R9-16-111. Prohibited Practice; Transfer of Care

A. A midwife shall not provide midwifery services in a location that has the potential to cause harm to the client or the client’s fetus or newborn. B. A midwife shall not accept as a client for midwifery services a pregnant women who has any of the following: 1. A previous surgery that involved: a. An incision in the uterus, except as provided in R9- 16-108(B)(1); or b. A previous uterine surgery that enters the myometrium; 2. A history of severe postpartum bleeding, of unknown cause, which required transfusion; 3. Gestational age greater than 34 weeks with no prior prenatal assessments or clinical examinations; 4. Multiple fetuses; 5. A pelvis that will not safely allow a fetus to pass through during labor; 6. Placenta previa or placenta accreta; 7. Deep vein thrombosis or pulmonary embolism; 8. Uncontrolled gestational diabetes; 9. Insulin-dependent diabetes; 10. Hypertension; 11. Rh disease with positive titers; 12. Active: a. Tuberculosis, b. Syphilis, c. Hepatitis until treated and recovered, or d. Gonorrhea until treated and recovered; 13. A blood pressure of 140/90 or an increase of 30 millimeters of Mercury systolic or 15 millimeters of Mercury diastolic over the client’s lowest baseline blood pressure for two consecutive readings taken at least six hours apart; 14. A persistent hemoglobin level below 10 grams; 15. A condition related to emotional or behavioral functioning, as a result of a mental disorder as defined in A.R.S. § 36-501, that: a. Is severe and persistent, resulting in a long-term limitation of the client’s capacity for primary activities of daily living such as interpersonal relationships, homemaking, self-care, employment, or recreation; and b. Impairs or substantially interferes with the client’s capacity to remain in the community without supportive treatment or services of a long-term or indefinite duration; or 16. Indications of the continued use of one of the following despite negative consequences, including six months prior to pregnancy, that is evident during an assessment of a client: a. Alcohol, b. Narcotics, or c. Other drugs. C. A midwife shall not continue midwifery services for a client who is diagnosed with or develops any of the following: 1. Any condition specified in subsections (B)(4) through (16); 2. A hematocrit below 30 during the third trimester; 3. Except as provided in R9-16-108(B)(2), a fetus that is not in a head-down position with the crown of the head being the leading body part; 4. Labor beginning before the beginning of 36 weeks gestation; 5. A progression of labor that does not meet the requirements of R9-16-108(J)(4), if applicable; 6. A gestation beyond 42 weeks; 7. Presence of ruptured membranes without onset of labor within 24 hours; 8. Abnormal fetal heart rate consistently less than 120 beats per minute or more than 160 beats per minute; 9. Presence of thick meconium, blood-stained amniotic fluid, or abnormal fetal heart tones; 10. A postpartum hemorrhage of greater than 500 milliliters in the current pregnancy; or 11. A non-bleeding placenta retained for more than 60 minutes. D. A midwife shall not perform a vaginal delivery after prior Cesarean section for a client who: 1. Had: a. More than one previous Cesarean section; b. A previous Cesarean section: i. With a classical, vertical, or unknown uterine incision; ii. Within 18 months before the expected delivery; iii. With complications, including uterine infection; or iv. Due to failure to progress as a result of cephalopelvic insufficiency; or c. Complications during a previous vaginal delivery after a Cesarean section; or 2. Has a fetus: a. With fetal anomalies, confirmed by an ultrasound; or b. In a breech presentation. E. A midwife shall not perform a vaginal delivery of a fetus in a breech presentation for a client who: 1. Had a previous: a. Unsuccessful vaginal delivery or other demonstration of an inadequate maternal pelvis, or b. Cesarean section; or 2. Has a fetus: a. With fetal anomalies, confirmed by an ultrasound; b. With an estimated fetal weight less than 2500 grams or more than 3800 grams; or c. In an incomplete breech presentation. F. If the client has any of the conditions in subsections (C) through (E), a midwife shall: 1. Document the condition in the client record, and 2. Initiate transfer of care. G. A midwife shall not perform any operative procedures except as provided in R9-16-113. H. A midwife shall not: 1. Use any artificial, forcible, or mechanical means to assist birth; or 2. Attempt to correct fetal presentations by external or internal movement of the fetus. I. A midwife shall not administer drugs or medications except as provided in R9-16-108(I)(3)(f), (K)(1)(g), or (K)(2)(c), or R9- 16-113. J. Except as provided in R9-16-113, a midwife shall: 1. Discontinue midwifery services and transfer care of a newborn in which any of the following conditions are present: a. Birth weight less than 2000 grams; b. Pale, blue, or gray color after 10 minutes; c. Severe swelling, especially of the newborn’s abdomen; d. Major congenital anomalies; or e. Respiratory distress; and 2. Document the condition in subsection (J)(1) in the newborn record.