Current through Register Vol. 18, September 20, 2024
(1) The terms "direct supervision", "indirect
supervision", and "personal supervision" used herein are defined in ARM
24.111.301.
(2) The direct-entry
midwife apprenticeship license program shall be that instructional period
composed of practical experience time obtained under the personal supervision
of a supervisor approved by the board.
(3) Applicants for a direct-entry midwife
apprenticeship license shall submit a completed application with the proper
fee, a current CPR card indicating certification to perform adult and infant
cardiopulmonary resuscitation, a supervision agreement, and a curriculum
outline or method of academic learning that meets the board's educational rule
requirements for licensure. A supervision agreement shall include:
(a) name of supervisor who shall be a
licensed direct-entry midwife, a certified nurse midwife, a licensed
naturopathic physician who is certified for the specialty practice of
childbirth attendance or a physician licensed under Title 37, chapter 3, MCA;
(b) agreement of parties that
supervision shall be provided which is consistent with these rules;
and
(c) agreement of supervisor to
supervise no more than four direct-entry midwife apprentices at the same time.
(4) A Level I
direct-entry midwife apprenticeship is served under the direct supervision of
the licensed supervisor, with a focus on prenatal care. To complete Level I,
the direct-entry midwife apprentice shall:
(a) observe 40 births;
(b) provide 20 prenatal
examinations;
(c) complete Level I
skills checklist; and
(d) submit a
positive evaluation of skills and educational progress form and written
verification by supervisor of completion of Level I.
(5) A Level II direct-entry midwife
apprenticeship is served under the direct supervision of the licensed
supervisor, with a focus on birth, postpartum, and newborn care. To complete
Level II, the direct-entry midwife apprentice shall:
(a) attend ten births as primary birth
attendant. Five of the ten births, as primary birth attendant in Level II, must
be supervised by a licensed direct-entry midwife. The births must be verified
by:
(i) signed birth certificates;
(ii) signed affidavits from the birthing
mothers; or
(iii) documented
records from the person who supervised the births to include prenatal records,
birth records, and postpartum records;
(b) provide 40 prenatal examinations;
(c) submit prenatal protocols;
(d) complete Level II skills
checklist;
(e) submit a positive
evaluation of skills and educational progress form and written verification by
supervisor of completion of Level II; and
(f) obtain approval from the board to proceed
to Level III.
(6) A
Level III direct-entry midwife apprenticeship is served as either Level III-A
or III-B, as defined below. The focus of Level III shall be continuous
prenatal, perinatal, and postnatal care. To complete Level III, the
direct-entry midwife apprentice shall:
(a)
complete 15 continuous-care births as the primary attendant:
(i) Eight of the 15 continuous-care births in
Level III must be supervised by a Montana-licensed direct-entry midwife. The
births must be verified by:
(A) signed birth
certificates;
(B) signed
affidavits from the birthing mothers; or
(C) documented records from the person who
supervised the births to include prenatal records, birth records, and
postpartum records;
(ii) Five of the 15 continuous-care births
must include prenatal exams, one of which must have been performed before the
beginning of the 28th week of gestation, as determined by last menstrual period
or sonogram, and include one postpartum exam;
(iii) Ten of the 15 continuous-care births
must have been performed under the personal supervision of a qualified
supervisor;
(iv) At least one of
the 15 continuous-care births must include a postpartum exam;
(b) provide 40 prenatal
examinations;
(c) submit protocols
for birth, postpartum, and newborn care;
(d) complete Level III skills checklist; and
(e) submit a positive evaluation
of skills and educational progress form and written verification by supervisor
of completion of Level III.
(7) Level III-A and Level III-B direct-entry
midwife apprentices are distinguished as follows:
(a) A Level III-A direct-entry midwife
apprentice shall require direct supervision by the licensed supervisor;
(b) A Level III-B direct-entry
midwife apprentice shall require indirect supervision by the licensed
supervisor when, in the professional judgment of the supervisor, with
concurrence of the board, the Level III-B apprentice is capable of safely and
competently performing midwifery services under indirect supervision after the
following requirements have been met:
(i)
verification of completion of ten directly supervised continuous-care births
which include five prenatal exams, one of which must have been performed before
the beginning of the 28th week of gestation, as determined by last menstrual
period or sonogram, and include one postpartum exam;
(ii) verification of completion of at least
75 percent of educational/academic requirements for full licensure;
and
(iii) a formal outline of the
method of indirect supervision communication shall be submitted in writing to
the board for approval, which shall include supervisor chart review and
telephone contact supervision.
(8) Direct-entry midwife apprenticeship
applicants who have at the time of application, through an apprenticeship or
other supervisory setting, participated as the primary birth attendant at 25
births, 15 of which included continuous care, may enter directly into
direct-entry midwife apprenticeship license Level III-B. To complete Level
III-B, at least eight continuous-care births must be supervised by a
Montana-licensed direct-entry midwife.
(a) The
25 births and 15 continuous-care births shall be evidenced by:
(i) the signed birth certificate as primary
birth attendant;
(ii) an affidavit
from the birth mother; or
(iii)
documented records from the person who supervised the births to include
prenatal records, birth records, and postpartum records.
(b) Documentation of each of the 15
continuous care births as defined in
37-27-103,
MCA, must include at least five prenatal exams, one of which must have been
performed before the beginning of the 28th week of gestation, as determined by
last menstrual period or sonogram, and include one postpartum exam. Ten of the
15 continuous care births must have been performed under the direct supervision
of a qualified supervisor.
(9) To be approved by the board as a
supervisor of a direct-entry midwife apprentice, each supervisor applicant must
submit an application on a form provided by the department and shall:
(a) hold a current, unencumbered Montana
license as a direct-entry midwife, a certified nurse midwife, a licensed
naturopathic physician who is certified for the specialty practice of
naturopathic childbirth attendance, or a physician as defined in
37-3-102,
MCA:
(i) A licensed direct-entry midwife who
has not completed 20 postlicensure continuous care births may only supervise
Level I apprentices;
(ii) A
licensed direct-entry midwife who has completed 20 postlicensure
continuous-care births as primary attendant may apply to supervise Level II and
III apprentices;
(b)
review and sign all documents required by the board under the direct-entry
midwife apprenticeship program;
(c) supervise no more than four direct-entry
midwife apprentices at the same time;
(d) notify the board in writing of any change
in the supervisory relationship, including advancement from direct to indirect
supervision, termination of the supervisory relationship, or any other relevant
changes, and submit supervision change notification to the board so that it is
received on or before the day that supervised tasks are performed in order for
them to count toward licensure requirements; and
(e) be directly responsible for all
activities undertaken by the apprentice(s) under their supervision agreement.
(10) Violation of the
board statutes or rules may result in license discipline action against the
direct-entry midwife apprentice, or supervisor, or both.
AUTH:
37-1-131,
37-27-105,
MCA; IMP:
37-1-131,
37-27-105,
37-27-201,
37-27-205,
37-27-321,
MCA
