Ala. Admin. Code r. 582-X-3-.09

Current through Register Vol. 43, No. 1, October 31, 2024

Section 582-X-3-.09 - Practice Guidelines

The Licensed Midwife will practice in accordance with the knowledge, clinical skills, and judgments described in the Midwives Alliance of North America (MANA) Core Competencies for Basic Midwifery Practice, within the bounds of the midwifery scope of practice as defined by Act 2017-383; the Alabama State Board of Midwifery Standards for the Practice of Licensed Midwifery in Alabama and; the practice guidelines of the individual midwifery practice.

(a) General Practice. According to the competency outlined in the NARM Job Analysis

(http://narm.org/about-narm/job-analysis/), a Licensed Midwife is trained to, but not limited to:

1. Provide midwifery care, antepartum, intrapartum, and the 6 weeks postpartum period, in any setting except a hospital;

2. Order routine antepartum and postpartum laboratory analyses and imaging studies to be performed by a licensed laboratory (34-19-16(7)(d);

3. Order and administer a urinalysis or blood glucose test as indicated.

4. Provide all clients, mother and neonate, with a plan for on-call availability throughout pregnancy, intrapartum and 6 weeks postpartum, including breastfeeding evaluation;

5. Provide clients with fetal monitoring and routine assessment once active labor is established.

6. Supervise delivery of neonate and placenta, assess newborn and maternal well-being in immediate postpartum, and perform APGAR scores;

7. Inspect the perineum and vagina postpartum for lacerations, and repair, administering local anesthetic, if required;

8. Observe mother and newborn postpartum for no fewer than 2 hours;

9. Instruct mother and other support persons, both verbally and in writing, of the care and precautions for both mother and newborn in the immediate postpartum period;

10. Ensure that a birth certificate, or fetal death report, is accurately completed and filed in accordance with state law 22-9A-7;

11. A licensed midwife shall instruct the client regarding the requirements of the administration of eye ointment ordered by the Department of Public Health pursuant to Section 22-20-2.

12. A licensed midwife shall instruct the client regarding the requirements of administration of newborn health screening ordered by the Department of Public Health pursuant to Section 22-20-3.

13. A licensed midwife may administer anti-hemorrhage medication and oxygen in an emergency circumstance.

14. Provide information for referral for continued well-baby care.

15. Report diseases to the Alabama Department of Public Health pursuant to Chapter 11A, or Title 22.

(b) Conditions for Which a Licensed Midwife May Not Perform Delivery. A licensed midwife may not deliver any of the following according to Act 2017-383:

1. Diagnosed multiple pregnancy

2. Diagnosed non-cephalic at the onset of labor

3. Vaginal birth after cesarean

(c) Procedures which are outside of the Scope of Practice for a Licensed Midwife

1. Epidural, spinal or caudal anesthetic.

2. Any type of narcotic analgesia.

3. Forceps or a vacuum extractor-assisted delivery.

4. Abortion.

5. Cesarean section or any surgery or surgical delivery except minimal episiotomies.

6. Pharmacological induction or augmentation of labor or artificial rupture of membranes prior to the onset of labor.

7. Administration of an anesthetic (other than a local anesthetic).

8. Administration of any prescription medication in a manner that violates the Alabama Uniform Controlled Substance Act.

(d) Conditions for Which a Licensed Midwife May Not Provide Care Without Health Care Provider Involvement. A licensed midwife may not provide care for a client with a history of the disorders, diagnoses, conditions, or symptoms listed here unless such disorders, diagnoses, conditions or symptoms are being treated, monitored or managed by a licensed healthcare provider. Before providing care to such a client, the licensed midwife must notify the client in writing that the client must obtain care from a licensed physician for those conditions, or obtain care from a practitioner working in a valid collaborative agreement with such physician, as a condition to the client's eligibility to maintain maternity care from the licensed midwife. The licensed midwife must, additionally, obtain the client's signed acknowledgement that the client has received the written notice. The disorders, diagnoses, conditions, and symptoms are included but not limited to:

1. Platelet sensitization, severe hematological or coagulation disorders;

2. HIV positive status;

3. Opiate use that places the infant at risk of neonatal abstinence syndrome;

4. Type 1 or type 2 diabetes;

5. Thyroid disease;

6. Epilepsy;

7. Hypertension;

8. Cardiac disease;

9. Pulmonary disease;

10. Renal disease;

11. Previous major surgery of pulmonary system, cardiovascular system, or urinary tract; or

12. Hepatitis.

(e) Conditions for which a Licensed Midwife must Facilitate Hospital Transfer. A licensed midwife must facilitate the immediate transfer of a client to a hospital for emergency care if the client has any of the following disorders, diagnoses, conditions or symptoms:

1. Maternal fever in labor of more than 100.4 degrees Fahrenheit, in the absence of environmental factors;

2. Suggestion of fetal jeopardy, such as frank bleeding before delivery, any abnormal bleeding (with or without abdominal pain), evidence of placental abruption, meconium with non-reassuring fetal heart tone patterns where birth is not imminent, or abnormal fetal heart tones with non-reassuring patterns where birth is not imminent;

3. Non-cephalic presentation at the onset of labor or rupture of membranes, whichever occurs first, unless imminent delivery is safer than transfer;

4. Spontaneous premature labor;

5. Preterm premature rupture of membranes;

6. Preeclampsia;

7. Grand mal seizure;

8. Coughing or vomiting of blood;

9. Severe chest pain; or

10. Sudden onset of shortness of breath and associated labored breathing.

Ala. Admin. Code r. 582-X-3-.09

Adopted by Alabama Administrative Monthly Volume XXXVI, Issue No. 12, September 28, 2018, eff. 11/9/2018.

Author: Alabama State Board of Midwifery

Statutory Authority:Code of Ala. 1975, §§ 34-19-14, et seq.