4 CCR 739-1.12 - STANDARDS FOR VAGINAL BIRTH AFTER CESAREAN SECTION (VBAC)

The purpose of this Rule is to establish parameters for VBAC clients seeking midwifery care during pregnancy in order to safeguard the client's welfare pursuant to section 12-225-106(11), C.R.S.

A. A direct- entry midwife shall not assume primary responsibility for prenatal care and birth attendance for women who have had a previous cesarean section unless all of the following conditions are met:

1. All prospective VBAC women shall sign an informed consent statement, which shall be retained in the client's records and include the following:

a. VBAC educational information including history of VBAC and client's own personal information;

b. Associated risks and benefits of VBAC at home;

c. A workable hospital transport plan;

d. Alternatives to VBAC at home; and

e. Other information as required by the Director.

2. A workable hospital transport plan must be established for home VBAC. The plan shall be in writing and include:

a. Place of birth within 30 minutes of transport to the nearest hospital or emergency medical center able to perform an emergency cesarean;

b. Readily available emergency numbers for the nearest hospital or emergency medical center; and

c. Provision for phone contact with the nearest hospital or emergency medical center prior to any transport notifying the destination that transport is in progress.

3. There has been at least 18 months from the client's cesarean delivery to the due date of the current pregnancy.

4. The client with 2 or more cesarean deliveries has also had a vaginal delivery since the last cesarean delivery.

B. The direct-entry midwife shall obtain prior client cesarean written records, shall analyze the indication for the previous cesarean, and retain the records along with a written assessment of the physical and emotional considerations in the client's files. If the direct-entry midwife is unable to obtain the written records, the direct-entry midwife shall not retain the woman as a client.

C. Records that show a previous classical uterine/vertical incision or any previous uterine surgery which required an incision into the uterine fundus are a contraindication to VBAC at home and shall require immediate transfer of care of the client.

D. Direct-entry midwife shall not induce or augment labor by the use of chemicals or herbal supplements or nipple stimulation.

E. A direct-entry midwife shall be present and manage the VBAC delivery from the onset of active labor throughout the immediate postpartum period.

Notes

4 CCR 739-1.12

40 CR 12, June 25, 2017, effective 8/1/2017 41 CR 01, January 10, 2018, effective 1/30/2018 43 CR 03, February 10, 2020, effective 1/1/2020 43 CR 07, April 10, 2020, effective 4/30/2020 43 CR 22, November 25, 2020, effective 12/15/2020 44 CR 09, May 10, 2021, effective 5/30/2021 44 CR 20, October 25, 2021, effective 11/14/2021 45 CR 17, September 10, 2022, effective 8/15/2022 45 CR 21, November 10, 2022, effective 11/30/2022