Alaska
Title 08. BUSINESS AND PROFESSIONS
Chapter 08.65. DIRECT-ENTRY MIDWIVES
Sec. 08.65.010. Board established.
(a)
There is established the Board of Certified Direct-Entry Midwives.
(b)
The board consists of five members appointed by the governor subject
to confirmation by the legislature in joint session. Members serve for
staggered terms of four years and, except as provided in AS
39.05.080(4), each member serves until a successor is appointed and
qualified. The board consists of two members who are certified in this
state as direct-entry midwives, one physician licensed by the State
Medical Board in this state who has an obstetrical practice or has
specialized training in obstetrics, one certified nurse midwife
licensed by the Board of Nursing in this state, and one public member.
(c)
The board shall elect a chair and a secretary from among its members
to terms of one year.
(d)
A member may serve no more than two complete consecutive terms on the
board.
Sec. 08.65.020. Meetings.
The board shall meet twice annually and may hold
special meetings at the call of the chair or on the written notice of
two board members.
Sec. 08.65.030. Duties and powers of board.
(a)
The board shall
(1)
examine applicants and issue certificates to those applicants it finds
qualified;
(2)
adopt regulations establishing certification and certificate renewal
requirements;
(3)
issue permits to apprentice direct-entry midwives;
(4)
hold hearings and order the disciplinary sanction of a person who
violates this chapter or a regulation of the board;
(5)
supply forms for applications, licenses, permits, certificates, and
other papers and records;
(6)
enforce the provisions of this chapter and adopt regulations necessary
to make the provisions of this chapter effective;
(7)
approve curricula and adopt standards for basic education, training,
and apprentice programs;
(8)
provide for surveys of the basic direct-entry midwife education
programs in the state at the times it considers necessary;
(9)
approve education, training, and apprentice programs that meet the
requirements of this chapter and of the board, and deny, revoke, or
suspend approval of such programs for failure to meet the
requirements.
(b)
The board may by regulation require that a certified direct-entry
midwife undergo a uniform or random period of peer review to ensure
the quality of care provided by the certified direct-entry midwife.
Sec. 08.65.040. Administrative Procedure Act.
AS 44.62 (Administrative Procedure Act) applies
to regulations and proceedings under this chapter.
Sec. 08.65.050. Qualifications for license.
The board shall issue a certificate to practice
direct-entry midwifery to a person who
(1)
applies on a form provided by the board;
(2)
pays the fees required under AS
08.65.100 ;
(3)
furnishes evidence satisfactory to the board that the person has not
engaged in conduct that is a ground for imposing disciplinary
sanctions under AS
08.65.110 ;
(4)
furnishes evidence satisfactory to the board that the person has
completed a course of study and supervised clinical experience; the
study and experience must be of at least one year's duration;
(5)
successfully completes the examination required by the board.
Sec. 08.65.060. Examinations.
The board shall conduct examinations at least
once each year. Examinations may be written, oral, or practical or a
combination of these. The board shall utilize the examination provided
by a nationally certified midwives organization recognized by the
board. An applicant who has failed the examination may not retake the
examination for a period of six months. An applicant who has failed
the examination more than one time may not retake the examination
unless the applicant has participated in or successfully completed
further education and training programs as prescribed by the board.
Sec. 08.65.070. Licensure by credentials.
The board may by regulation provide for the
certification without examination of a person who meets the
requirements of AS
08.65.050 (1) - (4), who is currently licensed in another
state with licensing requirements at least equivalent in scope,
quality, and difficulty to those of this state, and who has passed the
national examination required of certified direct-entry midwives in
this state. At a minimum, an applicant for certification by
credentials
(1)
may not be the subject of an unresolved complaint or disciplinary
action before a regulatory authority in this state or another
jurisdiction;
(2)
may not have failed the examination for a certificate or license to
practice midwifery in this state;
(3)
may not have had a certificate or license to practice midwifery
revoked in this state or another jurisdiction;
(4)
shall submit proof of continued competency satisfactory to the board;
and
(5)
shall pay the required fees.
Sec. 08.65.080. Renewal.
A certificate issued under AS
08.65.050 or 08.65.070 expires on a date determined by the
board and may be renewed every two years upon payment of the required
fee and the submission of evidence satisfactory to the board that the
certified direct-entry midwife has met the continuing education
requirements of the board, has demonstrated continued practical
professional competence under regulations adopted by the board, and
has not committed an act that is a ground for discipline under AS
08.65.110 .
Sec. 08.65.090. Apprentice direct-entry midwives.
(a)
The board shall issue a permit to practice as an apprentice
direct-entry midwife to a person who satisfies the requirements of AS
08.65.050(1) - (3) and who has been accepted into a program of
education, training, and apprenticeship approved by the board under AS
08.65.030. A permit application under this section must include
information the board may require. The permit is valid for a term of
two years and may be renewed in accordance with regulations adopted by
the board.
(b)
An apprentice direct-entry midwife may perform all the activities of a
certified direct-entry midwife if supervised in a manner prescribed by
the board by
(1)
a certified-direct-entry midwife who has been licensed and practicing
in this state for at least two years;
(2)
a certified direct-entry midwife who has been licensed for at least
two years in a state with licensing requirements at least equivalent
in scope, quality, and difficulty to those of this state at the time
of licensing, who is certified in this state, and who has practiced
midwifery for the last two years;
(3)
a physician licensed in this state with an obstetrical practice at the
time of undertaking the apprenticeship; or
(4)
a certified nurse midwife licensed by the Board of Nursing in this
state with an obstetrical practice at the time of undertaking the
apprenticeship.
Sec. 08.65.100. Fees.
The department shall set fees under AS
08.01.065 to implement this chapter.
Sec. 08.65.110. Grounds for discipline,
suspension, or revocation of certification.
The board may impose a disciplinary sanction on a
person holding a certificate or permit under this chapter if the board
finds that the person
(1)
secured a certificate or permit through deceit, fraud, or intentional
misrepresentation;
(2)
engaged in deceit, fraud, or intentional misrepresentation in the
course of providing professional services or engaging in professional
activities;
(3)
advertised professional services in a false or misleading manner;
(4)
has been convicted of a felony or other crime that affects the
licensee's ability to continue to practice competently and safely;
(5)
intentionally or negligently engaged in or permitted the performance
of client care by persons under the certified direct-entry midwife's
supervision that does not conform to minimum professional standards
regardless of whether actual injury to the client occurred;
(6)
failed to comply with this chapter, with a regulation adopted under
this chapter, or with an order of the board;
(7)
continued to practice after becoming unfit due to
(A)
professional incompetence;
(B)
failure to keep informed of current professional practices;
(C)
addiction or severe dependency on alcohol or other drugs that impairs
the ability to practice safely;
(D)
physical or mental disability;
(8)
engaged in lewd or immoral conduct in connection with the delivery of
professional service to clients.
Sec. 08.65.120. Disciplinary sanctions.
(a)
When it finds that a person holding a certificate or permit is guilty
of an offense under AS
08.65.110, the board, in addition to the powers provided
in AS
08.01.075, may impose the following sanctions singly or in
combination:
(1)
permanently revoke a certificate or permit to practice;
(2)
suspend a certificate or permit for a determinate period of time;
(3)
censure a person holding a certificate or permit;
(4)
issue a letter of reprimand;
(5)
place a person holding a certificate or permit on probationary status
and require the person to
(A)
report regularly to the board upon matters involving the basis of
probation;
(B)
limit practice to those areas prescribed;
(C)
continue professional education until a satisfactory degree of skill
has been attained in those areas determined by the board to need
improvement;
(6)
impose limitations or conditions on the practice of a person holding a
certificate or permit.
(b)
The board may withdraw probationary status if it finds that the
deficiencies that required the sanction have been remedied.
(c)
The board may summarily suspend a certificate or permit before final
hearing or during the appeals process if the board finds that the
person holding a certificate or permit poses a clear and immediate
danger to the public health and safety if the person continues to
practice. A person whose certificate or permit is suspended under this
subsection shall be entitled to a hearing by the board no later than
seven days after the effective date of the order. The person may
appeal the suspension after a hearing to the superior court.
(d)
The board may reinstate a certificate or permit that has been
suspended or revoked if the board finds after a hearing that the
applicant is able to practice with reasonable skill and safety.
(e)
The board shall seek consistency in the application of disciplinary
sanctions, and significant departure from prior decisions involving
similar situations shall be explained in findings of fact or orders.
Sec. 08.65.130. Criminal penalty.
A person who violates this chapter is guilty of a
class B misdemeanor.
Sec. 08.65.140. Required practices.
(a)
Except as provided in (e) of this section, a certified direct-entry
midwife may not assume the care or delivery of a client unless the
certified direct-entry midwife has recommended that the client undergo
a physical examination performed by a physician, physician assistant,
advanced nurse practitioner, or certified nurse midwife, who is
licensed in this state.
(b)
A certified direct-entry midwife shall inform a woman seeking home
birth of the possible risks of home birth and shall obtain a signed
informed consent, including the recommendation for a physical
examination required under (a) of this section, from the woman before
the onset of labor. The consent shall be maintained by the certified
direct-entry midwives as part of the woman's record. A certified
direct-entry midwife shall accept full legal responsibility for the
direct-entry midwife's acts or omissions.
(c)
A certified direct-entry midwife shall comply with the requirements of
AS
18.15.150 concerning taking of blood samples, AS 18.15.200
concerning screening of phenylketonuria (PKU), AS
18.50.160 concerning birth registration, AS
18.50.230 concerning registration of deaths, AS
18.50.240 concerning fetal death registration, and
regulations adopted by the Department of Health and Social Services
concerning prophylactic treatment of the eyes of newborn infants.
(d)
A certified direct-entry midwife may not knowingly deliver a woman who
(1)
has a history of thrombophlebitis or pulmonary embolism;
(2)
has gestational diabetes, diabetes, hypertension, Rh disease with
positive titer, active tuberculosis, active syphilis, active
gonorrhea, epilepsy, heart disease, or kidney disease;
(3)
contracts genital herpes simplex in the first trimester of pregnancy
or has active genital herpes in the last two weeks of pregnancy;
(4)
has severe psychiatric illness;
(5)
inappropriately uses controlled substances, including those obtained
by prescription;
(6)
has multiple gestation;
(7)
has a fetus of less than 37 weeks gestation at the onset of labor;
(8)
has a gestation of more than 42 weeks by dates and examination;
(9)
has a fetus in any presentation other than vertex at the onset of
labor;
(10)
is a primigravida with an unengaged fetal head in active labor, or any
woman who has rupture of membranes with unengaged fetal head, with or
without labor;
(11)
has a fetus with suspected or diagnosed congenital anomalies that may
require immediate medical intervention;
(12)
has pre-eclampsia or eclampsia;
(13)
has bleeding with evidence of placenta previa;
(14)
any condition determined by the board to be of high risk to the
pregnant woman and newborn;
(15)
has had a previous caesarian delivery or other uterine surgery;
(16)
experienced the rupture of membranes at least 24 hours before the
onset of labor; or
(17)
is less than 16 years of age at the time of delivery.
(e)
Notwithstanding (d) of this section, a certified direct-entry midwife
may deliver a woman with any of the complications or conditions listed
in (d)(1) - (17) of this section if
(1)
the delivery is a verifiable emergency; and
(2)
a physician or certified nurse midwife is not available in the
geographic vicinity.
(f)
A certified direct-entry midwife may not attempt to correct fetal
presentation by external or internal inversion unless
(1)
there is a verifiable emergency; and
(2)
a physician or certified nurse midwife is not available in the
geographic vicinity.
Sec. 08.65.150. Prohibited practices.
Except as provided in AS
08.65.170, a person who is not certified under this
chapter as a direct-entry midwife may not practice midwifery for
compensation.
Sec. 08.65.160. Certification required if
designation used.
A person who is not certified under this chapter
or whose certification is suspended or revoked, or whose certification
has lapsed, who knowingly uses in connection with the person's name
the words or letters "C.D.M.," "Certified Direct-Entry
Midwife," or other letters, words, or insignia indicating or
implying that the person is certified as a direct-entry midwife by
this state or who in any way, orally or in writing, directly or by
implication, knowingly holds out as being certified by the state as a
direct-entry midwife in this state is guilty of a class B misdemeanor.
Sec. 08.65.170. Exclusions.
This chapter does not apply to a person
(1)
who is licensed as a physician in this state;
(2)
who is licensed as a certified nurse midwife by the Board of Nursing
in this state;
(3)
who is practicing midwifery on June 26, 1992, and who receives
compensation for services if the person's cultural traditions have
included, for at least two generations, the attendance of lay midwives
at births, and if the person has attended at least 10 births;
(4)
whose cultural traditions have included, for at least two generations,
the attendance of midwives at births, who accepts compensation for the
practice of midwifery if the person has assisted another in at least
10 births and the person assisted is excluded from registration under
this section or is a certified direct-entry midwife, physician, nurse
midwife, or public health nurse.
Sec. 08.65.180. Responsibility for care.
If a certified direct-entry midwife seeks to
consult with or refer a patient to a licensed physician, the
responsibility of the physician for the patient does not begin until
the patient is physically within the physician's care.
Sec. 08.65.190. Definitions.
In this chapter,
(1)
"board" means the Board of Certified Direct-Entry Midwives;
(2)
"department" means the Department of Community and Economic
Development;
(3)
"practice of midwifery" means providing necessary
supervision, health care, and education to women during pregnancy,
labor, and the postpartum period, conducting deliveries on the
midwife's own responsibility, and providing immediate postpartum care
of the newborn; "practice of midwifery" includes
preventative measures, the identification of physical, social, and
emotional needs of the newborn and the woman, and arranging for
consultation, referral, and continued involvement when the care
required extends beyond the abilities of the midwife, and the
execution of emergency measures in the absence of medical assistance,
as specified in regulations adopted by the board.
Title 12 Professional and Vocational Regulations
Part 1 Boards and Commissions Subject to Centralized Licensing
Chapter
14 Board of Certified Direct-Entry Midwives
1.
Certification Requirements. (12 AAC 14.100 - 12 AAC 14.130)
2.
Education and Experience. (12 AAC 14.200 - 12 AAC 14.220)
3.
Examination. (12 AAC 14.300)
4.
Renewal and Continuing Competency Requirements. (12 AAC 14.400 - 12
AAC 14.470)
5.
Duties and Responsibilities. (12 AAC 14.500 - 12 AAC 14.580)
6.
Emergency Measures. (12 AAC 14.600 - 12 AAC 14.620)
7.
General Provisions. (12 AAC 14.900 - 12 AAC 14.990)
——————————
Article
1 Certification Requirements
Section
100.
(Repealed).
110.
Certification by examination.
120.
Certification by credentials.
130.
Apprentice permit.
12
AAC 14.100. Transitional certification
Repealed.
History: Eff. 2/18/94, Register 129; repealed
1/1/2000, Register 152
12
AAC 14.110. Certification by examination
(a) The board will issue a certificate as a
direct-entry midwife to an applicant who meets the requirements of
this section and passes the examination required in 12 AAC 14.300.
(b) An applicant for certification shall
(1) submit documentation that the applicant is at
least 18 years of age;
(2) apply on a form provided by the department;
(3) pay the fees established in 12 AAC 02.145;
(4) submit verification of a high school education or
its equivalent;
(5) submit copies of certification in the Basic Life
Support for Health Care Providers Program (BLS) and neonatal
resuscitation showing that the certification is current at the time of
application;
(6) submit an affidavit signed by the applicant that
verifies compliance with AS
08.65.050 (3); and
(7) submit written evidence of satisfactory completion
of the course of study requirements in 12 AAC 14.200
and supervised clinical experience requirements in 12 AAC 14.210;
the combined length of study and experience must be at least one year.
(c) In order to be scheduled for review by the board
at its next regularly scheduled meeting, a complete application for
certification and all supporting documents, including the requirements
of (b) of this section, must be received by the division's Juneau
office at least 30 days before the date of the next regularly
scheduled meeting of the board. For the purpose of this subsection,
"division" means the division of occupational licensing,
Department of Community and Economic Development.
History: Eff. 5/11/94, Register 130; am 4/4/2002,
Register 162; am 3/2/2003, Register 165
Authority: AS
08.65.030
AS
08.65.050
Editor's note: The division's Juneau office
mailing address is State of Alaska, Department of Community and
Economic Development, Division of Occupational Licensing, P.O. Box
110806, Juneau, Alaska 99811-0806, and its physical address is State
Office Building, 9th Floor, 333 Willoughby Avenue, Juneau,
Alaska.
12
AAC 14.120. Certification by credentials
(a) The board may issue a certificate as a
direct-entry midwife without examination to an applicant who meets the
requirements of AS
08.65.070 , 12 AAC 14.110(b)
and (c), and this section.
(b) An applicant for certification by credentials
shall provide documentation of fulfillment of the continuing
competency requirements in 12 AAC 14.420
- 12 AAC 14.440
during the two years immediately preceding the date of application for
certification.
History: Eff. 5/11/94, Register 130; am 4/4/2002,
Register 162
Authority: AS
08.65.030
AS
08.65.070
12
AAC 14.130. Apprentice permit
(a) The board will issue a permit to practice as an
apprentice direct-entry midwife to an applicant who meets the
requirements of 12 AAC 14.110(b)
(1) - (b)(6) and provides evidence of acceptance into an
apprenticeship program that meets the requirements of 12 AAC 14.220.
(b) As part of the evidence of acceptance into an
approved apprenticeship program, the applicant shall provide written
documentation of a relationship with an apprenticeship program
preceptor.
(c) An apprentice shall submit written notice to the
department within 30 days of any addition or change to the preceptor
relationship.
(d) For purposes of this section, and apprenticeship
program preceptor means an individual who meets the supervisory
requirements of AS
08.65.090 (b), or, until December 27, 1994, a preceptor who meets
the requirements of sec. 11, ch. 130, SLA 1992.
History: Eff. 5/11/94, Register 130
Authority: AS
08.65.030
AS
08.65.090
——————————
Article
2 Education and Experience
Section
200.
Course of study requirements.
210.
Supervised clinical experience requirements.
220.
Apprenticeship programs.
12
AAC 14.200. Course of study requirements
(a) An acceptable course of study for certification as
a direct-entry midwife must include
(1) the following subjects related to health and
social sciences and services:
(A) communication, counseling, and teaching
techniques, including client education;
(B) human anatomy and physiology relevant to human
reproduction;
(C) community standards of care, including standards
for midwifery and medical standards for women during the childbearing
cycle;
(D) communication and collaboration with community
health and social resources for women and children;
(E) documentation of client care through the
childbearing cycle;
(F) informed decision making;
(G) health education, health promotion, and self care;
(H) clean and aseptic techniques, and universal
precautions;
(I) psychosocial, emotional, and physical components
of human sexuality, including indicators of common problems and
methods of counseling;
(J) ethical considerations relevant to reproductive
health;
(K) epidemiologic concepts and terms relevant to
perinatal and women's health;
(L) principles of accessing and evaluating current
research relevant to midwifery practice;
(M) family centered care including maternal, infant,
and family bonding;
(N) appropriate referral of women and their families
for treatment of disease;
(O) importance of accessible, quality health care for
all women that includes continuity of care;
(2) the following subjects related to antepartum care:
(A) preconceptional factors likely to influence
pregnancy outcome;
(B) basic genetics, embryology, and fetal development;
(C) anatomy and assessment of the soft and bony
structure of the pelvis;
(D) identification and assessment of the normal
changes in pregnancy, fetal growth, and position;
(E) nutritional requirements for pregnant women and
methods of nutritional assessment and counseling;
(F) environmental and occupational hazards for
pregnant women;
(G) education and counseling to promote health
throughout the childbearing cycle;
(H) methods of diagnosing pregnancy including the
testing of urine and blood;
(I) common discomforts of pregnancy, including the
etiology and treatment of those discomforts, and the appropriate
referral when indicated;
(J) assessment of physical and emotional status,
including relevant historical and psychosocial data;
(K) counseling for individual birth experiences,
parenthood, and changes in the family;
(L) screening and diagnostic tests used during
pregnancy, including indications for use and the risks and benefits of
the tests;
(M) the etiology, assessment, treatment, and
appropriate referral related to abnormalities of pregnancy;
(N) identification, implications, and the appropriate
treatment of various sexually transmitted diseases (STD) and vaginal
infections related to abnormalities of pregnancy;
(O) special needs of the woman with Rh negative type
blood;
(P) identification and care of women who are human
immune deficiency virus (HIV) positive, have hepatitis, or have other
diseases;
(3) the following subjects related to intrapartum
care:
(A) normal labor and birth processes;
(B) anatomy of the fetal skull, including its critical
landmarks;
(C) assessment of maternal and fetal status;
(D) emotional changes, comfort, and support during
labor, birth, and immediately postpartum;
(E) techniques to aid the spontaneous vaginal delivery
of the baby and placenta;
(F) abnormalities of the four stages of labor,
including the etiology and assessment of those abnormalities, and the
appropriate referral, transport, and emergency measures indicated for
the fetus, mother, or newborn affected by those abnormalities,
including
(i) review of the side effects and administration of
pharmaceutical agents, such as emergency administration of pitocin to
control postpartum hemorrhage; and
(ii) performing an emergency episiotomy;
(G) adaptation of the newborn to life after birth;
(H) medical interventions and technologies used during
labor and birth;
(I) assessment and care of the perineum and
surrounding tissues;
(4) the following subjects related to postpartum care:
(A) anatomy and physiology of the newborn during the
postpartum period;
(B) anatomy, physiology, lactation, and appropriate
care of the breast;
(C) assessment and promotion of postpartum recovery;
(D) the etiology and management of the discomforts of
the postpartum period;
(E) emotional, psychosocial, and sexual changes that
may occur during the postpartum period;
(F) nutritional requirements for women during the
postpartum period;
(G) abnormalities of the postpartum period, including
the etiology, assessment, treatment, and appropriate referral of the
mother or newborn experiencing the abnormalities;
(H) assessment of the breastfeeding relationship,
identification of lactation problems, and making appropriated
referrals;
(5) the following subjects related to neonatal care:
(A) anatomy and physiology of the newborn as they
relate to the newborn's adaptation and stabilization in the first days
of life;
(B) methods for assessing newborn status including
relevant historical data and gestational age;
(C) nutritional needs of the newborn;
(D) administration of prophylactic treatments commonly
used during the neonatal period, including state laws applicable to
that administration;
(E) common screening tests for the newborn, including
indications, risks, benefits, and methods of performing those tests;
(F) neonatal abnormalities, including the etiology and
assessment of those abnormalities, and the screening and diagnostic
test, emergency measures, appropriate transport, referral, and
treatment necessary as a result of those abnormalities;
(6) the following subjects related to family planning
and well woman care;
(A) steroidal, mechanical, chemical, physiological,
and surgical conception control methods;
(B) issues involved in decision making regarding
unplanned pregnancies and resources for counseling and referral;
(C) abnormalities of the reproductive system and
breast, including the etiology and assessment of those abnormalities,
and the treatment and appropriate referral of the woman experiencing
those abnormalities;
(D) assessment of physical and emotional status,
including relevant historical data;
(7) training on the performance of the following
permitted practices:
(A) catheterization of the urinary bladder;
(B) clamping and cutting of the umbilical cord;
(C) artificial rupture of the amniotic membranes;
(D) venipuncture;
(E) capillary blood sampling, and
(F) suturing;
(8) the following subjects related to professional,
legal, and other aspects of midwifery practice:
(A) peer review, chart review, case presentation, and
developing midwifery protocols;
(B) data collection and analysis relevant to midwifery
practice;
(C) laws governing the practice of midwifery in the
state;
(D) history of midwifery, medicine, and health care in
the United States;
(E) organization of maternal and infant care in the
United States and the factors affecting that care; and
(F) various sites, styles, and modes of practice
within midwifery.
(b) To meet the requirements of (a) of this section, a
course of study must be approved by the board or accredited by the
Midwifery Education Accreditation Counsel (MEAC).
(c) An applicant shall document completion of a course
of study that meets the requirements of (a) of this section by
submitting
(1) an official transcript, diploma, or certificate of
graduation; or
(2) a notarized academic program completion
certification form, provided by the department, signed by the
applicant's primary preceptor.
(d) The board may require additional documentation it
considers necessary to verify an applicant's study of a subject,
including an essay written by the applicant on subjects studied
independently.
(e) The board will maintain a list of organized
courses of study that it finds meets the requirements of (a) of this
section.
History: Eff. 2/18/94, Register 129; am 12/9/2001,
Register 160
Authority: AS
08.65.030
AS
08.65.050
12
AAC 14.210. Supervised clinical experience requirements
(a) An applicant must have completed all clinical
experience requirements of this section under the supervision of a
preceptor who
(1) meets the qualifications of AS
08.65.090 (b); or
(2) is a midwife who has been licensed in another
state or country and practicing midwifery for at least the two years
immediately preceding the date that the supervision began and as
determined by the board, the state or country in which the midwife has
been licensed had licensing requirements substantially equivalent in
scope, quality, and difficulty to those of this state at the time of
licensure; or
(3) is a physician licensed in another state or
country with an obstetrical practice at the time of the supervision;
or
(4) is a certified nurse midwife licensed in another
state or country with an obstetrical practice at the time of the
supervision; or
(5) has met the requirements of AS
08.65.050 (3) and (4); the course of study must have included the
subjects listed in 12 AAC 14.200(a)
; the supervised clinical experience must have met the requirements of
this section.
(b) Supervised clinical experience must have included
at least the following types and numbers of experiences:
(1) 100 prenatal visits;
(2) 10 labor and delivery observations that preceded
any primary responsibility for labor and delivery;
(3) 20 assisted labor managements that preceded any
primary responsibility for labor and delivery
(4) primary responsibility for 30 labor and deliveries
of the newborn and placenta;
(5) 30 newborn examinations; and
(6) 30 postpartum examinations of the mother.
(c) As part of the supervised clinical experiences
required in (b) of this section, an applicant must have provided
continuous care to at least 15 clients. "Continuous care"
means, for the same client, the applicant
(1) performed at least six prenatal visits;
(2) observed, assisted with, or had primary
responsibility for labor and delivery of the newborn and placenta;
(3) performed a newborn examination; and
(4) performed a postpartum examination of the mother.
(d) An applicant must have completed at least 10 of
the supervised clinical experiences required in (b)(3) and (b)(4) of
this section, in any combination, within the two years immediately
preceding the date of application.
(e) On a form provided by the department, an applicant
shall document the applicant's clinical experience, including the
following information, if applicable:
(1) the date of birth;
(2) the location of birth;
(3) the infant's gender;
(4) the infant's weight;
(5) the name of the person who managed the labor;
(6) the name of the person who delivered the newborn
and placenta;
(7) any complication and its outcome;
(8) a detailed explanation of any situation that
required emergency transport; and
(9) the signature of the applicant's preceptor
verifying that the experience was supervised and that the care
provided was within the scope of AS
08.65 and this chapter.
History: Eff. 2/18/94, Register 129; am 4/16/2003,
Register 166
Authority: AS
08.65.030
AS
08.65.050
12
AAC 14.220. Apprenticeship programs
(a) To be approved by the board, an apprenticeship
program must
(1) be for a duration of at least one year;
(2) be conducted under the supervision of an
apprenticeship program preceptor; and
(3) provide a training program for the apprentice that
meets the course of study and supervised clinical experience
requirements of 12 AAC 14.200
and 12 AAC 14.210.
(b) For purposes of this section, an apprenticeship
program preceptor means an individual who meets the supervisory
requirements of AS
08.65.090 (b), or, until December 27, 1994, a preceptor who meets
the requirements of sec. 11, ch. 130, SLA 1992.
History: Eff. 5/11/94, Register 130
Authority: AS
08.65.030
AS
08.65.090
——————————
Article
3 Examination
Section
300.
Examination.
12
AAC 14.300. Examination
(a) The examination required for certification as a
direct-entry midwife is the national examination prepared and graded
by the North American Registry of Midwives. The national examination
required under this subsection for certification is
(1) any version of the national examination
administered before February 18, 1994, if the applicant passed the
examination before February 18, 1994; or
(2) any version of the national examination, revised
on or after December 28, 1993.
(b) An applicant for certification as a direct-entry
midwife must submit a certified true copy of the results of the
national examination specified in (a) of this section showing that the
applicant has received a passing score on the national examination.
(c) In order to be scheduled for an examination, the
following items must be received by the department from the applicant
no later than 60 days before the scheduled date for that examination:
(1) a complete, notarized application on a form
provided by the department;
(2) the fees established under 12 AAC 02.145;
(3) copies of current certification in Basic Life
Support for Health Care Providers Program (BLS) and neonatal
resuscitation;
(4) an authorization from the applicant for release of
the applicant's records to the department, on a form provided by the
department; and
(5) verification of completion of the course of study
requirements required under 12 AAC 14.200,
on a form provided by the department.
History: Eff. 2/18/94, Register 129; am 1/1/2000,
Register 152; am 12/9/2001, Register 160; am 3/2/2003, Register 165
Authority: AS
08.65.030
AS
08.65.050
AS
08.65.060
Editor's note: The examination described in 12
AAC 14.300
is prepared by the North American Registry of Midwives, P.O. Box 15,
Linn, West Virginia 26384. Information regarding the examination may
be obtained by contacting the division of occupational licensing
offices in Anchorage and Juneau.
——————————
Article
4 Renewal and Continuing Competency Requirements
Section
400.
Certification renewal requirements.
410.
Apprentice permit renewal requirements.
420.
Continuing education requirements.
430.
Approved continuing education programs.
440.
Continuing professional practice requirements.
450.
Continuing competency requirements for first time certificate
renewals.
460.
Affidavit of compliance.
470.
Reinstatement of a lapsed certificate.
12
AAC 14.400. Certification renewal requirements
(a) A certificate as a direct-entry midwife expires on
December 31 of even numbered years.
(b) A certified direct-entry midwife applying for
certificate renewal shall
(1) apply on a form provided by the department;
(2) pay the fees established in 12 AAC 02.145;
(3) submit sworn verification that the applicant has
not committed an act that is a ground for a disciplinary sanction
under AS
08.65.110 ;
(4) submit copies of certification in Basic Life
Support for Health Care Providers Program (BLS) and neonatal
resuscitation showing that the certification is current at the time of
the requested renewal;
(5) demonstrate continued practical professional
competence by verifying
(A) fulfillment of the continuing competency
requirements in 12 AAC 14.420
- 12 AAC 14.450;
and
(B) compliance with the peer review requirements in 12
AAC 14.900.
History: Eff. 5/11/94, Register 130; am 5/16/96,
Register 138; am 3/2/2003, Register 165
Authority: AS
08.65.030
AS
08.65.080
12
AAC 14.410. Apprentice permit renewal requirements
(a) An apprentice direct-entry midwife permit is valid
for two years from the date of issue.
(b) An individual applying for renewal of an
apprentice direct-entry midwife permit shall
(1) apply on a form provided by the department;
(2) pay the fees established in 12 AAC 02.145;
and
(3) document continued qualification under 12 AAC 14.130.
History: Eff. 5/11/94, Register 130
Authority: AS
08.65.030
AS
08.65.090
12
AAC 14.420. Continuing education requirements
(a) Except as provided in 12 AAC 14.450,
an applicant for renewal of a certificate as a direct-entry midwife
shall certify having completed 20 contact hours of continuing
education approved by the board during the concluding license period.
The 20 contact hours must include the following:
(1) at least four hours of the required continuing
education contact hours must be in pharmacology;
(2) at least two hours of the required continuing
education contact hours must be for the completion of the self-study
program described in 12 AAC 14.430(e)
.
(b) No more than 10 of the required continuing
education contact hours may be completed in a self-study program.
(c) For the purposes of this section,
(1) one contact hour equals a minimum of 50 minutes of
instruction;
(2) one continuing education unit awarded by a
professional association equals 10 contact hours;
(3) one academic semester credit hour equals 15
contact hours;
(4) one academic quarter credit hour equals 10 contact
hours.
History: Eff. 5/11/94, Register 130; am 12/9/2001,
Register 160
Authority: AS
08.65.030
AS
08.65.080
12
AAC 14.430. Approved continuing education programs
(a) To be approved by the board, a continuing
education program must cover one or more of the course of study
subjects listed in 12 AAC 14.200
and directly relate to the clinical practice of midwifery.
(b) A continuing education program sponsored by any of
the following organizations that meets the requirements of (a) of this
section is considered approved by the board:
(1) the American College of Obstetrics and Gynecology
(ACOG);
(2) the American Medical Association (AMA);
(3) the Association for Women's Health, Obstetrics,
and Neonatal Nurses (AWHONN);
(4) the American College of Nurse Midwives (ACNM);
(5) the Midwives' Alliance of North America (MANA);
(6) repealed 4/4/2002;
(7) the Midwives' Association of Alaska (MAA);
(8) repealed 4/4/2002;
(9) the American Nurses' Association (ANA);
(10) an accredited postsecondary educational
institution; and
(11) the Midwifery Education Accreditation Council
(MEAC).
(c) A self-study continuing education program
sponsored by one of the organizations listed in (b) of this section
that meets the requirements of (a) of this section is considered
approved by the board.
(d) A continuing education program not sponsored by
one of the organizations listed in (b) of this section must be
individually approved by the board.
(e) The board's self study program required in 12 AAC 14.420(a)
(2) covers the board's current statutes and regulations in AS
08.65 and 12 AAC 14,
and will be revised for each renewal. The board's self-study program
and a booklet containing the board's current statutes and regulations
will be mailed to each licensee with the renewal form.
History: Eff. 5/11/94, Register 130; am 12/9/2001,
Register 160; am 4/4/2002, Register 162
Authority: AS
08.65.030
AS
08.65.080
12
AAC 14.440. Continuing professional practice requirements
Except as provided in 12 AAC 14.450,
an applicant for renewal of a certificate as a direct-entry midwife
shall certify having assisted with, or been primarily responsible for,
10 deliveries during the concluding license period.
History: Eff. 5/11/94, Register 130
Authority: AS
08.65.030
AS
08.65.080
12
AAC 14.450. Continuing competency requirements for first time
certificate renewals
An individual who is applying for a direct-entry
midwife certificate renewal for the first time shall certify having
completed one half of the continuing competency requirements in 12 AAC
14.420
- 12 AAC 14.440
for each complete calendar year that the applicant was certified
during the concluding license period.
History: Eff. 5/11/94, Register 130
Authority: AS
08.65.030
AS
08.65.080
12 AAC 14.460. Affidavit of compliance
(a) A certified direct-entry midwife shall submit, on
a form provided by the department, a sworn affidavit of compliance
with the requirements of 12 AAC 14.420 - 12 AAC 14.450 at the time the
certificate holder applies for renewal.
(b) The board will, in its discretion, require an
applicant for renewal to submit additional evidence of compliance with
the requirements of 12 AAC 14.420 - 12 AAC 14.450. The certificate
holder shall maintain evidence of compliance with the requirements of
12 AAC 14.420 - 12 AAC 14.450 for three years.
History: Eff. 5/11/94, Register 130
Authority: AS 08.65.030
AS 08.65.080
12 AAC 14.470. Reinstatement of a lapsed
certificate
(a) The board will, in its discretion, reinstate a
certificate that has been lapsed less than two years if the applicant
(1) pays the penalty fee required in 12 AAC 02.105;
and
(2) complies with the certificate renewal requirements
in 12 AAC 14.400(b) .
(b) The board will reinstate a certificate that has
been lapsed for at least two years, but not more than five years, if
the applicant
(1) repealed 12/17/97;
(2) pays the renewal fee required in 12 AAC 02.145 for
the current renewal period;
(3) submits sworn verification that the applicant has
not committed an act that is a ground for a disciplinary sanction
under AS 08.65.110 ;
(4) submits copies of certification in Basic Life
Support for Health Care Providers Program (BLS) and neonatal
resuscitation showing that the certification is current at the time of
application for reinstatement;
(5) documents completion of the continuing education
requirements in 12 AAC 14.420 for the entire period since the
certificate lapsed; and
(6) documents completion of
(A) the continuing professional practice requirements
in 12 AAC 14.440 for the entire period since the certificate lapsed;
or
(B) at least 10 supervised deliveries in the year
immediately preceding the application for reinstatement.
(c) The board will not reinstate a certificate that
has been lapsed more than five years at the time of application for
reinstatement.
History: Eff. 5/11/94, Register 130; am 12/17/97,
Register 144; am 3/2/2003, Register 165
Authority: AS 08.01.100
AS 08.65.030
AS 08.65.080
——————————
Article 5 Duties and Responsibilities
Section
500. Prenatal care.
510. Intrapartum care.
520. Postpartum care.
530. Infant care.
540. Records.
550. Medical back-up arrangements.
560. Permitted practices.
570. Medications.
580. Withdrawal from service.
12 AAC 14.500. Prenatal care
(a) The board recommends that a certified direct-entry
midwife make prenatal visits to a client every four weeks until the
28th week of gestation, every two weeks from the 29th through the 35th
week of gestation, and weekly from the 36th week of gestation until
birth.
(b) At the initial prenatal visit, the certified
direct-entry midwife shall recommend that the client undergo a
physical examination as required in AS 08.65.140 to screen for health
problems that could complicate the pregnancy or delivery and that
includes a review of the laboratory studies required in (c) of this
section. The certified direct-entry midwife shall obtain a signed
written consent from the client reflecting the client's informed
choice regarding the recommended physical examination and retain the
consent in the client's record.
(c) At the initial prenatal visit, the certified
direct-entry midwife shall
(1) order the following laboratory tests:
(A) a serological test for syphilis, either rapid
plasma reagin (RPR) or veneral disease research laboratory (VDRL);
(B) blood group;
(C) Rh factor and screen;
(D) rubella titer;
(E) complete blood count;
(F) gonorrhea screen; and
(G) urinalysis;
(2) recommend the following laboratory tests:
(A) test for tuberculosis; and
(B) test for hepatitis and human immune deficiency
virus (HIV).
(d) At 15 - 20 weeks of gestation, the certified
direct-entry midwife shall discuss with the client the availability of
maternal serum alphafetoprotein screening.
(e) At 24 - 28 weeks of gestation, the certified
direct-entry midwife shall recommend a 50 gm glucose tolerance test
for gestational diabetes.
(f) At 28 and 36 weeks of gestation, the certified
direct-entry midwife shall order a hemoglobin or hematocrit test, and,
for a woman with Rh negative type blood, an antibody screen.
(g) At each prenatal visit, the certified direct-entry
midwife shall order the analysis of a clean catch urine sample for
glucose and protein.
(h) The certified direct-entry midwife shall comply
with AS 08.65.140 (b) in obtaining a signed informed consent for home
delivery.
(i) During the third trimester, the certified
direct-entry midwife shall consult with the client concerning
selection of a pediatrician, family physician, or other health care
provider who will assume responsibility for the infant. The certified
direct-entry midwife shall record the client's choice in the client's
record. If the client cannot or will not select a provider for the
infant, the certified direct-entry midwife shall document this
information in the client's record.
(j) The certified direct-entry midwife shall consult
with a physician if, during the prenatal period, the client
(1) develops 2 + or greater pitting edema on the face
and hands;
(2) develops consistent glucosuria or proteinuria of 1
+ or greater;
(3) has marked or severe polyhydramnios or
oligohydramnios;
(4) prior to 37 weeks gestation, has six or greater
contractions per hour not resolved with hydration or rest, or has
effacement or dilation of the cervix;
(5) has severe protruding varicose veins of the
extremities or vulva;
(6) develops blood pressure of 140/90 or an increase
of 30 mm Hg systolic or 15 mm Hg diastolic over the usual blood
pressure;
(7) develops severe, persistent headaches, epigastric
pain, or visual disturbances;
(8) has symptoms of urinary tract infection such as a
rise in temperature, kidney or flank pain, urinary frequency, or
dysuria;
(9) has rupture of membranes before 37 weeks
gestation;
(10) has marked decrease or cessation of fetal
movement;
(11) has fetal heart tones of less than 100 or more
than 170 per minute;
(12) has inappropriate gestational size;
(13) has fever of 100.4ø F. or 38ø C. for 24 hours
or more;
(14) has severe or ongoing medical complications;
(15) has demonstrated anemia by blood test (hematocrit
27 percent or hemoglobin 9 grams);
(16) is found to have a positive antibody screen;
(17) has vaginal bleeding other than show before the
onset of labor;
(18) fails a three-hour oral glucose tolerance test;
or
(19) has a positive purified protein derivative (PPD)
test, hepatitis screen, or human immune deficiency virus (HIV) test.
(k) If, following the consultation set out in (j) of
this section, the physician recommends referral for immediate medical
care the certified direct-entry midwife shall refer the client for
immediate medical care. A referral for immediate medical care does not
preclude the possibility of a home delivery if, following the
referral, the client does not have any of the conditions set out in AS
08.65.140 (d).
(l) During the third trimester, the certified
direct-entry midwife shall ensure that the client is adequately
prepared for a home birth by discussing issues such as sanitation,
facilities, adequate heat, availability of telephone and
transportation, plans for emergency evacuation to a hospital, and the
skills and equipment that the midwife will bring to the birth.
(m) A certified direct-entry midwife shall make a home
visit three to five weeks before the estimated date of confinement to
assess the physical environment, to determine whether the client has
the necessary supplies, to prepare the family for the birth, and to
instruct the family in correction of problems or deficiencies.
History: Eff. 5/11/94, Register 130
Authority: AS 08.65.030
AS 08.65.140
AS 08.65.190
12 AAC 14.510. Intrapartum care
(a) Intrapartum care includes the management of low
risk women whose labor, delivery, postpartum course, and infant are
not reasonably expected to require consultation with a physician or
referral for medical care.
(b) A certified direct-entry midwife may not perform a
vaginal examination on a client with ruptured membranes and no onset
of labor unless
(1) less than 24 hours have elapsed since the rupture
of the membranes; and
(2) there is a reasonable and strong suspicion of a
prolapsed cord.
(c) A certified direct-entry midwife shall obtain
medical consultation or refer for medical care any client who during
the intrapartum period
(1) develops a blood pressure of 160/100 or an
increase of 30 mm Hg systolic or 15 mm Hg diastolic over the baseline
blood pressure;
(2) develops a fever of 100.4ø F. or 38ø C.;
(3) has bleeding other than show before delivery;
(4) develops severe headaches, epigastric pain, or
visual disturbance;
(5) develops respiratory distress;
(6) has persistent or recurrent fetal heart tones
below 100 or above 170 beats per minute at any time, or a fetal heart
rate that is irregular or showing late or variable decelerations;
(7) has meconium stained amniotic fluid other than
very light;
(8) desires medical consultation or transfer.
(d) A consultation or referral as required in (c) of
this section does not preclude the possibility of a home delivery if,
following the consultation with a physician or referral for medical
care, the client does not have any of the conditions set out in AS
08.65.140 (d).
(e) A certified direct-entry midwife shall ensure that
a client on whom an intravenous infusion is started or cardiopulmonary
resuscitation is administered is immediately transported to a
hospital.
(f) A certified direct-entry midwife shall accompany
to the hospital any client requiring hospitalization and provide
copies of all pertinent client data and make a verbal report to the
physician assuming care. If reasonably possible, the certified
direct-entry midwife shall remain with the client to receive
information regarding the results of the client's hospitalization.
History: Eff. 5/11/94, Register 130
Authority: AS 08.65.030
AS 08.65.140
AS 08.65.190
12 AAC 14.520. Postpartum care
(a) Postpartum care is management of the client
through the six-week postpartum period.
(b) After normal delivery, a certified direct-entry
midwife shall remain with the client and infant for at least three
hours postpartum or until both the client's and infant's conditions
are stable. If the client or infant is not stable within five hours,
the certified direct-entry midwife shall transfer the client to an
appropriate medical facility.
(c) Maternal stability is evidenced by normal blood
pressure, pulse, and respiration; firmness of fundus; normal lochia;
and the ability to empty the bladder.
(d) Neonatal stability is evidenced by established
respirations, normal temperature, normal heart rate, and strong
sucking of the infant.
(e) A certified direct-entry midwife shall maintain
close contact with the client during the first 72 hours postpartum,
making at least one postpartum visit to evaluate the condition of the
mother and infant within 36 hours of birth. A certified direct-entry
midwife shall determine whether the mother is bleeding excessively,
has a firm fundus, has a normal temperature, and is establishing
successful breast-feeding or bottle-feeding.
(f) In the case of a mother with Rh negative type
blood, a certified direct-entry midwife shall
(1) obtain a sample of cord blood from the placenta
and arrange for testing; and
(2) administer or arrange for and be certain that the
mother receives RH immune globulin as indicated within 72 hours of
delivery.
(g) A certified direct-entry midwife shall obtain
medical consultation or refer for medical care any client who, during
the postpartum period,
(1) does not void within six hours after birth;
(2) has a third or fourth degree perineal or cervical
laceration;
(3) develops a fever greater than 100.4ø F. or 38ø
C. on any two of the first 10 postpartum days;
(4) develops foul smelling lochia;
(5) develops hematoma;
(6) does not deliver the placenta within one hour of
delivery of the infant;
(7) bleeds more than 1,000 cc (four cups) immediately
after the delivery of the placenta and the bleeding is not readily
controlled;
(8) has a partially separated placenta with
(A) heavy bleeding;
(B) a blood pressure below 90 systolic;
(C) a pulse rate of 110 beats per minute or more; or
(D) weakness and dizziness; or
(9) has retained placental fragments or membranes.
History: Eff. 5/11/94, Register 130
Authority: AS 08.65.030
AS 08.65.140
AS 08.65.190
12 AAC 14.530. Infant care
(a) A certified direct-entry midwife shall consult
with a physician concerning an infant who
(1) has an Apgar score of seven or less at five
minutes;
(2) has a congenital defect;
(3) has tachycardia of 170 or above, bradycardia of
100 or below, or cardiac irregularities;
(4) develops jaundice within 24 hours of birth or
significant scleral icterus within one week of birth;
(5) has an abnormal cry;
(6) shows signs of prematurity, dysmaturity, or
postmaturity;
(7) had meconium stained fluid before birth other than
very light;
(8) is lethargic or does not feed well;
(9) has edema;
(10) develops grunting respirations, retractions,
central cyanosis, or apnea;
(11) has a pale, generalized cyanotic or grey color;
(12) weighs less than five and one half pounds or
2,500 grams, or more than 10 pounds or 4,500 grams;
(13) does not urinate or pass meconium within 24 hours
of birth;
(14) requires resuscitation by bag and mask or
cardiopulmonary resuscitation; or
(15) appears weak, flaccid, or abnormal in any other
respect.
(b) Within two hours of birth, a certified
direct-entry midwife shall administer appropriate eye prophylaxis to
the newborn infant in accordance with 7 AAC 27.111.
(c) A certified direct-entry midwife shall offer, to
one or both of the parents, to administer intramuscular vitamin K to
the infant for the prevention of acute and late onset hemorrhagic
disease. If a parent consents to the administration of the
intramuscular vitamin K, the certified direct-entry midwife shall
administer the vitamin K within two hours of birth. A certified
direct-entry midwife shall note in the client's records a parent's
acceptance or refusal of intramuscular vitamin K.
(d) A certified direct-entry midwife shall ensure that
the newborn receives metabolic blood disorder screening in accordance
with 7 AAC 27.510 - 7 AAC 27.580. The certified direct-entry midwife
shall use a metabolic blood disorder screening kit obtained from the
Department of Health and Social Services.
(e) A certified direct-entry midwife shall recommend
to the client an evaluation of the infant by a physician within one
week of birth or sooner if it becomes apparent that the infant needs
medical attention.
(f) A certified direct-entry midwife shall complete
and file a birth certificate within seven days after the birth in
accordance with AS 18.50.160 .
History: Eff. 5/11/94, Register 130
Authority: AS 08.65.030
AS 08.65.140
AS 08.65.190
Editor's note: The metabolic blood disorder
kits may be obtained from the Department of Health and Social
Services, division of public health, section of child and family
health, 1231 Gambell Street, Anchorage, Alaska 99501-4627.
12 AAC 14.540. Records
(a) A certified direct-entry midwife shall maintain
records of each client on standard obstetric forms prescribed by the
board.
(b) A certified direct-entry midwife shall maintain
records of the recommended medical visit, all prenatal visits, the
charting of labor and delivery, the summary of birth, and the charting
of the newborn examination and postpartum visits.
(c) A certified direct-entry midwife shall maintain
birth records of an infant until at least two years after the infant
has reached the age of 19 years. Prenatal and infant records must be
maintained for at least seven years from the date of the birth.
(d) A certified direct-entry midwife shall provide
copies of pertinent records to medical personnel when the client or
infant is referred for medical care or transported for emergency care.
(e) All records maintained by the certified
direct-entry midwife are subject to review by the board.
History: Eff. 5/11/94, Register 130; am 5/16/96,
Register 138
Authority: AS 08.65.030
AS 08.65.140
AS 08.65.190
12 AAC 14.550. Medical back-up arrangements
(a) A certified direct-entry midwife shall have
written back-up arrangements that must include procedures concerning
(1) alternate midwife assistance for clients in the
certified direct-entry midwife's absence;
(2) abnormal conditions and medically indicated
maternal or infant consultations; and
(3) conducting laboratory tests.
(b) A certified direct-entry midwife shall present the
written back-up arrangements to the board upon request.
History: Eff. 5/11/94, Register 130
Authority: AS 08.65.030
AS 08.65.140
AS 08.65.190
12 AAC 14.560. Permitted practices
(a) The following practices may be performed by a
certified direct-entry midwife who provides documentation acceptable
to the board of having acquired the training and skills necessary to
safely perform them:
(1) catheterization of the urinary bladder;
(2) administration of medications as specified in 12
AAC 14.570 and 12 AAC 14.600;
(3) clamping and cutting the umbilical cord;
(4) artificial rupture of the amniotic membrane if the
fetal head is at zero station or lower and the client is past five
centimeters dilation.
(5) venipuncture;
(6) capillary blood sampling;
(7) suturing; and
(8) emergency measures as specified in 12 AAC 14.600.
(b) The board will notify the certified direct-entry
midwife that documentation submitted under this section is acceptable
to the board of competence in these practices. A certified
direct-entry midwife may not perform the practices set out in (a) of
this section until notification of acceptance has been provided by the
board.
History: Eff. 5/11/94, Register 130
Authority: AS 08.65.030
12 AAC 14.570. Medications
A certified direct-entry midwife may not administer
restricted drugs or medications except for the following, and only if
the certified direct-entry midwife has documented the training and
skills demonstrating competence to administer them as required in 12
AAC 14.560:
(1) xylocaine hydrochloride, one or two percent,
administered by infiltration, for the postpartum repair of tears,
lacerations, and episiotomy;
(2) cetacaine, applied topically, for the postpartum
repair of tears, lacerations, and episiotomy;
(3) vitamin K, administered by intramuscular
injection, for the prevention of acute and late onset hemorrhagic
disease of the infant;
(4) rhogam, administered by intramuscular injection,
for an unsensitized client with Rh negative type blood to prevent Rh
disease;
(5) eye prophylaxis as required by 7 AAC 27.111;
(6) pitocin, administered by intramuscular injection
or intravenous drip, in an emergency situation for the control of
postpartum hemorrhage;
(7) methergine, administered orally or by
intramuscular injection, in an emergency situation for the control of
postpartum hemorrhage that was not controlled by the administration of
pitocin; and
(8) lactated ringers, plain or with dextrose five
percent, administered intravenously to a laboring or postpartum
client, in an emergency situation to prevent or treat shock or to
stabilize her condition.
History: Eff. 5/11/94, Register 130
Authority: AS 08.65.030
AS 08.65.190
12 AAC 14.580. Withdrawal from service
(a) A certified direct-entry midwife may withdraw from
responsibility for a client during the prenatal period if, for any
reason, the midwife does not feel comfortable continuing as the
client's midwife. The decision to withdraw may take into account
(1) the client's failure to consult a physician when
recommended to do so by the certified direct-entry midwife;
(2) the client's failure or refusal to follow
recommendations;
(3) personality incompatibilities; or
(4) any other factor that the certified direct-entry
midwife believes may create an unwarranted risk to the client, fetus,
or infant, or may interfere with the certified direct-entry midwife's
ability to care responsibly for the client, fetus, or infant.
(b) If the certified direct-entry midwife withdraws,
the midwife shall immediately notify the client in writing and shall
cooperate with the client in finding alternative care.
(c) After the onset of labor, a certified direct-entry
midwife may withdraw only if the midwife believes that the midwife is
unable to competently care for the client, fetus, or infant. The
certified direct-entry midwife shall arrange for transfer of the
client to medical care. If the client refuses to accept transfer to
medical care, the certified direct-entry midwife shall document the
relevant events and shall stay with the client until attended by
hospital or emergency medical personnel.
History: Eff. 5/11/94, Register 130
Authority:
——————————
Article 6 Emergency Measures
Section
600. Emergency practices.
610. Emergency transport plan.
620. Emergency defined.
12 AAC 14.600. Emergency practices
In addition to the practices permitted in AS 08.65.140
(e) and (f) and 12 AAC 14.560, in an emergency a certified
direct-entry midwife who has documented training and skills
demonstrating competence as set out in 12 AAC 14.560 may
(1) perform an episiotomy; and
(2) administer the medications listed in 12 AAC
14.570(6) - (8).
History: Eff. 5/11/94, Register 130
Authority: AS 08.65.030
AS 08.65.140
AS 08.65.190
12 AAC 14.610. Emergency transport plan
(a) A certified direct-entry midwife shall present a
copy of the midwife's emergency transport plan to each client before
the onset of labor.
(b) The emergency transport plan must be signed by the
client and include
(1) written permission to release the client's records
to a physician in an emergency; and
(2) a statement that costs will be incurred for
emergency transportation and an agreement as to who is responsible for
the costs.
(c) The certified direct-entry midwife shall include
the signed emergency transport plan in the client's records.
History: Eff. 5/11/94, Register 130
Authority: AS 08.65.030
AS 08.65.140
AS 08.65.190
12 AAC 14.620. Emergency defined
In this chapter and in AS 08.65, "emergency"
means a situation that presents an immediate hazard to the health and
safety of the client.
History: Eff. 5/11/94, Register 130
Authority: AS 08.65.030
AS 08.65.190
——————————
Article 7 General Provisions
Section
900. Peer review.
990. Definitions.
12 AAC 14.900. Peer review
(a) The board will designate, as a peer review
committee, a qualified organization with experience in certified
direct-entry midwifery to provide peer review to the board concerning
the quality of care provided by a certified direct-entry midwife.
(b) In the agreement for peer review services, the
board will require the organization providing peer review to
(1) maintain confidentiality of medical records as
required by law;
(2) randomly review summaries of births submitted by a
certified direct-entry midwife under (c)(1) of this section;
(3) review those summaries of births or other records
submitted under (c)(2) and (c)(3) of this section;
(4) review at the request of the board any case or
summary of birth relating to care by a certified direct-entry midwife;
(5) maintain records of the organization related to
the review;
(6) provide records to the board and division
investigative staff, as requested by the board or division
investigative staff; and
(7) report to the board or division investigative
staff on activities and results of the peer review conducted under
this section, including any recommendations for disciplinary action.
(c) A certified direct-entry midwife shall submit to
the board or, if an organization has been designated under (a) of this
section, to that organization the following information:
(1) a copy of the summary of birth for each labor and
delivery for which the certified direct-entry midwife had primary
responsibility during the 12-month period that began on April 1 of the
preceding year; the copy must be submitted on or before May 1 of each
year;
(2) all records required under 12 AAC 14.540 as
requested by the board through the organization providing peer review
for cases selected under (b)(2) of this section; and
(3) within 10 days after the delivery or transfer of
care, all records required under 12 AAC 14.540 for any case in which a
client for whom the certified direct-entry midwife had primary
responsibility
(A) died;
(B) required emergency hospital transport;
(C) required intensive care; or
(D) had any of the complications or conditions listed
in AS 08.65.140 (d)(1) - (d)(17).
(d) Failure to comply with the requirements of this
section is grounds for disciplinary sanctions under AS 08.65.110 (6).
History: Eff. 5/16/96, Register 138
Authority: AS 08.65.030
AS 08.65.110
12 AAC 14.990. Definitions
In this chapter
(1) "board" means the Board of Certified
Direct-Entry Midwives;
(2) "client" means a pregnant woman,
postpartum woman up to six weeks, fetus, or newborn, as appropriate;
(3) "department" means the Department of
Community and Economic Development;
(4) "preceptor" means a person qualified
under AS 08.65.090 (b) or 12 AAC 14.210(a) who supervises a person
training to be a direct-entry midwife;
(5) "supervision" means the direct
observation and evaluation by the preceptor of the clinical
experiences and technical skills of the apprentice direct-entry
midwife or other supervised person while present with the supervised
person in the same room.
History: Eff. 2/18/94, Register 129
Authority: AS 08.65.030
AS 08.65.090
Editor's note: As of Register 151 (October
1999), the regulations attorney made technical revisions under
AS\n44.62.125(b)(6) to reflect the name change of the Department of
Commerce and Economic Development to the Department of Community and
Economic Development made by ch. 58, SLA 1999 and the corresponding
title change of the commissioner of commerce and economic development.
——————————
Updated
8-28-2003
Home :: Site Map :: Contact
What is MANA? :: News
:: Definitions :: Conferences
:: Resources :: Links
|