1. A. In an emergency situation in which the health or safety of the client or newborn are determined to be at risk, a midwife:

   1. 1. Shall ensure that an emergency medical services provider is called; and

   2. 2. May perform the following procedures as necessary:

      1. a. Cardiopulmonary resuscitation of the client or newborn with a bag and mask;
      2. b. Administration of oxygen at no more than eight liters per minute via mask for the client and five liters per minute for the newborn via neonatal mask;
      3. c. Episiotomy to expedite the delivery during fetal distress;
      4. d. Suturing of episiotomy or tearing of the perineum to stop active bleeding, following administration of local anesthetic, contingent upon consultation with a physician or certified nurse midwife, or physician’s written orders;

      5. e. Release of shoulder dystocia, the wedging of the shoulders of the fetus in the client’s pelvis in such a way that the fetus is unable to be born without emergency action, by utilizing:

         1. i. Hyperflexion of the client’s legs to the abdomen,
         2. ii. Application of external pressure suprapubically,
         3. iii. Rotation of the nonimpacted shoulder until the impacted shoulder is released,
         4. iv. Delivery of the posterior shoulder,
         5. v. Application of posterior pressure on the anterior shoulder, or
         6. vi. Positioning of the client on all fours with the back arched;
      6. f. Manual exploration of the uterus for control of severe bleeding; or
      7. g. Manual removal of placenta.
2. B. A licensed midwife may administer a maximum dose of 20 units of pitocin intramuscularly, in 10-unit dosages each, 30 minutes apart, to a client for the control of postpartum hemorrhage, contingent upon physician or certified nurse midwife consultation and written orders by a physician, and arrangements for immediate transport of the client to a hospital.
3. C. A midwife shall document in the client’s record any medications taken by a client for the control of postpartum hemorrhage.

Historical Note

New Section R9-16-113 renumbered from R9-16-110 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).