1. (a) The following requirements must be met before a LLM can legally accept a client:

   1. (1) Licensing.

      1. (A) The LLM must possess a current Arkansas Lay Midwife License.
      2. (B) See 17 CAR § 47-201 et seq.;

   2. (2) Disclosure form.

      1. (A) At the time a request is made for care, the LLM must discuss certain information concerning LLM assisted home deliveries with the client.
      2. (B) This discussion must be documented by use of the disclosure form (found in Appendix A or available on the Department of Health website).
      3. (C) It must be signed and dated by the client at the same time the LLM and client enter into an agreement for services and sign a contract.
      4. (D) This form must be filed in the client’s medical record and noted on the next caseload and birth report log sent to the department by the LLM; and

   3. (3) Emergency plan.

      1. (A) As part of the disclosure form, an individual emergency plan must be established by the LLM and client.
      2. (B) The plan must include:
   4. (1) The name and contact information of the physicians who will be consulted for the mother and the newborn;
   5. (2) The arrangements for transport from the delivery site to a hospital, if needed;
   6. (3) The hospital with obstetric services, or the hospital where the physician or CNM has obstetric privileges, that will be used for transport, which must be located within fifty (50) miles of the delivery site; and
   7. (4) The nearest hospital to the delivery site.

2. (b) Termination of care.

   1. (1) An LLM shall terminate care of a client only in accordance with this subsection (b) unless a transfer of care results from an emergency situation.

   2. (2) Once the LLM has accepted a client, the relationship is ongoing and the LLM cannot refuse to continue to provide midwifery care to the client unless the:

      1. (A) Client has no need of further care;
      2. (B) Client terminates the relationship; or
      3. (C) LLM formally terminates the relationship due to a provision of this part or for any other reason.

   3. (3) The LLM may terminate care for any reason by:

      1. (A)

3. (i) Providing a minimum of thirty (30) days’ written notice, during which time the LLM shall continue to provide midwifery care until the client is able to select another healthcare provider.

   1. (ii) If continuing care would cause the LLM to violate this part, care can be terminated by the LLM without giving thirty (30) days’ notice.

      1. (iii) Justification for this action must be documented in the client’s record;

      2. (B)

         1. (i) Attempting to tell the client in person, and in the presence of a witness, of the LLM’s wish to terminate care.
         2. (ii) If the client will not meet with the LLM, the LLM must document that the attempt was made and how it was made;
      3. (C) Providing the client with referrals to other healthcare providers; and

      4. (D) Documenting the termination of care in the client medical record and submission of a department incident report.

         1. (c) Transfer of care.

   2. (1) If a transfer of care recommendation occurs during labor, delivery, or the immediate postpartum period and the client refuses transfer, the midwife shall:

      1. (A) Call 911; and
      2. (B) Provide further care as indicated by the situation.
   3. (2) If the midwife is unable to transfer to a healthcare professional, the client will be transferred to the nearest appropriate healthcare facility.
   4. (3) The midwife shall attempt to contact the facility and continue to provide care as indicated by the situation.

Codification Notes: "CNM" means certified nurse midwife.