1. (a)

   1. (1) An LLM assistant may be engaged by the LLM to complement their work, but shall not be used as a substitute for the LLM.

   2. (2) Tasks that may be delegated to the LLM assistant before an assessment of the client’s care needs is completed by the LLM include:

      1. (A) Noninvasive and non-sterile tasks if, in the judgment of the LLM, the LLM assistant has the appropriate knowledge and skills to perform the task;
      2. (B) The collecting, reporting, and documentation of temperature, weight, intake, output, and contractions, indicating their frequency and duration;
      3. (C) Reporting changes from baseline data established by the LLM;
      4. (D) Assisting the client with:

2. (i) Ambulation;

   1. (ii) Positioning; or

      1. (iii) Turning;
      2. (E) Assisting the client with personal hygiene; and
      3. (F) Reinforcing health teaching planned or provided by the LLM.

   2. (3) Tasks that must never be delegated to an LLM assistant include, but are not exclusive to, the following:

      1. (A) The performance of a physical assessment or evaluation;

      2. (B) Physical examination which includes, but is not limited to:

         1. (i) Fetal heart rate auscultation;
         2. (ii) Cervical exams; and
         3. (iii) Blood pressure measurements;
      3. (C) The provision of sterile invasive treatments;
      4. (D) The administration of any prescription drugs; and
      5. (E) The use of any medical devices.

3. (b) The LLM shall monitor and document the care and procedures performed by any LLM assistant or labor support attendant in the client’s medical record.

   1. (c) An LLM who has agreed to provide care to a client is held accountable to act according to the standards of care set out in this part, until such a time as that care is terminated by the client or the LLM in accordance with this part.

      1. (d)
   2. (1) An LLM may request a registered nurse to perform selected acts, tasks, or procedures that are outside the scope of the LLM’s practice but which do not exceed the scope of practice of the nurse’s license.
   3. (2) It is the nurse’s responsibility to be informed and act in accordance with both the Arkansas Nurse Practice Act and the Arkansas State Board of Nursing Rules, 17 CAR pt. 120.

4. (e)

   1. (1) An LLM who also holds an Arkansas nursing license is required to act in accordance with the following:

      1. (A) The Rules Governing the Practice of Licensed Lay Midwifery in Arkansas;
      2. (B) The Arkansas Nurse Practice Act, as codified in Arkansas Code § 17-87-101 et seq.; and
      3. (C) The Arkansas State Board of Nursing Rules, 17 CAR pt. 120, as promulgated by the Arkansas State Board of Nursing.
   2. (2) An LLM practicing under the scope of her or his nursing license while acting as an LLM may be referred to the board if any improper conduct is suspected.

Codification Notes: "LLM" means licensed lay midwife.