4 Colo. Code Regs. § 739-1.20

Current through Register Vol. 47, No. 22, November 25, 2024

Section 4 CCR 739-1.20 - SUTURING

The purpose of this Rule is to define perineal tear and various degrees of perineal tears, and to specify the limitations and requirements in order to perform the suturing of first-degree and second-degree perineal tears.

A. "Perineal tear" means a laceration of the skin and other soft tissue structures which, in women, separates the vagina from the anus.

B. "First-degree perineal tear" means a laceration limited to the fourchette and superficial perineal skin or vaginal mucosa.

C. "Second-degree perineal tear" means a laceration extending beyond fourchette, perineal skin and vaginal mucosa to perineal muscles and fascia, but not the anal sphincter.

D. "Third-degree perineal tear" means the tearing of the fourchette, perineal skin, vaginal mucosa, muscles and anal sphincter.

E. "Fourth-degree perineal tear" means the tearing of the fourchette, perineal skin, vaginal mucosa, muscles, anal sphincter and rectal mucosa.

F. A direct-entry midwife may perform the suturing of first-degree and second-degree perineal tears if the following conditions are met:

1. A direct-entry midwife shall apply to the Director, in a form and manner required by the Director, and pay any application fee the Director may impose, for an authorization to perform sutures of first-degree and second-degree perineal tears;

2. A direct-entry midwife shall attend and successfully complete an eight hour live class or workshop, accredited by the Midwifery Education Accreditation Counsel (MEAC), which instructs attendees regarding the: identification of muscles and anatomy of the vagina and perineum including the affected nerves; the selection of appropriate instruments; the suture material and needles types required for suturing; and appropriate techniques for basic repair. This instruction shall include identification of third and fourth-degree perineal tears and the proper referral of such tears; and

3. A direct-entry midwife shall provide proof of the MEAC-accredited training specified in this Rule 1.20 to the Director when applying for an authorization to perform sutures of first-degree and second-degree perineal tears.

H. A direct-entry midwife shall arrange for consultation and/or transport all third and fourth-degree perineal tears as required pursuant to Rule 1.7(F)(6).

4 CCR 739-1.20

40 CR 12, June 25, 2017, effective 8/1/2017

41 CR 01, January 10, 2018, effective 1/30/2018

43 CR 03, February 10, 2020, effective 1/1/2020

43 CR 07, April 10, 2020, effective 4/30/2020

43 CR 22, November 25, 2020, effective 12/15/2020

44 CR 09, May 10, 2021, effective 5/30/2021

44 CR 20, October 25, 2021, effective 11/14/2021

45 CR 17, September 10, 2022, effective 8/15/2022

45 CR 21, November 10, 2022, effective 11/30/2022