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;
2.
4.
Multiple fetuses;
3. Placenta previa or placenta
accreta;
4. A history of severe postpartum
bleeding, of unknown cause, which required transfusion;
5. A pelvis that will not safely
allow a fetus to pass through during labor;
6. Placenta previa or placenta
accreta;
5.
7. Deep vein thrombosis or pulmonary
embolism;
6.
8. Uncontrolled gestational diabetes;
7.
9.
Insulin-dependent diabetes;
8.
10.
Hypertension;
9.
11. Rh disease with positive titers;
10.
12.
Active:
a. Tuberculosis,
b. Syphilis,
c. Genital herpes at the onset of
labor;
d.
c. Hepatitis until treated and recovered, or
e.
d.
Gonorrhea until treated and recovered;
11. Preeclampsia or eclampsia
persisting after the second trimester;
12.
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;
13.
14. A
persistent hemoglobin level below 10 grams;
14. A pelvis that will not safely
allow a baby to pass through during labor;
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.
17. Except as provided in
R9-16-108(B)(2), a fetus with an abnormal presentation
18. Labor beginning before the
beginning of 36 weeks gestation;
19. A progression of labor that
does not meet the requirements of R9-16-108(J)(4), if
applicable;
20. Gestational age greater than
34 weeks with no prior prenatal care;
21. A gestation beyond 42
weeks;
22. Presence of ruptured membranes
without onset of labor within 24 hours;
23. Abnormal fetal heart rate
consistently less than 120 beats per minute or more than 160 beats per
minute;
24. Presence of thick meconium,
blood-stained amniotic fluid, or abnormal fetal heart tones;
25. A postpartum hemorrhage of
greater than 500 milliliters in the current pregnancy; or
26. A non-bleeding placenta
retained for more than 60 minutes.
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.
C.
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.
D.
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.
E.
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.
F.
G. A midwife shall not perform any operative
procedures except as provided in
R9-16-113.
G.
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.
H.
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.
I.
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.
