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OREGON HEALTH AUTHORITY

HEALTH LICENSING OFFICE, BOARD OF DIRECT ENTRY MIDWIFERY

 

DIVISION 25
PRACTICE STANDARDS

332-025-0020
General Practice Standards
Pursuant to ORS 687.480, licensees must
comply with the following practice standards when, advising the mother and in rendering
antepartum, intrapartum and postpartum care.
(1) A licensee must include
the designation LDM after the licensee’s name when completing birth certificates;
and
(2) As a condition of license
renewal, licensees must participate in peer review meetings in their regions or
in conjunction with professional organization meeting(s), which must include, but
are not limited to, the discussion of cases and obtaining feedback and suggestions
regarding care. Documentation must be made on forms approved by the board. Licensees
must participate in peer review according to the following schedule:
(a) Once per year if the
licensee served as the primary birth attendant at 40 or fewer births during the
license year; or
(b) Twice per year if the
licensee served as the primary birth attendant at more than 40 births during the
license year.
(c) For the purpose of reporting
peer review, if there is more than one birth attendant present at the same birth,
the birth attendants must designate which birth attendant is primary.
(d) If a licensee has not
attended any births, participation in peer review is not required. Licensee must
attest to not having attended any births on a form prescribed by the agency.
(3) In accordance with ORS
687.480 and 687.493 a licensee must maintain equipment necessary to: assess maternal,
fetal and newborn well being; maintain aseptic technique; respond to emergencies
requiring immediate attention; and to resuscitate mother and newborn when attending
an out-of-hospital birth.
(4) A licensee must dispose
of pathological waste resulting from the birth process in accordance with the Department
of Human Services Public Health Division under OAR 333 division 056. Provisions
include:
(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.
(5) Licensees must dispose
of biological waste materials that 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, mother, baby, 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.
(6) Licensees must dispose
of sharps that come into contact with blood or bodily fluids in a sealable, (puncture
proof) container that is strong enough to protect the licensee, mother, baby and
others from accidental cuts or puncture wounds during the disposal process.
(7) Sharps must 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.
(8) Licensees must maintain
a “patient disclosure form” providing current and accurate information
to prospective clients. Licensees must provide the mother with this information.
This statement must include, but is not limited to:
(a) Philosophy of care;
(b) Midwifery training and
education;
(c) Clinical experience;
(d) Services provided to
mother and baby;
(e) Types of emergency medications
and equipment used if appropriate;
(f) Responsibilities of the
mother and her family;
(g) Fees for services including
financial arrangements;
(h) Malpractice coverage;
(i) Risk assessment criteria
as listed in OAR 332-025-0021;
(j) Whether the licensee
has obtained the 40 hours of Initial renewal Legend Drugs and Devices continuing
education required under OAR 332-020-0010 or the additional eight hours continuing
education in intravenous antibiotics for Group B Streptococcal prophylaxis; and
(k) Signature of mother and
date of signature documenting discussion and receipt of patient disclosure form.
(9) A licensee must maintain
a plan for emergency transport and must discuss the plan with the mother. The plan
must include, but is not limited to:
(a) Place of transport;
(b) Mode of transport;
(c) Provisions for hospital
and physician support including location and telephone numbers; and
(d) Availability of private
vehicle or ambulance including emergency delivery equipment carried in the vehicle.
(10) Signature of mother
and date of signature documenting discussion of emergency transport plan must be
placed in the mother’s record.
(11) A licensee must maintain
complete and accurate written records documenting the course of midwifery care as
listed under OAR 332-025-0110.
(12) A licensee must maintain
current certification in cardiopulmonary resuscitation for adults and infants and
current certification in neonatal resuscitation.
(13) All births must be registered
with the Department of Human Services Vital Records Section, as provided in ORS
Chapter 432.
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; DEM 6-2010,
f. 12-30-10, cert. ef. 1-1-11; DEM 1-2011(Temp), f. & cert. ef. 4-4-11 thru
9-27-11; DEM 5-2011, f. & cert. ef. 9-26-11; DEM 1-2014(Temp), f. 12-31-14,
cert. ef. 1-2-15 thru 6-27-15; DEM 2-2015, f. & cert. ef. 7-1-15
332-025-0021
Risk Assessment Practice Standards
Licensees must
assess the appropriateness of an out-of-hospital birth taking into account the health
and condition of the mother and baby according to the following absolute and non-absolute
risk criteria:
(1) "Absolute
risk" as used in this rule means conditions or clinical situations of obstetrical
or neonatal risk that cannot be resolved and that preclude out-of-hospital care.
If the mother or baby presents with any absolute risk factors, the LDM must:
(a) During
the antepartum period, plan for transfer of care and an in-hospital birth;
(b) During
the intrapartum period, arrange transportation to the hospital and transfer of care
unless the birth is imminent;
(c) When
the birth is imminent, take the health and condition of the mother and baby and
conditions for transport into consideration in determining whether to proceed with
out-of-hospital birth or to arrange for transportation to a hospital and transfer
of care;
(d) During
the postpartum period, arrange for transportation of mother or baby to a hospital
and transfer of care;
(2) The
following constitute absolute risk factors:
(a) ANTEPARTUM
ABSOLUTE RISK CRITERIA:
(A) Active
cancer;
(B) Cardiac
condition with hemodynamic consequences;
(C) Severe
renal disease — active or chronic;
(D) Severe
liver disease — active or chronic;
(E) Uncontrolled
hyperthyroidism;
(F) Chronic
obstructive pulmonary disease;
(G) Essential
chronic hypertension over 140/90;
(H) Pre-eclampsia/eclampsia;
(I) Current
venous thromboembolic disease;
(J) Current
substance abuse known to cause adverse effects for the mother or baby;
(K) Incomplete
spontaneous abortion;
(L) Hemoglobin
under nine at term;
(M) Placental
abruption;
(N) Placenta
less than 2.0 centimeters from internal os at onset of labor;
(O) Persistently
or severely abnormal quantity of amniotic fluid;
(P) Signs
and symptoms of chorioamnionitis;
(Q) Ectopic
pregnancy;
(R) Pregnancy
lasting longer than 43 weeks gestation (21 days past the due date);
(S) Any
pregnancy with abnormal fetal surveillance tests;
(T) Active
acquired immune deficiency syndrome (AIDS);
(U) Higher
order multiples (three or more);
(V) Monochorionic,
monoamniotic twins;
(W) Twin-to-twin
transfusion;
(X) Presenting
twin transverse;
(Y) Three
cesarean sections unless previous successful vaginal birth;
(Z) Placenta
accreta, percreta or increta;
(AA) Non-cephalic
presentation except as noted in non-absolute risk criteria;
(BB) Previous
classical uterine incision, T-incision, prior uterine rupture or extensive transfundal
surgery;
(CC) Four
or more cesarean sections; and
(DD) Pre-existing
diabetes requiring oral medication or insulin.
(b) INTRAPARTUM
ABSOLUTE RISK CRITERIA:
(A) Documented
intrauterine growth restriction at term;
(B) Evident
or suspected uterine rupture;
(C) Prolapsed
cord or cord presentation;
(D) Evident
or suspected complete or partial placental abruption;
(E) Evident
or suspected placenta previa;
(F) Evident
or suspected chorioamnionitis;
(G) Pre-eclampsia/eclampsia;
(H) Thick
meconium-stained amniotic fluid without reassuring fetal heart tones and birth is
not imminent;
(I) Evidence
of fetal distress or abnormal fetal heart rate pattern unresponsive to treatment
or inability to auscultate fetal heart tones;
(J) Excessive
vomiting, dehydration, acidosis or exhaustion unresponsive to treatment;
(K) Blood
pressure greater than or equal to 150/100 which persists or rises, and birth is
not imminent;
(L) Labor
or premature rupture of membrane less than 35 weeks according to estimated due date;
(M) Current
substance abuse known to cause adverse effects for the mother or baby;
(N) Retained
placenta with suspected placenta accreta;
(O) Active
herpes lesion in an unprotectable area;
(P) Primary
herpes outbreak in labor; and
(Q) Evident
or suspected footling or kneeling breech.
(c) MATERNAL
POSTPARTUM ABSOLUTE RISK CRITERIA:
(A) Retained
placenta with suspected placenta accreta;
(B) Retained
placenta with abnormal or significant bleeding;
(C) Laceration
requiring referral of care for repair including but not limited to third and fourth-degree
lacerations;
(D) Uncontrolled
postpartum bleeding;
(E) Increasingly
painful or enlarging hematoma;
(F) Development
of pre-eclampsia; and
(G) Signs
or symptoms of shock unresponsive to treatment.
(d) INFANT
ABSOLUTE RISK CRITERIA:
(A) Apgar
less than 7 at 10 minutes of age;
(B) Respiration
rate greater than 100 within the first two hours postpartum, and greater than 80
thereafter, lasting more than one hour without improvement;
(C) Persistent
nasal flaring, grunting, or retraction after one hour of life without improvement;
(D) Seizures;
(E) Apnea;
(F) Central
cyanosis;
(G) Large
or distended abdomen;
(H) Any
condition requiring more than 12 hours of observation postbirth;
(I) Persistent
poor suck, hypotonia or a weak or high-pitched cry;
(J) Persistent
inability to maintain temperature between 97-100 degrees Fahrenheit;
(K) Persistent
projectile vomiting or emesis of fresh blood; and
(L) Signs
and symptoms of infection in the infant.
(3) "Non-absolute"
means a condition or clinical situation that places a mother or baby at increased
obstetric or neonatal risk, but does not automatically exclude a mother and baby
from an out-of-hospital birth.
(4) When
a mother or baby presents with one or more non-absolute risk factors, the LDM must:
(a) Arrange
for the transfer of care of the mother or baby; or
(b) Comply
with all of the following:
(A) Consult
with at least one Oregon licensed health care provider regarding the non-absolute
risk factors present.
(B) Discuss
the non-absolute risk(s) with the mother, including:
(i) Possible
adverse outcomes;
(ii) Whether
an out-of-hospital birth is a reasonably safe option based upon the risk(s) present;
(iii)
The anticipated risk(s) and the likelihood of reducing or eliminating said risks;
(iv) The
midwife's experience with said risk(s);
(v) The
ease and time involved in accomplishing transport or transfer of care;
(vi) Recommendation(s)
given by the consulting Oregon licensed health care provider(s); and
(vii)
Recommendation(s) given by the LDM to the mother.
(C) Document
discussion of information listed in subsection (B).
(D) To
the extent the LDM acts contrary to the recommendations given by the consulting
Oregon licensed health care provider, the LDM must document the justification.
(E) Informed
consent must be obtained and documented in records.
(5) The
following are non-absolute risk factors:
(a) MATERNAL
ANTEPARTUM NON-ABSOLUTE RISK CRITERIA:
(A) Conditions
that could negatively affect maternal or fetal status that require ongoing medical
supervision or ongoing use of medications;
(B) Inappropriate
fetal size for gestation;
(C) Significant
second or third trimester bleeding;
(D) Abnormal
fetal cardiac rate or rhythm;
(E) Decreased
fetal movement;
(F) Uterine
anomaly;
(G) Anemia
(hematocrit less than 30 or hemoglobin less than 10 at term);
(H) Seizure
disorder requiring prescriptive medication;
(I) Platelet
count of less than 75,000;
(J) Isoimmunization
to blood factors;
(K) Psychiatric
disorders;
(L) History
of thrombophlebitis and hemoglobinopathies;
(M) Dichorionic,
diamniotic twins;
(N) Monochorionic,
diamniotic twins;
(O) Known
fetal anomalies that require medical attention at birth;
(P) Two
cesarean sections without previous successful vaginal birth;
(Q) Three
cesarean sections with a previous successful vaginal birth;
(R) Blood
coagulation defect;
(S) Significant
glucose intolerance unresponsive to dietary and exercise intervention;
(T) Gestational
diabetes well controlled with diet or oral glycemic medications; and
(U) Primary
herpes outbreak.
(b) INTRAPARTUM
NON-ABSOLUTE RISK CRITERIA:
(A) No
prenatal care or unavailable records;
(B) History
of substance abuse during this pregnancy;
(C) Signs
and symptoms of infection including but not limited to a temperature 100.4 degrees
Fahrenheit or higher with adequate hydration in the mother;
(D) Labor
or premature rupture of membrane from 35 to 36 weeks gestation;
(E) Frank
and complete breech presentation, as determined by vaginal examination;
(F) Lack
of adequate progress in second stage:
(i) Lack
of adequate progress in vertex presentation is when there is no progress after a
maximum of three hours in cases with full dilation, ruptured membranes, strong contractions
and sufficient maternal effort; and
(ii) Lack
of adequate progress in breech presentation is when there is no progress in descent
after a maximum of one hour in cases with full dilation, ruptured membranes, strong
contractions and sufficient maternal effort.
(c) MATERNAL
POSTPARTUM NON-ABSOLUTE RISK CRITERIA:
(A) Signs
and symptoms of infection;
(B) Any
condition requiring more than 12 hours of postpartum observation;
(C) Retained
placenta greater than two hours with no unusual bleeding;
(D) Evidence
of urinary retention that cannot be resolved in an out-of- hospital setting; and
(d) INFANT
NON-ABSOLUTE RISK CRITERIA:
(A) Apgar
less than 7 at five minutes without improvement;
(B) Weight
less than 2,270 grams (five lbs.);
(C) Failure
to void within 24 hours or stool within 48 hours from birth;
(D) Excessive
pallor, ruddiness, or jaundice at birth;
(E) Any
generalized rash at birth;
(F) Birth
injury such as facial or brachial palsy, suspected fracture or severe bruising;
(G) Baby
with signs and symptoms of hypoglycemia unresolved in the out-of-hospital setting;
(H) Weight
decrease in excess of 10 percent of birth weight that does not respond to treatment;
(I) Maternal-infant
interaction problems;
(J) Direct
Coomb's positive cord blood;
(K) Infant
born to HIV positive mother;
(L) Suspected
or evident major congenital anomaly;
(M) Estimated
gestational age of less than 35 weeks;
(N) Maternal
substance abuse identified postpartum; and
(O) Cardiac
irregularities, heart rate less than 80 or greater than 160 (at rest) without improvement,
or any other abnormal or questionable cardiac findings.
(6) For
the purpose of this rule “transfer of care” means the process whereby
any LDM who has been providing care relinquishes this responsibility to a hospital
or to licensees under ORS chapter 682.
(a) The
LDM must provide the following at the time of transfer, to the hospital or licensees
under ORS chapter 682: medical history, prenatal flow sheet, diagnostic studies,
laboratory findings, and maternal and baby care notes through time of transfer;
(b) In
cases of emergency, at the time of transfer, the LDM must provide the records required
in subsection (a) to the hospital or licensees under ORS chapter 682, including
notes for care provided during the emergency, if available. If notes are not available,
an oral summary of care during the emergency must be made available to the hospital
or licensees under ORS chapter 682; and
(c) Under
no circumstances shall the midwife leave the mother or baby until such a time that
transport is arranged and another Oregon licensed health care provider or a licensee
under ORS chapter 682 assumes care.
(7) For
the purpose of this rule “consultation” means a dialogue for the purpose
of obtaining information or advice from an Oregon licensed health care provider
who has direct experience handling complications of the risk(s) present, as well
as the ability to confirm the non-absolute risk, which may include, but is not limited
to confirmation of a diagnosis and recommendation regarding management of medical,
obstetric, or fetal problems or conditions. Consultation may be by phone, in person
or in writing.
(8) For
the purpose of this rule “Oregon licensed health care provider” means
a physician or physician assistant licensed under ORS 677, a certified nurse midwife
or nurse practitioner licensed under ORS 678, a naturopath licensed under ORS 685,
or a licensed direct entry midwife licensed under ORS 687.
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; DEM 6-2010,
f. 12-30-10, cert. ef. 1-1-11; DEM 1-2011(Temp), f. & cert. ef. 4-4-11 thru
9-27-11; DEM 5-2011, f. & cert. ef. 9-26-11
332-025-0022
Mother and Baby Care Practice Standards
(1) An LDM may:
(a) Order
and receive laboratory and ultrasound results;
(b) Order
and receive fetal surveillance testing and results.
(c) Fit
barrier methods of contraception, if qualified to fit barrier methods of contraception.
(2) For
mother and baby care practice standards the agency and board adopt by reference
the MANA core competencies, current version as approved by MANA. Reference http://mana.org/manacore.html
for current version.
(3) In
addition to and not in lieu of the MANA core competencies, an LDM must adhere to
the following mother and baby care practice standards:
(a) Care
During Pregnancy (Antepartum) — The LDM must:
(A) Provide
health care, support and information to the mother throughout pregnancy;
(B) Determine
the need for consultation or referral as appropriate;
(C) Provide
a mechanism that ensures 24 hour coverage for the practice;
(D) Assess,
identify, evaluate and support maternal and fetal well-being throughout the process
of pregnancy;
(E) Thoroughly
educate and counsel mother regarding the childbearing cycle;
(F) Identify
preexisting conditions in a woman's health history that are likely to influence
her well-being when she becomes pregnant;
(G) Educate
mother regarding nutritional requirements of pregnant mother and provide methods
of nutritional assessment and counseling;
(H) Educate
mother regarding changes in emotional, psychosocial and sexual variations that may
occur during pregnancy;
(I) Identify
and educate mother regarding environmental and occupational hazards for pregnant
mother.
(J) Educate
mother regarding genetic factors that may indicate the need for counseling, testing
or referral;
(K) Educate
mother regarding the growth and development of the unborn baby;
(L) Identify
and educate mother regarding indications for, risks and benefits of bio-technical
screening methods and diagnostic tests used during pregnancy;
(M) Educate
mother regarding anatomy, physiology and evaluation of the soft and bony structures
of the pelvis;
(N) Exercise
palpation skills for evaluation of the fetus and uterus;
(O) Assess
and educate mother regarding causes and treatment of the common discomforts of pregnancy;
(P) Identify
implications of and appropriate treatment for various infections, disease conditions
and other problems that may affect pregnancy;
(Q) Identify
and educate of special needs of the Rh(D)-negative woman;
(R) Begin
fetal surveillance testing no later than 41 weeks and three days by arranging one
or more of the following:
(i) Biophysical
profile weekly and non-stress test bi-weekly;
(ii) Biophysical
profile weekly and auscultated acceleration testing bi-weekly;
(iii)
Amniotic fluid index and non-stress test bi-weekly; or
(iv) Amniotic
fluid index and auscultated acceleration testing bi-weekly.
(S) If
the mother declines fetal surveillance testing listed in subsection (R) of this
rule, the LDM must document refusal, initialed by the mother, and provide auscultated
acceleration testing bi weekly beginning no later than 41 weeks and three days until
delivery.
(T) If
the LDM is denied access to fetal surveillance testing listed in subsection (R)
of this rule, the LDM must document the place, date, time, and name of individual
who denied access in the mother’s records. If access to fetal surveillance
testing is denied, then the LDM must perform auscultated acceleration testing bi
weekly beginning no later than 41 weeks and three days until delivery.
(U) When
risk factors that could impair fetal or placental circulation are present at any
time during the pregnancy, an LDM must obtain fetal surveillance testing when the
risk factors are identified.
(V) If
the mother declines fetal surveillance testing or if the LDM is denied fetal surveillance
testing, an LDM must follow board approved practice standards for auscultated acceleration
testing, including: utilizing the auscultated acceleration testing graph; following
the procedure provided for the graph; and complying with interpretation requirements
for the graph. Graph, procedure and interpretation requirements are available on
the agency Web site at http://egov.oregon.gov/OHLA/DEM/forms.shtml.
(b) Care
During Labor, Birth and Immediately Thereafter (Intrapartum) — the LDM must:
(A) Provide
health care, support and information to the mother throughout labor, birth and the
hours immediately thereafter;
(B) Determine
the need for consultation or referral as appropriate;
(C) Make
appropriate and ongoing risk assessment and document maternal and fetal status and
response throughout labor;
(D) Evaluate
maternal and fetal well-being during labor, birth and immediately thereafter, including
relevant historical data;
(E) For
mothers and babies without signs of risk factors, during the active phase of the
first stage of labor, evaluate the fetal heart rate at least every 30 to 60 minutes,
listening toward the end of a contraction and for at least 30 seconds after;
(F) For
mothers and babies with risk factors, auscultate fetal heart tones more frequently
than every 30 to 60 minutes and listen through contractions as indicated in the
active stage of labor;
(G) Auscultate
fetal heart tones approximately every 5 to 10 minutes or after every contraction,
as indicated, with active pushing;
(H) Assess
birthing environment, assuring that it is clean, safe and supportive, and that appropriate
equipment and supplies are on hand;
(I) Assess
emotional responses and their impact during labor, birth and immediately thereafter;
(J) Provide
comfort and support measures during labor, birth and immediately thereafter;
(K) Evaluate
fetal and maternal anatomy and their interactions as relevant to assessing fetal
position and the progress of labor;
(L) Utilize
techniques to assist and support the spontaneous vaginal birth of the baby and placenta;
(M) Assess
and meet fluid and nutritional requirements during labor, birth and immediately
thereafter;
(N) Assess
and support maternal rest and sleep as appropriate during the process of labor,
birth and immediately thereafter;
(O) Assess
causes of, evaluate and treat variations that occur during the course of labor,
birth and immediately thereafter;
(P) Provide
appropriate support for the newborn's transition during the first minutes and hours
following birth;
(Q) Evaluate
and care for perineum and surrounding tissues; and
(R) Before
the LDM 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. Mother’s and baby’s
condition must be found to be within normal limits.
(c) Care
After Delivery (Postpartum Care) — The LDM must:
(A) Provide
health care, support and information to the mother throughout the postpartum period;
(B) Determine
the need for consultation or referral as appropriate;
(C) Assess
anatomy and physiology of the mother during the postpartum period;
(D) Educate
mother regarding lactation support and appropriate breast care including evaluation
of, identification of and treatments for problems with nursing;
(E) Evaluate
and promote maternal well-being;
(F) Assess
causes of, evaluate and treat maternal discomfort;
(G) Evaluate
and educate emotional, psychosocial and sexual variations;
(H) Monitor
and educate mother regarding maternal nutritional requirements during including
methods of nutritional evaluation and counseling;
(I) Assess
causes of, evaluate and treat problems arising during the postpartum period, consulting
as necessary;
(J) Provide
family with written and verbal postpartum instructions; and
(K) Provide
support, information and referral for family planning methods, as the individual
woman desires.
(d) Newborn
Care — The LDM must:
(A) Provide
health care to the newborn;
(B) Provide
support and information to parents regarding newborn care;
(C) Determine
the need for consultation or referral as appropriate;
(D) Evaluate
anatomy and physiology of newborn and support of the newborn's adjustment during
the first days and weeks of life;
(E) Evaluate
newborn wellness including relevant historical data and gestational age;
(F) Assess
and educate the mother regarding nutritional needs of the newborn;
(G) Educate
mother regarding state laws concerning indications for, administration of, and the
risks and benefits of prophylactic bio-technical treatments and screening tests
commonly used during the neonatal period;
(H) Educate
mother regarding causes of, assessment of, appropriate treatment and emergency measures
for newborn problems and abnormalities;
(I) Adhere
to state guidelines for the administration of vitamin K and ophthalmic prophylaxis
pursuant to ORS 433.306 and OAR 333-021-0800; and
(J) Ensure
infant metabolic screening is performed and documented according to the Department
of Human Services recommendations unless the mother declines, as provided ORS Chapter
432 and OAR 333-024-0205 through 0235.
(4) Declined
Procedure: In the event the mother refuses any testing or procedures required by
administrative rule or recommended by the LDM, the LDM must document discussion
with the mother of why the test or procedure is required or recommended, and document
the mother’s refusal of the test or procedures, including the mother’s
signature in the chart. In addition, the LDM must follow the requirements of ORS
Chapter 432, 433.306, OAR 333-021-0800 and 333-024-0205 through 0235 when the mother
declines administration of vitamin K or infant metabolic screening.
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; DEM 6-2010,
f. 12-30-10, cert. ef. 1-1-11; DEM 1-2011(Temp), f. & cert. ef. 4-4-11 thru
9-27-11; DEM 5-2011, f. & cert. ef. 9-26-11
332-025-0030
[Renumbered to 332-026-0000]
332-025-0040
[Renumbered to 332-026-0010]
332-025-0050
[Renumbered to 332-026-0020]
332-025-0060
[Renumbered to 332-026-0030]
332-025-0070
[Renumbered to 332-025-0110]
332-025-0080
[Renumbered to 332-025-0120]
332-025-0100
[Renumbered to 332-025-0130]
332-025-0110
Records
of Care Practice Standards
(1) The LDM must maintain complete and
accurate records of each mother and baby.
(2) Records mean written
documentation, including but not limited to:
(a) Midwifery care provided
to mother and baby;
(b) Demographic information;
(c) Medical history;
(d) Diagnostic studies and
laboratory findings;
(e) Emergency transport plan
defined under OAR 332-025-0020;
(f) Informed consent and
risk information documentation under OAR 332-025-0120;
(g) Health Insurance Portability
and Accountability Act (HIPAA) releases;
(h) Description of the reasoning
for transfer of care defined under OAR 332-025-0021 of the mother and baby;
(i) Documentation of all
consultations and recommendations from health care providers as defined under OAR
332-015-0000;
(j) Documentation of all
consultations and recommendations regarding non-absolute risk factors from Oregon
licensed health care providers as defined under OAR 332-025-0021;
(k) Documentation of any
declined procedures under OAR 332-025-0022;
(l) Documentation of termination
of care under OAR 332-025-0130; and
(m) Documentation that the
patient disclosure form has been received by the mother under OAR 332-025-0020,
including information regarding completion of the 40 hours of Initial Renewal Legend
Drugs and Devices Training or the additional eight hours of Subsequent Renewal Continuing
Education related to training in intravenous antibiotics for Group B Streptococcal
prophylaxis.
(3) Records must be maintained
for no less than seven years. All records are subject to review by the agency.
(4) All records must be legibly
written or typed, dated and signed.
(5) All records must include
a signature or initial of the LDM.
Stat. Auth.: ORS 487.485 & 676.615
Stats. Implemented: ORS 687.425,
687.480, 687.485, 676.606 & 676.607
Hist.: DEM 6-2010, f. 12-30-10,
cert. ef. 1-1-11; Renumbered from 332-025-0070 by DEM 5-2011, f. & cert. ef.
9-26-11; DEM 1-2014(Temp), f. 12-31-14, cert. ef. 1-2-15 thru 6-27-15; DEM 2-2015,
f. & cert. ef. 7-1-15
332-025-0120
Informed
Consent Practice Standards
(1) Informed consent
means the consent obtained following a thorough and easily understood explanation
of the information to the mother or mother’s guardian.
(2) The explanation
must be both verbal and written.
(3) An LDM
must document the verbal explanation and the written informed consent process in
the client’s record. Informed consent information must include the following:
(a) Definition
of procedure or process;
(b) Benefits
of procedure or process;
(c) Risk(s)
of procedure or process;
(d) Description
of adverse outcomes;
(e) Risk
of adverse outcomes; and
(f) Alternative
procedures or processes and any risk(s) associated with them if the alternative
procedures or processes are within the practice of midwifery.
(4) An LDM
must obtain mother’s dated signature acknowledging she has received, reviewed,
and understands the information, and has made an informed choice.
Stat. Auth.: ORS
487.485 & 676.615

Stats. Implemented:
ORS 687.425, 687.480, 687.485, 676.606 & 676.607

Hist.: DEM
6-2010, f. 12-30-10, cert. ef. 1-1-11; DEM 2-2011(Temp), f. & cert. ef. 5-19-11
thru 11-15-11; Renumbered from 332-025-0080 by DEM 5-2011, f. & cert. ef. 9-26-11;
DEM 6-2011(Temp), f. 10-14-11, cert. ef. 10-15-11 thru 4-11-12; DEM 1-2012(Temp),
f. 3-1-12, cert. ef. 4-12-12 thru 9-30-12; DEM 3-2012(Temp), f. & cert. ef.
5-10-12 thru 9-30-12; DEM 5-2012, f. 8-31-12, cert. ef. 9-7-12
332-025-0125
Disclosure for Patients of Traditional
Midwives
(1) Pursuant to ORS 687.415 an individual
who is acting as a traditional midwife, does not use legend drugs and devices, does
not advertise as a midwife, and provides the required written disclosures to clients,
may practice direct entry midwifery in this state without a license to practice
direct entry midwifery.
(2) Pursuant to ORS 687.415
a traditional midwife is prohibited from the following:
(a) Advertising that the
person is a midwife; and
(b) Use of legend drugs and
devices pursuant to ORS 687.493.
(3) A traditional midwife
must disclose the following information to clients both verbally and in writing
when the mother initially comes into care using a Board adopted form that is located
on the Office’s website at http://www.oregon.gov/OHLA/DEM/pages/index.aspx:
(a) That the person does
not possess a professional license issued by the state;
(b) That the person’s
education and qualification have not been reviewed by the state;
(c) That the person is not
authorized to carry and administer potentially lifesaving medications;
(d) That the risk of harm
or death to a mother or newborn may increase as a result of the information described
ORS 687.415(2)(b)(C) (i) and (ii);
(e) A plan for transporting
the client to the nearest hospital, as defined in ORS 442.015, if a problem arises
during labor or childbirth;
(f) That the client will
not have recourse through a complaint process;
(g) The types of midwives
who are licensed by the state; and
(h) Signature from the patient
that they have been given the information both in writing and verbally.
(4) The traditional midwife
must also obtain a patient signature when the mother initially comes into care on
the Board’s adopted form containing the information described in subsection
(3). A traditional midwife must retain a copy of the signed form in the patient
record and make it available to HLO upon request.
Stat. Auth.: ORS 676.615, 676.616, 687.410,
687.415, 687.420, 687.425, 687.445, 687.480 & 687.493
Stats. Implemented: ORS 676.615,
676.616, 687.410, 687.145, 687.420, 687.425, 687.445, 687.480 & 687.493
Hist.: DEM 2-2014, f. 12-31-14,
cert. ef. 1-1-15
332-025-0130
Practice
Standards for Terminating Midwifery Care
(1) The procedure
for terminating midwifery care in a non-emergent situation is as follows:
(a) Provide
written notice no fewer than three business days as postmarked, unless the mother
is in labor or during an emergency, at which time the LDM must continue to provide
midwifery care until another provider assumes care;
(b) Notice
must be sent to the last known address of the mother by certified mail, return receipt
requested, as well as by regular mail.
(c) Document
the termination of care in the mother’s records.
(2) To
terminate midwifery care in an emergency, the LDM must activate the 911 emergency
system and transfer care to a licensee under ORS chapter 682.
(3) An
LDM in the home setting may leave after transferring care to a licensee under ORS
Chapter 682.
(4) If
the mother refuses assistance from licensees under ORS chapter 682 the LDM must
continually urge the mother to transfer care to a licensee under ORS Chapter 682
and may:
(a) Continue
care to save a life; and
(b) Only
perform actions within the technical ability of the LDM.
(5) If
the mother loses consciousness, the LDM must activate the 911 emergency system and
transfer care to a licensee under ORS Chapter 682.
Stat. Auth.:
ORS 487.485 & 676.615

Stats.
Implemented: ORS 687.425, 687.480, 687.485, 676.606 & 676.607

Hist.:
DEM 6-2010, f. 12-30-10, cert. ef. 1-1-11; Renumbered from 332-025-0100 by DEM 5-2011,
f. & cert. ef. 9-26-11

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