Wyo. Code R. 036-0001-7
Midwifery, Board of
Chapter 7: Professional Responsibility
Effective Date: 07/18/2018 to 07/09/2019
Rule Type: Superceded Rules & Regulations
Reference Number: 036.0001.7.07182018
Section 1. Scope and Practice Standards. A licensed midwife shall adhere to the following scope and practice standards when providing antepartum, intrapartum, postpartum, and newborn care.
(a) The Board hereby incorporates by reference the following uniform rules outlining the scope and practice standards:
(i) Philosophy and Principles of Practice and Scope of Practice, adopted by the NACPM revised 2004, found at: http://nacpm.org/about-cpms/professional-standards/
(ii) For these rules incorporated by reference:
(A) The Board has determined that incorporation of the full text in these rules would be cumbersome or inefficient given the length or nature of the rules;
(B) The incorporation by reference does not include any later amendments or editions of the incorporated matter beyond the applicable date identified in subsection (a) of this section; and
(C) The incorporated rule is maintained at Board Office and is available for public inspection and copying at cost at the same location.
(b) Conditions for Which a Licensed Midwife May Not Provide Care Without Physician Involvement. A licensed midwife may not provide care for a client with a current history of the disorders, diagnoses, conditions, or symptoms listed herein unless such disorders, diagnoses, conditions or symptoms are being treated, monitored or managed by a licensed physician. Before providing care to such a client, the licensed midwife shall notify the client in writing that the client shall obtain the described physician care as a condition to the client's eligibility to obtain maternity care from the licensed midwife. The licensed midwife shall, additionally, obtain the client's signed acknowledgement that the client has received the written notice. The disorders, diagnoses, conditions, and symptoms are referenced in WS 33-46-103(j)(i)(B) or any the following:
(i) HIV positive;
(ii) Anemic with documented hemoglobin at less than ten (10) at thirty-seven (37) weeks.
(c) Follow the Conditions for Which a Licensed Midwife Shall Recommend Physician Involvement as referenced in the Act. Before providing care for a client with a history of any of the disorders, diagnoses, conditions or symptoms listed, a licensed midwife must provide written notice to the client that the client is advised to see a licensed physician during the client's pregnancy. Additionally, the licensed midwife shall obtain the client's signed acknowledgement that the client has received the written notice. The disorders, diagnoses, conditions, and symptoms are listed in Wyoming Statute 33-48-103(j)(i)(C):
(d) Conditions for Which a Licensed Midwife Shall Facilitate Hospital Transfer as referenced in the Act. A licensed midwife shall facilitate the immediate transfer of a client to a hospital for emergency care if the client has any of the following disorders, diagnoses, conditions or symptoms listed in Wyoming Statute 33-48-103(j)(i)(D) or any of the following:
(i) Maternal fever in labor of more than 100.4 degrees Fahrenheit, in the absence of environmental factors;
(ii) Suggestion of fetal jeopardy, such as any abnormal bleeding (with or without abdominal pain), evidence of placental abruption, thick meconium, or abnormal fetal heart tones with non-reassuring patterns where birth is not imminent;
(iii) Noncephalic presentation at the onset of labor or rupture of membranes, whichever occurs first, unless birth is imminent or;
(iv) Rupture of membranes greater than twenty-four (24) hours without intravenous (IV) antibiotic treatment or greater than seventy-two (72) hours with IV antibiotic treatment.
(e) Plan for Emergency Transfer and Transport. When facilitating a transfer, the licensee shall notify the hospital when the transfer is initiated, accompany the client to the hospital if feasible, or communicate by telephone with the hospital if the licensed midwife is unable to be present. The licensed midwife shall also ensure that the transfer of care is accompanied by the client's medical record, which include:
(i) The client's name, address, and next of kin contact information;
(ii) A list of diagnosed medical conditions;
(iii) A list of prescription or over the counter medications regularly taken;
(iv) A history of previous allergic reactions to medications; and
(v) If feasible, the licensed midwife's assessment of the client's current medical condition and description of the care provided by the licensed midwife before transfer.
Section 3. Record Keeping. Each client record shall be retained for a minimum of ten (10) years after the birth during which time reasonable efforts are to be made to advise clients of closure of practice or change in record location.
Section 4. Written Informed Consent. The licensee shall provide to the client written informed consent documents in accordance with W.S. 33-46-103(j)(ii).
Section 5. Medication Formulary. During the practice of midwifery a licensed midwife may obtain and administer the following drugs described in the midwifery formula, according to the protocol outlined in Appendix A, describing the indication for use, dosage, route of administration and duration of treatment:
(a) Oxygen; (b) Oxytocin as a postpartum antihemorrhagic agent; (c) Misoprostol as a postpartum antihemorrhagic agent; (d) Methylergonovine (Methergine) as a postpartum antihemorrhagic agent;
(e) Injectable local anesthetic for the repair of lacerations which are no more extensive than second degree;
(f) Antibiotics for group B streptococcus prophylaxis consistent with the guidelines set forth in Prevention of Perinatal Group B Streptococcal Disease, published by the Centers for Disease Control and Prevention and for prolonged rupture of membranes;
(g) Epinephrine administered via a metered dose auto-injector; (h) Intravenous fluids for stabilization of the woman; (i) Rho(D) immune globulin; (j) Phylloquinone (Vitamin K1); (k) Eye prophylactics for the baby; (l) Sterile H2O Papules; and (m) Terbutaline.
Section 6. Obtaining, Storing, and Disposing of Formulary Drugs. A licensee shall adhere to the following protocol for obtaining, storing, and disposing of formulary drugs during the practice of midwifery.
(a) Obtaining Formulary Drugs. A licensee shall obtain formulary drugs as allowed by law, including, without limitation, from:
(i) A person or entity that is licensed as a Wholesale Distributor by the Wyoming State Board of Pharmacy; or (ii) A retail pharmacy, in minimal quantities for office use.
(b) Storing Formulary Drugs. A licensed midwife shall store all formulary drugs in secure areas suitable for preventing unauthorized access and for ensuring a proper environment for the preservation of the drugs. However, licensed midwives may carry formulary drugs to the home setting while providing care within the course and scope of the practice of midwifery. The licensed midwife shall promptly return the formulary drugs to the secure area when the licensed midwife has finished using them for patient care.
(c) Disposing of Formulary Drugs. A licensed midwife shall dispose of formulary drugs using means that are reasonably calculated to guard against unauthorized access and harmful excretion of the drugs into the environment. The means that may be used include, without limitation:
(i) Transferring the drugs to a reverse distributor who is registered to destroy drugs with the U.S. Drug Enforcement Agency;
(ii) Removing the drugs from their original containers, mixing them with an undesirable substance such as coffee grounds or kitty litter, putting them in impermeable, non-descript containers such as empty cans or sealable bags, and throwing the containers in the trash; or
(iii) Flushing the drugs down the toilet if the accompanying patient information instructs that it is safe to do so.
(a) The licensee shall carry the equipment necessary for resuscitation of the newborn.
(b) Midwives shall transfer (immediately if indicated) any newborn showing the following signs to the nearest hospital or pediatric care provider:
(i) Ten (10) minute Apgar score of less than seven (7);
(ii) Signs of a medically significant anomaly;
(iii) Signs of respiratory distress including respiratory rate over eighty (80) per minute, poor color, grunting, nasal flaring and/or retractions that are not showing consistent improvement;
(iv) Need for oxygen for more than twenty (20) minutes, or after one (1) hour following the birth;
(v) Seizures;
(vi) Fontanel full and bulging;
(vii) Significant or suspected birth injury;
(viii) Cardiac irregularities including a heart rate that is consistently below eighty (80) beats per minute or greater than one hundred sixty (160) beats per minute; poor capillary refilling (greater than three (3) seconds);
(ix) Pale, cyanotic, gray color;
(x) Lethargy or poor muscle tone;
(xi) Temperature instability;
(xii) Jaundice at less than twenty-four (24) hours; or
(xiii) Loss of greater than ten (10) percent birth weight.
(c) All licensees shall comply with the Wyoming Department of Health's Newborn Screening requirements stated in W.S. 35-4-801.
(i) Informed consent of parents shall be obtained and if any parent or guardian of a child objects to a mandatory examination, the child is exempt from subsection (c).
(d) All licensees shall register births, stillbirths and deaths with the local registrar of the district in which the occurrence took place within ten (10) days after the birth pursuant to W.S. 35-1-401 through 431;
Section 8. Medical Waste. Medical waste (items removed from a private residence) shall be disposed of according to the following protocol:
(a) Containers for Non-Sharp, Medical Waste. Medical waste, except for sharps, shall be placed in disposable containers/bags which are impervious to moisture and strong enough to preclude ripping, tearing or bursting under normal conditions of use. The bags shall be securely tied so as to prevent leakage or expulsion of solid or liquid waste during storage, handling or transport. The containment system shall have a tight-fitting cover and be kept clean and in good repair. All bags used for containment of medical waste must be clearly identified by label or color, or both.
(b) Containers for Sharps. Sharps shall be placed in impervious, rigid, puncture-resistant containers immediately after use. Needles shall not be bent, clipped or broken by hand. Rigid containers of discarded sharps shall either be labeled or colored like the disposable bags used for other medical waste, or placed in such labeled or colored bags.
(c) Storage Duration. Medical waste may not be stored for more than seven (7) days, unless the storage temperature is below thirty-two (32) degrees Fahrenheit. Medical waste shall never be stored for more than ninety (90) days.
(a) Persons licensed by the Board shall:
(i) Use the term 'Licensed Midwife' and/or the initials LM only after the applicant is granted licensure by the Board;
(ii) Practice in a manner that is in the best interest of the public and does not endanger the public health, safety or welfare;
(iii) Be able to justify all services rendered to clients as necessary for diagnostic or therapeutic purposes;
(iv) Practice only within the competency areas for which they are trained and experienced. The licensee shall be able to demonstrate to the Board competency, training, and/or expertise;
(v) Report to the board outcomes of all clients for which they have provided services at any point during labor or delivery within thirty (30) days after each birth;
(vi) Report to the Board known or suspected violations of the laws and regulations governing the practice of licensed professionals;
(vii) Maintain accurate documentation of all professional services rendered to a client in confidential files for each client and ensure that client records are kept in a secure, safe, retrievable and legible condition;
(A) The licensee shall make provisions for the retention and/or release of client records if the licensee is unable to do so. Such provision shall include the naming of a qualified person who will retain the client records and properly release the client records upon request.
(viii) Clearly state the person's licensure status by the use of a title or initials such as 'licensed midwife' (LM) or a statement such as 'licensed by the Wyoming Board of Midwifery' in any advertising, public directory or solicitation, including telephone directory listings;
(ix) Respond to all requests for information and all other correspondence from the Board;
(x) Not permit, condone or facilitate unlicensed practice or any activity which is a violation of the Act or these rules and regulations;
(xi) Not use vacuum extraction or forceps as an aid in the delivery of a newborn; and
(xii) Not perform abortions.