7th Sub.
S.B.
93
LICENSED DIRECT ENTRY MIDWIFE AMENDMENTS
house floor
Amendments
Amendment 2 March 5, 2008 10:28 pm
Representative Sheryl L. Allen
proposes the following amendments:
1. Page 6, Lines 150 and 151: Delete "recommended" and insert "selected" and delete line 151
2. Page 6, Lines 155 through 177: Delete lines 155 through 177 and replace with the following:
"
(3) (a) The division shall submit the following to the advisory
committee:
(i) administrative rules adopted by the division prior to March 1,
2008 under the provisions of Section 58-77-601; and
(ii) any administrative rule proposed by the division after March 1,
2008 under the provisions of Section
58-77-601
.
(b) If the division does not incorporate a recommendation of the
advisory committee into an administrative rule, the division shall
provide a written report to the Legislative Administrative Rules
Review Committee which explains why the division did not adopt
a recommendation of the advisory committee.
(4) The division shall adopt administrative rules regarding
conditions that require:
(a) mandatory consultation with a physician licensed under
Chapter 67, Utah Medical Practice Act, or Chapter 68, Utah
Osteopathic Medical Practice Act, upon:
(i) miscarriage after 14 weeks;
(ii) failure to deliver by 42 completed weeks of gestation;
(iii) a baby in the breech position after 36 weeks gestation;
(iv) any sign or symptom of:
(A) placenta previa; or
(B) deep vein thrombosis or pulmonary embolus; or
(v) any other condition or symptom that may place the health of
the pregnant woman or unborn child at unreasonable risk as
determined by the division by rule;
(b) mandatory transfer of patient care before the onset of labor to a
physician licensed under Chapter 67, Utah Medical Practice Act, or
Chapter 68, Utah Osteopathic Medical Practice Act, upon evidence
of:
(i) placenta previa after 27 weeks;
(ii) diagnosed deep vein thrombosis or pulmonary embolism;
(iii) multiple gestation;
(iv) no onset of labor after 43 completed weeks of gestation;
(v) more than two prior c-sections, unless restricted by the division
by rule;
(vi) prior c-section with a known classical or inverted-T or J
incision;
(vii) prior c-section without an ultrasound that rules out placental
implantation over the uterine scar;
(viii) prior c-section without a signed informed consent document
detailing the risks of vaginal birth after caesarean;
(ix) prior c-section with a gestation greater than 42 weeks;
(x) Rh isoimmunization with an antibody titre of greater than 1:8
in a mother carrying an Rh positive baby or a baby of unknown Rh
type;
(xi) any other condition that could place the life or long-term
health of the pregnant woman or unborn child at risk;
(c) mandatory transfer of care during labor and an immediate
transfer in the manner specifically set forth in Subsections
58-77-601(4)(a), (b), or (c) upon evidence of:
(i) undiagnosed multiple gestation, unless delivery is imminent;
(ii) prior c-section with cervical dilation progress in the current
labor of less than 1 cm in three hours once labor is active;
(iii) fetus in breech presentation during labor unless delivery is
imminent;
(iv) inappropriate fetal presentation as determined by the licensed
Direct-entry Midwife;
(v) non-reassuring fetal heart pattern indicative of fetal distress
that does not immediately respond to treatment by the Direct-entry
midwife unless delivery is imminent;
(vi) moderate thick, or particulate meconium in the amniotic fluid
unless delivery is imminent;
(vii) failure to deliver after three hours of pushing unless delivery
is imminent; or
(viii) any other condition that could place the life or long-term
health of the pregnant woman or unborn child at significant risk if
not acted upon immediately; and
(d) mandatory transfer of care after delivery and immediate
transfer of the mother or infant in the manner specifically set forth
in Subsections 58-77-601 (4)(a), (b), or (c) upon evidence of any
condition that could place the life or long-term health of the mother
or infant at significant risk if not acted upon immediately.
"
Renumber remaining subsections accordingly.
3. Page 7, Line 182: Delete "
to serve as chair of the committee
" and insert "
and one of
the non-Direct-entry midwife members to serve as co-chairs of the
committee.
"
4. Page 7, Line 188: After "members" delete "present at a meeting"
5. Page 8, Lines 220 through 227: Amend the following subsections as shown:
"
(a)
(i)
limit the licensed Direct-entry midwife's practice to a
normal pregnancy, labor, postpartum, newborn and interconceptual
care, which for purposes of this section means a normal labor:
{
(i)
}
(A)
that is not pharmacologically induced;
{
(ii)
}
(B)
that is low risk at the start of labor;
{
(iii)
}
(C)
that remains low risk through out the course of
labor and delivery;
{
and
}
{
(iv)
}
(D)
in which the infant is born spontaneously in the
vertex position between 37 and 43 completed weeks of pregnancy;
and
(E) except as provided in Subsection (2)(a)(ii), in which after
delivery, the mother and infant remain low risk; and
(ii) the limitation of Subsection (2)(a)(i) does not prohibit a
licensed Direct-entry midwife from delivering an infant when
there is:
(A) intrauterine fetal demise; or
(B) a fetal anomaly incompatible with life; and
"
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sb0093s07.hfa.02.wpd
LRGC
Poconnor
EmilyBrown