04-360 Code Vt. R. 04-030-360-X - ADMINISTRATIVE RULES FOR LICENSED MIDWIVES
The Director of the Office of Professional Regulation has been given powers by Vermont law to protect the public health, safety, and welfare by setting standards, licensing applicants, and regulating licensed midwives and their practices.
Licensure is governed by a specific state law that establishes responsibilities for setting standards, issuing licenses, and regulating the profession. The law is the Midwives Act, Title 26, Vermont Statutes Annotated, Chapter 85. In addition, the Director of Professional Regulation is obligated to comply with several other state laws, such as the Administrative Procedure Act ( 3 V.S.A. §§ 801-849), the Open Meeting Law ( 1 V.S.A. §§ 311-314), the Access To Public Records Law ( 1 V.S.A. §§ 315-320), and the Law of Professional Regulation ( 3 V.S.A. §§ 121-131).
These laws set forth the rights of an applicant, licensed midwife, or member of the public. The complete text of these laws is available at most libraries and town clerks' offices. "Vermont Statutes Online" are also available on the Internet at www.leg.state.vt.us. The text of laws and rules governing midwives may be found at www.vtprofessionals.org/midwives [File Link Not Available].
Applications and information about licensure requirements are available from the Office of Professional Regulation (Office). An applicant must submit a completed application form with all supporting documentation and the fee to the Office. The Office reviews applications only after the supporting documentation is received.
To be eligible for licensure as a midwife, an applicant must (1) have obtained certification as a certified professional midwife (CPM) from the North American Registry of Midwives (NARM), (2) have earned a high school degree or its equivalent, and (3) have agreed to practice according to the scope and standards of practice set forth in these rules.
If the Director of the Office of Professional Regulation (Director) denies an applicant licensure, the Director will give specific reasons in writing and inform the applicant of the right to appeal this decision to an administrative law officer. After giving the applicant an opportunity to present the application and any additional information, the administrative law officer must affirm, reverse, or modify the Director's preliminary decision. Decisions of the administrative law officer may be appealed to the Washington Superior Court.
Licenses renew on a fixed biennial schedule: January 31 of the odd-numbered years. Initial licenses issued within 90 days of the renewal date will not be required to renew or pay the renewal fee. The license will be issued through the next full license period. Applicants issued an initial license more than 90 days prior to the renewal expiration date will be required to renew and pay the renewal fee.
Before the expiration date, the Office will mail a renewal application and notice of the renewal fee. A license will expire automatically if the renewal application and fee are not returned to the Office by the expiration date.
See also Rules 3.3 (continuing education requirements), 3.8 (peer reviews), 3.9 (individual practice data), and 3.10 (CPR certification) for additional license renewal requirements.
A license that has lapsed for three years or less will be renewed if the applicant submits the renewal fee, late renewal penalty, and renewal application showing:
An applicant is not required to pay renewal fees for years during which the license was lapsed.
A license that has lapsed for more than three years for reasons other than professional discipline may be renewed, but only if the applicant files an application for license reinstatement on a form approved by the Director and pays the required fee. An applicant for license reinstatement must show to the Director's satisfaction:
An applicant is not required to pay renewal fees for years during which the license was lapsed.
All midwives licensed and residing in this state must complete a minimum of 20 hours of continuing education during the two-year renewal period and must so certify at the time of license renewal. The continuing education requirement does not apply for the renewal period during which a midwife initially obtained licensure. It will begin with the first full two-year renewal period.
A continuing education program means classes, institutes, lectures, conferences, workshops, midwifery journals, scientific journals, audio- or videotaped presentations, and preceptorships. A program must consist of study covering new, review, experimental, research, and specialty subjects within the scope of practice of midwifery in this state. Excluded are programs that promote a company, individual, or product and programs whose subject is practice economics.
Programs offered by the following organizations, agencies, or institutions are approved by the Director for continuing education credit:
A course will be approved for the hours the provider assigns to the course. All other programs will be evaluated and may be eligible for credit if they meet the following criteria and comply with other provisions of these rules: the material is relevant to a midwifery practice (presenting a modality used by midwives), and the sponsoring organization is credible (able to verify attendance and course content).
No more than ten hours will be credited in a single subject area towards the 20-hour biennial continuing education requirement. No more than five hours will be granted for informal study or self-study of midwifery or scientific journals, audio- or videotaped presentations, or preceptorships.
The amount of credit to be allowed for correspondence and formal individual study programs (including taped study programs) will be that which is recommended by the program sponsor. Licensees claiming credit for such correspondence or formal individual study courses are required to obtain evidence of satisfactory completion of the course from the program sponsor. Credit will be allowed in the renewal period in which the course is completed.
A licensee residing in another jurisdiction who has met the continuing education requirements for the current biennial renewal period in that jurisdiction will be deemed by the Director to have met the continuing education requirements for license renewal in Vermont, provided that the other jurisdiction's requirements are reasonably equivalent to those in Vermont. A licensee who holds a current certification as a CPM from the NARM will also be deemed by the Director to have met the continuing education requirements for license renewal in Vermont, provided that NARM's continuing education requirements are reasonably equivalent to those in Vermont.
At the time of license renewal, each licensee must certify on the official renewal form that he or she has complied with the continuing education requirements. The Office may randomly audit licensees to ensure compliance. A licensee who is audited will be notified in writing by the Office and will be required to produce written documentation verifying successful completion of the 20 hours of continuing education during the two-year period at issue. A licensee must maintain such written documentation for a period of three years following the renewal period at issue. The Director may require a licensee who cannot produce such documentation to develop and complete a specific corrective action plan within 90 days, prior to renewal.
An educational activity will be eligible for approval as satisfying the continuing education requirements of these rules if it has significant intellectual and practical content directed at increasing the professional competence of midwives, and the activity consists of classroom-style instruction, educational seminars, or self-directed study with substantial written material available, whether conducted by live speakers, lecturers, panel members, video or audiotape presentation, or in written format. If the educational activity consists of classroom-style instruction or seminar, it must be conducted in a classroom or similar setting with a group of not fewer than three individuals. If the educational activity consists of a scientific journals, each journal article for which credit is sought must provide for a written examination and answer sheet, to be completed and mailed to the journal for correction and grading.
The activity may be approved by the Director upon a written request for approval. The name of the activity, the number of credits requested, and the names of the instructors and sponsors must be clearly indicated in the written request. Application may be filed by the sponsoring agency or group, or by any participant. Application for advance approval must be filed at least 120 days before the educational activity has commenced. All applications for approval must be filed within 30 days after the activity is completed. The Director will assign a maximum number of credit hours to each approved activity.
The Director may refuse to approve or may limit the number of hours to be accredited for any activity if the Director finds the activity:
When the Director has approved an activity, the sponsor may so state, including the number of credits for which the activity has been approved.
A licensee is responsible for notifying the Office promptly in writing if the licensee changes name, mailing address, or business address. For purposes of these rules, all initial licensure or renewal applications, notices, or other correspondence mailed to a licensed midwife by the Director or the Office at the licensed midwife's address on file with the Office will be considered as having been received by the licensed midwife.
Licensed midwives may be disciplined for unprofessional conduct under 26 V.S.A. § 4188 and 3 V.S.A. § 129a. In addition, 3 V.S.A. § 129(a)(6) provides a ground for discipline in this state if a licensee or applicant has been disciplined in another jurisdiction for any offense which would constitute unprofessional conduct in Vermont.
The Office has a published procedure for receiving, investigating, and acting on complaints of unprofessional conduct. Copies of the procedure are available from the Office.
A midwife licensed in this state must participate in at least four separate peer review meetings evaluating the midwife's practice during each two-year renewal period as a condition of license renewal. Peer reviews must be conducted in peer review meetings or in conjunction with professional organization meetings. Each peer review must be conducted by at least two other licensed midwives who have no personal, professional, or financial interest in the birth being reviewed. Peer reviews of the licensed midwife's practice must include but not be limited to process of care, outcome data, referral patterns, and discussion of specific cases and obtaining feedback and suggestions regarding care. Attendance at peer review sessions must be documented in writing on report forms approved by the Director and must be made available to the Director as required.
In addition to the four peer reviews required during each two-year renewal period, a licensed midwife must request and participate in peer review in the following specific situations:
Attendance at any peer review session conducted regarding a specific situation listed in paragraph (1) or (2) above must be documented in writing on report forms approved by the Director and must be filed with the Director within 30 days of the peer review session. Reports filed under paragraphs (1) or (2) above will be kept confidential by the Director, unless they result in the filing of charges of unprofessional conduct.
As a condition of license renewal, a midwife licensed in this state must submit to the Office, on a form approved by the Director, individual practice data covering each two-year renewal period. Information must not include any data that would identify the client. Such individual practice data must include, at a minimum, the following information about each home birth attended during the renewal period:
A midwife licensed in this state must show proof of current cardiopulmonary resuscitation certification for adults and newborns and for neonatal resuscitation as a condition of initial issuance of license and of license renewal. The Director will accept courses in external cardiopulmonary resuscitation which are approved by the Vermont Heart Association or the American Red Cross and courses in neonatal resuscitation approved by the American Academy of Pediatrics (AAP).
When providing midwifery care, student midwives in training and assistants must be under the direct on-site supervision of a licensed midwife.
Before accepting a client for care, a licensed midwife must first obtain written informed consent.
Informed consent must be shown by a written statement, in a form prescribed by the Director and signed by the licensee and the client to whom care is to be given, in which the licensee certifies that full disclosure of the following information has been made and acknowledged by the client:
The signed informed consent form must be filed in the client's record, and a copy must be provided to the client.
Throughout the care process, the midwife must continue to inform the client and obtain consent.
Role of the Midwife: The midwife is a person who provides well-woman care, support and education to healthy women during the childbearing cycle, including normal pregnancy, labor, childbirth and the postpartum period. Midwifery care emphasizes education, health promotion, shared responsibility, and mutual participation in decision making. The midwife works with each client and the client's family to identify their unique physical, social, cultural, and emotional needs. When the care required extends beyond the midwife's abilities, the midwife continues involvement and arranges for consultation, referral, and collaboration with appropriate health care providers.
Prenatal Care:
Labor, Birth, and Immediate Postpartum:
Follow-up Care:
At the final visit, the midwife may:
The licensed midwife recognizes that there are certain conditions when medical consultations or transfers, or both, are advisable.
Each licensed midwife must develop a written plan (1) for consultation with physicians (M.D. or D.O.) and other health care providers and (2) for emergency transfer and for transport of an infant or a client, or both, to an appropriate health care facility. The written plan must be submitted to the Director on an approved form with the initial license application and with every subsequent license renewal.
If a history of any of the following disorders or situations is found to be present at the initial interview or if any of the following disorders or situations becomes apparent through history, examination, or laboratory report as prenatal care proceeds, the midwife must not assume or continue to take responsibility for the client's pregnancy and birth care. For clients already under care, it is the responsibility of the midwife to arrange for orderly transfer of care to a licensed M.D. or D.O.
If the following situations or conditions are present or become apparent during prenatal care, the midwife must consult with a licensed M.D. or D.O, must document such consultation and the consultant's recommendations, and must document discussion of the consultation with the client.
The following requirements must be met for vaginal birth after cesarean (VBAC). In addition, prenatal consultation is advised when available.
No later than one year from the effective date of these rules or earlier upon written request, the Director, in consultation with the advisor appointees and the Commissioner of Health, will review current scientific research on vaginal birth after cesarean (VBAC), for the purpose of seeking amendment of this rule to reflect current scientific research findings, provided the Director concludes after consultation that amendment is necessary.
If the following conditions become apparent during the labor, birth, or immediate postpartum period, the midwife must facilitate transfer to a hospital setting if time allows. If transfer is not possible, the midwife must consult with a licensed M.D. or D.O. to determine whether and when transfer may become advisable:
Decision-making Conflicts:
Pre-natal, Birth Not Imminent: If a client chooses to give birth at home in a situation deemed higher- risk or potentially more complicated by the midwife or prohibited by these rules, the midwife must refer the client and her family to alternative care providers. The midwife must cease to take responsibility for the client's pregnancy care no later than one week after providing the referral.
Birth Imminent: If the birth is imminent, the midwife must not leave the client until the ambulance has arrived.
A licensed midwife must establish and maintain a record of the care provided and data gathered for each client. Each client's record must contain the following information, as applicable:
A licensed midwife must make records available upon request to the client, to the client's representative, to other health care providers engaged in the care and treatment of the client, for peer reviews required by Rule 3.8 (peer reviews), or upon request by the Director for periodic quality review. For other persons or entities, information in the client's record may be released by the midwife only with the written consent of the client, legal guardian, or as otherwise provided by law.
A licensed midwife may purchase and use the legend devices listed below which are deemed integral to providing safe care to the public.
A licensed midwife may obtain (by purchase or by prescription written by a Vermont-licensed MD or DO) and administer the legend drugs listed in Table A, for the purposes listed in that table. The routes of administration listed in the table are the only approved routes. Abbreviations used to define the routes of administration are defined as follows:
|
PO |
= |
by mouth |
|
IM |
= |
intramuscular |
|
IV |
= |
intravenous |
|
SQ |
= |
subcutaneous |
|
Topical |
= |
applied to skin |
|
Blow-by |
= |
oxygen blown at the nose and mouth |
The client's records must contain documentation of all medications administered.
A licensed midwife may administer any other medication prescribed by a licensed physician (MD or DO) for a specific client and with the intent that the licensed midwife administer the medication. The licensed midwife must administer such medication consistent with the scope of midwifery practice as defined in Rule 3.13 (scope and practice standards).
TABLE A
|
Legend Drug |
Indication |
Dose |
Route of Administration |
Duration of Treatment |
Comments |
|
Oxygen |
Fetal distress |
Blow-by or Mask |
20 minutes or until EMT arrives |
||
|
1% Silver Nitrate Solution or |
Neonatal Ophthalmia |
2 drops in each eye from unit dose package |
Topical |
Single dose |
|
|
0.5% Erythromycin |
1 cm ribbon in each eye from unit |
||||
|
Ophthalmic |
dose |
||||
|
Ointment or 1% Tetracycline |
package 1 cm ribbon in each eye from unit |
||||
|
Ophthalmic |
dose |
||||
|
Ointment |
package |
||||
|
Oxytocin 10 units/ml |
Postpartum hemorrhage |
10 units |
IM only |
1-2 Doses |
|
|
Methyl-ergo novine 0.2 mg/ml or 0.2 mg tabs |
Postpartum hemorrhage |
0.2 mg |
IM or PO |
3-4 times daily for 30 days |
Do not use in patients with Raynaud's Disease |
|
Vitamin K 2 mg/ml |
Prophylaxis of Hemorrhagic Disease of the Newborn |
0.5 ml 1 ml |
IM PO |
Single Dose |
Infants with active bleeding must be referred to a licensed physician (MD or DO) |
|
RH[o] (D) Immune Globulin |
Prevention of RH[o] (D) Sensitization in RH[o] (D) negative women |
Unit dose |
IM Only |
Single dose at 26-28 weeks gestation for RH[o] (D) negative, antibody negative women And Single dose given within 72 hours of delivery of RH[o] (D) positive infant |
May administer an additional dose approximately 12 weeks after the initial dose if delivery is not imminent. |
|
Lidocaine HCI Injection 0.5 or 1% And Lidocaine HCI and epinepherine Injection 0.5 or 1% |
Local anesthetic for use during postpartum repair of lacerations , tears or episiotomy |
Maximum 50 ml |
Percutaneous infiltration only |
||
|
Epinepherine HCI 1:1000 solution |
Treatment or post-exposure prevention of severe allergic reactions |
0.3 ml |
SQ or IM |
Every 10-15 minutes until EMT arrives |
Administer first dose then immediately contact emergency services by telephoning 911 |
|
Rubella Virus Vaccine, Live |
Prevention of Rubella in susceptible women in the immediate postpartum period |
Unit dose |
SQ only |
Single dose |
Must be in compliance with Federal-law regarding vaccine record keeping |
|
5% Dextrose in Ringer =s Lactate, or Ringer = s Lactate |
To prevent or correct dehydration complicating labor and delivery |
Consult with licensed MD or DO for dose |
IV |
Effective date: December 1, 2001
Notes
Statutory Authority: 26 V.S.A. § 4185(b)
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