Okla. Admin. Code § 310:395-5-6.1

Current through Vol. 42, No. 4, November 1, 2024

Section 310:395-5-6.1 - Provisions for VBAC, multiple, and breech births

(a) A Licensed Midwife shall not provide prenatal care and/or birth attendance for a woman who is having a VBAC, vaginal multiple birth, or vaginal breech birth unless the following requirements are met:

(1) Informed Consent specific to VBAC, vaginal multiple birth, or vaginal breech birth is provided to and signed by the client as required by OAC 310:395-5-5 of this Chapter;

(2) In event of transport, the Licensed Midwife implements and acts in accordance with the hospital transportation plan established pursuant to these rules; and

(3) The Licensed Midwife performs fetal auscultation at least every fifteen (15) minutes during Active first stage of labor and at least every five (5) minutes during Second Stage of labor.

(b) For vaginal birth after cesarean deliveries, the following additional requirements must be met:

(1) There must be at least eighteen (18) months from the Client's previous cesarean to the due date of the current pregnancy;

(2) There must not be a previous classical uterine/vertical incision or any other uterine scars through the myometrium;

(3) The Licensed Midwife must obtain, retain, and analyze prior physician and hospital cesarean records, in writing, prior to acceptance of the Client. Records showing that requirements of this section cannot be met shall require immediate referral of care of the Client. If the Licensed Midwife is unable to obtain the written records, the Licensed Midwife shall not retain the Client; and

(4) The placenta shall not be previa or marginal placenta previa in accordance with OAC 310:395-5-6(a)(20).

(5) The Licensed Midwife is required to disclose the following item verbally and written, which is listed on the VBAC informed consent form: The place of birth is/is not within twenty (20) minutes of transport to the nearest hospital with twenty-four (24) hour obstetrical and anesthesia services available. If transport is over 20 minutes, increased distance to surgical interventions, NICU, and pediatric services may increase risk of infant and maternal death.

(c) For planned breech deliveries, the baby shall be in a frank or complete breech position. If baby is in an incomplete or footling breech position, the Licensed Midwife shall transfer care of the Client to a physician when it is possible to do so without endangering the health of the mother or baby.

(d) The requirement to refer listed in subsection (c) of this section is exempted in the event of an imminent breech delivery.

(e) For planned multiple deliveries, the following additional requirements must be met:

(1) Multiples shall be no more than two fetuses;

(2) Determination of chorionicity by the late first trimester or early second trimester by ultrasound with images performed by a Registered Diagnostic Medical Sonographer (RDMS). If the chorionicity is not di/di, the Licensed Midwife should transfer care to a physician upon diagnosis;

(3) A Maternal Fetal Medicine (MFM) consultation is required when twin pregnancy is identified. If the consultation is not obtained, the Licensed Midwife shall refer the Client to a physician;

(4) Discordance of greater than 20% of fetal difference should be referred to a physician at time of recognition;

(5) The presenting twin (baby A) must be head down at term; and

(6) At least three Licensed Midwives should attend the birth.

Okla. Admin. Code § 310:395-5-6.1

Adopted by Oklahoma Register, Volume 38, Issue 12, March 1, 2021, eff. 2/2/2021

Adopted by Oklahoma Register, Volume 38, Issue 24, September 1, 2021, eff. 9/11/2021