Ariz. Admin. Code § 9-16-111

Current through Register Vol. 30, No. 50, December 13, 2024

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 fetus or newborn.

B. A midwife shall not accept as a client for midwifery services a pregnant women who has 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 myometrium;

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

3. Gestational age greater than 34 weeks with no prior prenatal assessments or clinical examinations;

4. Multiple fetuses;

5. A pelvis that will not safely allow a fetus to pass through during labor;

6. Placenta previa or placenta accreta;

7. Deep vein thrombosis or pulmonary embolism;

8. Uncontrolled gestational diabetes;

9. Insulin-dependent diabetes;

10. Hypertension;

11. Rh disease with positive titers;

12. Active:

a. Tuberculosis,

b. Syphilis,

c. Hepatitis until treated and recovered, or

d. Gonorrhea until treated and recovered;

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

14. A persistent hemoglobin level below 10 grams;

15. A condition related to emotional or behavioral functioning, as a result of a mental disorder as defined in A.R.S. § 36-501, that:

a. Is severe and persistent, resulting in a long-term limitation of the client's capacity for primary activities of daily living such as interpersonal relationships, homemaking, self-care, employment, or recreation; and

b. Impairs or substantially interferes with the client's capacity to remain in the community without supportive treatment or services of a long-term or indefinite duration; or

16. Indications of the continued use of one of the following despite negative consequences, including six months prior to pregnancy, that is evident during an assessment of a client:

a. Alcohol,

b. Narcotics, or

c. Other drugs.

;

C. A midwife shall not continue midwifery services for a client who is diagnosed with or develops any of the following:

1. Any condition specified in subsections (B)(4) through (16);

2. A hematocrit below 30 during the third trimester;

3. Except as provided in R9-16-108(B)(2), a fetus that is not in a head-down position with the crown of the head being the leading body part;

4. Labor beginning before the beginning of 36 weeks gestation;

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

6. A gestation beyond 42 weeks;

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

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

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

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

11. A non-bleeding placenta retained for more than 60 minutes.

D. 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 infection; or

iv. Due to failure to progress as a result of cephalopelvic 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.

E. 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 demonstration 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.

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

1. Document the condition in the client record, and

2. Initiate transfer of care.

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

H. 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 internal movement of the fetus.

I. A midwife shall not administer drugs or medications except as provided in R9-16-108(I)(3)(f), (K)(1)(g), or (K)(2)(c), or R9-16-113.

J. 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. Severe swelling, especially of the newborn's abdomen;

d. Major congenital anomalies; or

e. Respiratory distress; and

2. Document the condition in subsection (J)(1) in the newborn record.

Ariz. Admin. Code § R9-16-111

Adopted effective March 14, 1994 (Supp. 94-1). R9-16-111 renumbered to R9-16-116; new Section R9-16-111 renumbered from R9-16-108and amended by exempt rulemaking at 19 A.A.R. 1805, effective July 1, 2013 (Supp. 13-2). Amended by final expedited rulemaking at 28 A.A.R. 1119, effective 5/4/2022.