Board of Direct Entry Midwifery_332

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The Oregon Administrative Rules contain OARs filed through January 15, 2010

OREGON HEALTH LICENSING AGENCY, BOARD OF DIRECT ENTRY MIDWIFERY

DIVISION 25

PRACTICE

332-025-0020

Practice Standards

Pursuant to ORS 687.480, licensed direct entry midwives shall comply with the following practice standards when supervising the conduct of labor and childbirth, advising the parent and, in rendering prenatal, intrapartum and postpartum care.

(1) To facilitate the cooperation of collection and reporting data on births in accordance with ORS 687.480 and 687.495, a licensed direct entry midwife shall include the designation L.D.M. after their name when completing birth certificates; and

(2) As a condition of license renewal, licensed direct entry midwives shall participate in peer review meetings in their regions or in conjunction with professional organization meeting(s), which shall include, but not be limited to the discussion of cases, and obtaining feedback and suggestions regarding care. Documentation shall be made on forms approved by the Board. Licensees shall participate in peer review according to the following schedule:

(a) Once per year if the licensee performed as the primary birth attendant at less than 40 births during the license year; or

(b) Twice per year if the licensee performed as the primary birth attendant at more than 40 births during the license year.

(3) A general explanation of the midwife's emergency transport plan shall be included in the client disclosure form to be given to the client. It shall include but not be limited to destination of transport; mode of transport; and provision for delivery equipment to be carried in the vehicle.

(4) Licensed direct entry midwives shall maintain equipment necessary to: assess maternal, fetal and newborn well being; maintain aseptic technique; respond to emergencies requiring immediate attention; and resuscitate mother and newborn when attending an out-of-hospital birth. In accordance with ORS 687.480(4) and 687.493(2), the Board recommends the following equipment as a guideline for licensed direct entry midwives;

(a) Anti-hemorrhagic agents;

(b) Antiseptic scrub;

(d) Blood pressure cuff;

(e) Bulb syringe;

(f) Equipment for amniotomy;

(g) Equipment for administering injections;

(h) Flashlight or lantern and batteries;

(i) Heat source for newborn resuscitation;

(j) Infant and adult resuscitation equipment;

(k) Infant suction catheter with mucus trap;

(l) Labor, delivery postpartal and statistics records forms;

(m) Nitrazine paper;

(n) Scales and measuring tape;

(o) Sealable plastic containers for blood and bodily fluids;

(p) Sharps and rigid sealable containers;

(q) Sterile and non-sterile exam gloves;

(r) Stethoscope and fetascope;

(s) Thermometer

(t) Three hemostats;

(u) Umbilical cord occlusion devices;

(v) Urine dipsticks;

(w) Venipuncture equipment;

(x) Equipment for administering intravenous fluids; and

(y) Approved legend drugs/medications and devices listed in OAR 332-025-0040, 332-025-0050 and 332-025-0060.

(5) Licensed direct entry midwives shall ensure that mandatory services for newborns are provided in accordance with the provisions of OAR 333-021-0800 and 333-024-0205 through 0235.

(6) Licensed direct entry midwives who satisfactorily complete the Board approved education are authorized by license endorsement for access to and administration of legend drugs and devices, including items used for perineal and labial repair, amnihooks, infant suction catheter with mucus trap in the performance of services in accordance with ORS 687.405(3) and 687.493(2).

(7) Licensed direct entry midwives shall dispose of pathological waste resulting from the birth process in accordance with Oregon State Health Division provisions:

(a) Incineration, provided the waste is properly containerized at the point of generation and transported without compaction to the site of incineration; or

(b) Burial on private property if burial of human remains on such property is not prohibited or regulated by a local government unit at the designated site. Such burials shall be made in accordance with the provisions of the local government unit and the Department of Human Services, Health Services.

(8) Licensed direct entry midwives shall dispose of biological waste materials, which come into contact with blood and/or body fluids in a sealable plastic bag (separate from sealable trash or garbage liners) or in a manner that protects the licensee and the client and others who may come into contact with the material during disposal. Biological wastes may also be incinerated or autoclaved in equipment dedicated to treatment of infectious wastes.

(9) Licensed direct entry midwives shall dispose of sharps which come into contact with blood or bodily fluids in a sealable rigid (puncture proof) container that is strong enough to protect the licensee and the client and others from accidental cuts or puncture wounds during the disposal process.

(10) Sharps shall be placed into appropriate containers at the point of generation and may be transported without compaction to a landfill having an area designed for sharps burial or transported to an appropriate health care facility equipped to handle sharps disposal, provided the lid of the container is tightly closed or taped to prevent the loss of content and the container is appropriately labeled.

(11) Licensees shall maintain a midwife disclosure statement providing current and accurate information to prospective clients and must provide clients with this information. This statement must include but not be limited to:

(a) Philosophy of care;

(b) Midwifery training and education;

(d) Services provided to clients;

(e) Types of emergency medications and equipment used;

(f) Responsibilities of the mother and her family;

(g) Fees for services including financial arrangements;

(h) Malpractice coverage.

(12) Licensees shall maintain a plan for emergency transport and must discuss the plan with the client. The plan must include but not be limited to:

(a) Place of transport;

(b) Mode of transport;

(d) Availability of private vehicle or ambulance including emergency delivery equipment carried in the vehicle.

(13) Licensees shall maintain accurate written client records documenting the course of midwifery care.

Stat. Auth.: ORS 676.605, 676.615, 687.480, 687.485
Stats. Implemented: ORS 676.605, 676.615, 687.480, 687.485
Hist.: DEM 1-1993(Temp), f. & cert. ef. 12-22-93; DEM 1-1994, f. & cert. ef. 6-15-94; DEM 2-1998, f. 4-14-98, cert. ef. 4-15-98; DEM 1-1999(Temp), f. 9-1-99, cert. ef. 9-9-99 thru 2-29-00; DEM 2-1999, f. 12-17-99, cert. ef. 12-20-99; DEM 2-2000(Temp), f. 8-22-00, cert. ef. 8-22-00 thru 2-17-00; DEM 2-2000(Temp), f. 8-22-00, cert. ef. 8-22-00 thru 2-17-01; DEM 3-2000, f. 9-29-00, cert. ef. 10-1-00; DEM 1-2001(Temp), f. & cert. ef. 10-1-01 thru 3-29-02; Administrative correction 11-7-01; DEM 1-2002, f. 2-25-02 cert. ef. 3-1-02; DEM 1-2004, f. 6-29-04, cert. ef. 7-1-04

332-025-0021

Risk Assessment Criteria

Licensed direct entry midwives shall assess the appropriateness of an out-of-hospital birth for each client, taking into account the health and condition of the mother and fetus or baby according to the following two categories of risk assessment criteria in determining appropriate care:

(1) "Absolute risk" as defined in OAR 332-015-0000(36)(a). Clients who present one or more of the following absolute risk factors are not appropriate candidates for out-of-hospital birth:

(a) When absolute risk factors are present during the antepartum period, the midwife and the client must plan for an in-hospital birth;

(b) When absolute risk factors appear during the intrapartum period, the midwife must arrange to have the client transported to the hospital unless the birth is imminent;

(c) When absolute risk factors appear when the birth is imminent the midwife must take the health and condition of the mother and baby into consideration in determining whether to proceed with out-of-hospital birth or arranging for transportation to a hospital;

(d) When absolute risk factors appear postpartum, the midwife must immediately arrange for transportation to a hospital;

(e) When absolute risk factors appear in the infant, the midwife must immediately arrange for transportation to a hospital.

(2) The following constitute absolute risk factors:

(a) ANTEPARTUM ABSOLUTE RISK CRITERIA: active cancer; cardiac disease; severe renal disease -- active or chronic; severe liver disease -- active or chronic; uncontrolled hyperthyroidism; chronic obstructive pulmonary disease; essential chronic hypertension over 140/90; pre-eclampsia/eclampsia; acute or chronic thrombophlebitis; current substance abuse known to cause adverse effects; incomplete spontaneous abortion; hemoglobin under 9 at term; placental abruption; placenta previa at onset of labor; persistent severe abnormal quantity of amniotic fluid; blood coagulation defect; amnionitis; ectopic pregnancy; pregnancy lasting longer than 43 weeks gestation (21 days past the due date); pregnancy lasting longer than 42 weeks (14 days past the due date) with an abnormal non-stress test; any pregnancy with abnormal fetal surveillance tests; rupture of membranes for greater than 72 hours before the onset of labor with chorioamnionitis; secondary herpes that cannot be covered at the onset of labor; HIV positive status with AIDS; higher order multiples (3 or more).

(b) INTRAPARTUM ABSOLUTE RISK CRITERIA: documented IUGR at term; suspected uterine rupture; active herpes lesion in an unprotectable area; prolapsed cord or cord presentation; suspected complete or partial placental abruption; suspected placental previa; suspected chorioamnionitis; pre-eclampsia/eclampsia; thick meconium stained amniotic fluid without reassuring fetal heart tones and birth is not imminent; evidence of fetal distress or abnormal fetal heart rate pattern unresponsive to treatment or inability to auscultate fetal heart tones; excessive vomiting, dehydration, acidosis or exhaustion unresponsive to treatment; blood pressure greater than or equal to 150/100 which persists or rises, and birth is not imminent; maternal exhaustion; fetal distress; labor or PROM less than 35 weeks according to due date; current substance abuse.

(c) MATERNAL POSTPARTUM ABSOLUTE RISK CRITERIA: retained placenta with suspected placenta accreta; retained placenta with abnormal or significant bleeding; laceration requiring hospital repair; uncontrolled postpartum bleeding; increasingly painful or enlarging hematoma; development of pre-eclampsia; signs or symptoms of shock unresponsive to treatment.

(d) INFANT ABSOLUTE RISK CRITERIA: Apgar less than 7 at 10 minutes of age; respiration rate greater than 80 within the first 2 hours postpartum, and greater than 60 thereafter, accompanied by any of the following lasting more than one hour without improvement: nasal flaring, grunting, or retraction; cardiac irregularities, heart rate less than 80 or greater than 160 (at rest) without improvement, or any other abnormal or questionable cardiac findings; seizures; evidence of infectious process; apnea; central cyanosis; large or distended abdomen; any condition requiring more than 12 hours of observation postbirth; gestational age under 35 weeks; persistent poor suck, hypotonia or a weak or high pitched cry; persistent projectile vomiting or emesis of fresh blood; any infant with active AIDS; signs and symptoms of infection in the newborn.

(3) "Non-absolute" risk as defined in OAR 332-015-0000(36)(b). Clients who present one or more non-absolute risk factor are at increased obstetric or neonatal risk. When one or more non-absolute risk factor presents, the midwife must either arrange for the transport or transfer of care of the client(s) or comply with all of the following:

(a) Consult with at least one Oregon licensed health care provider as defined in OAR who has direct experience handling complications of the risk(s) present as well as the ability to confirm the non-absolute risk. Additional complicating factors identified by the consultant must be considered in order to determine if a home birth is indicated. The midwife must consult with the provider(s) regarding appropriate care related to the birth considering the following: the risks present, the risks anticipated, the midwife's experience, the birth setting, and the ease and time involved in obtaining emergency transport or transfer of care. The consultation(s) must be documented in the client records, including all recommendations given by the provider(s). The consultation(s) may be conducted in person or by direct telephone conversation depending on the clinical and geographical situation.

(b) Determine whether a home birth is a reasonably safe option based upon the risks present, the anticipated risks, the likelihood of reducing or eliminating said risks, the midwife's experience, the birth setting, the ease and time involved in obtaining emergency transport or transfer of care and the recommendation of the licensed health care provider(s) with whom the midwife consulted.

(c) Advise the client regarding the non-absolute risk(s), possible adverse outcomes, and the recommendation(s) given by the licensed health care provider(s) with whom the midwife consulted.

(d) Document the advice given to the client by the midwife and, if applicable, obtain the client's informed consent to proceed with an out-of-hospital birth. In addition, to the extent the midwife acts contrary to the recommendation(s) given by the licensed health care provider(s) with whom the midwife consulted, the midwife must document the reasons justifying acting contrary to the provider's recommendations and obtain informed client consent.

(4) The following are non-absolute risk factors:

(a) MATERNAL ANTEPARTUM NON-ABSOLUTE RISK CRITERIA: conditions requiring on-going medical supervision or on-going use of medications; significant glucose intolerance; inappropriate fetal size for gestation; significant 2nd or 3rd trimester bleeding; abnormal fetal cardiac rate or rhythm, or decrease of movement; uterine anomaly; anemia (hematocrit less than 30 or hemoglobin less than 10 at term; seizure disorder requiring prescriptive medication; platelet count less than 75,000; previous uterine incision other than low transverse cesarean and/or myomectomy with review of surgical records and/or subsequent birth history; isoimmunization to blood factors; psychiatric disorders; history of thrombophlebitis and hemoglobinopathies; twin gestation; malpresentation at term.

(b) INTRAPARTUM NON-ABSOLUTE RISK CRITERIA: no prenatal care or unavailable records; maternal exhaustion unresponsive to treatment; history of substance abuse during this pregnancy; or malpresentation unless birth is imminent; persistent unexplained fever > 101 degrees Fahrenheit (38 degrees Centigrade) taken orally; labor or PROM 35-36 weeks according to due date.

(c) MATERNAL POSTPARTUM NON-ABSOLUTE RISK CRITERIA: infectious process; any condition requiring more than 12 hours of postpartum observation; retained placenta greater than 3 hours.

(d) INFANT NON-ABSOLUTE RISK CRITERIA: Apgar less than 7 at 5 minutes without improvement; weight less than 2270 grams (5 lbs.); jitteriness; failure to void within 24 hours or stool within 48 hours from birth; maternal substance abuse identified intrapartum or postpartum; excessive pallor, ruddiness, or jaundice at birth; any generalized rash at birth; birth injury such as facial or brachial palsy, suspected fracture or severe bruising; baby with signs and symptoms of hypoglycemia; weight decrease in excess of 10% of birth weight; maternal-infant interaction problems; direct Coomb's positive cord blood; infant born to HIV positive mother; and major congenital anomaly; gestational age of 35-36 weeks; inability to maintain axillary temperature between 97-100 degrees Fahrenheit.

(5) In the event that the client refuses transport for herself or her infant upon the midwife's recommendation for absolute, non-absolute, or other risk factors, the midwife must:

(a) Document the midwife's discussion including potential adverse/fatal outcomes with the client that the out of hospital care is no longer appropriate, and document the client's refusal to transport, with client's signature in the chart; and

(b) If the situation is immediately life-threatening for the mother or infant or if, in the midwife's judgment it is warranted, activate the 911 emergency response system.

(6) Under no circumstances shall the midwife leave the client until such a time that transport is arranged and another care provider assumes care, or until the situation is satisfactorily resolved.

332-025-0022

Standards of Care

Standards of care for the determination of initial visits, laboratory tests, prenatal visits, education/counseling/anticipatory guidance, emergency access, intrapartum care, postpartum care, and newborn care include:

(1) INITIAL VISITS: In the first prenatal visits, the following history shall be taken including but not be limited to: health, reproductive, family, social and current pregnancy. The primary care giver will evaluate nutritional status, height, weight and blood pressure, uterine size relative to gestational age, urinary analysis.

(2) DIAGNOSTIC TESTS: Pursuant to ORS 438.430, the Board authorizes licensed direct entry midwives to order and receive laboratory and ultrasound results. Licensed direct entry midwives shall recommend the following tests: CBC; minor blood factor antibody screen; STD and syphilis screening; Hepatitis B surface antigen; blood group and Rh type; rubella titer; ultrasound and Pap Smear if indicated.

(3) PRENATAL VISITS: The following schedule of prenatal visits is recommended: every four weeks for the first 32 weeks, every two to three weeks until 36 weeks, and weekly thereafter. Each visit must include the interval history and physical examination, including blood pressure, weight, fundal height, fetal presentation, fetal heart rate, evaluation of urine for protein and glucose with a dipstick, and the mother's assessment of fetal activity. The midwife shall assess the breasts for nursing. The midwife must continuously evaluate the pregnancy for risks taking into consideration information derived from physical examination, laboratory tests, maternal complaints, documented history, and the overall physical and emotional well being of the mother. The family must be kept informed of these risks. A home visit must be conducted before labor and include assessment of the birthing environment including telephone access.

(4) ASSESSMENT OF FETAL WELL-BEING: At 41 weeks, midwives shall conduct one of the following tests:

(a) Non-stress test or accelerated auscultation test every three to four days, with an amniotic fluid index at 42 weeks; or

(b) Biophysical profile weekly.

(5) EDUCATION/COUNSELING/ANTICIPATORY GUIDANCE: The midwife must offer information or referral to community resources on childbirth preparation, breast-feeding, exercise and nutrition, parenting, and care of the newborn. Using the informed consent process, birth attendants must inform pregnant women and their families about available obstetric and pediatric tests and procedures, multiple genetic marker screen, chorionic villi sampling, amniocentesis, prenatal Rho immune globulin, ultrasound, human immunodeficiency virus (HIV) counseling and testing, newborn metabolic screening, eye prophylaxis, herpes testing and treatment, neonatal vitamin K and circumcision. The midwife shall counsel the parents regarding the current Centers for Disease Control (CDC) protocol regarding Group B Strep testing, and document the client's informed consent.

(6) ACCESS: Each licensed direct entry midwife shall provide a mechanism that ensures twenty-four hour coverage for the practice.

(7) INTRAPARTUM CARE:

(a) Assessment during labor: The following parameters shall be included as part of the initial assessment of a laboring woman and her baby as indicated: maternal temperature, blood pressure, pulse, frequency, duration and intensity of uterine contractions, and the physical and emotional environment. Fetal well-being shall also be assessed which includes fetal lie, position, and presentation, fetal movement, heart rate before, during and after uterine contractions, fetal scalp color as appropriate, and if relevant, the color, odor and clarity of amniotic fluid. Appropriate assessment of mother and fetus should be ongoing during labor including regular assessment of fetal heart tones.

(b) Fetal heart tones shall be evaluated as soon as possible following rupture of membranes. For clients without signs of risk factors, during the active phase of the first stage of labor, the fetal heart rate shall be evaluated at least every 30-60 minutes. For those clients with risk factors, fetal heart tones shall be auscultated more frequently in active stage of labor. Fetal heart tones shall be auscultated approximately every 5 to 10 minutes or after every contraction as indicated with active pushing

(c) Premature rupture of membranes at term: When a client reports suspected rupture of membranes before the onset of labor at 37 weeks gestation or greater, timely evaluation must include obtaining a careful history, documentation of ruptured membranes, and evaluation for the presence of infection and/or fetal distress. Clients must be instructed in measures to prevent and identify infection. No vaginal examination shall be performed until the client is in active labor, unless cord prolapse is suspected.

(d) Physiologic care during labor: The primary care giver must make certain that the mother is receiving nourishing, easily digestible foods and adequate fluid throughout labor. The woman must be encouraged to urinate every one to two hours.

(8) POSTPARTUM CARE:

(a) Postpartum assessment and care: The maternal pulse, uterine fundus, and lochia must be checked within the first 15 minutes. The uterine fundus and lochia discharge shall be checked regularly for the first hour after birth and thereafter until the woman's condition is stable. The perineum and vagina shall be inspected for lacerations. If any required repair does not fall within the expertise of the primary care giver, arrangements must immediately be made for transfer or proper attendance. Before the primary care giver leaves or the family is discharged, the placenta must be delivered and the mother's general condition, blood pressure, pulse, temperature, fundus, lochia, and ability to ambulate and urinate must be assessed and found to be within normal limits. The primary care giver or other qualified persons must stay with the mother and infant until both are stable and secure and at least two hours have passed since the birth. The family must be instructed to make certain that someone is with the mother at all times during the first twenty-four hours and that she receives support and care for at least the first few days.

(b) Postpartum instructions: The family must be provided with instructions that include: self and baby care and hygiene, signs of infection and methods for prevention (mother and infant), signs of illness in the newborn, normal infant feeding patterns, uterine massage and normal parameters of lochial flow. Safety in the home and car, emotional needs, the changes in family dynamics, and the importance of rest, fluids, and good nutrition must be reviewed. Further follow-up must be arranged and instructions for the reporting of problems or deviation from normal will be given. Parents will be encouraged to contact the primary care giver with any questions or concerns.

(c) Laboratory studies/medications: Rubella vaccine must be discussed with non-immune women postpartum. A Rho Immune Globulin workup must be done for Rh negative women, including cord blood. Unsensitized Rh-negative women who have given birth to an Rh-positive infant must be given Rho immune globulin intramuscularly within 72 hours post-birth.

(d) Follow-up: Postpartum follow-up care must minimally include: visits during the first 24 to 36 hours following birth, at 3 to 4 days to assess mother and baby, and a visit or telephone consultation within 1 to 2 weeks post-birth. The primary care giver must continue to monitor appropriate vital signs, and physical and social parameters including adequacy of support systems and signs of infection. Information must be provided regarding lactation, postpartum exercise, and community resources available. Education may be provided on various family planning methods. Those midwives who are qualified to fit barrier methods of contraception may do so at the six-week check up.

(9) NEWBORN CARE:

(a) Newborn assessment and care: Newborn assessment must include the monitoring of temperature, pulse, and respirations each hour for the first two hours post-birth and thereafter until stable. A thorough physical examination must be done shortly after birth including assessment of length, weight, head circumference, fontanels, palate, heart, lungs, abdomen, genitalia, muscular and skeletal system, dislocated hips, back, buttocks, rectum, assessment of neurological status (including assessment for jitteriness or lethargy as well as the presence of normal newborn reflexes), and general appearance. A gestational age assessment must be done. The family must be informed of any deviation from normal. The primary care giver or another qualified person must stay with the family until a minimum of two hours post-birth have passed, all parameters of physical assessment are found to be within normal limits, and the infant has demonstrated normal suck and swallow reflexes.

(b) Laboratory studies/medications/birth registrations: Out-of-hospital care providers must adhere to state guidelines for the administration of vitamin K and ophthalmic prophylaxis. Infant metabolic screening shall be performed and/or documented according to the Department of Human Services, Health Services recommendations unless the parent declines, which requires obtaining a signed informed consent to be retained in the client's record. Additional laboratory studies may be warranted as determined by the infant's condition or pediatric consultation. All births must be registered with the Department of Human Services, Health Services, Vital Records Section.

(c) Prolonged rupture of membranes: If the birth has taken place more than twenty four hours after rupture of membranes, the baby must be closely observed for twenty-four hours for signs and symptoms of infection.

(d) Follow-up: It is recommended that follow-up care include: a visit within 24 to 36 hours following birth, at 3 to 4 days, visit or telephone consultation within 1 to 2 weeks post-birth, and a visit at 6 weeks of age to monitor appropriate vital signs, weight, length, head circumference, color, infant feeding, and sleep/wake and stool/void patterns. Information must be provided about infant safety and development issues, immunization, circumcision, and available community resources.

(10) In the event that the client refuses any testing or procedures required by administrative rule or recommended by the midwife, the midwife shall document client education and discussion with the client of why the test or procedure is required or recommended, and document the client's informed consent and refusal of the test or procedures, including client's signature in the chart.

Stat. Auth.: 676.605, 676.615, 687.480, 687.485
Stats. Implemented: 676.605, 676.615, 687.480, 687.485
Hist.: DEM 1-1993(Temp), f. & cert. ef. 12-22-93; DEM 1-1994, f. & cert. ef. 6-15-94; DEM 2-1998, f. 4-14-98, cert. ef. 4-15-98; DEM 1-1999(Temp), f. 9-1-99, cert. ef. 9-9-99 thru 2-29-00; DEM 2-1999, f. 12-17-99, cert. ef. 12-20-99; DEM 2-2000(Temp), f. 8-22-00, cert. ef. 8-22-00 thru 2-17-00; DEM 2-2000(Temp), f. 8-22-00, cert. ef. 8-22-00 thru 2-17-01; DEM 3-2000, f. 9-29-00, cert. ef. 10-1-00; DEM 1-2001(Temp), f. & cert. ef. 10-1-01 thru 3-29-02; Administrative correction 11-7-01; DEM 1-2002, f. 2-25-02 cert. ef. 3-1-02; DEM 1-2004, f. 6-29-04, cert. ef. 7-1-04

332-025-0030

Access to and Administration of Legend Drugs and Devices

Pursuant to ORS 687.493, a licensed direct entry midwife who satisfactorily completes the prescribed education outlined in OAR 332-015-0070 is authorized access to and administration of specific legend drugs and devices listed in OAR 332-025-0040, 332-025-0050, and 332-025-0060. The following requirements shall be adhered to:

(1) Licensed midwives shall comply with all local, state and federal laws and regulations regarding the administration, distribution, storage, transportation and disposal of approved legend drugs and devices listed in OAR 332-025-0040 through 332-025-0060.

(2) Approved legend drugs must be inventoried and securely stored by the midwife at all times the product is not in use, including samples or any remaining portion of a drug.

(3) Records regarding approved legend drugs and devices shall be maintained for a period of three years. Records shall be kept on the business premises and available for inspection upon request by the Health Licensing Office Enforcement Officers. Upon request by the Board or agency, a licensed midwife shall provide a copy of records. Records shall include, but not be limited, to the following:

(a) Name of drug, amount received, date of receipt, and drug expiration date;

(b) Name of drug and to who administered; date and amount of drug administered to client;

(4) Expired, deteriorated or unused legend drugs shall be disposed of in a manner that protects the licensee, client and others who may come into contact with the material during disposal.

Stat. Auth.: ORS 676.605, 676.615, 687.485, 687.493
Stats. Implemented: ORS 676.605, 676.615, 687.485, 687.493
Hist.: DEM 1-2001(Temp), f. & cert. ef. 10-1-01 thru 3-29-02; DEM 1-2002, f. 2-25-02 cert. ef. 3-1-02; DEM 1-2004, f. 6-29-04, cert. ef. 7-1-04

332-025-0040

Approved Legend Drugs For Maternal Use

Licensed Direct Entry Midwives may administer the following legend drugs as approved by the Board for maternal use:

(1) Anti-Hemorrhagics for use by intramuscular injection includes:

(a) Synthetic Oxytocin (Pitocin, Syntocin and generic);

(b) Methylergonovine (Methergine);

(2) Anti-Hemorrhagics by intravenous infusion is limited to Synthetic Oxytocin (Pitocin, Syntocin, and generic).

(3) Anti-Hemorrhagics for oral administration is limited to:

(a) Methylergonovine (Methergine);

(b) Misoprostol (Cytotec).

(4) Anti-Hemorrhagics for rectal administration is limited to Misoprostol (Cytotec).

(5) Resuscitation is limited to medical oxygen and I.V. fluid replacement.

(6) Intravenous fluid replacement includes:

(a) Lactated Ringers Solution;

(b) 0.9% Saline Solution;

(d) D5W (5% Dextrose in water).

(7) Anaphylactic treatment by subcutaneous injection is limited to Epinephrine.

(8) Local Anesthetic includes:

(a) Lidocaine HCl (1% and 2%) (Xylocaine and generic);

(b) Topical anesthetic;

(d) Sterile water papules.

(9) Rhesus Sensitivity Prophylaxis is limited to Rho(d) Immune Globulin (RhoGAM, Gamulin Rh, Bay Rho-D and others).

(10) Tissue adhesive (Dermabond or generic).

332-025-0050

Approved Legend Drugs For Neonatal Use

Licensed Direct Entry Midwives may administer the following legend drugs as approved by the Board for neonatal use:

(1) Eye Prophylaxis for disease of the newborn is limited to Erythromycin Ophthalmic (0.5%) Ointment (Ilotycin, AK-Mycin and generics).

(2) Prophylaxis for hemorrhagic disease of the newborn for oral use is limited to Mephyton.

(3) Prophylaxis for hemorrhagic disease of the newborn for intramuscular injection includes:

(a) AquaMephyton; and

(b) Konakion.

(4) Resuscitation is limited to medical oxygen.

332-025-0060

Approved Devices

Licensed Direct Entry Midwives may use or provide as appropriate the following devices as approved by the Board:

(1) Devices for injection of medications including:

(a) Needles; and

(b) Syringes.

(2) Devices for administration of intravenous fluids including:

(a) Drip sets; and

(b) Catheters.

(3) Devices for maternal and neonatal resuscitation including:

(a) Suction devices;

(b) Oxygen delivery devices; and

(4) Devices for rupturing the amniotic sac are limited to Amnihooks.

(5) Devices for repairing the perineal area including:

(a) Sutures; and

(b) Local anesthetic administration devices.

(6) Barrier methods of contraception.

Stat. Auth.: ORS 183, ORS 487.485 & ORS 687.493
Stats. Implemented: ORS 183, ORS 687.485 & ORS 687.493
Hist.: DEM 1-2001(Temp), f. & cert. ef. 10-1-01 thru 3-29-02; DEM 1-2002, f. 2-25-02 cert. ef. 3-1-02

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