Current through Vol. 42, No. 1, September 16, 2024
(a) A Licensed Midwife shall not provide
prenatal care and/or birth attendance for a woman who is having a VBAC, vaginal
multiple birth, or vaginal breech birth unless the following requirements are
met:
(1) Informed Consent specific to VBAC,
vaginal multiple birth, or vaginal breech birth is provided to and signed by
the client as required by OAC 310:395-5-5 of this Chapter;
(2) In event of transport, the Licensed
Midwife implements and acts in accordance with the hospital transportation plan
established pursuant to these rules; and
(3) The Licensed Midwife performs fetal
auscultation at least every fifteen (15) minutes during Active first stage of
labor and at least every five (5) minutes during Second Stage of labor.
(b) For vaginal birth
after cesarean deliveries, the following additional requirements must be met:
(1) There must be at least eighteen (18)
months from the Client's previous cesarean to the due date of the current
pregnancy;
(2) There must not be a
previous classical uterine/vertical incision or any other uterine scars through
the myometrium;
(3) The Licensed
Midwife must obtain, retain, and analyze prior physician and hospital cesarean
records, in writing, prior to acceptance of the Client. Records showing that
requirements of this section cannot be met shall require immediate referral of
care of the Client. If the Licensed Midwife is unable to obtain the written
records, the Licensed Midwife shall not retain the Client; and
(4) The placenta shall not be previa or
marginal placenta previa in accordance with OAC 310:395-5-6(a)(20).
(5) The Licensed Midwife is required to
disclose the following item verbally and written, which is listed on the VBAC
informed consent form: The place of birth is/is not within twenty (20) minutes
of transport to the nearest hospital with twenty-four (24) hour obstetrical and
anesthesia services available. If transport is over 20 minutes, increased
distance to surgical interventions, NICU, and pediatric services may increase
risk of infant and maternal death.
(c) For planned breech deliveries, the baby
shall be in a frank or complete breech position. If baby is in an incomplete or
footling breech position, the Licensed Midwife shall transfer care of the
Client to a physician when it is possible to do so without endangering the
health of the mother or baby.
(d)
The requirement to refer listed in subsection (c) of this section is exempted
in the event of an imminent breech delivery.
(e) For planned multiple deliveries, the
following additional requirements must be met:
(1) Multiples shall be no more than two
fetuses;
(2) Determination of
chorionicity by the late first trimester or early second trimester by
ultrasound with images performed by a Registered Diagnostic Medical Sonographer
(RDMS). If the chorionicity is not di/di, the Licensed Midwife should transfer
care to a physician upon diagnosis;
(3) A Maternal Fetal Medicine (MFM)
consultation is required when twin pregnancy is identified. If the consultation
is not obtained, the Licensed Midwife shall refer the Client to a physician;
(4) Discordance of greater than
20% of fetal difference should be referred to a physician at time of
recognition;
(5) The presenting
twin (baby A) must be head down at term; and
(6) At least three Licensed Midwives should
attend the birth.
