1. 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.

2. B. A midwife shall not accept as a client for midwifery services a pregnant women who has any of the following:

   1. 1. A previous surgery that involved:

      1. a. An incision in the uterus, except as provided in R9-16-108(B)(1); or
      2. b. A previous uterine surgery that enters the myometrium;
   2. 2. A history of severe postpartum bleeding, of unknown cause, which required transfusion;
   3. 3. Gestational age greater than 34 weeks with no prior prenatal assessments or clinical examinations;
   4. 4. Multiple fetuses;
   5. 5. A pelvis that will not safely allow a fetus to pass through during labor;
   6. 6. Placenta previa or placenta accreta;
   7. 7. Deep vein thrombosis or pulmonary embolism;
   8. 8. Uncontrolled gestational diabetes;
   9. 9. Insulin-dependent diabetes;
   10. 10. Hypertension;
   11. 11. Rh disease with positive titers;

   12. 12. Active:

       1. a. Tuberculosis,
       2. b. Syphilis,
       3. c. Hepatitis until treated and recovered, or
       4. d. Gonorrhea until treated and recovered;
   13. 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. 14. A persistent hemoglobin level below 10 grams;

   15. 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:

       1. 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
       2. 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. 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:

       1. a. Alcohol,
       2. b. Narcotics, or
       3. c. Other drugs.

3. C. A midwife shall not continue midwifery services for a client who is diagnosed with or develops any of the following:

   1. 1. Any condition specified in subsections (B)(4) through (16);
   2. 2. A hematocrit below 30 during the third trimester;
   3. 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. 4. Labor beginning before the beginning of 36 weeks gestation;
   5. 5. A progression of labor that does not meet the requirements of R9-16-108(J)(4), if applicable;
   6. 6. A gestation beyond 42 weeks;
   7. 7. Presence of ruptured membranes without onset of labor within 24 hours;
   8. 8. Abnormal fetal heart rate consistently less than 120 beats per minute or more than 160 beats per minute;
   9. 9. Presence of thick meconium, blood-stained amniotic fluid, or abnormal fetal heart tones;
   10. 10. A postpartum hemorrhage of greater than 500 milliliters in the current pregnancy; or
   11. 11. A non-bleeding placenta retained for more than 60 minutes.

4. D. A midwife shall not perform a vaginal delivery after prior Cesarean section for a client who:

   1. 1. Had:

      1. a. More than one previous Cesarean section;

      2. b. A previous Cesarean section:

         1. i. With a classical, vertical, or unknown uterine incision;
         2. ii. Within 18 months before the expected delivery;
         3. iii. With complications, including uterine infection; or
         4. iv. Due to failure to progress as a result of cephalopelvic insufficiency; or
      3. c. Complications during a previous vaginal delivery after a Cesarean section; or

   2. 2. Has a fetus:

      1. a. With fetal anomalies, confirmed by an ultrasound; or
      2. b. In a breech presentation.

5. E. A midwife shall not perform a vaginal delivery of a fetus in a breech presentation for a client who:

   1. 1. Had a previous:

      1. a. Unsuccessful vaginal delivery or other demonstration of an inadequate maternal pelvis, or
      2. b. Cesarean section; or

   2. 2. Has a fetus:

      1. a. With fetal anomalies, confirmed by an ultrasound;
      2. b. With an estimated fetal weight less than 2500 grams or more than 3800 grams; or
      3. c. In an incomplete breech presentation.

6. F. If the client has any of the conditions in subsections (C) through (E), a midwife shall:

   1. 1. Document the condition in the client record, and
   2. 2. Initiate transfer of care.
7. G. A midwife shall not perform any operative procedures except as provided in R9-16-113.

8. H. A midwife shall not:

   1. 1. Use any artificial, forcible, or mechanical means to assist birth; or
   2. 2. Attempt to correct fetal presentations by external or internal movement of the fetus.
9. 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.

10. J. Except as provided in R9-16-113, a midwife shall:

    1. 1. Discontinue midwifery services and transfer care of a newborn in which any of the following conditions are present:

       1. a. Birth weight less than 2000 grams;
       2. b. Pale, blue, or gray color after 10 minutes;
       3. c. Severe swelling, especially of the newborn’s abdomen;
       4. d. Major congenital anomalies; or
       5. e. Respiratory distress; and
    2. 2. Document the condition in subsection (J)(1) in the newborn record.

Historical Note

Adopted effective March 14, 1994 (Supp. 94-1). R9-16-111 renumbered to R9-16-116; new Section R9-16-111 renumbered from R9-16-108 and amended by exempt rulemaking at 19 A.A.R. 1805, effective July 1, 2013 (Supp. 13-2). Section amended by final expedited rulemaking at 28 A.A.R. 1119 (May 27, 2022), with an immediate effective date of May 4, 2022 (Supp. 22-2).