Midwifery Rules in Montana

http://mt.gov/dli/bsd/license/bsd_boards/ahc_board/pdf/ahc_rules.pdf

 

ADMINISTRATIVE RULES OF MONTANA 6/30/08 24-7553

ALTERNATIVE HEALTH CARE 24.111.601

Subchapter 6

Licensing and Scope of Practice – Direct-Entry Midwifery

24.111.601 MINIMUM DIRECT-ENTRY MIDWIFE EDUCATION

STANDARDS (1) The board may approve a direct-entry midwife program or course

of study which shall include instruction in a core program which requires each

student to demonstrate competence in each of the following substantive content

areas:

(a) antepartum care, including:

(i) preconceptional factors likely to influence pregnancy outcome;

(ii) basic genetics, embryology and fetal development;

(iii) anatomy and assessment of the soft and bony structure of the pelvis;

(iv) identification and assessment of the normal changes of pregnancy, fetal growth and position;

(v) nutritional requirements for pregnant women and methods of nutritional assessment and counseling;

(vi) environmental and occupational hazards for pregnant women;

(vii) education and counseling to promote health throughout the childbearing cycle;

(viii) methods of diagnosing pregnancy;

(ix) the etiology, treatment and referral, when indicated, of the common

discomforts of pregnancy;

(x) assessment of physical and emotional status, including relevant historical and psychosocial data;

(xi) counseling for individual birth experiences, parenthood and changes in the family;

(xii) indications for, risks and benefits of screening/diagnostic tests used

during pregnancy;

(xiii) etiology, assessment of, treatment for and appropriate referral for

abnormalities of pregnancy;

(xiv) identification of, implications of and appropriate treatment for various STD/vaginal infections during pregnancy;

(xv) special needs of the Rh negative woman; and

(xvi) identification and care of women who are HIV positive, have hepatitis or other communicable and noncommunicable diseases.

 

ADMINISTRATIVE RULES OF MONTANA 3/31/07 24-7561   24.111.601 DEPARTMENT OF LABOR AND INDUSTRY

(b) intrapartum care, including:

(i) normal labor and birth processes;

(ii) anatomy of the fetal skull and its critical landmarks;

(iii) parameters and methods for assessing maternal and fetal status,

including relevant historical data;

(iv) emotional changes and support during labor and delivery;

(v) comfort and support measures during labor, birth, and immediately

postpartum;

(vi) techniques to facilitate the spontaneous vaginal delivery of the baby and placenta;

(vii) etiology, assessment of, appropriate referral or transport of and/or

emergency measures (when indicated) for the mother or newborn for abnormalities

of the four stages of labor;

(viii) anatomy, physiology, and supporting normal adaptation of the newborn to extrauterine life;

(ix) familiarity with medical interventions and technologies used during labor and birth; and

(x) assessment and care of the perineum and surrounding tissues, including suturing necessary for perineal repair.

(c) postpartum care, including:

(i) anatomy and physiology of the postpartum period;

(ii) anatomy and physiology and support of lactation, and appropriate breast care and assessment;

(iii) parameters and methods for assessing and promoting postpartum

recovery;

(iv) etiology and methods for managing the discomforts of the postpartum period;

(v) emotional, psychosocial and sexual changes which may occur

postpartum;

(vi) nutritional requirement for women during the postpartum period;

(vii) etiology, assessment of, treatment for and appropriate referral for

abnormalities of the postpartum period;

(viii) methods to assess the success of the breastfeeding relationship and

identify lactation problems, and mechanisms for making appropriate referrals;

(ix) suturing necessary for episiotomy repair;

(x) dispensing and administering pitocin (intramuscular) postpartum; and

(xi) dispensing and administering xylocaine (subcutaneous).

 

24-7562 3/31/07 ADMINISTRATIVE RULES OF MONTANA

ALTERNATIVE HEALTH CARE 24.111.601

(d) neonatal care, including:

(i) anatomy and physiology of the newborn’s adaptation and stabilization in the first hours and days of life;

(ii) parameters and methods for assessing newborn status, including relevant historical data at gestational age;

(iii) nutritional needs of the newborn;

(iv) ARM and MCA standards for an administration of prophylactic treatments commonly used during the neonatal period;

(v) ARM and MCA standards for indications, risks and benefits of, and

method of performing common screening tests for the newborn; and

(vi) etiology, assessment of (including screening and diagnostic tests),

emergency measures and appropriate transport/referral or treatments for neonatal

abnormalities.

(e) health and social sciences, including:

(i) communication, counseling and teaching techniques, including the areas of client education and interprofessional collaboration;

(ii) human anatomy and physiology relevant to human reproduction;

(iii) ARM and MCA standards of care, including midwifery and medical

standards for women during the childbearing cycle;

(iv) interprofessional communication and collaboration with community health and social resources for women and children;

(v) significance of and methods for thorough documentation of client care

through the childbearing cycle;

(vi) informed decision making;

(vii) health education, health promotion, and self care;

(viii) the principles of clean and aseptic techniques, and universal

precautions;

(ix) psychosocial, emotional and physical components of human sexuality,

including indications of common problems and method of counseling;

(x) ethical considerations relevant to reproductive health;

(xi) epidemiologic concepts and terms relevant to perinatal and women’s

health;

(xii) the principles of how to access and evaluate current research relevant to midwifery practice;

(xiii) family centered care, including maternal, infant and family bonding;

(xiv) identification of an appropriate referral of disease in women and their families; and,

(xv) the importance of accessibility, quality health care for all women that

includes continuity of care, and special requirements for home births.

 

ADMINISTRATIVE RULES OF MONTANA 3/31/07 24-7563

24.111.601 DEPARTMENT OF LABOR AND INDUSTRY

 

(2) The applicant shall submit certificates of completion or certified transcripts

sent directly from the institution, as verification the education is equivalent to or

exceeds the minimum direct-entry midwife educational standards required by the

board’s laws and rules.

 

(3) The applicant shall submit course and program descriptions, from the

time of applicant’s graduation or completion, found in pertinent institution catalogs

and brochures, to verify the training received fulfills minimum direct-entry midwife

educational standards.

 

(4) The board reserves the right to evaluate individual applications as to their

compliance with equivalent direct-entry midwife educational standards, on a caseby-

case basis, in the sole discretion of the board. (History: 37-27-105, MCA; IMP,

37-27-201, MCA; NEW, 1992 MAR p. 2722, Eff. 12/25/92; TRANS, from Commerce,

2001 MAR p. 1642.)

 

24-7564 3/31/07 ADMINISTRATIVE RULES OF MONTANA

ALTERNATIVE HEALTH CARE 24.111.602

24.111.602 DIRECT-ENTRY MIDWIFE APPRENTICESHIP

REQUIREMENTS

(1) The terms “direct supervision”, “indirect supervision”, and

“personal supervision” used herein are defined in ARM 24.111.301.

(2) The direct-entry midwife apprenticeship license program shall be that

instructional period composed of practical experience time obtained under the

personal supervision of a supervisor approved by the board.

(3) Applicants for a direct-entry midwife apprenticeship license shall submit a

completed application with the proper fee, a current CPR card indicating certification

to perform adult and infant cardiopulmonary resuscitation, a supervision agreement

and a curriculum outline or method of academic learning that meets the board’s

educational rule requirements for licensure. A supervision agreement shall include:

(a) name of supervisor who shall be a licensed direct-entry midwife, a

certified nurse midwife, a licensed naturopathic physician who is certified for the

specialty practice of childbirth attendance or a physician licensed under Title 37,

chapter 3, MCA;

(b) agreement of parties that supervision shall be provided which is

consistent with these rules; and

(c) agreement of supervisor to supervise no more than four direct-entry

midwife apprentices at the same time.

(4) A Level I direct-entry midwife apprenticeship is served under the direct

supervision of the licensed supervisor, with a focus on prenatal care. To complete

Level I, the direct-entry midwife apprentice shall:

(a) observe 40 births;

(b) provide 20 prenatal examinations;

(c) complete Level I skills checklist;

(d) submit evaluation of skills and educational progress form, with written

verification by supervisor of completion of Level I.

(5) A Level II direct-entry midwife apprenticeship is served under the direct

supervision of the licensed supervisor, with a focus on birth, postpartum and

newborn care. To complete Level II, the direct-entry midwife apprentice shall:

(a) attend ten births as primary birth attendant, which births are verified by signed birth certificates, or affidavit from supervisor;

(b) provide 40 prenatal examinations;

(c) submit prenatal protocols;

(d) complete Level II skills checklist;

(e) submit evaluation of skills and educational progress form, with written

verification by supervisor of completion of Level II.

 

ADMINISTRATIVE RULES OF MONTANA 3/31/07 24-7565

24.111.602 DEPARTMENT OF LABOR AND INDUSTRY

(6) A Level III direct-entry midwife apprenticeship is served as either Level IIIA

or III-B, as defined below. The focus of Level III shall be continuous prenatal,

perinatal and postnatal care. To complete Level III, the direct-entry midwife

apprentice shall:

(a) complete 15 continuous care births as the primary attendant, which are verified by signed birth certificates, or affidavit from supervisor;

(i) documentation of each of the 15 continuous care births as defined in 37- 27-103, MCA, must include at least five prenatal exams, one of which must have been performed before the beginning of the 28th week of gestation, as determined by last menstrual period or sonogram, and include one postpartum exam. Ten of the 15 continuous care births must have been performed under the personal supervision of a qualified supervisor.

(b) provide 40 prenatal examinations;

(c) submit protocols for birth, postpartum and newborn care;

(d) complete Level III skills checklist;

(e) submit evaluation of skills and educational progress form, with written

verification by supervisor of completion of Level III.

(7) Level III direct-entry midwife apprentices are separated as follows:

(a) A Level III-A direct-entry midwife apprentice shall require direct

supervision by the licensed supervisor;

(b) A Level III-B direct-entry midwife apprentice shall require direct

supervision by the licensed supervisor unless, in the professional judgment of the

supervisor, with concurrence of the board, the Level III-B apprentice is capable of

safely and competently performing midwifery services under indirect supervision

after the following requirements have been met:

(i) verification of completion of ten directly supervised continuous care births, as required by ARM 24.111.604;

(ii) verification of completion of at least 75 percent of educational/academic requirements for full licensure;

(iii) a formal outline of the method of indirect supervision communication shall be submitted in writing to the board for approval, which shall include supervisor chart review and telephone contact supervision.

 

24-7566 6/30/08 ADMINISTRATIVE RULES OF MONTANA

ALTERNATIVE HEALTH CARE 24.111.602

(8) Direct-entry midwife apprenticeship applicants who have, at the time of

application, through an apprenticeship or other supervisory setting, participated as

the primary birth attendant at 25 births, 15 of which included continuous care, may

enter directly into direct-entry midwife apprenticeship license Level III-B. The 25

births and 15 continuous care births shall be evidenced by the signed birth certificate

as primary birth attendant, an affidavit from the birth mother or documented records

from the applicant, as shown on the birth experience form furnished by the board.

(a) Documentation of each of the 15 continuous care births as defined in 37- 27-103, MCA, must include at least five prenatal exams, one of which must have been performed before the beginning of the 28th week of gestation, as determined by last menstrual period or sonogram, and include one postpartum exam. Ten of the 15 continuous care births must have been performed under the direct supervision of a qualified supervisor.

(9) To be approved by the board as a supervisor of a direct-entry midwife

apprentice, each supervisor shall:

(a) hold a current, unencumberedMontanalicense as a direct-entry midwife, a certified nurse midwife, a licensed naturopathic physician who is certified for the specialty practice of naturopathic childbirth attendance, or a physician as defined in 37-3-102, MCA.

(i) A licensed direct-entry midwife supervisor shall have 20 postlicensure continuous care births as primary attendant before becoming a supervisor for Level II and III apprentices, except for those licensees who have successfully passed the first licensing exam administered by the board.

(ii) A licensed direct-entry midwife who has not completed 20 postlicensure continuous care births may only supervise Level I apprentices;

(b) review and sign all documents required by the board under the directentry

midwife apprenticeship program;

        (c) supervise no more than four direct-entry midwife apprentices at the same

time;

(d) notify the board in writing of any change in the supervisory relationship,

including advancement from direct to indirect supervision, termination of the

supervisory relationship or any other relevant changes and submit supervision

change notification to the board so that it is received on or before the day that

supervised tasks are performed in order for them to count toward licensure

requirements; and

(e) be directly responsible for all activities undertaken by the apprentice(s)

under their supervision agreement.

 

(10) Violation of the board statutes or rules may result in license discipline

action against the direct-entry midwife apprentice, or supervisor, or both. (History:

37-1-131, 37-27-105, MCA; IMP, 37-27-105, 37-27-201, 37-27-205, 37-27-321,

MCA; NEW, 1992 MAR p. 2498, Eff. 11/26/92; AMD, 1993 MAR p. 1639, Eff.

7/30/93; AMD, 1996 MAR p. 2576, Eff. 10/4/96; AMD, 2000 MAR p. 456, Eff.

2/11/00; TRANS, from Commerce, 2001 MAR p. 1642; AMD, 2003 MAR p. 2873,

Eff. 12/25/03; AMD, 2005 MAR p. 745, Eff. 5/13/05; AMD, 2007 MAR p. 263, Eff.

2/23/07; AMD, 2008 MAR p. 1033, Eff. 5/23/08.)

ADMINISTRATIVE RULES OF MONTANA 6/30/08 24-7567

24.111.603 DEPARTMENT OF LABOR AND INDUSTRY

24.111.603 DIRECT-ENTRY MIDWIFE PROTOCOL STANDARD LIST

REQUIRED FOR APPLICATION

(1) The antepartum protocol standards include, but are not limited to, the following:

(a) abruptio placenta (suspected);

(b) anemia;

(c) bleeding, first, second and third trimesters;

(d) breech presentation;

(e) candidiasis;

(f) care schedule;

(g) date/size discrepancy;

(h) ectopic pregnancy;

(i) fetal demise first, second, third trimester;

(j) genetic counsel;

(k) glycosuria/glucose screen;

(l) group beta strep;

(m) Hepatitis B;

(n) HIV;

(o) human papilloma virus (HPV);

(p) hyperemesis gravidarum;

(q) internal pelvic examination;

(r) intrauterine growth retardation;

(s) minor pregnancy discomfort (heartburn, constipation, insomnia, etc.);

(t) placenta previa (suspected);

(u) polyhydramnios;

(v) post dates pregnancy;

(w) pregnancy induced hypertension (mild, severe);

(x) proteinuria;

(y) Rh negative;

(z) sexually transmitted diseases (chlamydia, herpes, bacterial vaginosis,

gonorrhea, trichomosis, etc.);

(aa) transfer of care/termination of midwife-parent relationship;

(ab) twins (diagnosis of);

(ac) ultrasound (indications for);

(ad) urinary tract infection;

(ae) vaginal birth after cesarean.

 

24-7568 3/31/07 ADMINISTRATIVE RULES OF MONTANA

ALTERNATIVE HEALTH CARE 24.111.603

(2) The intrapartum protocol standards include, but are not limited to, the

following:

(a) amnionitis/chorioamnionitis;

(b) bleeding in labor;

(c) care schedule;

(d) edematous cervical lip;

(e) emergency breech delivery;

(f) emergency twin delivery;

(g) face presentation;

(h) fetal distress;

(i) fetal heart rate evaluation;

(j) indications for transfer of care;

(k) meconium staining;

(l) nuchal cord;

(m) oxygen in labor;

(n) perineal support;

(o) placenta abruptio;

(p) posterior fetal presentation;

(q) premature labor;

(r) prolonged rupture of membranes;

(s) prolapsed cord;

(t) shoulder dystocia;

(u) stillbirth;

(v) vaginal birth after cesarean.

(3) The postpartum protocol standards include, but are not limited to, the

following:

(a) assessment of placenta;

(b) breast care;

(c) care schedule;

(d) delivery of placenta;

(e) depression;

(f) hematoma;

(g) hemorrhage;

(h) hemorrhoids;

(i) perineal second degree laceration or episiotomy repair (suture);

(j) preparation of mother for transport;

(k) retained placenta (manual removal);

(l) Rh negative mom;

(m) shock;

(n) subinvolution;

(o) uterine infection;

(p) uterine inversion.

 

ADMINISTRATIVE RULES OFMONTANA3/31/07 24-7569

24.111.603 DEPARTMENT OF LABOR AND INDUSTRY

(4) The newborn protocol standards include, but are not limited to, the

following:

(a) care schedule (postpartum visits);

(b) eye prophylaxis;

(c) hypoglycemia (suspected);

(d) hypothermia;

(e) infection (suspected sepsis);

(f) evaluation of jaundice;

(g) neonatal resuscitation;

(h) newborn examination to include gestational age determination and

assessment of minor anomalies;

(i) newborn metabolic screening;

(j) normal newborn transition to include maintenance of body temperature,

cardiopulmonary function;

(k) normal infant feeding patterns;

(l) polycythemia (suspected);

(m) preparation of infant for transport;

(n) problems of large- and small-for-gestational-age infants;

(o) respiratory distress;

(p) umbilical cord care;

(q) vitamin K administration. (History: 37-1-131, 37-27-105, MCA; IMP, 37-

27-201, MCA; NEW, 1999 MAR p. 2038, Eff. 9/24/99; TRANS, from Commerce,

2001 MAR p. 1642; AMD, 2001 MAR p. 1644, Eff. 8/24/01.)

 

24-7570 3/31/07 ADMINISTRATIVE RULES OF MONTANA

ALTERNATIVE HEALTH CARE 24.111.604

24.111.604 LICENSING BY EXAMINATION

 (1) Applicants for direct-entry

midwifery licensure by examination shall submit a completed application with the

proper fees and supporting documents, at least 90 days prior to the examination

date, to the board office. Applications for licensure by examination shall expire one

year from the date of receipt of the application. An applicant who, for any reason,

fails or neglects to take the examination within the year shall be required to file

another application and submit another application fee. Supporting documents shall

include:

(a) written documentation of good moral character consisting of three letters

of reference, at least one of which must be from a licensed direct-entry midwife;

(b) a copy of a certified transcript sent directly from a high school, showing

evidence the applicant has graduated from the school;

(c) a GED or other high school equivalency program certificate of completion;

or

(d) any other documents, affidavits and certificates required by 37-27-201 or

37-27-203, MCA, whichever is applicable, and board rules;

(i) documentation of each of the 15 continuous care births as defined in 37- 27-103, MCA, must include at least five prenatal exams, one of which must have been performed before the beginning of the 28th week of gestation, as determined by last menstrual period or sonogram, and include one postpartum exam. Ten of the 15 continuous care births must have been performed under the direct supervision of a qualified supervisor.

 

(2) All applicants shall take the North American Registry of Midwives (NARM)

examination as endorsed by the board, or any other examination to be prescribed or

endorsed by the board, and have their scores reported to the board office by the

proper NARM interstate reporting service, or its equivalent. All applicants for NARM

examination shall:

(a) sit for the NARM examination only when administered by the board, at its designatedMontanasite, or when administered by proper NARM officials in conjunction with the annual Midwives Alliance of North America (MANA) national meeting;

(b) achieve a scaled score of 75.

(3) Applicants who fail the licensing examination twice shall in addition to

being retested, file in advance with the board a plan regarding arrangements for

securing further professional training and experience. (History: 37-27-105, MCA;

IMP, 37-27-201, 37-27-202, 37-27-203, MCA; NEW, 1992 MAR p. 2048, Eff.

9/11/92; AMD, 1993 MAR p. 1639, Eff. 7/30/93; AMD, 1998 MAR p. 529, Eff.

2/27/98; AMD, 1999 MAR p. 2038, Eff. 9/24/99; TRANS, from Commerce, 2001

MAR p. 1642; AMD, 2007 MAR p. 263, Eff. 2/23/07; AMD, 2008 MAR p. 1033, Eff.

5/23/08.)

 

ADMINISTRATIVE RULES OF MONTANA 6/30/08 24-7571

24.111.605 DEPARTMENT OF LABOR AND INDUSTRY

24.111.605 LICENSURE OF OUT-OF-STATE APPLICANTS

 (1) A license to practice as a direct-entry midwife in the state of Montana may be issued at the discretion of the board provided the applicant completes and files with the board an application for licensure and the required application fee. Applications for licensure from out-of-state applicants shall expire one year from the date of receipt of the application. The candidate must meet the following requirements:

(a) The candidate holds a current, valid and unrestricted license to practice

as a direct-entry midwife in another state or jurisdiction, which was issued under

standards equivalent to or greater than current standards in this state. Official

written verification of such licensure status must be received by the board directly

from the other state(s) or jurisdiction(s);

(b) The candidate shall supply a copy of a high school diploma or its

equivalent, plus verification in the form of certified transcripts sent directly from an institute of higher education, or certificates of completion from other courses of study, indicating the candidate has successfully completed educational requirements in pregnancy and natural childbirth, approved by the board as per ARM 24.111.601;

(c) The candidate shall supply proof of successful completion of all parts of the North American Registry of Midwives (NARM) examination with a scaled score of 75 or higher. Candidate scores on the examination must be forwarded by the exam agency directly to the board;

(d) Candidates who were licensed without sitting for the NARM examination shall supply proof of successful completion of a qualifications examination (acceptable to the board) administered by the licensing authority of the state or jurisdiction granting the license.

(e) The candidate shall supply written documentation of good moral

character consisting of three letters of reference, at least one of which must be from a licensed direct-entry midwife;

(f) The candidate shall supply a copy of the laws and rules from the state of licensure, which were in effect at the time the license was granted in the other state.

(History: 37-27-105, MCA; IMP, 37-1-304, 37-27-202, MCA; NEW, 1996 MAR p. 2576, Eff. 10/4/96; AMD, 1998 MAR p. 921, Eff. 4/17/98; AMD, 1999 MAR p. 2038, Eff. 9/24/99; TRANS, from Commerce, 2001 MAR p. 1642; AMD, 2001 MAR p. 1644, Eff. 8/24/01.) Rules 24.111.606 through 24.111.608 reserved

 

 

NEXT PAGE IS 24-7579

24-7572 3/31/07 ADMINISTRATIVE RULES OF MONTANA

ALTERNATIVE HEALTH CARE 24.111.609

24.111.609 ADDITIONAL RECOMMENDED SCREENING PROCEDURES

(1) Consistent with generally accepted standards of practice and conduct,

direct-entry midwives and direct-entry midwife apprentices shall recommend to their

clients that the following tests, in addition to those in 37-27-312, MCA, be secured

from an appropriate health care provider:

(a) a recommendation that mothers:

(i) be screened prenatally for Hepatitis C;

(ii) be screened prenatally for group “B” Beta Strep; and

(iii) obtain a prenatal Pap smear; and

(b) a recommendation that infants:

(i) be screened for bilirubin within 72 hours after birth;

(ii) have expanded newborn metabolic tests within 72 hours after birth; and

(iii) have a newborn hearing screening within one month after birth.

 

(2) When the above recommendations are required to be made to clients of

Level I, II, or III-A apprentices or to clients of Level III-B apprentices who are not

approved by the board for indirect supervision, such recommendations shall be

made by the apprentice’s supervisor. If the supervisor is a physician or nursemidwife

who is not subject to the board’s jurisdiction, the recommendation shall be

made by the apprentice.

 

(3) Level III-B apprentices approved by the board for indirect supervision

shall always make the recommendations required by this rule to clients of the Level

III-B apprentice.

 

(4) Documentation of compliance with this rule shall be maintained in the

client record. (History: 37-1-131, 37-27-105, MCA; IMP, 37-27-102, 37-27-105, 37-

27-312, MCA; NEW, 2007 MAR p. 263, Eff. 2/23/07.)

NEXT PAGE IS 24-7581

 

 

ADMINISTRATIVE RULES OF MONTANA 3/31/07 24-7579

ALTERNATIVE HEALTH CARE 24.111.610

24.111.610 HIGH RISK PREGNANCY: CONDITIONS REQUIRING

PRIMARY CARE BY A PHYSICIAN

(1) If the following conditions are present, the

licensed direct-entry midwife shall not accept the woman as a client:

(a) chronic medical problems:

(i) cardiac disease (Class II or greater);

(ii) diabetes mellitus (Class II or greater);

(iii) essential hypertension (greater than 140/90 Hg, not controlled by

medication);

(iv) hemoglobinopathies:

(v) renal disease (chronic, diagnosed, not urinary tract infection);

(vi) thrombophlebitis or pulmonary embolism;

(vii) epilepsy currently on medication;

(viii) current severe psychiatric condition requiring medication within a sixmonth

period prior to pregnancy;

(ix) active: tuberculosis, syphilis, gonorrhea, strep B, hepatitis, AIDS, genital

herpes at onset of labor;

(x) current drug or alcohol abuse/dependency;

(xi) current malignant disease;

(xii) chronic obstructive pulmonary disease, except for controlled asthma.

(b) current pregnancy related conditions:

(i) pregnancy induced hypertension (preeclamptic or eclamptic symptoms);

(ii) premature labor (before 36 1/2 weeks gestation verified estimated date of

delivery by dates and physical exam);

(iii) placental abruption;

(iv) placenta previa at onset of labor;

(v) has a fetus in any presentation other than vertex at onset of labor;

(vi) multiple gestation;

(vii) contracts primary genital herpes in the first trimester;

(viii) Rh sensitization.

(c) previous obstetrical history:

(i) previous Rh sensitization;

(ii) history of inverted uterus. (History: 37-27-105, MCA; IMP, 37-27-105,  MCA; NEW, 1993 MAR p. 1639, Eff. 7/30/93; AMD, 1995 MAR p. 2684, Eff. 12/8/95; TRANS, from Commerce, 2001 MAR p. 1642.)

 

ADMINISTRATIVE RULES OF MONTANA 3/31/07 24-7581

24.111.611 DEPARTMENT OF LABOR AND INDUSTRY

24.111.611 CONDITIONS WHICH REQUIRE PHYSICIAN CONSULTATION

OR TRANSFER OF CARE

 

(1) If the following conditions are present in a client, the direct-entry midwife shall attempt to consult a physician and/or transfer care to a physician. A certified nurse midwife or licensed direct-entry midwife shall also be consulted if appropriate attempts to consult a physician have been unsuccessful. Documentation of the condition, recommendation (including continuation of care by the licensed direct-entry midwife, if appropriate) and treatment must be maintained in the client records. Conditions include, but are not limited to the following:

(a) prenatal factors:

(i) severe hyperemesis;

(ii) rubella contracted in the first or second trimester;

(iii) maternal anemia (hemoglobin less than ten, hematocrit less than 30)

unresponsive within one month of treatment;

(iv) oligohydramnios (suspected);

(v) polyhydramnios (suspected);

(vi) premature rupture of membranes at less than 36 1/2 weeks;

(vii) post term at 42 weeks by dates and physical exam;

(viii) large for gestational age (LGA) or small for gestational age (SGA)

(suspected);

(ix) Rh sensitization in present pregnancy (not resulting from recent

Rhogam);

(x) history of severe postpartum hemorrhage requiring transfusion;

(xi) known serious maternal viral/bacterial infection at term;

(xii) blood pressure greater than 140/90 or increase of 30 mm Hg systolic or

15 mm Hg diastolic over baseline, that is unresolved within seven days;

(xiii) develops signs and symptoms of preeclampsia;

(xiv) develops signs and symptoms of gestational diabetes;

(xv) has unresolved vaginitis that requires antibiotic treatment;

(xvi) has unresolved urinary tract infection;

(xvii) continued vaginal bleeding before onset of labor;

(xviii) signs of fetal distress including prolonged fetal tachycardia (more than

170) or prolonged fetal bradycardia (less than 100), or fetal demise;

(xix) persistent fever;

(xx) history of preterm delivery (less than 36 1/2 weeks);

(xxi) positive maternal diagnosis of HIV;

(xxii) abnormal Pap smear (showing atypia or CIN);

(xxiii) all condylomas;

(xxiv) grand multiparity;

(xxv) maternal age less than 16 or greater than 40;

(xxvi) history of previous stillbirth;

(xxvii) history of incompetent cervix;

(xxviii) history of previous birth with Erb’s Palsy or fractured clavicle or

humerus;

(xxix) history of neonatal anomaly; or

(xxx) history of previous cesarean birth.

 

24-7582 3/31/07 ADMINISTRATIVE RULES OF MONTANA

ALTERNATIVE HEALTH CARE 24.111.611

(b) labor, birth risks, and postpartum factors:

(i) significant fetal distress including prolonged fetal tachycardia (more than

170) or prolonged fetal bradycardia (less than 100);

(ii) unengaged vertex above -3 station in primipara in active labor;

(iii) fever of 102 degrees Fahrenheit or greater;

(iv) prolonged rupture of membranes (greater than 24 hours with no progress

of labor);

(v) thick meconium stained fluid with delivery not imminent;

(vi) severe bleeding prior to or during delivery;

(vii) maternal respiratory distress;

(viii) mother desires consult or transfer;

(ix) maternal hemorrhage uncontrolled by IM pitocin;

(x) third or fourth degree perineal laceration;

(xi) signs of infection;

(xii) evidence of thrombophlebitis.

(c) newborn risk factors:

(i) less than three vessels in umbilical cord;

(ii) Apgar score less than seven at five minutes;

(iii) fails to urinate or move bowels within 24 hours;

(iv) obvious anomaly;

(v) respiratory distress;

(vi) cardiac irregularities;

(vii) pale cyanotic or gray color;

(viii) abnormal cry;

(ix) jaundice within 24 hours of birth;

(x) signs of prematurity, dysmaturity, or postmaturity;

(xi) lethargic;

(xii) has edema;

(xiii) signs of hypoglycemia;

(xiv) abnormal facial expression;

(xv) abnormal body temperature (outside the 97-100 degrees Fahrenheit range, not resolved within one hour);

(xvi) abnormal neurological signs, including jitteriness, decreased tones, seizures or poor sucking reflex; or (xvii) inability to nurse after 12 hours. (History: 37-27-105, MCA; IMP, 37-

27-105, MCA; NEW, 1993 MAR p. 1639, Eff. 7/30/93; AMD, 1994 MAR p. 386, Eff.  2/25/94; AMD, 1995 MAR p. 2684, Eff. 12/8/95; TRANS, from Commerce, 2001 MAR p. 1642.)

 

ADMINISTRATIVE RULES OF MONTANA 3/31/07 24-7583

24.111.612 DEPARTMENT OF LABOR AND INDUSTRY

24.111.612 VAGINAL BIRTH AFTER CESAREAN (VBAC) DELIVERIES

(1) A licensed direct-entry midwife shall not assume primary responsibility for

prenatal care and/or birth attendance for women who have had a previous cesarean

section, unless all of the following conditions are met:

(a) An informed consent statement, on a form furnished by the board, shall be signed by all prospective VBAC parents and the licensee, and retained in the licensee’s records. The form shall include:

(i) VBAC educational information, including history of VBAC and client’s own

personal information;

(ii) associated risks and benefits of VBAC at home;

(iii) a workable hospital transport plan;

(iv) alternatives to VBAC at home;

(v) other information as required by the board.

(b) A workable hospital transport plan must be established for home VBAC. The plan shall include:

(i) provision for physician/hospital backup, e.g., through the

physician/hospital policy on backup;

(ii) place of birth within 30 minutes of transport to the nearest hospital able to perform an emergency cesarean;

(iii) readily available phone numbers for physician backup and nearest hospital, in writing, in client’s records;

(iv) phone contact with nearest hospital at onset of labor and prior to any transport to notify that transport is in progress; and at conclusion of home birth if no transport is necessary.

(c) Licensee shall obtain prior doctor/hospital cesarean records, in writing, prior to acceptance of the woman as a client, and shall analyze the indication for the previous cesarean, and retain the records and a written assessment of the physical and emotional considerations in licensee’s files. Records which show a previous classical uterine/vertical incision, any other uterine scars into the endometrium, or less than 18 months between last surgery to the next delivery are contraindications to VBAC at home, and shall require immediate transfer of care of the client. If a licensee is unable to obtain written records, the licensee shall not retain the woman as a client.

(d) VBAC deliveries shall be performed by a fully licensed midwife (not an

apprentice licensee), skilled with VBAC support, able to assess true complications

and emergencies, to be present from the onset of active labor, throughout the

immediate postpartum period.

 

(2) The board shall conduct a “sunset” review, including the necessity for and

safety of the VBAC rule, on or about May, 2001, or five years from the effective date

of this rule. (History: 37-27-105, MCA; IMP, 37-27-105, 37-27-311, MCA; NEW,

1996 MAR p. 1829, Eff. 7/4/96; TRANS, from Commerce, 2001 MAR p. 1642; AMD,

2003 MAR p. 2873, Eff. 12/25/03; AMD, 2007 MAR p. 263, Eff. 2/23/07.)

24-7584 3/31/07 ADMINISTRATIVE RULES OF MONTANA

ALTERNATIVE HEALTH CARE 24.111.613

24.111.613 REQUIRED REPORTS

(1) A licensed direct-entry midwife shall submit semiannual summary reports on each client, covering the six-month period of January 1 through July 1, or July 1 through January 1 as appropriate, as required by 37-27-320, MCA. The reports are due on or before January 15 and July 15 of each year.

(a) If a licensed direct-entry midwife does not have any clients during a

reporting period, the licensee shall notify the board in writing by the reporting date.

(2) A licensed direct-entry midwife who is supervising a licensed midwife

apprentice shall be responsible for filing the statutorily required 72-hour

mortality/morbidity report and the semiannual summary report on clients seen by a

Level I, II or III apprentice who is not approved for indirect supervision.

(a) A Level III-B apprentice direct-entry midwife, approved by the board for indirect supervision, shall be responsible for filing the statutorily required 72-hour mortality/morbidity report and the semiannual summary report.

(b) If a Level III-B direct-entry midwife apprentice does not have any clients during a reporting period, the apprentice shall notify the board in writing by the reporting date.

(c) Certified nurse midwife, physician or naturopathic supervisors of an

apprentice direct-entry midwife shall be responsible to ensure the Level I, II or III (not approved for indirect supervision) apprentice files the statutorily required 72-hour mortality/morbidity report and the semiannual summary reports. (History: 37-1-131, 37-27-105, MCA; IMP, 37-27-320, MCA; NEW, 1993 MAR p. 1639, Eff. 7/30/93;

AMD, 1996 MAR p. 2576, Eff. 10/4/96; TRANS, from Commerce, 2001 MAR p.

1642; AMD, 2005 MAR p. 745, Eff. 5/13/05.)

 

Subchapters 7 through 20 reserved

NEXT PAGE IS 24-7651

ADMINISTRATIVE RULES OF MONTANA 3/31/07 24-7585 ALTERNATIVE HEALTH CARE 24.111.2101

Subchapter 21

Renewals and Continuing Education

24.111.2101 RENEWALS

 (1) A renewal notice will be sent as specified in

ARM 24.101.414.

(2) The renewal date for naturopathic physician licenses, naturopathic

specialty certificates, direct-entry midwife apprentice licenses, and direct-entry

midwife licenses is the date set by ARM 24.101.413.

(a) If a direct-entry midwife apprentice has held the initial apprentice license for less than one year on the first renewal date following such licensure, then the apprentice is not required to renew the initial apprentice license until the following renewal date.

(3) Any licensee who fails to renew or submit a renewal fee on or before the

renewal date must pay the late penalty fee as specified in ARM 24.101.403.

Renewals may not be processed until all fees are paid.

(4) The provisions of ARM 24.101.408 apply. (History: 37-1-131, 37-1-141,

37-26-201, 37-27-105, 37-27-205, MCA; IMP, 37-1-131, 37-1-141, 37-26-201, 37-

27-105, 37-27-205, MCA; NEW, 1992 MAR p. 555, Eff. 3/27/92; AMD, 1996 MAR p.

2576, Eff. 10/4/96; TRANS, from Commerce, 2001 MAR p. 1642; AMD, 2006 MAR

p. 1583, Eff. 7/1/06.)

ADMINISTRATIVE RULES OF MONTANA 3/31/07 24-7651

24.111.2102 DEPARTMENT OF LABOR AND INDUSTRY

24.111.2102 NATUROPATHIC PHYSICIAN CONTINUING EDUCATION

REQUIREMENTS

(1) Naturopaths must obtain 15 continuing education credits

each renewal period except as provided in (9). At least five of the credits must be in

naturopathic pharmacy. If the naturopath holds a naturopathic childbirth specialty

certification as provided in ARM 24.111.510, an additional five credits per renewal

period must be obtained in obstetrics. One hour of education (excluding breaks)

equals one continuing education credit.

(2) No more than three continuing education credits per renewal period will

be approved for preparation of and for a single presentation of a program meeting

the requirements of this rule.

(3) Continuing education programs will not be preapproved by the board or

staff.

(4) In order to be approved, a continuing education program must:

(a) have significant intellectual or practical content;

(b) relate to substantive naturopathic medicine topics within the scope of

practice for naturopaths inMontana, except as otherwise provided herein;

(c) be presented by person(s) qualified by practical experience and academic

credentials; and

(d) issue certificates of completion (except nonlive programs) and program

agendas/syllabi containing the following information:

(i) title and date(s) of program;

(ii) name(s) and qualification of presenter(s);

(iii) outline of program content;

(iv) credit hours of instruction;

(v) description of presentation delivery (i.e., live or nonlive); and

(vi) identification of sponsoring organization.

(5) Continuing education programs from other professions or academic

disciplines are eligible for approval if substantially related to the role of naturopaths.

(6) In accordance with 37-1-131, MCA, compliance with this rule shall be

attested to by the naturopath on the renewal application. The board will conduct

random audits after each renewal period closes of 20 percent of all naturopaths with

renewed licenses, for documentary verification of compliance. Documentary

evidence of program completion must be maintained by the naturopath for a period

of two years for audit purposes. Documentary evidence of completion of nonlive

programs (e.g., internet, videotape, audiotape, DVD) may be in the form of proof that the naturopath passed an exam on the program content, a certificate of completion, or the naturopath’s notes summarizing the program content.

 

 

24-7652 3/31/09 ADMINISTRATIVE RULES OF MONTANA

ALTERNATIVE HEALTH CARE 24.111.2103

(7) No continuing education credits are required for a naturopath renewing

the naturopath’sMontanalicense for the first time.

(8) Continuing education credit will not be approved for programs:

(a) relating to general business or economic issues other than workers’

compensation; or (b) primarily intended to educate the general public such as CPR and first aid other than programs relating to public health issues. (History: 37-1-131, 37-1-319, 37-26-201, MCA; IMP, 37-1-131, 37-1-141, 37-1-306, MCA; NEW, 1994 MAR p. 386, Eff. 2/25/94; AMD, 1996 MAR p. 2576, Eff. 10/4/96; AMD, 1998 MAR p. 529, Eff. 2/27/98; AMD, 1999 MAR p. 2038, Eff. 9/24/99; TRANS, from Commerce, 2001

MAR p. 1642; AMD, 2001 MAR p. 1644, Eff. 8/24/01; AMD, 2003 MAR p. 2873, Eff. 12/25/03; AMD, 2006 MAR p. 1583, Eff. 7/1/06; AMD, 2007 MAR p. 263, Eff. 2/23/07; AMD, 2009 MAR p. 265, Eff. 2/27/09.)

 

24.111.2103 MIDWIVES CONTINUING EDUCATION REQUIREMENTS

(1) Midwives must obtain 14 continuing education credits each renewal

period except as provided in (9). One hour of education (excluding breaks) equals

one continuing education credit.

(2) No more than three continuing education credits per renewal period will

be approved for preparation of and for a single presentation of a program meeting

the requirements of this rule.

(3) Continuing education programs will not be preapproved by the board or

staff.

(4) In order to be approved, a continuing education program must:

(a) have significant intellectual or practical content;

(b) relate to substantive midwifery topics within the scope of practice for

direct-entry midwives inMontana, except as otherwise provided herein;

(c) be presented by person(s) qualified by practical experience and academic credentials; and

(d) issue certificates of completion (except nonlive programs) and program agendas/syllabi containing the following information:

(i) title and date(s) of program;

(ii) name(s) and qualification of presenter(s);

(iii) outline of program content;

(iv) credit hours of instruction;

(v) description of presentation delivery (i.e., live or nonlive); and

(vi) identification of sponsoring organization.

 

ADMINISTRATIVE RULES OF MONTANA 3/31/09 24-7653

24.111.2105 DEPARTMENT OF LABOR AND INDUSTRY

(5) Continuing education programs from other professions or academic

disciplines are eligible for approval if substantially related to the role of midwives.

(6) In accordance with 37-1-131, MCA, compliance with this rule shall be

attested to by the midwife on the renewal application. The board will conduct

random audits after each renewal period closes of 20 percent of all midwives with

renewed licenses, for documentary verification of compliance. Documentary

evidence of completion of nonlive programs (e.g., internet, videotape, audiotape,

DVD) may be in the form of proof that the midwife passed an exam on the program

content, a certificate of completion, or the midwife’s notes summarizing the program

content. Documentary evidence of program completion must be maintained by the

midwife for a period of two years for audit purposes.

(7) No continuing education credits are required for a midwife renewing

his/herMontanalicense for the first time.

(8) Continuing education credit will not be approved for programs:

(a) relating to general business or economic issues other than workers’

compensation; or

(b) primarily intended to educate the general public such as CPR and first aid other than programs relating to public health issues. (History: 37-1-131, 37-1-319, 37-27-105, MCA; IMP, 37-1-131, 37-1-141, 37-1-306, MCA; NEW, 1994 MAR p. 386, Eff. 2/25/94; AMD, 1996 MAR p. 2576, Eff. 10/4/96; AMD, 1998 MAR p. 529, Eff. 2/27/98; AMD, 1999 MAR p. 2038, Eff. 9/24/99; TRANS, from Commerce, 2001 MAR p. 1642; AMD, 2001 MAR p. 1644, Eff. 8/24/01; AMD, 2003 MAR p. 2873, Eff. 12/25/03; AMD, 2006 MAR p. 1583, Eff. 7/1/06; AMD, 2007 MAR p. 263, Eff.  2/23/07; AMD, 2009 MAR p. 265, Eff. 2/27/09.)

 

Rule 24.111.2104 reserved

24.111.2105 LICENSE RENEWAL FOR ACTIVATED MILITARY

RESERVISTS (1) When a licensee is called to federal active duty status:

(a) a license may be renewed using the existing renewal process; or

(b) license renewal may be deferred pursuant to 37-1-138, MCA provided

that the licensee is not required by the military to maintain current professional or

occupational licensing as a condition of the reservist’s military service.

(2) If maintaining a current license while in federal active duty status is not a

requirement for the reservist’s military service, the licensee may defer renewing the

license and fulfilling continuing education requirements by submitting to the board:

(a) a deferral request; and

(b) a copy of the reservist’s orders to federal active duty status.

 

24-7654 3/31/09 ADMINISTRATIVE RULES OF MONTANA

ALTERNATIVE HEALTH CARE 24.111.2105

(3) Compliance with rules relating to continuing education and renewal fees

is not required of reservists who have requested deferral pursuant to this rule for so

long as they remain on active duty status. When renewing a license pursuant to this

rule after being released from active duty status, a reservist who was activated for

more than two years may be required by the board to first obtain such continuing

education credits as the board deems appropriate for the protection of the public

taking into account the factors set out in 37-1-138, MCA.

(4) A reservist who is required by these rules or by statute to have current

CPR certification and/or neonatal resuscitation certification as a condition of

licensure or renewal must present evidence of current certification at the time of

renewing a license following release from federal active duty status regardless of the

duration of the activated status.

(5) If a license renewal has been deferred pursuant to this rule during a

reservist’s federal active duty status, said license must be renewed within 90 days of

the reservist’s discharge from active duty or else the license will expire as provided

in 37-1-141, MCA.

(6) In order to renew a license following deferment pursuant to this rule, the

reservist must submit to the board the following:

(a) a completed application for renewal together with any documents

regularly required for renewal except as otherwise provided herein;

(b) a prorated renewal fee for the current renewal period; and

(c) a copy of the document discharging the reservist from federal active duty status.

(7) Deferring renewal pursuant to this rule will continue the license in the

same status (e.g., clear, probationary, suspended) as existed the day before the

licensee was called to federal active duty status for the duration of the activation and

until the license is either renewed following discharge from active duty or until the

license expires, whichever occurs first. (History: 37-26-201, 37-27-105, MCA; IMP,

37-1-138, MCA; NEW, 2006 MAR p. 1881, Eff. 7/28/06.)

Subchapter 22 reserved

NEXT PAGE IS 24-7701

 

ADMINISTRATIVE RULES OF MONTANA 3/31/09 24-7655

ALTERNATIVE HEALTH CARE 24.111.2301

Subchapter 23

Unprofessional Conduct

24.111.2301 UNPROFESSIONAL CONDUCT

(1) The board defines unprofessional conduct for naturopathy and midwifery as follows:

(a) Violation of any state or federal statute or administrative rule regulating the practice of naturopathy or midwifery;

(b) Incompetence, negligence, or use of any procedure in the practice of

naturopathy or midwifery which creates an unreasonable risk of physical harm or serious financial loss to the patient;

(c) Failing to cooperate with an investigation authorized by the Board of

Alternative Health Care by:

(i) not furnishing any papers or documents in the possession of and under the control of the license holder;

(ii) not furnishing in writing a full and complete explanation covering the matter contained in the complaint; or

(iii) not responding to subpoenas issued by the board or the department, whether or not the recipient of the subpoena is the accused in the proceedings.

(d) Practice beyond the scope of practice encompassed by the license;

(e) Failing to maintain appropriate records as specified in statute or in the

rules of the board;

(f) Failing to adequately supervise auxiliary staff to the extent that the

patient’s physical health or safety is at risk;

(g) Practicing naturopathy or midwifery while the license is suspended,

revoked, or expired;

(h) Offering, undertaking or agreeing to cure or treat disease or affliction by a secret method, procedure, treatment, or the treating, operating, or prescribing for any health condition by a method, means, or procedure which the licensee refuses to divulge upon demand from the board;

(i) Abandoning, neglecting, or otherwise physically or emotionally abusing a client or patient requiring care;

(j) Intentionally or negligently causing physical or emotional injury or abuse to a client or patient, or sexual contact with a client or patient in a clinical setting;

(k) Operating under unsanitary conditions after a warning from the board or consistently maintaining an unsanitary office;

(l) Failure to file reports required in the board’s statutes or rules;

(m) Failure by a midwife to maintain current and valid certifications in adult and infant cardiopulmonary resuscitation and neonatal resuscitation as provided by 37-27-201, MCA. (History: 37-1-131, 37-1-319, 37-26-201, 37-27-105, MCA; IMP, 37-1-141, 37-1-316, 37-1-319, 37-26-201, 37-27-105, MCA; NEW, 1993 MAR p. 1639, Eff. 7/30/93; AMD, 1996 MAR p. 2576, Eff. 10/4/96; TRANS, from Commerce, 2001 MAR p. 1642; AMD, 2006 MAR p. 1583, Eff. 7/1/06; AMD, 2007 MAR p. 263, Eff. 2/23/07.)

 

NEXT PAGE IS 24-7721

ADMINISTRATIVE RULES OF MONTANA 3/31/07 24-7701

ALTERNATIVE HEALTH CARE

Sub-Chapter 24

Complaint Procedures

24.111.2401 COMPLAINT PROCEDURE

(1) A person, government or

private entity may submit a written complaint to the board charging a licensee or

license applicant with a violation of board statute or rules, and specifying the

grounds for the complaint.

(2) Complaints must be in writing, and shall be filed on the proper complaint

form prescribed by the board. The board form shall contain a release of medical

records statement, to be signed by the complainant.

(3) Upon receipt of the written complaint form, the board office shall log in the

complaint and assign it a complaint number. The complaint shall then be sent to the

licensee complained about for a written response. Upon receipt of the licensee’s

written response, both complaint and response shall be considered by the screening

panel of the board for appropriate action including dismissal, investigation or a

finding of reasonable cause of violation of a statute or rule. The board office shall

notify both complainant and licensee of the determination made by the screening

panel.

(4) If a reasonable cause violation determination is made by the screening

panel, the Montana Administrative Procedure Act shall be followed for all disciplinary

proceedings undertaken.

(5) The screening panel shall review anonymous complaints to determine

whether appropriate investigative or disciplinary action may be pursued, or whether

the matter may be dismissed for lack of sufficient information. (History: 37-26-201,

37-27-105, MCA; IMP, 37-1-308, 37-1-309, MCA; NEW, 1996 MAR p. 2576, Eff.

10/4/96; TRANS, from Commerce, 2001 MAR p. 1642.)

 

24.111.2402 SCREENING PANEL

 (1) The board screening panel shall consist of at least four board members including the naturopathic physician member who has served the longest on the board, the direct-entry midwife member who has served the longest on the board, the public board member and the medical doctor board member. The chairman may reappoint screening panel members, or replace screening panel members as necessary at the chairman’s discretion. (History: 37- 26-201, 37-27-105, MCA; IMP, 37-1-307, MCA; NEW, 1996 MAR p. 2576, Eff. 10/4/96; TRANS, from Commerce, 2001 MAR p. 1642.) ADMINISTRATIVE RULES OF MONTANA 3/31/02 24-7721