue of the Utah State Bulletin, on page 14. The first CPR upon which this second CPR is based was published in the April 1, 2006, issue of the Utah State Bulletin, on page 21. Underlining in the rule below indicates text that has been added since the publication of the proposed rule mentioned above; strike-out indicates text that has been deleted. You must view the first CPR, the second CPR, and the proposed new rule together to understand all of the changes that will be enforceable should the agency make this rule effective.)

 

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)

 

Anticipated cost or savings to:

the state budget:

No additional costs are anticipated as a result of these proposed amendments beyond those previously identified in the original rule filing.

 

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:

No additional costs or savings are anticipated as a result of these proposed amendments beyond those previously identified in the original rule filing for persons applying for licensure as a direct-entry midwife. The proposed amendments do however increase the number and type of problems with respect to a client that must be transferred to another appropriate provider. The cost to the client would increase in this situation because a home birth would no longer be an option. The Division is not able to determine an exact increase in costs to a client as the costs would depend on numerous variable factors.

 

Compliance costs for affected persons:

No additional costs or savings are anticipated as a result of these proposed amendments beyond those previously identified in the original rule filing for persons applying for licensure as a direct-entry midwife. The proposed amendments do however increase the number and type of problems with respect to a client that must be transferred to another appropriate provider. The cost to the client would increase in this situation because a home birth would no longer be an option. The Division is not able to determine an exact increase in costs to a client as the costs would depend on numerous variable factors.

 

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

This change to proposed rules addresses comments received from the industry. No additional impact to businesses is anticipated beyond those described above regarding mandatory client transfers to an appropriate provider due to certain medical problems. 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:

08/31/2006

valign=

 

This rule may become effective on:

09/08/2006

 

Authorized by:

J. Craig Jackson, Director

 

 

RULE TEXT

R156. Commerce, Occupational and Professional Licensing.

R156-77. Direct-Entry Midwife Act Rules.

 

. . . . . . .

 

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 restriction;

(ii) [mild preeclampsia defined as a sustained diastolic blood pressure of 90 mm or greater in two readings at least six hours apart and 1+ to 2+ proteinurea;

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

(iv) hyperemesis ]severe vomiting unresponsive to LDEM treatment;

([v]iii) pain unrelated to common discomforts of pregnancy;

([vi]iv) presence of condylomata that may obstruct delivery;

(v[ii]) anemia unresponsive to LDEM treatment;

(vi[ii]) history of genital herpes;

([ix]vii) suspected fetal demise;

([x]viii) suspected multiple gestation;

([xi]ix) confirmed chromosomal or genetic aberrations;

(x[ii]) hepatitis C; and

(xi[ii]) 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 pregnancy induced]mild hypertension defined as a sustained diastolic blood pressure of between [100]90 mm and [110]100 mm in two readings at least six hours apart; and

(vi) [persistent oligohydramnios or polyhydramnios; and

(vii) ]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) changes in the breasts not related to pregnancy or lactation;

(iii) severe psychiatric illness responsive to treatment;

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

(v) 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) loss of 15% of birth weight;

(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]with Subsection 58-77-601(3)(b):

(a) antepartum:

(i) current drug or alcohol abuse;

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

(iii) current diagnosis of cancer;

(iv) [Rh isoimmunization]persistent oligohydramnios not responsive to LDEM treatment;

(v) confirmed intrauterine growth restriction;

(vi) [insulin-dependent diabetes]confirmed breech presentation;

(vii) twins;

(viii) two previous c-sections;

(ix) history of preterm delivery less than 34 weeks;

(x) history of severe postpartum bleeding;

(xi) primary genital herpes outbreak;

(xii) mild preeclampsia defined as a sustained diastolic blood pressure of 90 mm or greater in two readings at least six hours apart and 1+ to 2+ proteinurea;

([vii]xiii) gestation greater than 43 weeks; and

([viii]xiv) any other condition in the judgment of the LDEM may require transfer;

(b) intrapartum:

(i) [suspected chorioamnionitis;

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

(ii[i]) visible genital lesions suspicious of herpes virus infection;

([iv]iii) moderate hypertension defined as a sustained diastolic blood pressure of greater than 110 mm in two readings at least six hours apart;

(iv) excessive vomiting, dehydration, acidosis, or exhaustion unresponsive to LDEM treatment; and

(v[i]) 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 severe 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) diagnosed partial placenta previa at week 36, or complete placenta previa at 32 weeks;

(v) confirmed ectopic pregnancy;

(vi) severe psychiatric illness non-responsive to treatment;

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

(viii) mono-amniotic multiple gestation;

(ix) twin-to-twin transfusion syndrome;[ and]

(x) three or more previous c-sections;

(xi) higher order (greater than two) multiple gestations;

(xii) RH isoimmunization in a mother carrying Rh positive baby or a baby of unknown Rh type;

(xiii) insulin-dependent diabetes;

(xiv) significant vaginal bleeding after 20 weeks not consistent with normal pregnancy and posing a continuing risk to mother or baby; and

(xv) 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) suspected chorioamnionitis;

([viii]ix) 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) severe psychiatric illness non-responsive to treatment;

(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) low heart rate of less than 60 beats per minute after one complete neonatal resuscitation cycle;

(v) absent heart rate except with confirmed fetal death or congenital anomalies incompatible with life, or shoulder dystocia resulting in death;

(vi) hemorrhage;

(vii) seizure;

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

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

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

 

. . . . . . .

 

KEY: licensing, midwife, direct-entry midwife

Date of Enactment or Last Substantive Amendment: 2006

Authorizing, and Implemented or Interpreted Law: 58-1-106(1)(a); 58-1-202(1)(a); 58-77-202(4) 58-77-601(2)