Current through Register Vol. 6, March 25, 2022
(1) A licensed direct-entry midwife shall not
assume primary responsibility for prenatal care and/or birth attendance for
women who have had a previous cesarean section, unless all of the following
conditions are met:
(a) An informed consent
statement, on a form furnished by the board, shall be signed by all prospective
VBAC parents and the licensee, and retained in the licensee's records. The form
(i) VBAC educational
information, including history of VBAC and client's own personal
(ii) associated risks
and benefits of VBAC at home;
a workable hospital transport plan;
(iv) alternatives to VBAC at home;
(v) other information as required by the
(b) A workable
hospital transport plan must be established for home VBAC. The plan shall
(i) provision for physician/hospital
backup, e.g., through the physician/hospital policy on backup;
(ii) place of birth within 30 minutes of
transport to the nearest hospital able to perform an emergency
(iii) readily available
phone numbers for physician backup and nearest hospital, in writing, in
contact with nearest hospital at onset of labor and prior to any transport to
notify that transport is in progress; and at conclusion of home birth if no
transport is necessary.
(c) Licensee shall obtain prior
doctor/hospital cesarean records, in writing, prior to acceptance of the woman
as a client, and shall analyze the indication for the previous cesarean, and
retain the records and a written assessment of the physical and emotional
considerations in licensee's files. Records which show a previous classical
uterine/vertical incision, any other uterine scars into the endometrium, or
less than 18 months between last surgery to the next delivery are
contraindications to VBAC at home, and shall require immediate transfer of care
of the client. If a licensee is unable to obtain written records, the licensee
shall not retain the woman as a client.
(d) VBAC deliveries shall be performed by a
fully licensed midwife (not an apprentice licensee), skilled with VBAC support,
able to assess true complications and emergencies, to be present from the onset
of active labor, throughout the immediate postpartum period.
(2) The board shall conduct a
"sunset" review, including the necessity for and safety of the VBAC rule, on or
about May, 2001, or five years from the effective date of this rule.
Mont. Admin. R.
NEW, 1996 MAR p. 1829,
Eff. 7/4/96; TRANS, from Commerce, 2001 MAR p. 1642; AMD, 2003 MAR p. 2873,
Eff. 12/25/03; AMD, 2007 MAR p. 263, Eff.