N.H. Code Admin. R. Ann. Mid — Midwifery Council (See RSA 326-D:5, I.)

Chapter Mid 100 Organizational Rules

Part Mid 101 Purpose

N.H. Code Admin. R. Ann. Mid 101.01 Purpose {#sec-mid-101.01 omnilex-key=us-nh-regs-official--agency-mid--Mid 101.01}

These rules implement the statutory responsibilities of the New Hampshire Midwifery Council created by RSA 326-D:3.

History

#7412, eff 12-5-00

Part Mid 102 Definitions

N.H. Code Admin. R. Ann. Mid 102.01 Definitions {#sec-mid-102.01 omnilex-key=us-nh-regs-official--agency-mid--Mid 102.01}

(a) “Active practice” means the practice of midwifery as defined in RSA 326-D:2, V.

(b) “American College of Nurse-Midwives (ACNM)” means the national professional association of certified nurse-midwives and certified midwives.

(c) “Certified midwife (CM)” means an individual who has been designated as a certified midwife by the American Midwifery Certification Board (AMCB), formerly the ACNM Certification Council, Inc. (ACC), and any successor organization.

(d) “Certified nurse-midwife (CNM)” means a registered nurse who has graduated from a nurse-midwifery education program accredited by the Division of Accreditation of the American College of Nurse-Midwives and has successfully taken the national examination required for designation as a CNM by the American Midwifery Certification Board (AMCB), formerly the ACNM Certification Council, Inc. (ACC).

(e) “Certified professional midwife (CPM)” means an individual who has met the standards for certification in the practice of midwifery set by the North American Registry of Midwives and who holds such certification.

(f) “Consultation” means the process whereby a NHCM who maintains primary management responsibility for the client seeks the advice or opinion of another appropriate healthcare practitioner.

(g) “Council” means “council” as defined in RSA 326-D:2, II, namely, "the midwifery council established in RSA 326-D:3".

(h) “Intrapartum” means the period from the onset of labor to its termination with the delivery of the placenta.

(i) “Midwifery” means “midwifery” as defined in RSA 326-D:2, V, namely “the practice, by persons other than physicians or surgeons licensed under RSA 329, nurses registered under RSA 326-B, or physician's assistants licensed under RSA 328-D, of:

(a) Providing the necessary supervision, care and advice to women during pregnancy, labor and the postpartum period;

(b) Conducting vaginal deliveries on the midwife's own responsibility, and caring for the newborn and the infant; such care to mother and child to include preventive measures, the detection of abnormal conditions, the procurement of medical assistance, and the execution of emergency measures in the absence of medical help; and

(c) Consulting with a physician whenever there are significant deviations from normal or whenever there is a medical emergency in either the mother or the infant.”

(j) “Midwifery practice coverage” means specific arrangements for on call coverage with another NHCM or health care provider whose scope of practice includes birth.

(k) “Neonatal resuscitation program (NRP)” means an educational program that introduces the concepts and basic skills of neonatal resuscitation.

(l) “New Hampshire certified midwife (NHCM)” means an individual who has been designated as a New Hampshire certified midwife pursuant to RSA 326-D.

(m) “Obstetrician” means a physician specializing in obstetrics, a branch of medical science that encompasses pregnancy, childbirth, and the postpartum period.

(n) “Postpartum” means the time period occurring after childbirth.

(o) “Prenatal” means during the period of time between conception and the onset of labor.

History

#7412, eff 12-5-00; ss by #14496, eff 2-8-26

Part Mid 103 Description of the Council and Council Meetings

N.H. Code Admin. R. Ann. Mid 103.01 Composition of the Council {#sec-mid-103.01 omnilex-key=us-nh-regs-official--agency-mid--Mid 103.01}

The council consists of 6 members appointed pursuant to, and meeting the eligibility requirements of, RSA 326-D:3, I.

History

#7412, eff 12-5-00; ss by #14496, eff 2-8-26

N.H. Code Admin. R. Ann. Mid 103.02 Responsibilities of the Council {#sec-mid-103.02 omnilex-key=us-nh-regs-official--agency-mid--Mid 103.02}

The council’s responsibilities include, but are not limited to:

(a) Establishing qualifications for certification to practice midwifery, renewal of certification, and reinstatement after lapse of certification;

(b) Establishing the requirements for license renewal eligibility, including requirements for continuing education and peer review;

(c) Defining the scope of practice and procedures for the practice of midwifery in accordance with RSA 326-D:5, I(c); and

(d) Any other matters necessary for the proper administration of RSA 326-D.

History

#7412, eff 12-5-00; ss by #14496, eff 2-8-26

N.H. Code Admin. R. Ann. Mid 103.03 Council Meetings and Quorum {#sec-mid-103.03 omnilex-key=us-nh-regs-official--agency-mid--Mid 103.03}

(a) Pursuant to RSA 326-D:3, IV the council shall meet no fewer than 4 times a year and at such additional times as the council chair or a majority of the council members shall designate.

(b) Pursuant to RSA 326-D:3, IV the quorum required for council meetings is a majority of members of the council who have been approved by the governor and council.

History

#7412, eff 12-5-00; ss by #14496, eff 2-8-26

N.H. Code Admin. R. Ann. Mid 103.04 Ineligibility of Council Members to Vote On Certain Matters and Participate in Certain Deliberations {#sec-mid-103.04 omnilex-key=us-nh-regs-official--agency-mid--Mid 103.04}

(a) A council member shall not be eligible to vote on, or participate in the council's deliberations about, matters pertaining to:

(1) The member's own application for initial or renewal certification or recertification; and

(2) Any matter in which the member has a personal, professional, or financial interest including, but not limited to, any matter involving:

a. The member;

b. The member's spouse, parent, child or business partner; or

c. A business investment of the member.

(b) Under the circumstances described in paragraph (a) the council member shall:

(1) Promptly disclose to the council his or her interest; and

(2) Recuse himself or herself from voting on, and participating in council deliberations about, the matter.

History

#7412, eff 12-5-00

N.H. Code Admin. R. Ann. Mid 103.05 Attendance at Meetings By Members of the Public {#sec-mid-103.05 omnilex-key=us-nh-regs-official--agency-mid--Mid 103.05}

Pursuant to RSA 91-A:2, II, members of the public may attend and record council meetings, except for those parts of the meetings which are nonpublic sessions as defined in RSA 91-A:3.

History

#7412, eff 12-5-00

N.H. Code Admin. R. Ann. Mid 103.06 Notice of Meetings {#sec-mid-103.06 omnilex-key=us-nh-regs-official--agency-mid--Mid 103.06}

(a) Notice of the time and place of council meetings, excluding emergency meetings, shall be given in accordance with RSA 91-A:2, II.

(b) Information about the time and place of council meetings shall also be available by telephone at the number stated in Mid 104.01 (b).

History

#7412, eff 12-5-00

N.H. Code Admin. R. Ann. Mid 103.07 Minutes of Council Meetings {#sec-mid-103.07 omnilex-key=us-nh-regs-official--agency-mid--Mid 103.07}

(a) Minutes shall be kept of council meetings and of official actions taken by the council.

(b) Such minutes shall:

(1) Record the members participating in each vote; and

(2) Separately record the position of members who dissent, abstain or concur.

History

#7412, eff 12-5-00

Part Mid 104 Public Requests for Information

N.H. Code Admin. R. Ann. Mid 104.01 Office Location and Mailing Address, Telephone Number, and Number for TTY Users {#sec-mid-104.01 omnilex-key=us-nh-regs-official--agency-mid--Mid 104.01}

(a) The council's office location and mailing address is:

NH Midwifery Council

c/o Office of Professional Licensure and Certification

7 Eagle Square

Concord, NH 03301

(b) The council's telephone number is (603) 271-2152.

History

#7412, eff 12-5-00; ss by #12039, eff 11-10-16; ss by #14496, eff 2-8-26

N.H. Code Admin. R. Ann. Mid 104.02 Communication with the Council {#sec-mid-104.02 omnilex-key=us-nh-regs-official--agency-mid--Mid 104.02}

Persons wishing to make submissions to the council shall do so through the office of professional licensure and certification (OPLC) at the address provided in Mid 104.01(a).

History

#7412, eff 12-5-00; ss by #14496, eff 2-8-26

N.H. Code Admin. R. Ann. Mid 104.03 Public Access to Records {#sec-mid-104.03 omnilex-key=us-nh-regs-official--agency-mid--Mid 104.03}

Any individual who wishes to request information or access to council records shall do so in accordance with Plc 104.

Appendix

Rule

Specific State Statutes Implemented

Mid 101

RSA 326-D:2, V

Mid 102.01(a)

RSA 326-D:2, V

Mid 102.01(b) – Mid 102.01(f)

RSA 326-D:5, I(b)-(c)

Mid 102.01(g)

RSA 326-D:2, II

Mid 102.01(i)

RSA 326-D:2, V

Mid 102.01(h), Mid 102.01(j) – Mid 102.01(o)

RSA 326-D:5, I(b)-(c)

Mid 103.01

RSA 326-D:3, I

Mid 103.02(a)

RSA 326-D:5, I(d)

Mid 103.02(b)

RSA 326-D:5, I(e)

Mid 103.02(c)

RSA 326-D:5, I(c)

Mid 103.02(d)

RSA 541-A:16, I(a)

Mid 103.03

RSA 326-D:3, IV

Mid 103.04

RSA 326-D:5, I

Mid 103.05, Mid 103.06(a)

RSA 91-A:2, II

Mid 103.06(b)

RSA 541-A:16, I(a)

Mid 103.07

RSA 541-A:16, I(a); RSA 91-A:2, II

Mid 104

RSA 541-A:16, I(a); RSA 91-A:4

History

#7412, eff 12-5-00; ss by #14496, eff 2-8-26

Chapter Mid 200 Procedural Rules

Part Mid 201 Applicability and Waiver of Substantive Rules

N.H. Code Admin. R. Ann. Mid 201.01 Applicability of Plc 200 {#sec-mid-201.01 omnilex-key=us-nh-regs-official--agency-mid--Mid 201.01}

The Plc 200 rules shall govern the midwifery council with regards to all procedures for:

(a) The receipt and investigation of misconduct complaints;

(b) The conduct of adjudicative and non-adjudicative proceedings;

(d) Public comment hearings;

(e) Declaratory rulings;

(f) Explanation of adopted rules;

(g) Voluntary surrender of licenses; and

(h) Waivers.

APPENDIX

RULE

STATUTE

Mid 201

RSA 541-A:16, I(b)

History

#14492, eff 2-8-26

Chapter Mid 300 Certification Requirements

Part Mid 301 Definitions

N.H. Code Admin. R. Ann. Mid 301.01 Definitions {#sec-mid-301.01 omnilex-key=us-nh-regs-official--agency-mid--Mid 301.01}

(a) "American College of Nurse-Midwives (ACNM)" means the national professional association of certified nurse-midwives and certified midwives.

(b) "Certified midwife (CM)" means an individual who has been designated as a certified midwife by the Certification Council of the ACNM.

(c) “Certified nurse-midwife (CNM)” means a registered nurse who has graduated from a nurse-midwifery education program accredited by the ACNM Division of Accreditation and has passed a national examination to become professionally designated as a CNM by the ACNM Certification Council.

(d) “Certified professional midwife (CPM)” means an individual who has met the standards for certification in the practice of midwifery set by NARM and who holds such certification.

(e) "Doula" means a person trained to give women information, comfort, and emotional support before, during, and after birth.

(f) “Neonatal resuscitation program (NRP)” means an educational program that introduces the concepts and basic skills of neonatal resuscitation.

(g) “North American Registry of Midwives (NARM)” means a non-profit agency established to certify practitioners of midwifery on the basis of experience and examination.

(h) “Prenatal” means during the period of time between conception and the onset of labor.

History

#7421, eff 1-3-01, EXPIRED: 1-3-09
#9691, eff 4-8-10; ss by #12660, eff 11-5-18

Part Mid 302 Application Procedure

N.H. Code Admin. R. Ann. Mid 302.01 Application Process for Initial Certification {#sec-mid-302.01 omnilex-key=us-nh-regs-official--agency-mid--Mid 302.01}

(a) An individual who wishes to be issued a first certificate to practice midwifery shall submit to the midwifery council:

(1) A completed “Application Form: NH Midwifery Certification” provided by the midwifery council and described in Mid 302.03;

(2) The documentation specified in Mid 302.05; and

(3) Payment of the certification fee specified in Mid 306.03.

(b) The application form shall be completed by:

(1) Printing the required information legibly in ink or using a keyboard; and

(2) Completing all sections or designating them as not applicable to the applicant.

History

#7421, eff 1-3-01; ss by #9691, EXPIRED: 1-3-09
#9691, eff 4-8-10; ss by #12660, eff 11-5-18

N.H. Code Admin. R. Ann. Mid 302.02 Application Review and Notification Procedure {#sec-mid-302.02 omnilex-key=us-nh-regs-official--agency-mid--Mid 302.02}

(a) Within 60 days of the receipt of the application, the midwifery council shall:

(1) Review the application form and documentation for legibility and completeness;

(2) Determine whether additional information or documentation is required to clarify the application or to ascertain whether the applicant meets the qualifications for certification; and

(3) Notify the applicant in writing of any deficiencies in the application and of any additional information or documentation required.

(b) An application shall be deemed completed on the date when the midwifery council has received:

(1) The completed application form;

(2) The supporting documentation required by Mid 302.05; and

(3) Any additional information and documentation required under (a)(3) above.

(c) An application for which the midwifery council is waiting for additional information or documentation shall be held open for one year from the date of its receipt by the council, after which time it shall be closed and the application denied.

(d) Within 120 days from the completion of the application the midwifery council shall notify the applicant in writing of the following:

(1) Whether or not the application has been approved and the applicant certified; and

(2) In the case of denial of certification:

a. The reason(s) for the denial; and

b. The right of the applicant to make a written request within 30 days for a hearing pursuant to Mid 200 to challenge the denial.

(e) All applications for certification shall be kept as part of the permanent records of the midwifery council.

History

#7421, eff 1-3-01, EXPIRED: 1-3-09
#9691, eff 4-8-10; ss by #12660, eff 11-5-18

N.H. Code Admin. R. Ann. Mid 302.03 Application Form for Initial Certification {#sec-mid-302.03 omnilex-key=us-nh-regs-official--agency-mid--Mid 302.03}

On the 2-part application form the applicant shall furnish:

(a) On the publicly available part of the form:

(1) The applicant’s name and any names previously used;

(2) The date of the application;

(3) The applicant’s date of birth;

(4) The applicant’s work address;

(5) The applicant's work numbers, including, as applicable, the applicant's office telephone number, cell phone number and fax number;

(6) The applicant's business e-mail address, if applicable;

(7) In the space provided, a statement by the applicant expressing intent to engage in the practice of midwifery in the state;

(8) The name and address of the high school attended by the applicant and the date of graduation, or the date of completion of high school equivalent;

(9) If applicable, a list of colleges and universities the applicant attended, the dates of attendance, and the degrees received;

(10) A written description of any part of the applicant's professional background which is relevant to the practice of midwifery, such as:

a. Midwifery training or experience in any state or country; or

b. Any training or experience in the fields of newborn or maternal care, acquired in any state or country, such as emergency technician, obstetric or pediatric nursing, childbirth education or work as a doula;

(11) A list of midwifery schools attended and, for each such school:

a. The dates attended;

b. The date of graduation; and

c. The degree, certificate, or diploma awarded;

(12) A list of midwifery certifications, licenses, registrations or other permits to practice midwifery held by the applicant currently or in the past, including for each such permit:

a. The state, country, or organization of issuance; and

b. The dates of issuance and expiration;

(13) A list of all certifications, licenses, registrations, or other permits to practice in a health or healing field other than midwifery, including for each such permit:

a. The state or country of issuance; and

b. The dates of issuance and expiration;

(14) A statement describing the circumstances of any conviction of a crime disclosed by any affidavit required to be submitted by Mid 302.05(h);

(15) A statement describing the arrangements the applicant has made for the medical back-up as required by Mid 303.01(h), including in the description:

a. Arrangements for coverage for clients in the event of the applicant’s absence or illness;

b. Arrangements for consultation with obstetricians, family practitioners, pediatricians or any other physicians concerning abnormal conditions;

c. Arrangements for transferring the care of clients from the midwife to obstetricians, family practitioners, pediatricians or any other physicians;

d. Identification of privileges at hospitals; and

e. Identification of hospital services to be used in medical emergencies;

(16) A statement describing the applicant's arrangements for:

a. Laboratory testing;

b. Newborn screening; and

c. Obtaining medications permitted by law;

(17) The applicant's signature to a statement preprinted on the form which states that:

a. The information provided on the application form and the documentation provided to support the application are true, accurate, complete and unaltered; and

b. The applicant acknowledges that, pursuant to RSA 641:3, the knowing making of a false statement on the application form is punishable as a misdemeanor; and

(18) The date of the signature;

(b) On the confidential part of the form:

(1) The applicant's name;

(2) The applicant’s home address and home telephone number;

(3) The applicant's home e-mail address, if he or she chooses to provide it;

(4) Disclosure of the following information, the relative seriousness of which shall be used to evaluate the fitness of the applicant to practice midwifery pursuant to Mid 303.01(g):

a. Whether a malpractice claim has been made against the applicant within the last 6 years, regardless of whether a lawsuit was filed in relation to the claim;

b. Whether the applicant has ever been denied a midwifery certificate, license, registration or permit to practice midwifery for any reason;

c. Whether the applicant’s employment or appointment in a hospital, clinic or other health care facility was ever suspended;

d. Whether the applicant has ever resigned from employment or appointment in a hospital, clinic or other health care facility in lieu of being subjected to disciplinary action;

e. Whether there are pending against the applicant any disciplinary charges before any licensing authority, medical council, health care facility or professional midwifery association;

f. Whether any disciplinary action has been taken against the applicant by any licensing authority, medical council, health care facility or professional midwifery association;

g. Whether the applicant has ever voluntarily surrendered a certificate, license, registration or permit to practice midwifery or other healing art in lieu of facing disciplinary action;

h. Whether the applicant has ever had a professional certificate, license, registration or permit to practice in a field other than midwifery revoked, suspended, or otherwise terminated on disciplinary grounds; and

i. Whether the applicant currently has an emotional disturbance or mental illness, a physical illness, or an addictive disorder impairing the applicant’s ability to practice midwifery;

(5) A statement describing in detail the circumstances of any affirmative answers to the questions listed; and

(6) The applicant's social security number provided in the space below the following preprinted notice:

"The Midwifery Council will deny certification if you refuse to submit your social security number (SSN). Your professional certificate will not display your SSN. Your SSN will not be made available to the public.

The Midwifery Council is required to obtain your social security number for the purpose of child support enforcement in compliance with 42 USC 666(a)(13) and RSA 161-B:11. This collection of your social security number is mandatory."; and

(c) If the applicant so chooses, the information requested on the attached “Optional Informational Question”, effective August 2018.

History

#7421, eff 1-3-01, EXPIRED: 1-3-09
#9691, eff 4-8-10; ss by #12660, eff 11-5-18

N.H. Code Admin. R. Ann. Mid 302.04 Meaning of Signature {#sec-mid-302.04 omnilex-key=us-nh-regs-official--agency-mid--Mid 302.04}

The meaning of the applicant's signature on the application form shall be the applicant's:

(a) Certification that the information provided on the application form and the documentation provided to support the application are true, accurate, complete and unaltered; and

(b) Acknowledgement that, pursuant to RSA 641:3, the knowing making of a false statement on the application form is punishable as a misdemeanor.

History

#7421, eff 1-3-01, EXPIRED: 1-3-09
#9691, eff 4-8-10; ss by #12660, eff 11-5-18

N.H. Code Admin. R. Ann. Mid 302.05 Documentation Required to Support An Application for Initial Certification {#sec-mid-302.05 omnilex-key=us-nh-regs-official--agency-mid--Mid 302.05}

Applicants for a first certificate to practice midwifery shall submit the following documentation at the time of application:

(a) A photocopy of a high school diploma or evidence of completion of high school equivalent;

(b) A photocopy of the applicant’s current certificate as a CPM;

(c) Proof of having passed one college-level anatomy and physiology course or proof of receipt through examination of college-level credit in anatomy and physiology, in the form of:

(1) An official transcript; or

(2) An original signed letter issued by the registrar or records office of the institution awarding the college-level credit;

(d) Official transcripts from, or photocopies of diplomas received from, all colleges and universities attended, if any;

(e) Official transcripts from all midwifery schools and colleges attended, if applicable;

(f) A photocopy of the front and back of:

(1) The applicant’s current cardiopulmonary resuscitation certificate, also known as basic life support for healthcare providers, issued by the American Heart Association;

(2) The applicant's current certificate in adult cardiopulmonary resuscitation issued by the American Red Cross together with the applicant’s current certificate in infant and child cardiopulmonary resuscitation issued by the American Red Cross; or

(3) The applicant's current certificate in adult, child and infant cardiopulmonary resuscitation issued by Medic First Aid or by the American Safety and Health Institute;

(g) A copy of the front and back of the applicant’s current NRP provider card;

(h) A copy of the certificate of completion of a course(s) in birth-related laceration repairs that are credentialed by one of the organizations listed in Mid 405.02(a)(2), or a copy of the transcript or module’s educational objectives or syllabus for birth-related laceration repairs from the program that prepared the applicant for CPM certification;

(i) The signed statement regarding the number of supervised birth-related laceration repairs from the preceptor as described in Mid 303.02(c)(3);

(j) If applicable, a notarized affidavit disclosing criminal convictions;

(k) The names, addresses, phone number, and written references from at least 4 people, including at least 2 from certified or licensed health care professionals familiar with the applicant’s midwifery experience, and not more than one from a client, affirming the applicant’s competence and high standards in providing midwifery care; and

(l) For identification, a photocopy of the applicant’ current driver’s license, passport or other government-issued identification card bearing the applicant's picture.

History

#7421, eff 1-3-01, EXPIRED: 1-3-09
#9691, eff 4-8-10; ss by #12660, eff 11-5-18; ss by #12939-B, eff 12-10-19

Part Mid 303 Qualifications

N.H. Code Admin. R. Ann. Mid 303.01 Eligibility for Initial Certification {#sec-mid-303.01 omnilex-key=us-nh-regs-official--agency-mid--Mid 303.01}

To be eligible for initial certification an applicant shall:

(a) Have completed high school or its equivalent;

(b) Hold a current certificate as a CPM;

(c) Have completed one college-level course in human anatomy and physiology, or received equivalent college-level credit through examination in anatomy and physiology;

(d) Hold current certificate(s) in adult, child and infant cardiopulmonary resuscitation issued by at least one of the following:

(1) The American Heart Association;

(2) The American Red Cross;

(3) The American Safety and Health Institute; or

(4) Medic First Aid;

(e) Hold a current certificate as a provider of neonatal resuscitation which shows that the applicant has successfully completed at least the following modules of the NRP provider course:

(1) Introduction to the program;

(2) Initial steps in resuscitation;

(3) Use of a resuscitation bag and mask; and

(4) Chest compressions;

(f) Show completion of a course in birth-related lacerations, as evidenced by a copy of a certificate of completion as required under Mid 302.05(h), or a copy of the transcript or module’s educational objectives or syllabus for birth-related laceration repairs from the program that prepared the applicant for CPM certification;

(g) Have not been convicted as an adult of the following, whether in NH or in another jurisdiction, unless the conviction was annulled, overturned or reversed on appeal:

(1) A crime involving as a victim a minor, an individual with a disability or an elderly adult;

(2) A violation of a controlled drug law;

(3) A crime involving fraud or misrepresentation; or

(4) A crime involving a violation of a fiduciary duty;

(h) Have no mental or physical condition preventing the applicant from the performance required of a midwife by Mid 500;

(i) Have made arrangements for medical back-up to support to the applicant’s practice;

(j) Have made arrangements for:

(1) Prenatal laboratory testing;

(2) Newborn screening; and

(3) Obtaining the medications permitted by law;

(k) Have performed birth-related laceration repairs in a manner deemed satisfactory by the applicant’s preceptor, as further described in Mid 303.02; and

(l) Meet the examination and examination-fee requirements of Mid 304.

History

#7421, eff 1-3-01, EXPIRED: 1-3-09
#9691, eff 4-8-10; ss by #12660, eff 11-5-18; ss by #12939-B, eff 12-10-19

N.H. Code Admin. R. Ann. Mid 303.02 Laceration Repairs {#sec-mid-303.02 omnilex-key=us-nh-regs-official--agency-mid--Mid 303.02}

(a) An applicant for certification shall:

(1) Have completed a course in birth-related laceration repairs by one of the programs listed under (b) below, as evidenced by a copy of a certificate of completion as required under Mid 302.05(h); and

(2) Have performed birth-related laceration repairs to the satisfaction of a preceptor meeting the requirements under (c) below, as required under Mid 302.05(i).

(b) The program which prepared the applicant for CPM certification shall be a program qualified under (a)(1) above if the program:

(1) Provided instruction in the assessment and techniques for birth-related laceration repairs; and

(2) Evaluated the applicant’s competence at birth-related laceration repairs.

(1) Was, at the time of the preceptorship:

a. A midwife certified in New Hampshire;

b. The holder of a license, certificate, permit or other approval to practice midwifery issued by any state, foreign country or province of a foreign country;

c. A CPM;

d. A CNM;

e. A CM; or

f. A physician with experience in the active practice of obstetrics and licensed in any state, foreign country or province of a foreign country;

(2) Instructed, supervised and evaluated the applicant's birth-related laceration repairs; and

(3) Has issued to the applicant, or will issue to the applicant, a signed statement:

a. Indicating which of the credentials in the list in (c)(1) above are the preceptor's credentials; and

b. Indicating the number of supervised, birth-related laceration repairs performed satisfactorily by the applicant.

History

#7421, eff 1-3-01, EXPIRED: 1-3-09
#9691, eff 4-8-10; ss by #12660, eff 11-5-18; ss by #12939-B, eff 12-10-19

Part Mid 304 Examination and Examination Fee

N.H. Code Admin. R. Ann. Mid 304.01 Examination Requirements {#sec-mid-304.01 omnilex-key=us-nh-regs-official--agency-mid--Mid 304.01}

(a) As a condition of certification, the applicant shall pass the following examinations in the order in which they are described in this section:

(1) The NARM oral and written examinations for certification as a CPM; and

(2) After payment of the examination fee set forth in Mid 306.03, the written examination administered by the midwifery council testing the applicant’s knowledge of RSA 326-D and the midwifery council's administrative rules.

(b) An applicant who has failed the midwifery council's examination shall have the opportunity to pay a second examination fee and retake the examination:

(1) No more than twice ever; and

(2) No sooner than 6 weeks after the applicant last failed the examination.

History

#7421, eff 1-3-01, EXPIRED: 1-3-09
#9691, eff 4-8-10; ss by #12660, eff 11-5-18

Part Mid 305 Reserved

N.H. Code Admin. R. Ann. Mid 305.01 Certification Requirements {#sec-mid-305.01 omnilex-key=us-nh-regs-official--agency-mid--Mid 305.01}

– Mid 305.04 REPEALED

History

#7421, eff 1-3-01; ss by #9088, eff 2-20-08; rpld by #9692, eff 4-8-10

Part Mid 306 Duration of Certifications and Fees

N.H. Code Admin. R. Ann. Mid 306.01 Duration of Certifications {#sec-mid-306.01 omnilex-key=us-nh-regs-official--agency-mid--Mid 306.01}

The duration of certifications and renewed certifications shall be 2 years.

History

#7421, eff 1-3-01, EXPIRED: 1-3-09
#9691, eff 4-8-10; ss by #12660, eff 11-5-18

N.H. Code Admin. R. Ann. Mid 306.02 Certification Fees {#sec-mid-306.02 omnilex-key=us-nh-regs-official--agency-mid--Mid 306.02}

No applicant for initial certification or certification based on reciprocity shall be certified before the applicant has paid the non-refundable certification fee specified in Mid 306.03.

History

#7421, eff 1-3-01, EXPIRED: 1-3-09
#9691, eff 4-8-10; ss by #12660, eff 11-5-18

N.H. Code Admin. R. Ann. Mid 306.03 Fee Schedule {#sec-mid-306.03 omnilex-key=us-nh-regs-official--agency-mid--Mid 306.03}

Fees shall be as set forth in Table 3-1.

Table 3-1 Fees for Examinations and Certifications

Certification and Fee Category

Fee

New Hampshire Examination

$20.00

Certification

$110.00

Renewal of Certification

$110.00

APPENDIX

Rule

Specific State Statute the Rule Implements

Mid 301

RSA 541-A:7

Mid 302

RSA 326-D:4, I(a); RSA 326-D:5, I(d); RSA 326-D:6, I

Mid 303.01

RSA 326-D:4, I(a); RSA 326-D:5, I(a); RSA 326-D:7

Mid 303.02

RSA 326-D:5, I(a); RSA 326-D:7, V and VI; RSA 541-A:16, I(b)

Mid 304.01

RSA 326-D:7, VII and VIII

Mid 306.01

RSA 326-D:6, II

Mid 306.02

RSA 326-D:4, I (b)

Mid 306.03

RSA 326-D:5, I; 326-D:6, I & II

History

#7421, eff 1-3-01, EXPIRED: 1-3-09
#9691, eff 4-8-10; ss by #12040, eff 11-10-16

Chapter Mid 400 Continued Status

Part Mid 401 Definitions

N.H. Code Admin. R. Ann. Mid 401.01 Definitions {#sec-mid-401.01 omnilex-key=us-nh-regs-official--agency-mid--Mid 401.01}

In this part, the following terms shall have the following meanings:

(a) "Active practice" means the practice of midwifery as defined in RSA 326-D:2 V;

(b) "Contact hour" means a unit of measure of continuing professional education or professional activity;

(c) "Continuing professional education or activity" means structured courses, activities, and experiences beyond entry-level professional preparation that are designed to provide advanced or enhanced knowledge in the field of midwifery;

(d) "Distance-learning" means participation in continuing education described in Mid 405.02 through self-study online computer courses and correspondence courses;

(e) “Intrapartum” means the period from the onset of labor to its termination with the delivery of the placenta;

(f) “Maternal mortality” means death of the client during pregnancy or within 6 weeks of birth;

(g) “Medical backup” means specific arrangements for on call coverage with another midwife or licensed health care provider whose scope of practice includes birth;

(h) "Midwifery-related field" means any of the following fields: women's health, maternal-newborn nursing, counseling, nutrition, pregnancy, childbirth, postpartum care, breastfeeding, newborn care, pharmacology, herbology, and homeopathy;

(i) “Neonatal mortality” means fetal demise at or after 20 weeks’ gestation or death of the baby up to 6 weeks of age. The term includes “fetal mortality”;

(j) “Neonatal resuscitation program (NRP)” means a course of study in the prevention and treatment of neonatal respiratory depression which is cosponsored by the American Academy of Pediatrics and the American Heart Association;

(k) "Peer review” means the confidential presentation in a meeting of at least 3 midwives of a midwifery case of educational value with respect to medical, obstetrical, gynecological, psychosocial, or neonatal matters, together with a confidential discussion about the case; and

(l) "Significant morbidity" means an illness, injury, or morbidity to the newborn or mother up to 6 weeks after birth, which is or is not captured by hospitalization, that is directly related to pregnancy, birth, or postpartum.

History

#8840, eff 3-13-07, EXPIRED: 3-13-15
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16; ss by #13611, eff 6-13-23

Part Mid 402 Renewal and Lapse of Certificates

N.H. Code Admin. R. Ann. Mid 402.01 Term of Certificates; Lapse of Certificates {#sec-mid-402.01 omnilex-key=us-nh-regs-official--agency-mid--Mid 402.01}

(a) An initial or renewed certificate to practice midwifery shall be valid for 2 years if application for its renewal is made timely and completely in accordance with these rules.

(b) Pursuant to RSA 326-D:11, if a renewal application is made timely and completely, the certificate to be renewed shall not lapse until the council has taken final action upon the application.

(c) If a renewal application is not made timely and completely and therefore the midwifery council cannot take action on it before the expiration date of the certificate to be renewed:

(1) The certificate to be renewed shall lapse; and

(2) The midwife shall not practice until:

a. The certificate has been reinstated pursuant to Mid 403; or

b. The midwife has been newly certified in accordance with the procedures and eligibility standards set out in Mid 300.

History

#8840, eff 3-13-07, EXPIRED: 3-13-15
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16

N.H. Code Admin. R. Ann. Mid 402.02 Eligibility for Renewed Certificate {#sec-mid-402.02 omnilex-key=us-nh-regs-official--agency-mid--Mid 402.02}

The midwifery council shall issue a renewed certificate to practice midwifery if the applicant:

(a) Has complied with the renewal application process of Mid 402.03;

(b) Has completed the continuing education required by Mid 405 within the 26-month period just preceding the date of expiration shown on the certificate being renewed and has not had any of such continuing education credited to a previous application for renewal;

(c) Has participated in at least 6 peer reviews within the 2-year period since issuance of the certificate being renewed, including at least one in which the applicant presented a case for peer review;

(d) Is currently certified by the American Heart Association or the American Red Cross in adult and infant and child cardiopulmonary resuscitation;

(e) Holds a current certificate as a provider of neonatal resuscitation which shows that the applicant has successfully completed at least the following modules of the NRP course:

(1) Introduction to the program;

(2) Initial steps in resuscitation;

(3) Use of a resuscitation bag and mask; and

(4) Chest compressions;

(f) Has not been convicted of a crime involving theft or physical or emotional injury to others;

(g) Has no mental or physical condition that might discredit the renewal applicant as a midwife, or prevent the renewal applicant from meeting the requirements of RSA 326-D and the midwifery council's administrative rules;

(h) Has made arrangements for medical back-up to support the renewal applicant’s practice; and

(i) Has made arrangements for:

(1) Prenatal laboratory testing;

(2) Newborn metabolic screening; and

(3) Any necessary administration of Rh(D) immune globulin.

History

#8840, eff 3-13-07, EXPIRED: 3-13-15
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16

N.H. Code Admin. R. Ann. Mid 402.03 Application Process for Certificate Renewal {#sec-mid-402.03 omnilex-key=us-nh-regs-official--agency-mid--Mid 402.03}

Any midwife wishing to renew a certificate shall submit the following materials to the midwifery council no later than 30 days before the date of expiration shown on the certificate being renewed:

(a) The completed renewal application form provided by the midwifery council;

(b) The supporting documentation described in Mid 402.07; and

History

#8840, eff 3-13-07, EXPIRED: 3-13-15
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16

N.H. Code Admin. R. Ann. Mid 402.04 Application Review and Notification Procedure {#sec-mid-402.04 omnilex-key=us-nh-regs-official--agency-mid--Mid 402.04}

(a) Upon receipt of an application for certificate renewal the midwifery council shall:

(1) Review the application form and supporting documentation for legibility and completeness;

(2) Determine whether additional information or documentation is required to clarify the application or determine whether the applicant meets the qualifications for certificate renewal; and

(3) Notify the applicant in writing within 20 days of any deficiencies in the application or the council's need for additional information or documentation.

(b) An application for certificate renewal shall be deemed complete on the date the midwifery council has received the materials required by Mid 402.03 and any additional materials requested under (a) (3) above.

(1) Issue a renewed certificate showing the date of its expiration, after ascertaining that the check in payment of the renewal fee has cleared; or

(2) Advise the renewal applicant in writing of:

a. Its intent to deny renewal of certification and reimburse any renewal fee already paid; and

b. The renewal applicant's right to challenge the midwifery council's intent to deny renewal certification through a hearing pursuant to Mid 200.

(d) A renewal applicant who has received notice of the midwifery council's intent to deny renewal of certification shall have the right to challenge the council's intent through a due process hearing if the applicant requests such a hearing within 60 days.

(e) All applications for certificate renewal shall be kept as part of the permanent records of the midwifery council.

History

#8840, eff 3-13-07, EXPIRED: 3-13-15
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16

N.H. Code Admin. R. Ann. Mid 402.05 Application Form for Renewal of Certificate {#sec-mid-402.05 omnilex-key=us-nh-regs-official--agency-mid--Mid 402.05}

(a) An applicant for renewal of certification shall:

(1) Complete the “Renewal of Midwifery Certificate” application form, effective 10/2016, furnished by the midwifery council electronically or legibly in ink;

(2) Complete all sections of the renewal application form or designate them as not applicable;

(3) Date the renewal application form; and

(4) Sign the renewal application form in compliance with (b) below.

(b) An applicant for renewal of certification shall:

(1) Place his or her signature below the following statement preprinted on the renewal application form:

"The information provided on the renewal application form and the documentation provided to support the renewal application are, to the best of my knowledge and belief, true, accurate, complete and unaltered. I acknowledge that, pursuant to RSA 641:3, the knowing making of a false statement on the renewal application form is punishable as a misdemeanor"; and

(2) Place the date next to his or her signature.

History

#8840, eff 3-13-07, EXPIRED: 3-13-15
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16

N.H. Code Admin. R. Ann. Mid 402.06 Effect of Signature {#sec-mid-402.06 omnilex-key=us-nh-regs-official--agency-mid--Mid 402.06}

The effect of the signature required by Mid 402.05 (b) shall be that the applicant for renewal of certification:

(a) States that, to the best of his or her knowledge and belief, the information provided on the renewal application form and the documentation provided to support the renewal application are accurate, complete and unaltered; and

(b) Acknowledges that, pursuant to RSA 641:3, the intentional making of a false statement on the renewal application form is punishable as a misdemeanor.

History

#8840, eff 3-13-07, EXPIRED: 3-13-15
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16

N.H. Code Admin. R. Ann. Mid 402.07 Documentation Required to Support an Application for Renewal of Certificate {#sec-mid-402.07 omnilex-key=us-nh-regs-official--agency-mid--Mid 402.07}

Applicants for certificate renewal shall submit the following:

(a) Documentation in accordance with Mid 406 of the completion of 20 contact hours of continuing education;

(b) A statement for each peer review in which the renewal applicant either participated or presented a case for review since the applicant was last issued an initial or renewal certificate, containing the following information:

(1) The renewal applicant's name;

(2) The date of the peer review meeting;

(3) The name of the midwife presenting the midwifery case for peer review;

(4) The topic of the case presented for peer review;

(5) Whether attendance was recorded in minutes of the peer review meeting; and

(6) If attendance was not recorded in minutes of the meeting, the names of at least 2 other participating midwives;

(1) The front and back of the renewal applicant’s current certificate in basic life skills for healthcare providers issued by the American Heart Association; or

(2) The front and back of the renewal applicant's current certificate in adult cardiopulmonary resuscitation issued by the American Red Cross and of the renewal applicant's current certificate in infant and child cardiopulmonary resuscitation issued by the American Red Cross;

(d) A copy of the front and back of the applicant’s current NRP provider card; and

(e) If applicable, a notarized affidavit disclosing criminal convictions occurring since the applicant last submitted an application for initial or renewal certification.

History

#8840, eff 3-13-07, EXPIRED: 3-13-15
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16

Part Mid 403 Reinstatement of Certification

N.H. Code Admin. R. Ann. Mid 403.01 Definitions {#sec-mid-403.01 omnilex-key=us-nh-regs-official--agency-mid--Mid 403.01}

In Mid 403 the following terms have the following meanings:

(a) “Certified nurse-midwife (CNM)” means a registered nurse who has graduated from a nurse-midwifery education program accredited by the ACNM Division of Accreditation and has passed a national examination to become professionally designated as a CNM by the ACNM Certification Council;

(b) “Prenatal” means during the period of time between conception and the onset of labor;

(d) "Primary midwife" means the midwife:

(1) With whom the client contracts to provide care; and

(2) Who assumes primary responsibility for the health of the mother, the fetus, and the newborn; and

(e) “Regulating” means certifying or licensing by a state which oversees its midwives.

History

#9089, eff 2-20-08, EXPIRED: 2-20-16
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16

N.H. Code Admin. R. Ann. Mid 403.02 Recertification After Expiration of Certificate {#sec-mid-403.02 omnilex-key=us-nh-regs-official--agency-mid--Mid 403.02}

(a) The midwifery council shall reinstate a certificate after its lapse:

(1) In accordance with Mid 403.03 if the certificate expired:

a. No more than 90 days before the application for recertification; and

b. The certificate lapsed when the midwife failed to apply timely and completely for renewal because of one of the hardships listed in Mid 403.03(a);

(2) In accordance with Mid 403.04 if the midwife's certificate has been expired for no more than 3 consecutive years and the midwife is unable to meet the requirements of Mid 403.03; and

(3) In accordance with Mid 403.06 if the midwife's certificate has been expired for more than 3 consecutive years but fewer than 12 consecutive years.

(b) The midwifery council shall not reinstate a certification expired for more than 12 years.

(c) A person whose certificate has been expired for more than 12 years shall be re-admitted to the practice of midwifery only if:

(1) He or she meets the standards for initial certification based on:

a. The qualifications set forth in Mid 303; or

b. Reciprocity as set forth in Mid 305; and

(2) Follows the application procedures set forth in Mid 302.

History

#9089, eff 2-20-08, EXPIRED: 2-20-16
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16

N.H. Code Admin. R. Ann. Mid 403.03 Recertification After Maximum 90 Day Lapse of Certificate Because of Hardship {#sec-mid-403.03 omnilex-key=us-nh-regs-official--agency-mid--Mid 403.03}

The midwifery council shall reinstate a certificate expired no more than 90 days if:

(a) The failure to apply timely and completely for renewal of recertification resulted from one of the following circumstances of hardship:

(1) Illness or injury sufficiently serious to prevent the midwife from engaging in his or her usual work for at least 2 consecutive weeks;

(2) Illness in the midwife's household or in the midwife's immediate family sufficiently serious to prevent the midwife from engaging in his or her usual work for at least 2 consecutive weeks;

(3) Death in the midwife's household or of a member of her immediate family;

(4) Active military duty; or

(5) The destruction by fire, flood, or other accidental or natural disaster of:

a. Continuing education records; or

b. Other materials required by Mid 402.07 to be submitted with a renewal application;

(b) The midwife is eligible under Mid 402.02 for renewal of certification; and

(1) Completes the renewal process set forth in Mid 402.03; and

(2) Makes a written request for recertification based on one of the reasons set forth in (a) above.

History

#9089, eff 2-20-08, EXPIRED: 2-20-16
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16

N.H. Code Admin. R. Ann. Mid 403.04 Recertification of Midwives When the Certificate Has Been Expired for No More Than 3 Consecutive Years {#sec-mid-403.04 omnilex-key=us-nh-regs-official--agency-mid--Mid 403.04}

(a) For midwives not eligible for recertification under Mid 403.03, the midwifery council shall reinstate a certificate if the applicant for recertification:

(1) Meets the recency of practice requirement set forth in (b) below;

(2) Complies with the maintenance of competence requirements set forth in (c) below;

(3) Is prepared for practice as required by (d) below; and

(4) Follows the application procedures set forth in (e) below.

(b) The recency of practice requirement shall be:

(1) The expiration of the New Hampshire certificate no more than 3 years preceding the application for recertification; or

(2) The practice of midwifery in another state regulating the practice of midwifery within the 3 years just preceding the application for recertification.

(1) Completion of the continuing education required by Mid 405 within the 24 months just preceding the application for recertification; and

(2) Participation in at least 6 peer reviews within the 24 months just preceding the application for recertification.

(d) Preparation for practice requirements shall consist in:

(1) Current certification by the American Heart Association or the American Red Cross in adult cardiopulmonary resuscitation and in infant and child cardiopulmonary resuscitation;

(2) Current certification as a provider of neonatal resuscitation who has successfully completed at least the following modules of the NRP course:

a. Introduction to the program;

b. Initial steps in resuscitation;

c. Use of a resuscitation bag and mask; and

d. Chest compressions;

(3) No conviction of a crime involving theft or physical or emotional injury to others since the midwife was last certified;

(4) No mental or physical condition that might prevent her or him from meeting the requirements of RSA 326-D and the midwifery council's administrative rules;

(5) Having current arrangements for medical back-up to support her or his midwifery practice; and

(6) Having current arrangements for:

a. Prenatal laboratory testing;

b. Newborn metabolic screening; and

c. Any necessary administration of Rh(D) immune globulin.

(e) Application procedures shall be:

(1) Submission of the completed recertification application form described in Mid 403.05; and

(2) Submitting, or arranging for the submission of, the following materials:

a. If the recertification applicant practiced in another state regulating the practice of midwifery during the lapse of the New Hampshire certificate:

A photocopy of the front and back of each license or certificate authorizing the practice of midwifery issued by such other state, whether or not still in effect; and
An official letter of verification sent directly to the council from each such state indicating whether:

i. The authorization is or was, during its period of validity, in good standing, and

ii. Any disciplinary action taken against the applicant;

b. Documentation in accordance with Mid 406 of the completion of 20 contact hours of continuing education within the 24 months just preceding the application for recertification;

c. A statement for each peer review in which the midwife, within 24 months just preceding the submission of the application for recertification, either participated in the review or presented a case for review, including;

The midwife's name;
The date of the peer review meeting;
The name of the midwife presenting the midwifery case for peer review;
The topic of the case presented for peer review;
Whether attendance was recorded in minutes of the peer review meeting; and
If attendance was not recorded in minutes of the meeting, the names of at least 2 other participating midwives;

d. A copy of:

The front and back of the midwife's current cardiopulmonary resuscitation certificate, known as basic life skills for healthcare providers, issued by the American Heart Association; or
The front and back of the midwife's current certificate in adult cardiopulmonary resuscitation issued by the American Red Cross together with the midwife's current certificate in infant and child cardiopulmonary resuscitation issued by the American Red Cross;

e. A copy of the front and back of the midwife's current NRP provider card; and

f. If applicable, a notarized affidavit disclosing criminal convictions occurring since the midwife was last certified.

History

#9089, eff 2-20-08, EXPIRED: 2-20-16
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16

N.H. Code Admin. R. Ann. Mid 403.05 Application Form for Recertification After Lapse of the Certificate to Practice Midwifery {#sec-mid-403.05 omnilex-key=us-nh-regs-official--agency-mid--Mid 403.05}

(a) An applicant for recertification after lapse of his or her certificate shall:

(1) Legibly complete the “Recertification After Lapse of the Certificate to Practice Midwifery” application form, effective 10/2016, furnished by the midwifery council;

(2) Complete all sections of the recertification application form or designate them as not applicable;

(3) Date the recertification application form; and

(4) Sign the recertification application form in accordance with (b) below.

(b) An applicant for recertification shall:

(1) Place his or her signature below the following statement preprinted on the recertification application form:

"The information provided on the recertification application form and the documentation provided to support the recertification application are, to the best of my knowledge and belief, true, accurate, complete and unaltered. I acknowledge that, pursuant to RSA 641:3, the knowing making of a false statement on the recertification application form is punishable as a misdemeanor"; and

(2) Place the date next to the signature.

(1) States that, to the best of his or her knowledge and belief, the information provided on the recertification application form and the documentation provided to support the recertification application are accurate, complete and unaltered; and

(2) Acknowledges that, pursuant to RSA 641:3, the knowing making of a false statement on the recertification application form is punishable as a misdemeanor.

History

#9089, eff 2-20-08, EXPIRED: 2-20-16
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16

N.H. Code Admin. R. Ann. Mid 403.06 Recertification of Midwives Ineligible for Recertification Under Mid 403.04 {#sec-mid-403.06 omnilex-key=us-nh-regs-official--agency-mid--Mid 403.06}

For midwives not eligible for recertification under Mid 403.04 because they do not meet the recency of practice requirements of Mid 403.04(b), the midwifery council shall reinstate a certificate if the applicant for recertification:

(a) Has been provisionally certified pursuant to Mid 403.07; and

(b) Within 78 weeks of having been provisionally certified has met the supervised midwifery practice requirements set forth in Mid 403.08 and Mid 403.09.

History

#9089, eff 2-20-08, EXPIRED: 2-20-16
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16

N.H. Code Admin. R. Ann. Mid 403.07 Provisional Certification {#sec-mid-403.07 omnilex-key=us-nh-regs-official--agency-mid--Mid 403.07}

(a) The council shall provisionally certify a midwife who:

(1) Has met the eligibility requirements of Mid 403.04(a);

(2) Has completed the application process set forth in Mid 403.04(b);

(3) Has updated his or her skills by:

a. Performing the observations described in (b) below; or

b. Gaining the practice experience described in (c) below; and

(4) Has, within 30 days of updating his or her skills as required by (3) above, documented the observations or practice experience in accordance with (d) below.

(b) Observation to update skills:

(1) Shall consist in:

a. The observation of at least 2 out-of-hospital births attended by a New Hampshire certified midwife, a CNM, or a midwife authorized to practice in another state regulating the practice of midwifery; and

b. The observation of at least 2 sets of client visits by a New Hampshire certified midwife, a CNM or a midwife authorized to practice in another state regulating the practice of midwifery:

Each set consisting in at least 2 prenatal visits and one postpartum visit; and
At least one of the sets consisting in visits with the client whose out-of-hospital birth was also observed; and

(2) Shall be performed once for every year or part of a year that the New Hampshire certificate has been expired, provided that the total number of observations shall not exceed 6.

(1) Shall consist in acting, under licensure, certification, or other authorization, as the primary midwife for a client located in another state regulating the practice of midwifery; and

(2) Shall be performed once for every year or part of a year that the New Hampshire certificate has been expired provided that the total number of practice experiences shall not exceed 6.

(d) Documentation of the updating of skills shall be:

(1) If the updating of skills is through observation as described in (b) above, for each observation a letter signed by the midwife being observed or by the midwife's client, stating:

a. The kind of visit observed;

b. The date of the observation;

c. For the midwife observed:

His or her name; and
The state and number of his or her certificate, license or other authorization to practice midwifery;

d. The client's name, if the client agrees to its use for this purpose; and

e. The town and state of the out-of-hospital birth; and

(2) If the updating of skills is through practice experience as described in (c) above, for each instance of acting as the primary midwife:

a. A photocopy of the certificate, license, or other authorization to practice issued by the state in which he or she acted as primary midwife; and

b. A letter signed by the client, stating:

The client's name;
The town and state of the out-of-hospital birth; and
The beginning and ending dates of the midwife's care for the client.

(e) A provisional certificate shall be valid for no more than 78 weeks from the date of its issuance.

History

#9089, eff 2-20-08, EXPIRED: 2-20-16
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16

N.H. Code Admin. R. Ann. Mid 403.08 Practice by a Provisionally Certified Midwife {#sec-mid-403.08 omnilex-key=us-nh-regs-official--agency-mid--Mid 403.08}

(a) A provisionally certified midwife shall practice:

(1) Only under supervision; and

(2) Only as long as the provisional certificate is valid.

(b) A provisionally certified midwife seeking full recertification shall:

(1) While provisionally certified, complete the supervised practice required by (c) and (d) below;

(2) Before beginning such supervised practice, and each time that he or she has a new supervisor, submit to the midwifery council the signed supervisor's letter described in Mid 403.09(d); and

(3) After completion of the supervised practice, submit to the midwifery council proof of such completion in accordance with (e) below.

(1) For the number of New Hampshire clients determined in accordance with (d) below; and

(2) Do so under the supervision described in Mid 403.09.

(d) The number of New Hampshire clients for which a provisionally certified midwife shall act as the primary midwife shall be as follows:

(1) A minimum of one client for every 5-year period or fraction of a 5-year period, provided that a total of 6 clients shall be sufficient, if the provisionally certified midwife practiced midwifery in another state regulating the practice during the period the New Hampshire certificate was expired; or

(2) The following number of clients, if the provisionally certified midwife did not practice midwifery in another state during the period the New Hampshire certificate was expired:

a. At least one client if, before the expiration of the New Hampshire certificate, the midwife had practiced in New Hampshire for 4 years or more; and

b. At least 2 clients if, before the expiration of the New Hampshire certificate, the midwife had practiced in New Hampshire for fewer than 4 years.

(e) As proof of having completed the required supervised practice, a provisionally certified midwife shall submit to the midwifery council:

(1) A signed and dated letter reporting for each instance in which the provisionally certified midwife acted as the primary midwife:

a. The name of the client;

b. The address of the client;

c. The beginning and ending dates of the period during which he or she acted as the primary midwife; and

d. The name of the supervising midwife;

(2) A written statement that the supervised practice was in compliance with Mid 403.08 and Mid 403.09; and

(3) If the midwife acted as the primary midwife for the number of clients called for by (d)(1) above, a written statement:

a. Describing the extent of his or her out-of-state practice; and

b. Including his or her other-state license or certificate number(s).

History

#9089, eff 2-20-08, EXPIRED: 2-20-16
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16

N.H. Code Admin. R. Ann. Mid 403.09 Supervision of Midwifery Practiced by a Provisionally Licensed Midwife {#sec-mid-403.09 omnilex-key=us-nh-regs-official--agency-mid--Mid 403.09}

(a) Supervision of a provisionally licensed midwife fulfilling the supervised practice requirements of Mid 403.08 shall be by a midwife who is a:

(1) Currently certified New Hampshire midwife; or

(2) Currently certified CNM with a practice consisting of out-of-hospital births.

(b) A supervisor shall be present and intervene as necessary during:

(1) Each out-of-hospital birth; and

(2) During all other contacts between the provisionally licensed midwife and the client.

(1) The health of the mother, the fetus, and the newborn; and

(2) The provisionally certified midwife's compliance with Mid 500.

(d) Before beginning to supervise a provisionally certified midwife, each supervisor shall provide the provisionally certified midwife with a signed letter including:

(1) The supervisor's name and address;

(2) The supervisor's:

a. New Hampshire certificate number and date of expiration; or

b. CNM certificate number and date of expiration;

(3) If the supervisor is a CNM, the statement that her or his practice consists of out-of-hospital births; and

(4) The statement that she or he is familiar with the requirements of Mid 403.08 and Mid 403.09 and will comply with them.

History

#9089, eff 2-20-08, EXPIRED: 2-20-16
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16

Part Mid 404 Revocation, Suspension and Other Sanctions

N.H. Code Admin. R. Ann. Mid 404.01 Definitions {#sec-mid-404.01 omnilex-key=us-nh-regs-official--agency-mid--Mid 404.01}

In Mid 404 the following terms shall have the following meanings:

(a) "Private reprimand" means a written reprimand of a midwife by the midwifery council; and

(b) "Public reprimand" means a written reprimand of a midwife by the midwifery council together with notification to New Hampshire certified midwives of such reprimand.

History

#9090, eff 2-20-08, EXPIRED: 2-20-16
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16

N.H. Code Admin. R. Ann. Mid 404.02 Misconduct {#sec-mid-404.02 omnilex-key=us-nh-regs-official--agency-mid--Mid 404.02}

(a) Pursuant to RSA 326-D:8, II, misconduct shall be:

(1) The practice of fraud or deceit in procuring or attempting to procure certification;

(2) Conviction of any crime demonstrating unfitness to practice midwifery, as further set forth in (b) below;

(3) Demonstrable gross incompetence of the certificate holder, as evidenced by a violation of Mid 500 resulting in harm to the mother, the fetus, or the newborn;

(4) Addiction to the use of alcohol or other habit-forming drugs to a degree which renders the certificate holder unfit to practice;

(5) A legal finding of mental incompetence;

(6) Willful or repeated violation of RSA 326-D; and

(7) Suspension or revocation without subsequent reinstatement of certification in another jurisdiction.

(b) Crimes demonstrating unfitness to practice midwifery shall be crimes involving theft, injury to others, physical, or emotional exploitation of others and violence towards others.

History

#9090, eff 2-20-08, EXPIRED: 2-20-16
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16

N.H. Code Admin. R. Ann. Mid 404.03 Sanctions {#sec-mid-404.03 omnilex-key=us-nh-regs-official--agency-mid--Mid 404.03}

(a) Pursuant to RSA 326-D:8, III, disciplinary measures available to the council to sanction misconduct shall be:

(1) Revocation of certification;

(2) Public or private reprimand;

(3) Suspension, limitation, or restriction of certification, as further set forth in (b) below; and

(4) The assessment of administrative fines in amounts not exceeding $2,000 per offense, or in the case of a continuing offense, $250 for each day the violation continues.

(b) Suspension, limitation and restriction of certification shall include:

(1) Suspension of certification for a specified period of time, the period to be determined in accordance with Mid 404.05;

(2) Suspension of certification pending the achievement of specified competence requirements, specified continuing education, or specified clinical experience;

(3) Suspension of certification pending successful participation in:

a. A specified mental or physical health treatment program;

b. A specified rehabilitative program;

c. Specified counseling;

d. A specified professional assistance program; or

e. Any other program designed to overcome the deficiency or condition in the certificate holder which appears to have caused the misconduct; and

(4) The requirement that another midwife currently certified by the council supervise the practice of the certificate holder for a specified period of time, the period to be determined in accordance with Mid 404.05.

History

#9090, eff 2-20-08, EXPIRED: 2-20-16
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16

N.H. Code Admin. R. Ann. Mid 404.04 Procedure for Imposition of Sanctions {#sec-mid-404.04 omnilex-key=us-nh-regs-official--agency-mid--Mid 404.04}

Other than the immediate suspension of certification authorized by RSA 541-A:30, III, the council shall impose disciplinary sanctions only:

(a) After prior notice to the certificate holder in accordance with Mid 207.01 and the opportunity for the certificate holder to be heard; or

(b) By agreement in a settlement between the council and the certificate holder made pursuant to Mid 213.

History

#9090, eff 2-20-08, EXPIRED: 2-20-16
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16

N.H. Code Admin. R. Ann. Mid 404.05 Determinations Required for Sanctions {#sec-mid-404.05 omnilex-key=us-nh-regs-official--agency-mid--Mid 404.05}

(a) In determining which sanction or combination of sanctions to impose, the council shall:

(1) First determine the nature of the act or omission constituting the misconduct done by the certificate holder;

(2) Next determine whether the misconduct has one or more of the characteristics listed in (b) below; and

(3) Finally, apply the standards in (c) below.

(b) The characteristics shall be:

(1) The misconduct actually caused physical or mental harm to the mother or the newborn;

(2) The misconduct had the potential to cause physical or mental harm to the mother or the newborn;

(3) The misconduct repeated earlier misconduct done by the certificate holder, as determined by:

a. An earlier hearing;

b. An earlier settlement agreement predicated on the same misconduct by the certificate holder; or

c. An admission by the certificate holder;

(4) The misconduct was not the first misconduct by the certificate holder, as determined by:

a. An earlier hearing;

b. An earlier settlement agreement predicated on misconduct by the certificate holder; or

c. An admission by the certificate holder; and

(5) The misconduct was intentional rather than the result of negligence or inadvertence.

(1) From the list in Mid 404.03; and

(2) By choosing, in light of the characteristics determined pursuant to (b) above, the sanction most likely to:

a. Protect public health and safety;

b. Prevent future misconduct by the certificate holder;

c. Take into account any acknowledgement of fault by the certificate holder and any cooperation by the certificate holder with the council's investigation of misconduct;

d. Correct any attitudinal, educational, or other deficiencies which led to the misconduct of the certificate holder;

e. Encourage the responsible practice of midwifery; and

f. Demonstrate to the certificate holder and the public the council's intention to insure that those certified by the council practice in accordance with applicable law and the public welfare.

(d) When imposing an administrative fine pursuant to Mid 404.03(a)(4), the council shall determine the amount of the fine by applying the standards in (c)(2) above.

History

#9090, eff 2-20-08, EXPIRED: 2-20-16
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16

Part Mid 405 Continuing Education

N.H. Code Admin. R. Ann. Mid 405.01 Continuing Education Requirements {#sec-mid-405.01 omnilex-key=us-nh-regs-official--agency-mid--Mid 405.01}

(a) For eligibility to renew certification a midwife shall complete continuing education requirements by completing 20 contact hours of continuing education per renewal period in accordance with (b)-(d) below.

(b) Continuing education activities shall improve or maintain a midwife's professional competence in midwifery as defined in Mid 102.01(b).

(c) Unless otherwise specified in Mid 405, at least 12 of the 20 contact hours shall be earned through participation in academic or other courses, classes, seminars, workshops, distance learning courses, or journal study described in Mid 405.02.

(d) Any contact hours not earned in accordance with (c) above shall be earned through participation in the following activities in midwifery-related fields:

(1) Informal independent study, as further described in Mid 405.03;

(2) Publication of the midwife's own writing, as further described in Mid 405.04;

(3) Public professional presentations, as further described in Mid 405.05;

(4) Teaching midwifery, as further described in Mid 405.06;

(5) Participation in the work of midwifery-related professional boards or committees and participation in the work of midwifery-related governmental regulatory agencies, as further described in Mid 405.07; or

(6) Product development, as further described in Mid 405.08.

History

#8840, eff 3-13-07, EXPIRED: 3-13-15
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16

N.H. Code Admin. R. Ann. Mid 405.02 Participation in Courses, Classes, Seminars, Workshops, Distance Learning Courses and Journal Study {#sec-mid-405.02 omnilex-key=us-nh-regs-official--agency-mid--Mid 405.02}

(a) The council shall recognize as continuing education a midwife's completion of any academic or other courses, classes, seminars, workshops, and distance learning:

(1) In a midwifery-related field; and

(2) Accredited or given by an academic institution or other entity which is accredited by:

a. Midwives Education Accreditation Council;

b. Middle States Association of Colleges and Schools;

c. New England Association of Schools and Colleges;

d. North Central Association of Colleges and Schools;

e. Northwest Commission on Colleges and Universities;

f. Southern Association of Colleges and Schools;

g. Western Association of Schools and Colleges;

h. American College of Nurse-Midwives;

i. Accreditation Council for Continuing Medical Education;

j. National League for Nursing Accrediting Commission;

k. American Nurses Credentialing Center's Commission on Accreditation;

l Commission on Continuing Education of the New Hampshire Nurses Association;

m. National Certification Corporation of Obstetrical, Gynecological and Neonatal Nursing;

n. American Academy of Nurse Practitioners;

o. International Childbirth Education Association;

p. International Board of Lactation Consultants Examiners;

q. National Board for Certified Counselors;

r. American Dietetic Association;

s. The American Association of Nurse Practitioners; or

t. Any other entity approved by the council.

(b) The midwifery council shall credit the midwife with completing any academic courses taken at an academic institution with one contact hour for each clock hour of coursework, provided that it shall credit a maximum of 12 contact hours for a single academic course.

(c) The midwifery council shall credit the midwife with completing any courses, classes, seminars, workshops, and distance learning courses other than academic courses taken at an academic institution with the contact hours attributed to them by the sponsor or provider, provided that it shall credit a maximum of 12 contact hours for a single such course, class, seminar, workshop, or distance learning course.

(d) The midwifery council shall recognize as continuing education a midwife's journal study in a midwifery-related field provided that the journal study is:

(1) Accredited, sponsored, or provided by an academic institution or other entity accredited by one of the organizations listed in (a)(2) above; and

(2) Requires:

a. Reading a journal article in a midwifery-related field;

b. Completing a test on the article;

c. Submitting the test for scoring by the journal study program sponsor or provider; and

d. Receiving a certificate from the journal study program sponsor or provider which meets the requirements of Mid 406.01(c).

(e) The midwifery council shall credit the midwife with the contact hours attributed to the journal study by its sponsor or provider.

History

#8840, eff 3-13-07, EXPIRED: 3-13-15
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16; amd by #12660, eff 11-5-18

N.H. Code Admin. R. Ann. Mid 405.03 Informal Independent Study {#sec-mid-405.03 omnilex-key=us-nh-regs-official--agency-mid--Mid 405.03}

(a) The midwifery council shall recognize informal independent study in midwifery as continuing education.

(b) Informal independent study shall include:

(1) Reading midwifery-related books and journals;

(2) Viewing midwifery-related videotapes, digital video discs, or live streaming video programs; and

(3) Listening to audio recordings.

(c) The midwifery council shall credit the midwife with one contact hour for every 2 clock hours of informal independent study, to a maximum of 4 contact hours, provided that the midwife writes a report of the major theses of the book, journal, videotape, or digital video disc.

History

#8840, eff 3-13-07, EXPIRED: 3-13-15
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16

(a) The midwifery council shall recognize as continuing education the publication of writing related to midwifery written in part or in whole by the midwife, including the publication of books, chapters of books, and articles, provided that no more than 2 publications shall be credited during any licensing renewal period.

(b) For the publication or co-publication of a book the midwifery council shall:

(1) Credit the midwife with 12 contact hours; and

(2) Require that only 8 of the required 20 contact hours shall be earned through participation in academic or other courses, classes, seminars, workshops or distance learning courses described in Mid 405.02.

(c) For the publication or co-publication of a chapter of a book or an article the midwifery council shall credit the midwife with 4 contact hours.

History

#8840, eff 3-13-07, EXPIRED: 3-13-15
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16

N.H. Code Admin. R. Ann. Mid 405.05 Public Professional Presentations Relating to Midwifery {#sec-mid-405.05 omnilex-key=us-nh-regs-official--agency-mid--Mid 405.05}

(a) The midwifery council shall recognize a midwife's public professional presentations relating to midwifery as continuing education.

(b) The midwifery council shall credit the midwife with 2 contact hours for each clock hour of a public presentation, to a maximum of 4 contact hours, provided that, if the midwife gives substantially the same public presentation more than once, the council shall credit the midwife for only a single presentation.

History

#8840, eff 3-13-07, EXPIRED: 3-13-15
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16

N.H. Code Admin. R. Ann. Mid 405.06 Teaching Midwifery {#sec-mid-405.06 omnilex-key=us-nh-regs-official--agency-mid--Mid 405.06}

(a) The midwifery council shall recognize as continuing education a midwife's teaching a midwifery course at:

(1) A college or university accredited by an accreditor listed in Mid 405.02(a)(2); or

(2) A conference or other event:

a. Offering contact hour credit for the course taught; and

b. Approved by an accreditor listed in Mid 405.02(a)(2).

(b) The midwifery council shall credit the midwife with 2 contact hours for each clock hour of teaching, to a maximum of 4 contact hours, provided that, if the midwife gives substantially the same course more than once, the council shall credit the midwife for only a single presentation of the course.

History

#8840, eff 3-13-07, EXPIRED: 3-13-15
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16

(a) The midwifery council shall recognize as continuing education the participation by a midwife in the work of midwifery-related professional boards or committees and participation by a midwife in the work of midwifery-related governmental regulatory agencies.

(b) The midwifery council shall credit the midwife with 2 contact hours for each board, committee or governmental regulatory agency served, to a maximum of 4 contact hours.

History

#8840, eff 3-13-07, EXPIRED: 3-13-15
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16

N.H. Code Admin. R. Ann. Mid 405.08 Product Development {#sec-mid-405.08 omnilex-key=us-nh-regs-official--agency-mid--Mid 405.08}

(a) The midwifery council shall recognize as continuing education the development, co-development or re-development of a product related to midwifery, provided that the product is distributed or disseminated by a manufacturer, distributor, publisher, or government agency.

(b) The midwifery council shall credit the midwife for the development, co-development, or re-development of substantially the same product only once.

(c) The midwifery council shall credit the applicant with 4 contact hours for the development, co-development, or redevelopment of a product described in (a) above, to a maximum of 4 contact hours.

History

#8840, eff 3-13-07, EXPIRED: 3-13-15
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16

Part Mid 406 Documentation of Continuing Education

N.H. Code Admin. R. Ann. Mid 406.01 Participation in Courses, Classes, Seminars, Workshops, Distance Learning Courses and Journal Study {#sec-mid-406.01 omnilex-key=us-nh-regs-official--agency-mid--Mid 406.01}

Documentation of participation in courses, classes, seminars, workshops, and distance learning courses as described in Mid 405.02 shall be:

(a) For academic courses:

(1) A photocopy of an official transcript showing the date of the course and its successful completion;

(2) Either the description of the course copied from the institution's catalogue or the course syllabus; and

(3) The midwife's written statement of the number of hours that the midwife participated in the course;

(b) For all other courses, classes, seminars, workshops, and distance learning courses, a photocopy of a certificate or other confirmation of attendance or participation showing:

(1) The midwife's name;

(2) The name of the course, class seminar, or workshop;

(3) The name of the accrediting agency from the list in Mid 405.02(a)(2);

(4) The beginning and end dates(s) of the course, class, seminar, workshop or distance learning course; and

(5) The number of contact hours credited by the provider or sponsoring entity; and

(1) The midwife's name;

(2) The name of the journal study program;

(3) The name of the accrediting agency from the list in Mid 405.02(a)(2);

(4) The date that the certificate was issued; and

(5) The number of contact hours credited by the journal study program sponsor or provider.

History

#8840, eff 3-13-07, EXPIRED: 3-13-15
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16

N.H. Code Admin. R. Ann. Mid 406.02 Informal Independent Study {#sec-mid-406.02 omnilex-key=us-nh-regs-official--agency-mid--Mid 406.02}

(a) Documentation of informal independent study shall include:

(1) The applicant's signed written statement setting forth, for each item read or listened to, or videotape or digital video disc viewed:

a. The title of the item read or viewed;

b. The author and publisher of the item read or the producer of the item viewed;

c. The clock hours spent in reading or viewing; and

d. The date of completion of the reading or viewing; and

(2) The applicant's one-page, double-spaced report, in 12 point Times New Roman font, of the major thesis or theses of the item read or viewed describing how it applies to midwifery.

(b) The effect of the signature required by (a)(1) above shall be to assert the accuracy of the information provided.

History

#8840, eff 3-13-07, EXPIRED: 3-13-15
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16

Documentation of publication of writing related to midwifery written in part or in whole by the midwife shall be any materials showing:

(a) The title of the writing;

(b) The date of publication; and

History

#8840, eff 3-13-07, EXPIRED: 3-13-15
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16

N.H. Code Admin. R. Ann. Mid 406.04 Public Professional Presentations Relating to Midwifery {#sec-mid-406.04 omnilex-key=us-nh-regs-official--agency-mid--Mid 406.04}

Documentation of public professional presentations relating to midwifery shall include:

(a) A copy of the official program of the presentation; or

(b) Written verification signed by a representative of the program's sponsor showing:

(1) The title of the presentation;

(2) The name of the midwife as presenter;

(3) The date of the presentation;

(4) The hours during which the presentation took place; and

(5) The type of audience attending the presentation.

History

#8840, eff 3-13-07, EXPIRED: 3-13-15
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16

N.H. Code Admin. R. Ann. Mid 406.05 Teaching Midwifery {#sec-mid-406.05 omnilex-key=us-nh-regs-official--agency-mid--Mid 406.05}

Documentation of midwifery teaching shall include:

(a) The name of the course(s) taught; and

(b) A letter of confirmation signed by an official of the institution sponsoring the courses.

History

#8840, eff 3-13-07, EXPIRED: 3-13-15
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16

(a) Documentation of participation in the work of midwifery-related professional boards, professional committees, and governmental regulatory agencies shall include a letter conforming to (b) below and issued by:

(1) The authority appointing the midwife to the board, committee, or agency; or

(2) The board, committee, or agency served by the midwife.

(b) The letter shall state:

(1) The appointment to the board, committee, or agency; or

(2) The following information:

a. The fact of the midwife's participation; and

b. The beginning and ending dates of the midwife's service.

History

#8840, eff 3-13-07, EXPIRED: 3-13-15
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16

N.H. Code Admin. R. Ann. Mid 406.07 Product Development {#sec-mid-406.07 omnilex-key=us-nh-regs-official--agency-mid--Mid 406.07}

Documentation of product development shall be a letter written by a representative of the distributor or disseminator on the letterhead of the distributor or disseminator:

(a) Describing the product; and

(b) Acknowledging the midwife as the developer or co-developer.

History

#8840, eff 3-13-07, EXPIRED: 3-13-15
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16

Part Mid 407 Ongoing Requirements

N.H. Code Admin. R. Ann. Mid 407.01 Reporting Significant Morbidity and Mortality {#sec-mid-407.01 omnilex-key=us-nh-regs-official--agency-mid--Mid 407.01}

(a) Significant morbidity shall be reported when hospitalization lasts longer than 48 hours or the illness, injury, or morbidity not captured by hospitalization occurs within 6 weeks of the date of the birth; and

(b) A midwife shall submit a “Significant Morbidity and Mortality Report Form” described in Mid 407.02 to the board through the office of professional licensure and certifications within 10 days of a significant morbidity and mortality incident.

History

#8840, eff 3-13-07, EXPIRED: 3-13-15
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16; ss by #13611, eff 6-13-23

N.H. Code Admin. R. Ann. Mid 407.02 Significant Morbidity and Mortality Report Form {#sec-mid-407.02 omnilex-key=us-nh-regs-official--agency-mid--Mid 407.02}

When reporting an incident of maternal or neonatal significant morbidity or mortality, a midwife shall provide the following information on the “Significant Morbidity and Mortality Report Form” provided by the midwifery council and available on the boards web site, https://www.oplc.nh.gov/midwifery-council-forms-and-documents:

(a) The name of the midwife;

(b) The Midwife’s address;

(d) The midwife’s certification number;

(e) The name of the client;

(f) The client’s address and phone number;

(g) The client’s date of birth;

(h) The newborn’s name and date of birth, if applicable;

(i) The location of the incident of significant morbidity or mortality;

(j) If the client or newborn was transferred to a hospital:

(1) A detailed description of the reason for the transfer of the care of the client or newborn to the hospital;

(2) The name and location of the hospital to which the care of the client or newborn was transferred and the phone number of the hospital’s medical records department;

(3) The date and time of the call for transportation to the hospital;

(4) The date and time the client or newborn arrived at the hospital; and

(5) The means of transportation to the hospital;

(k) A detailed description of the maternal illness, injury, or morbidity, and outcome;

(l) A detailed description of the newborn’s illness, injury, or morbidity, and outcome;

(m) A detailed description of any additional significant concerns or information; and

(n) The midwife’s signature and date of signing.

History

#8840, eff 3-13-07, EXPIRED: 3-13-15
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16; ss by #13611, eff 6-13-23

N.H. Code Admin. R. Ann. Mid 407.03 Record of Client Care {#sec-mid-407.03 omnilex-key=us-nh-regs-official--agency-mid--Mid 407.03}

(a) A midwife shall establish and maintain a record of the care provided and the data gathered for each client and newborn.

(b) Each client’s record shall contain the following information, as applicable:

(1) The client's identification information including:

a. Name;

b. Address;

c. Telephone number;

d. Date of birth;

e. Marital status;

f. Name of spouse or partner, if any; and

g. Emergency contact person;

(2) The client’s health history;

(3) Notes documenting the midwife's actions and guidance during personal and telephone contacts between:

a. The client and the midwife; and

b. The client’s spouse or partner and the midwife;

(4) The dates and findings of:

a. Prenatal care given pursuant to Mid 502.03(a); and

b. Extended postpartum care given pursuant to Mid 502.07;

(5) Results of consultations with physicians or other health care providers;

(6) Laboratory and diagnostic reports;

(7) Documentation of all medications administered to the client;

(8) The signed originals of all forms required by these rules or other law to be signed by the client;

(9) The name and phone number of the health care provider chosen by the client to care for the newborn;

(10) Contemporaneously recorded details of the labor, the birth and the immediate postpartum period, annotated with the date and time for each entry;

(11) The midwife's written summary of the most important facts of the labor, the birth, and the assessment of the newborn; and

(12) The reasons for any transfer of the client's care.

(c) A midwife shall, with the written consent of the client, provide the newborn’s health care provider with a copy of the summary required by (b)(11) above.

(d) A midwife shall retain each client’s records for the longer of the following:

(1) A period of 21 years from the date of birth of a baby born while the client was in the care of the midwife; or

(2) A period of 7 years from the date of the midwife's last contact with the client if no baby was born while the client was in the care of the midwife.

History

#8840, eff 3-13-07, EXPIRED: 3-13-15
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16

N.H. Code Admin. R. Ann. Mid 407.04 Maintenance of Practice Data {#sec-mid-407.04 omnilex-key=us-nh-regs-official--agency-mid--Mid 407.04}

A midwife shall record and maintain in her records the following practice data:

(a) Each out-of-hospital birth attended as midwife to a client;

(b) Each out-of-hospital birth attended in the capacity of an assistant to another midwife;

(c) Each transfer of a client to the hospital, whether the transfer was made during the intrapartum period or the postpartum period;

(d) Each transfer of a newborn to the hospital; and

(e) Each of the following events, together with the date that the event was reported to the council pursuant to Mid 407.01:

(1) Maternal mortality;

(2) Significant maternal morbidity;

(3) Neonatal mortality; and

(4) Significant neonatal morbidity.

History

#8840, eff 3-13-07, EXPIRED: 3-13-15
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16

N.H. Code Admin. R. Ann. Mid 407.05 Reporting and Other Administrative Requirements {#sec-mid-407.05 omnilex-key=us-nh-regs-official--agency-mid--Mid 407.05}

A midwife shall:

(a) Inform the midwifery council of a principal address to which official council communications shall be directed;

(b) Inform the council of all business addresses where the midwife is practicing;

(d) Display the midwife's current midwifery certificate at the midwife's principal place of business, and a copy at any other place of business;

(e) Inform the midwifery council within 30 days of becoming aware of any:

(1) Disciplinary charges pending or disciplinary action taken against the midwife by any licensing authority, medical council, health care facility, or professional midwifery association;

(2) Suspension from employment or appointment in a hospital, clinic, or other health care facility;

(3) Voluntary surrender by the midwife of a certificate, license, registration or permit to practice midwifery, or other healing art in lieu of facing disciplinary action;

(4) Revocation, suspension, or other termination on disciplinary grounds of a professional certificate, license, registration, or permit to practice in a field other than midwifery;

(5) Decisions adverse to the midwife made in civil actions or on insurance claims; or

(6) Emotional disturbance, mental illness, organic illness, or addictive disorder which impairs the midwife’s ability to practice midwifery.

History

#8840, eff 3-13-07, EXPIRED: 3-13-15
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16

N.H. Code Admin. R. Ann. Mid 407.06 Confidentiality of Client Information and Records {#sec-mid-407.06 omnilex-key=us-nh-regs-official--agency-mid--Mid 407.06}

A midwife shall hold confidential all communications with a client, information obtained from the client, and the contents of the client's record unless the client has given written consent to the release of such information.

History

#8840, eff 3-13-07, EXPIRED: 3-13-15
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16

N.H. Code Admin. R. Ann. Mid 407.07 Compliance with Laws {#sec-mid-407.07 omnilex-key=us-nh-regs-official--agency-mid--Mid 407.07}

A midwife shall comply with applicable New Hampshire laws, including but not limited to:

(a) The requirements of RSA 332-I relating to medical records and patient information;

(b) Rules of the bureau of vital records regarding the reporting of births;

(d) The reporting requirements of RSA 132:6, II and any rules relating to prevention of eye inflammation which have been adopted by the commissioner of the department of health and human services; and

(e) The requirements of RSA 132:10-a and RSA 132:10-aa relating to newborn screening tests.

APPENDIX

Rule

Specific State Statute the Rule Implements

Mid 401

RSA 541-A:7

Mid 402.01-Mid 402.03(b)

RSA 326-D:6, II, RSA 326-D:11, RSA 326-D:5, I(e)

Mid 402.03(c)

RSA 326-D:4, I(b), RSA 326-D:6, II

Mid 402.04

RSA 541-A:16, I(b)

Mid 402.05-Mid 402.06

RSA 326-D:6, II, RSA 326-D:11

Mid 402.07(a) and (b)

RSA 326-D:5, I(e)

Mid 402.07(c) and (d)

RSA 326-D:6, II, RSA 326-D:11

Mid 402.07(e)

RSA 326-D:7, IV

Mid 403.01

RSA 541-A:7

Mid 403.02 through Mid 403.09

RSA 326-D:5, I(d)

Mid 404.01

RSA 541-A:7

Mid 404.02

RSA 326-D:8, II

Mid 404.03

RSA 326-D:8, III

Mid 404.04 and Mid 404.05

RSA 541-A:16, I.(b)

Mid 405-Mid 406

RSA 326-D:11, RSA 326-D:5, I(e)

Mid 407

RSA 326-D:5, I(j)

Mid 407.01

RSA 326-D:5, I(i)

Mid 407.02

RSA 326-D:5, I(i)

History

#8840, eff 3-13-07, EXPIRED: 3-13-15
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16

Chapter Mid 500 Scope of Midwifery Practice

Part Mid 501 Definitions

N.H. Code Admin. R. Ann. Mid 501.01 Definitions {#sec-mid-501.01 omnilex-key=us-nh-regs-official--agency-mid--Mid 501.01}

(a) “The American College of Obstetricians and Gynecologists (ACOG)” means a fellowship of physicians with special interest in obstetrics and gynecology and the promotion of women’s reproductive health care.

(b) “Apgar assessment” means an evaluation of the newborn based on an assessment of the heart rate, respiration, reflexes, color, and muscle tone, performed at intervals of one minute and 5 minutes after birth.

(d) “Central cyanosis” means a bluish discoloration of the skin and mucous membranes involving the whole body and resulting from a lack of oxygen in the blood.

(e) “Cervical insufficiency” means the premature painless dilatation of the cervix after the first trimester and typically before 24 weeks gestation, which, without medical intervention, is often associated with repeated second trimester spontaneous abortion.

(f) “Community birth” means a home birth or a birth in a freestanding birth center.

(g) “Chronic hypertension” means elevated blood pressures diagnosed or present before pregnancy or before 20 weeks gestation. Elevated blood pressures are defined at systolic blood pressure (sBP) 140 mm Hg or more, or diastolic blood pressure (dBP) 90 mm Hg or more on 2 occasions at least 4 hours apart.

(h) “Extended postpartum period” means the period from the birth of the newborn to 6 weeks after the birth.

(i) “Fetal heart auscultation” means listening to the fetal heartbeat through the abdominal and uterine walls of the client.

(j) “Freestanding birth center” means an out-patient maternity care facility.

(k) “Grand multiparity” means the condition of having borne 5 or more children.

(l) “High grade squamous intraepithelial lesions (HGSIL)” means squamous cells that are highly suggestive of being pre-cancerous or pre-invasive cancerous.

(m) “Holistic care” means care which attends to the needs of the client in all areas, including physical, emotional, and social.

(n) “Home birth” means a planned home delivery attended by a New Hampshire (NH) certified midwife or a licensed health care provider whose scope of practice includes birth, taking primary responsibility for the care of the client and the newborn.

(o) “Immediate postpartum period” means the period from birth until the midwife determines that client and newborn are in stable condition.

(p) “Intrauterine growth restriction (IUGR)” means ultrasound estimated fetal weight less than the 10th percentile for gestational age.

(q) “Large for gestational age (LGA)” means a newborn weighing more than the 90th percentile for gestational age.

(r) “Macrosomia” means an infant whose birth weight is 4500 grams or 9 pounds 15 ounces or higher.

(s) “Multipara” means a person who has carried a pregnancy 20 weeks or longer at least once prior to the current pregnancy.

(t) “Oligohydramnios” means an abnormally small amount of amniotic fluid during pregnancy.

(u) “Pap test” means a procedure by which cervical cells are collected and tested in a laboratory for pre-cancer and other abnormal conditions.

(v) “Placenta previa” means the condition whereby the placenta is implanted in the lower portion of the uterus, covering the cervix marginally, partially, or completely.

(w) “Placental abruption” means premature separation of the placenta from the uterine wall.

(x) “Polyhydramnios” means an excess of amniotic fluid during pregnancy.

(y) “Preeclampsia” means a maternal condition of pregnancy occurring at or after 20 weeks 0 days of gestation or postpartum in which the person has a systolic blood pressure of 140 mm Hg or more or diastolic blood pressure of 90 mm Hg or more on 2 occasions 4 hours apart plus proteinuria of 300 mg or more on the 24-hours collection or protein, creatinine ratio of 0.3, or more or urine dipstick of 2+ protein or more.

(z) “Primigravida” means a person who is pregnant for the first time.

(aa) “Primipara” means a person is carrying a pregnancy beyond 20 weeks for the first time.

(ab) “Postpartum” means occurring after the delivery of the placenta until 6 weeks after childbirth.

(ac) “Rh immune globulin” means a medication used to prevent the development of Rh antibodies in Rh negative pregnant person.

(ad) “Rh sensitivity with positive antibody titre” means the development of Rh antibodies in a pregnant person which might cross the placenta and destroy the red blood cells of an Rh-positive fetus.

(ae) “Severe preeclampsia” means a maternal condition of pregnancy beyond 20 weeks 0 days of pregnancy with new-onset hypertension, even in the absence of proteinuria, with any of the following features:

(1) Systolic blood pressure of 160 mm Hg or more;

(2) Diastolic blood pressure of 110 mm Hg or more;

(3) Thrombocytopenia of less than 100,000;

(4) Renal insufficiency of creatinine of 1.1 mg/dl or higher;

(5) Impaired liver function with liver transaminases (ALT and AST) twice normal or higher, pulmonary edema, or visual disturbances; or

(6) New-onset headache unresponsive to medication.

(af) “Significant postpartum hemorrhage” means blood loss of greater than 1,000 milliliters.

(ag) “Small for gestational age (SGA)” means a newborn weighing less than 5 pounds, 8 ounces, 10th percentile for gestational age.

(ah) “Squamous cells” means flat, scaly cells forming the outer surface of the body and lining the body cavities and the principal tubes and passageways leading to the exterior of the body.

(ai) “Vaginal birth after cesarean (VBAC)” means a vaginal birth after any previous delivery by cesarean section.

History

#7759, eff 9-7-02, EXPIRED: 9-7-10
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16; ss by #14594, eff 7-20-26, EXPIRES: 7-20-36

Part Mid 502 Scope of Practice

N.H. Code Admin. R. Ann. Mid 502.01 Midwifery Care {#sec-mid-502.01 omnilex-key=us-nh-regs-official--agency-mid--Mid 502.01}

Acting autonomously, a midwife shall provide the following supervision, care, and advice, as appropriate, to the client and the newborn:

(a) Counseling and education about:

(1) Conception;

(2) Health and nutrition;

(3) Pregnancy;

(4) Labor and delivery;

(5) Lactation;

(6) Family planning; and

(7) The postpartum period;

(b) Holistic care;

(d) Detection of any abnormal conditions in the client, fetus, and newborn;

(e) Procurement of medical assistance, if necessary;

(f) Execution of emergency measures in the absence of medical help, if necessary; and

(g) Lactation assistance.

History

#7759, eff 9-7-02, EXPIRED: 9-7-10
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16; ss by #14594, eff 7-20-26, EXPIRES: 7-20-36

N.H. Code Admin. R. Ann. Mid 502.02 Midwifery Procedures {#sec-mid-502.02 omnilex-key=us-nh-regs-official--agency-mid--Mid 502.02}

The procedures of midwifery shall include, as appropriate, the following:

(a) Basic physical examination;

(b) Breast examination;

(d) Venipuncture;

(e) Hematocrit and hemoglobin specimen collection;

(f) Capillary blood collection;

(g) Pap smear collection and Human Papillomavirus (HPV) testing, as indicated;

(h) Culture collection;

(i) Urinalysis;

(j) Wet mount specimen collection;

(k) Administration of oxygen to client and newborn;

(l) Urinary bladder catheterization;

(m) Episiotomy;

(n) Neonatal resuscitation;

(o) Repair of tears, lacerations, or episiotomy, infiltration of lidocaine hydrochloride, and use of suture material;

(p) Intramuscular injection of the following medications:

(1) Oxytocins, such as pitocin, and methergine, only for postpartum control of maternal hemorrhage;

(2) Rh immune globulin, if indicated;

(3) Vitamin K for prevention of vitamin K deficiency bleeding (VKDB) and hemorrhagic disease of the newborn; and

(4) Other medications as prescribed by a physician, consistent with the scope of midwifery practice as defined in this chapter;

(q) Oral, buccal, or rectal administration of the following medications:

(1) Methergine, and misoprostol, only for postpartum control of maternal hemorrhage;

(2) Vitamin K, for prevention of acute and late-onset hemorrhagic disease of the newborn;

(3) Oral tranexamic acid for severe postpartum control of maternal hemorrhage; and

(4) Other medications as prescribed by a physician, consistent with the scope of midwifery practice as defined in this chapter;

(r) Intravenous administration of the following:

(1) Lactated ringer’s solutions, with or without D5;

(2) Normal saline (0.9%), with or without D5;

(3) Tranexamic acid only for postpartum control of maternal hemorrhage; and

(4) Other medications as prescribed by a physician, consistent with the scope of midwifery practice as defined in this chapter;

(s) Clamping and cutting of the umbilical cord;

(t) Administration of newborn eye prophylaxis in accordance with RSA 132:6, I;

(u) Metabolic screening of the newborn in accordance with RSA 132:10-a and RSA 132:10-c;

(v) Newborn hearing screening;

(w) Newborn pulse oximetry screening, as required by RSA 132:10-aa; and

(x) Contraception counseling and family planning methods.

History

#7759, eff 9-7-02, EXPIRED: 9-7-10
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16; ss by #14594, eff 7-20-26, EXPIRES: 7-20-36

N.H. Code Admin. R. Ann. Mid 502.03 Requirements for Prenatal Care {#sec-mid-502.03 omnilex-key=us-nh-regs-official--agency-mid--Mid 502.03}

(a) A midwife shall provide prenatal care to a client at least:

(1) Once a month through the twenty-eighth week of pregnancy;

(2) Once every 2 weeks from the twenty-eighth through the thirty-sixth week of pregnancy; and

(3) Once a week from the thirty-sixth week of pregnancy until the onset of labor.

(b) A midwife shall schedule the initial prenatal visit with a client in the first or second trimester of pregnancy.

(c) If a client requesting midwifery care does not contact the midwife before the third trimester of pregnancy, the midwife shall accept the client only if:

(1) A reliable due date can be established by:

a. Determining that one or more of the following conditions are present:

Certainty of the last menstrual period;
Knowledge of the date of conception or ovulation;
Fundal height consistent with menstrual dates; or
Documentation of a first- or second-trimester ultrasound; or

b. Meeting the current guidelines set by:

The American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine, committee opinion on “Methods of Estimating Due Date” Number 700 dated May 2017 and available as indicated in Appendix B; or
The World Health Organization “WHO recommendations on antenatal care for positive pregnancy experience” 2016 publication, available as indicated in Appendix B;

(2) The client has had adequate prenatal care, or has met the criterion for a low risk birth as required by the midwifery scope of practice pursuant to Mid 502.08 and Mid 502.09; and

(3) The client displays adequate fetal growth, fetal heart rate, and fetal movement.

(d) During the initial prenatal visit, the midwife shall:

(1) Obtain a maternal health, obstetrical, and gynecological history;

(2) Perform a nutritional assessment and provide nutritional counseling;

(3) Screen for tobacco, alcohol, marijuana, prescription drugs, or illicit drugs;

(4) Offer to perform or provide referral to a prenatal provider trained to counsel for antenatal screening for chromosomal and other genetic disorders;

(5) Obtain height, weight, and baseline blood pressure;

(6) Perform a pelvic exam, if indicated, including:

a. Uterine sizing to estimate gestational age;

b. Pelvimetry;

c. A chlamydia and gonorrhea screening test; and

d. A Pap test;

(7) Offer or recommend the following blood or urine tests:

a. Antibody screening;

b. Blood type and Rh factor;

c. Complete blood count or hemogram;

d. Gestational diabetics screening;

e. Gonorrhea and chlamydia urine screening

f. Hepatitis B surface antigen;

g. Hepatitis C antibody;

h. HIV testing;

i. Rubella titre;

j. Syphilis screening either by treponemal antibody or rapid plasma reagin (RPR);

k. Thyroid stimulating hormone (TSH);

l. Varicella titer;

m. Vitamin D; and

n. Urine culture;

(8) Document client education and counseling about prenatal tests as well as the client’s acceptance or refusal of specific prenatal tests;

(9) Recommend that the client receive a general physical exam by a qualified health care provider to screen for general health problems that have the potential to complicate the pregnancy or delivery; and

(10) For those parents planning a VBAC, obtain an informed consent by completing an informed consent document with the clients by performing the following:

a. The midwife to place the name of the client and their name at the top of the form;

b. The client to place their initials before each of the following statements:

“I have read my midwife’s informed consent for out of hospital VBAC, discussed the topic in depth, and have had all my questions and concerns addressed”;

“I am aware of the risks associated with planned vaginal birth after cesarean, including the risk of uterine rupture. I understand that if my uterus were to rupture in labor this could result in serious damage to myself and my baby, and there is an increased risk that my baby could die”;

“I understand that being a greater distance from emergency services could increase the risk to myself and my baby. I have discussed the distance between the hospital and my intended place of birth with my midwife”;

“I understand that I have the option to attempt a VBAC at a hospital or to plan a repeat cesarean at a hospital”;

“I agree that if my NH certified midwife recommends a transfer I will comply with their recommendation”;

“I have had only one previous cesarean, and the scar is in the lower part of my uterus”;

“My single previous cesarean occurred 18 months or more before the due date of my current pregnancy”;

“I will give permission for the release of the operative records of my previous cesarean birth to my midwife”;

“I agree to having at least one prenatal ultrasound in the second or third trimester of this pregnancy to determine the location of my placenta”; and

“I agree to having lab work done in this pregnancy that determines my blood group and type”;

c. The midwife to provide the following:

The certified midwife’s NH certification number;
The certified midwife’s business address; and
The name of the freestanding birth center;

d. The NH certified midwife to place their full name printed legibly, signature, and date of signing;

e. The client to place their full name printed legibly, signature, and date of signing under the following affirmation:

“I understand that these measures are required to improve the safety of my care. Given the increased risks associated with planning an out of hospital VBAC, I agree that if my midwife recommends a transfer of care or emergency transport in labor I will promptly comply with this recommendation. Having received adequate information and resources, and having had my questions addressed, I express my understanding of the risks and my desire to initiate care with "insert the midwife’s name"."; and

f. An individual who is 18 years or older to witness the client and midwife by signing and dating the form and attesting to that fact by placing their full name printed legibly, signature, and date of signing on the bottom of the form.

(e) The midwife shall screen for domestic violence and history of sexual trauma or abuse.

(f) During subsequent prenatal visits, the midwife shall:

(1) Assess maternal nutrition and weight gain;

(2) Obtain blood pressure;

(3) Assess general well-being;

(4) Check for signs and symptoms of edema, bleeding, headache, visual disturbances, or unusual vaginal discharge;

(5) Obtain fundal height measurement;

(6) Arrange for periodic hematocrit or hemoglobin testing;

(7) Assess fetal heart rate and fetal activity;

(8) Assess position and presentation of the fetus;

(9) Provide education of, perform, or order the following:

a. Rh antibody screening;

b. Urinalysis;

c. Microscopic analysis of vaginal discharges;

d. Obstetric ultrasound;

e. Prophylactic Rh immune globulin injection;

f. Blood sugar screening Tetanus, Diphtheria, Acellular Pertussis (Tdap) booster;

g. Thyroid screening, if indicated;

h. Gestational diabetes screening;

i. Group B strep screening; and

j. Herpes Simplex Virus (HSV) in pregnancy and labor, if applicable;

(10) Observe aseptic technique and standard precautions; and

(11) Discuss:

a. Any recent illnesses, symptoms, or social or emotional problems;

b. Diet;

c. Medications and supplements;

d. Educational resources;

e. Social determinants of health;

f. Exercise;

g. Rest and sleep requirements;

h. Sexuality;

i. Partner's role;

j. Birth preparation;

k. Newborn care;

l. Parenting; and

m. Transportation arrangements.

(g) A midwife shall advise any client with genital herpes of the ACOG herpes protocol current at the time of the midwife's conversation with the client.

(h) A midwife shall encourage any client expecting a first child to attend childbirth education classes.

(i) A midwife shall discuss with the client, during the prenatal period, the selection of a pediatrician, family physician, or other health care provider who will assume care of the newborn.

(j) A midwife shall alert the client to:

(1) Signs of complications that necessitate immediate contact with the midwife; and

(2) Signs of labor and when it is time to call the midwife.

(k) A midwife shall be on call or make specific arrangements for on-call coverage with another midwife or licensed health care provider whose scope of practice includes birth.

(l) In the third trimester, a midwife shall ensure that a client is adequately preparing for birth in community location by discussing:

(1) The place of the birth and the facilities available there;

(2) The availability of adequate heat and water;

(3) The supplies the client needs to procure;

(4) The availability of a telephone;

(5) Arrangements for help after the birth;

(6) With a client preparing for birth in a private home, the importance of keeping readily available the following written information, as appropriate:

a. The name, location, and phone number of the nearest ambulance service for non emergency transport;

b. The name, location, and phone number of the nearest hospital and the hospital with obstetric and neonatal services;

c. Availability of 911 services at the proposed birth location;

d. The name and phone number of the newborn's health care provider; and

e. Directions to the location of the birth.

(m) The midwife shall transfer care of the client to a hospital setting as needed, when appropriate.

History

#7759, eff 9-7-02, EXPIRED: 9-7-10
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16; ss by #14594, eff 7-20-26, EXPIRES: 7-20-36

N.H. Code Admin. R. Ann. Mid 502.04 Requirements for Care during Labor, Birth, and the Immediate Postpartum Period {#sec-mid-502.04 omnilex-key=us-nh-regs-official--agency-mid--Mid 502.04}

(a) During the appropriate period of labor, birth, and the immediate postpartum period a midwife shall:

(1) Assess maternal vital signs at regular intervals;

(2) Assess fetal heart tones at regular intervals;

(3) Support and encourage the laboring client;

(4) Assist with the birth;

(5) Assist the client with breastfeeding;

(6) Inspect the perineum and lower vagina;

(7) Inspect as necessary the cervix and upper vaginal vault;

(8) Perform necessary laceration repairs or transfer the client to the hospital for third or fourth degree lacerations;

(9) Examine and assess the health of the newborn;

(10) Inspect the placenta, membranes, and vessels of the umbilical cord;

(11) Manage any third-stage bleeding;

(12) Administer the medications listed in RSA 326-D:12 as needed;

(13) Administer eye prophylaxis to the newborn in accordance with RSA 132:6, I;

(14) Administer vitamin K to the newborn;

(15) Remain with the client and newborn:

a. At least 2 hours after the birth; and

b. If the conditions of the client and the newborn are not stable after 2 hours, until the conditions of the client and the newborn have become stable;

(16) Provide the client with information concerning routine postpartum care of both the client and newborn, and indications that warrant contacting the midwife or physician;

(17) Recommend to the client that they contact the newborn’s health care provider within 24 to 48 hours after birth to arrange for an examination; and

(18) Follow aseptic technique and use standard precautions.

(b) In the event the client is transferred to a hospital setting, a midwife shall make every effort to remain with that client to provide labor support.

(c) In the event of a hospital transfer, the midwife shall notify the hospital staff in accordance with the hospital transfer protocols and provide a complete set of prenatal, intrapartum, and newborn records.

History

#7759, eff 9-7-02, EXPIRED: 9-7-10
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16; ss by #14594, eff 7-20-26, EXPIRES: 7-20-36

N.H. Code Admin. R. Ann. Mid 502.05 Consultation With Physician or Certified Nurse Midwife to Determine Setting for Care During the Intrapartum Period {#sec-mid-502.05 omnilex-key=us-nh-regs-official--agency-mid--Mid 502.05}

A midwife shall consult immediately with a physician with experience in the active practice of obstetrics or with a certified nurse midwife (CNM) about whether the care of the client should be transferred to the hospital setting if any of the following conditions should occur intrapartum:

(a) Unforeseen malpresentations;

(b) Unforeseen multiple fetuses;

(d) The presence of particulate meconium;

(e) Failure to progress such that:

(1) In the first stage of labor, there is a lack of progress in dilation and descent with an active contraction pattern for more than 20 hours in the case of a primipara or 14 hours in the case of a multipara;

(2) In the second stage, there is no descent after more than 3 hours for a primipara and more than 2 hours for a multipara; or

(3) In the third stage, there is more than one hour without delivery of the placenta;

(f) More than 24 hours elapse following the rupture of the membranes without the onset of labor; and

(g) Maternal distress including:

(1) Extreme physical or mental exhaustion;

(2) Abnormal vital signs; or

(3) Abnormal vaginal bleeding equal to or more than a typical menstrual period.

History

#7759, eff 9-7-02, EXPIRED: 9-7-10
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16; ss by #14594, eff 7-20-26, EXPIRES: 7-20-36

N.H. Code Admin. R. Ann. Mid 502.06 Consultation to Determine Setting for Care During the Immediate Postpartum Period {#sec-mid-502.06 omnilex-key=us-nh-regs-official--agency-mid--Mid 502.06}

A midwife shall consult immediately with a physician practicing hospital obstetrics or pediatrics or a CNM with hospital privileges about whether the care of the client or the newborn should be transferred to the hospital setting if any of the following conditions should occur immediately postpartum:

(a) Significantly bleeding cervical lacerations;

(b) Third or fourth degree perineal lacerations;

(d) Maternal fever or unstable vital signs;

(e) An Apgar score of 6 or less at 5 minutes after birth, or an Apgar score that is dropping;

(f) Jaundice in the newborn appearing before 24 hours after birth;

(g) Obvious congenital anomalies;

(h) A newborn who is SGA;

(i) A newborn who shows signs of hypoglycemia, such as jitteriness, lethargy, or hypothermia;

(j) A newborn with persistent central cyanosis or pallor;

(k) A newborn with persistent signs of respiratory difficulty without signs of improvement within one hour after birth;

(l) A newborn with a pulse rate greater than 160 at rest persisting for longer than 2 hours;

(m) A newborn with respirations greater than 80 at rest persisting for longer than 2 hours;

(n) A newborn with temperature outside the parameters of 97.7-99.4 degrees Fahrenheit or 36.5 to 37.5 degrees Celsius persisting for longer than 2 hours; or

(o) Other conditions which the midwife assesses as outside normal limits.

History

#7759, eff 9-7-02, EXPIRED: 9-7-10
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16; ss by #14594, eff 7-20-26, EXPIRES: 7-20-36

N.H. Code Admin. R. Ann. Mid 502.07 Requirements for Care During the Extended Postpartum Period {#sec-mid-502.07 omnilex-key=us-nh-regs-official--agency-mid--Mid 502.07}

During the extended postpartum period, a midwife shall:

(a) Maintain close contact with the client through phone calls and at least one home or office visit within the first 72 hours after the birth;

(b) Ascertain during the visit described in (a) above that:

(1) The newborn is alert;

(2) The newborn has good color;

(3) The newborn is breathing normally;

(4) The newborn is establishing a healthy pattern of waking, sleeping, feeding, voiding, and stooling;

(5) The client is not bleeding excessively;

(6) The client has a firm fundus;

(7) The client does not have a fever or other sign of infection;

(8) The client is voiding properly; and

(9) The client, if intending and able to do so, is establishing successful breastfeeding;

(d) Be available to consult with the newborn’s health care provider about the newborn’s condition;

(e) Recommend or perform newborn hearing screening;

(f) Test the newborn for metabolic disorders as required by RSA 132:10-a at 24 to 72 hours after birth;

(g) Perform newborn pulse oximetry screening for congenital cardiac defects pursuant to RSA 132:10-aa;

(h) By 6 weeks postpartum provide the following:

(1) A pelvic exam including a Pap test, if indicated;

(2) Hemoglobin or hematocrit testing, if indicated;

(3) Screening for postpartum mental health disorders;

(4) Contraceptive counseling and family planning methods; and

(5) Referral for rubella vaccination if the client showed no immunity to rubella when tested at the time of the initial visit with the midwife.

History

#7759, eff 9-7-02, EXPIRED: 9-7-10
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16; ss by #14594, eff 7-20-26, EXPIRES: 7-20-36

N.H. Code Admin. R. Ann. Mid 502.08 Ineligibility for Midwifery Care {#sec-mid-502.08 omnilex-key=us-nh-regs-official--agency-mid--Mid 502.08}

A midwife shall not accept a person as a client if that person appears to have or reports any of the following:

(a) Diabetes requiring medication to control glucose;

(b) Seizure disorder with convulsive activity during pregnancy or within the 12 months prior to pregnancy;

(d) Current hepatitis B positive antigen;

(e) Current HIV positivity or AIDS;

(f) Chemical dependency or substance abuse that is current or the patient is on medication assisted treatment (MAT);

(g) Chronic pulmonary disease that interferes with oxygen saturation;

(h) Rh sensitivity with positive antibody titre;

(i) Chronic hypertension;

(j) History of significant heart disease;

(k) Renal disease requiring dialysis;

(l) Mental illness or condition which has the potential to interfere with the client's ability to effectively participate in their own care;

(m) Diseases and disorders such as:

(1) Addison’s disease;

(2) Cushing’s disease;

(3) Systemic lupus erythematosus;

(4) Anti-phospholipid syndrome;

(5) Scleroderma;

(6) Periarteritis nodosa;

(7) Marfan’s syndrome; and

(8) Other systemic and rare diseases and disorders;

(n) Acute toxoplasmosis infection, where the client is currently symptomatic;

(o) Acute rubella infections, where the client is currently symptomatic;

(p) Acute cytomegalovirus infection, where the client is currently symptomatic; or

(q) Deep vein thrombosis or pulmonary embolism.

History

#7759, eff 9-7-02, EXPIRED: 9-7-10
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16; ss by #14594, eff 7-20-26, EXPIRES: 7-20-36

N.H. Code Admin. R. Ann. Mid 502.09 Obstetrical Consultation Required to Determine Eligibility for Midwifery Care {#sec-mid-502.09 omnilex-key=us-nh-regs-official--agency-mid--Mid 502.09}

A midwife shall consult with a physician practicing hospital obstetrics or a CNM with hospital privileges to evaluate whether a client is an appropriate candidate for a community birth when the client or fetus, as applicable, appears to have or develops any of the following conditions:

(a) A first pregnancy at an age younger than 16 or older than 40;

(b) Maintenance on anti-epileptic medications without a history of convulsions in the previous year;

(c) Maintenance on psychotropic medication, including but not limited to, SSRI’s, benzodiazepines, antipsychotics, and lithium;

(d) Maintenance on a psychotropic medication which the client's physician has determined has the potential to sedate the newborn;

(e) Gestational hypertension with a systolic blood pressure of 140 mm Hg or more or a diastolic blood pressure of 90 mm Hg or more on 2 occasions 4 hours apart;

(f) An arrhythmia or a heart murmur other than a benign, functional murmur;

(g) A history of hereditary problems with the potential to affect the fetus or newborn;

(h) A history of significant postpartum hemorrhage;

(i) A history of previous intrauterine death of a fetus of more than 20 weeks' gestation;

(j) A history of stillbirth;

(k) A history of prior obstetrical problems including:

(1) Prematurity;

(2) Uterine abnormalities;

(3) Placental abruption; and

(4) Insufficient cervix;

(l) Cancerous or pre-cancerous condition of the cervix as indicated by an abnormal Pap test;

(m) Renal disease not requiring dialysis, such as recurrent urinary tract or kidney infection;

(n) Acute parvovirus infection, where the client is currently symptomatic;

(o) Inflammatory bowel disease that is not in remission;

(p) Rheumatoid arthritis;

(q) Hepatitis C antibody positive;

(r) Active gonorrhea;

(s) Active chlamydia;

(t) Primary herpes before 37 weeks if recurrent or during pregnancy at or after 28 weeks;

(u) Gestational diabetes with blood sugars not normalized with diet and exercise alone;

(v) Significant second or third-trimester vaginal bleeding, more than spotting;

(w) Grand multiparity;

(x) Multiple fetuses;

(y) Malpresentation after 36 weeks;

(z) Suspected SGA to rule out developing intrauterine growth restriction (IUGR);

(aa) Suspected large for gestational age;

(ab) Polyhydramnios;

(ac) Oligohydramnios;

(ad) Ultrasound evidence of a fetal or placental abnormality;

(ae) Post term gestation at 42 weeks 0 days or beyond;

(af) Thyroid diseases;

(ag) Obesity with a pre-pregnancy body mass index (BMI) of 50 or greater;

(ah) History of deep vein thrombosis or pulmonary embolism;

(ai) Toxoplasmosis infection during pregnancy;

(aj) Rubella infection during pregnancy;

(ak) Anemia measured by hemoglobin of less than 10g or a hematocrit of less than 30% unresolved by 36 weeks’ gestation;

(al) Fetus is SGA by obstetric ultrasound;

(am) Indications that the fetus of more than 12 weeks’ gestation has died in utero;

(an) Rh sensitization with positive antibody titre;

(ao) Cytomegalovirus infection during pregnancy; or

(ap) Parvovirus infection during pregnancy.

History

#7759, eff 9-7-02, EXPIRED: 9-7-10
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16; ss by #14594, eff 7-20-26, EXPIRES: 7-20-36

N.H. Code Admin. R. Ann. Mid 502.10 Conditions Requiring Transfer From Midwifery Care {#sec-mid-502.10 omnilex-key=us-nh-regs-official--agency-mid--Mid 502.10}

(a) A midwife shall transfer to the care of a physician with experience in the active practice of obstetrics or a CNM any client who appears to have or develops any of the following conditions during the prenatal period:

(1) Multiple fetuses;

(2) Malpresentation of the fetus, including presentation in breech position, that is not resolved before the onset of labor;

(3) Preeclampsia;

(4) Placenta previa;

(5) Placental abruption;

(6) Onset of labor prior to 37 weeks;

(7) Primary herpes outbreak at or after 37 weeks;

(8) History of uterine surgery involving myometrial surgery; or

(9) Any criteria met pursuant to Mid 502.08.

(b) Upon transfer of the client's care pursuant to paragraph (a) above, the midwife shall give the health care provider to whose care the client is transferred a copy of the client's chart.

History

#7759, eff 9-7-02, EXPIRED: 9-7-10
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16; ss by #14594, eff 7-20-26, EXPIRES: 7-20-36

N.H. Code Admin. R. Ann. Mid 502.11 Termination of Services by the Midwife {#sec-mid-502.11 omnilex-key=us-nh-regs-official--agency-mid--Mid 502.11}

(a) During the prenatal period, a midwife shall terminate services if:

(1) The client refuses the transfer of their care as required by Mid 502.10;

(2) The client consistently fails or refuses to follow the recommendations of the midwife; or

(3) The environment for home birth is unsafe or unsanitary.

(b) A midwife terminating services during the prenatal period shall immediately notify the client in person or by phone, and follow-up with written notification of the termination.

(c) A midwife terminating services during the prenatal period shall offer to assist the client in finding another health care provider.

(d) After the onset of labor, a midwife shall terminate services only if:

(1) The client refuses a transfer of care determined necessary on the basis of the consultation required by Mid 502.05; or

(2) The midwife believes they are unable to care adequately for the client or the newborn.

(e) A midwife terminating services after the onset of labor shall:

(1) Document the events causing the termination; and

(2) Attempt to ensure that the client is not left unattended by:

a. Calling the on-call obstetrician or family physician practicing obstetrics at the nearest hospital to inform the physician of the situation;

b. Contacting a local rescue service, a hospital emergency room, or other appropriate emergency resource; or

c. Dialing 911.

History

#7759, eff 9-7-02, EXPIRED: 9-7-10
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16; ss by #14594, eff 7-20-26, EXPIRES: 7-20-36

Part Mid 503 Midwifery Care When Previous Birth Was by Cesarean Section

N.H. Code Admin. R. Ann. Mid 503.01 Definitions {#sec-mid-503.01 omnilex-key=us-nh-regs-official--agency-mid--Mid 503.01}

In this part the following terms shall have the following meanings:

(a) “Active labor” means the period of labor beginning when the cervix is at least 6 centimeters dilated and the client is experiencing regular uterine contractions until the cervix is fully dilated;

(b) “Second stage of labor” means the period of labor from the time the cervix is fully dilated and the client begins expulsive efforts until the birth of the baby; and

History

#7931, eff 8-6-03, EXPIRED: 8-6-11
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16; ss by #14594, eff 7-20-26, EXPIRES: 7-20-36

N.H. Code Admin. R. Ann. Mid 503.02 Eligibility for Midwifery Care {#sec-mid-503.02 omnilex-key=us-nh-regs-official--agency-mid--Mid 503.02}

A midwife shall accept a person as a client if the person has had a previous birth by cesarean section only if:

(a) The potential client has had only one previous cesarean section;

(b) The midwife can confirm through a review of the records of the previous delivery by cesarean section that the section was performed through a low transverse uterine segment incision and shall analyze the indication for the previous cesarean;

(c) The potential client has had no other uterine incisions based on review of the operative notes from any other uterine incisions;

(d) At least 18 months’ time separates the date of the potential client’s previous cesarean section and the due date of the current pregnancy;

(e) An obstetric ultrasound in the second trimester documents that the placenta is not in a low-lying anterior position nor is there any indication of any placenta accreta spectrum disorder;

(f) The midwife:

(1) Documents the client’s blood group and type in the current pregnancy;

(2) Reviews the diagnostic obstetric ultrasound in the second trimester and refers the client to a maternal-fetal medicine specialist if:

a. The placenta is low-lying and anterior; or

b. There is any indication of any placenta accreta spectrum disorder;

(3) Recommends, encourages, and offers to arrange for a consultation between the client and a practicing obstetrician to discuss the risk and benefits of VBAC and document refusal if the client declines;

(g) The midwife provides the potential client with the information required by Mid 503.04; and

(h) The midwife obtains the potential client's signature and date of signing on the informed consent form specified in Mid 503.05.

History

#7931, eff 8-6-03, EXPIRED: 8-6-11
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16; ss by #14594, eff 7-20-26, EXPIRES: 7-20-36

N.H. Code Admin. R. Ann. Mid 503.03 Duties of the Midwife {#sec-mid-503.03 omnilex-key=us-nh-regs-official--agency-mid--Mid 503.03}

A midwife attending a client who has had a previous birth by cesarean section shall:

(a) Provide all services required by this chapter;

(b) Monitor the fetal heart rate at least every 15 minutes during active labor;

(d) Monitor for signs of uterine rupture, including but not limited to:

(1) Abnormal fetal heart rate pattern;

(2) Loss of engagement of fetal station;

(3) Unstable vital signs;

(4) Inability to asculate fetal heart tones;

(5) Inability to palpate the uterine fundus;

(6) Changes in maternal mental status, including but not limited to:

a. Confusion;

b. Abnormal speech patterns;

c. Abnormal thinking patterns; and

d. Disorientation;

(7) Unexplained changes in clinical status;

(8) Excessive vaginal bleeding; and

(9) Abnormal abdominal pain;

(e) Monitor the client during labor for excessive vaginal bleeding;

(f) Monitor the client during labor for abnormal abdominal pain;

(g) Monitor the labor for failure to progress as indicated by the following:

(1) The passage of at least 4 hours without cervical change during active labor;

(2) The passage of at least one hour without progress in descent of the head or the passage of at least 2 hours with slow progress in descent of the head during the second stage of labor; or

(3) The passage of at least one hour without delivery of the placenta during the third stage of labor;

(h) Consult immediately with an obstetrician if any of the circumstances listed in (d) above occur;

(i) Transfer the client to the hospital closet to the planned location of the birth when any of the following occur:

(1) Repeated fetal heart rate decelerations less than 110 bpm in the first stage of labor;

(2) Persistent fetal heart tachycardia more than 160 BPM; and

(3) Any of the symptoms of uterine rupture listed in (d) above; and

(j) In the event of an emergency transfer to a hospital, immediately notify the hospital to which the client is to be transferred of the nature of the emergency and the estimated time of arrival of the client.

History

#7931, eff 8-6-03, EXPIRED: 8-6-11
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16; ss by #14594, eff 7-20-26, EXPIRES: 7-20-36

N.H. Code Admin. R. Ann. Mid 503.04 Midwife's Duty to Provide Client with Information {#sec-mid-503.04 omnilex-key=us-nh-regs-official--agency-mid--Mid 503.04}

A midwife shall:

(a) Provide the client with current resources for data comparing VBAC safety versus planned cesarean section;

(b) Provide the client with a copy of Mid 503;

(1) That community VBAC involves labor and delivery at home or in a freestanding birth center with a certified midwife in attendance at either location;

(2) As part of a review of Mid 503:

a. The midwife's obligation to comply with Mid 503;

b. The client's eligibility for community VBAC pursuant to Mid 503.02; and

c. How the midwife would carry out the duties set forth in Mid 503.03 if the client were to choose community VBAC;

(3) The normal risks of labor and of VBAC in any setting, including the risk of uterine rupture during labor and abnormally adherent placenta after the birth resulting in severe hemorrhage;

(4) That the distance of the birth location to a hospital with obstetrical and anesthesia services, whether in-house or on-call, impacts the risk of catastrophic outcome for the client, the baby, or both. These risks include, but are not limited to:

a. Permanent brain damage for the baby;

b. Death of the baby;

c. Emergency hysterectomy;

d. Intensive care;

e. Multiple transfusions; or

f. Death of the client;

(5) The precautions that the midwife would take if the client were to choose community birth, including but not limited to:

a. Use of obstetric ultrasound for the location of the placenta, and if the placenta is low and anterior, that the client will be ineligible for midwifery care; and

b. Closer monitoring of client and baby during active labor;

(6) The possible benefits of community VBAC over in-hospital VBAC including but not limited to:

a. No surgical intervention;

b. Greater freedom of movement and of positioning at time of birth; and

c. Birth in familiar and private surroundings with the support of the client's midwife;

(7) The possible benefits of in-hospital VBAC over community VBAC, including the availability in hospitals of resources not available in community setting, including but not limited to, immediate access to surgical intervention and intensive care facilities and services; and

(8) The possibility that the client might need to be transferred to a hospital; and

(d) Ensure the client's questions are answered.

History

#7931, eff 8-6-03, EXPIRED: 8-6-11
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16; ss by #14594, eff 7-20-26, EXPIRES: 7-20-36

(a) A midwife shall review with the VBAC client an informed consent document and shall obtain the information listed in (b) below.

(b) The informed consent document shall be signed by the client in the presence of the midwife and the client and midwife shall provide the following:

(1) The client’s full legal name;

(2) The certified midwife’s name as it appears on their New Hampshire certification;

(3) The certified midwife’s NH certification number;

(4) The certified midwife’s business address;

(5) The name of the freestanding birth center, if applicable;

(6) The client’s acknowledgement that they:

a. Have read the midwife’s informed consent form for out of hospital VBAC, discussed the topic in depth, and have had all of their questions and concerns addressed;

b. Have read and understand Mid 503.04 and acknowledge that the midwife is required to adhere to the laws and rules governing their profession;

c. Are aware of the risks associated with planned VBAC , including the risk of uterine rupture. The client understands that if their uterus were to rupture in labor it could result in serious damage to themselves or their baby, and if a uterine rupture were to occur that there is an increased risk that the baby could die;

d. Have discussed with the midwife and understand that the greater the distance from a hospital with obstetrical and anesthesia services on call 24 hours a day that there is an increased risk to themselves or the baby; and

e. Understand that they have the option to attempt a VBAC at a hospital or to plan a repeat cesarean at a hospital; and

(7) An acknowledgement by the client that the following statements about their previous medical history provided to the midwife is accurate:

a. They have had only one previous cesarean and the scar is transverse in the lower part of their uterus; and

b. The cesarean indicated in (7)a. above occurred 18 months or more before the due date of the current pregnancy;

(8) An agreement to:

a. Give permission for the release of the operative records of the previous cesarean birth to the midwife; and

b. Having at least one prenatal ultrasound in the second or third trimester of their pregnancy to determine the location of their placenta.

(1) Print their legal names on the document;

(2) Provide their signatures on the bottom of the document; and

(3) Date the document when they have signed it.

History

#7931, eff 8-6-03, EXPIRED: 8-6-11
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16; ss by #14594, eff 7-20-26, EXPIRES: 7-20-36

By signing the document described in Mid 503.05, the client acknowledges that:

(a) They understand the information described in Mid 503.04(c);

(b) They have read the documents described in Mid 503.04(a) and (b) and understand the significance of the facts in both documents;

(d) The midwife has answered all questions to the satisfaction of the client; and

(e) They consent to midwifery services community VBAC .

Appendix A

Rule

Specific State Statute which the Rule Implements

Mid 501

RSA 326-D:5, I (c)

Mid 502.01

RSA 326-D:5, I (c) & (f); RSA 326-D:2, V

Mid 502.02

RSA 326-D:2, V(a) and (b); RSA 326-D:12, I(a)-(h)

Mid 502.03 – Mid 502.11

RSA 326-D:5, I(c)

Mid 503.01 – Mid 503.06

RSA 326-D:5, I(c)

Appendix B

Rule

Title

Obtain at:

Mid 502.03(c)(1)d.i.

The American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine, committee opinion on “Methods of Estimating Due Date” dated 5/2017

Obtain for no cost online at:

https://www.acog.org/-/media/project/acog/acogorg/clinical/files/committee-opinion/articles/2017/05/methods-for-estimating-the-due-date.pdf

Mid 502.03(c)(1)d.ii.

The World Health Organization “WHO recommendations on antenatal care for a positive pregnancy experience” 2016 publication

Obtain for no cost online at:

https://apps.who.int/iris/bitstream/handle/10665/250796/9789241549912-eng.pdf

History

#7931, eff 8-6-03, EXPIRED: 8-6-11
#11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16
#12040, eff 11-10-16; ss by #14594, eff 7-20-26, EXPIRES: 7-20-36

N.H. Code Admin. R. Ann. Mid — Midwifery Council (See RSA 326-D:5, I.)

Chapter Mid 100 Organizational Rules

Part Mid 101 Purpose

N.H. Code Admin. R. Ann. Mid 101.01 Purpose {#sec-mid-101.01 omnilex-key=us-nh-regs-official--agency-mid--Mid 101.01}

Part Mid 102 Definitions

N.H. Code Admin. R. Ann. Mid 102.01 Definitions {#sec-mid-102.01 omnilex-key=us-nh-regs-official--agency-mid--Mid 102.01}

Part Mid 103 Description of the Council and Council Meetings

N.H. Code Admin. R. Ann. Mid 103.01 Composition of the Council {#sec-mid-103.01 omnilex-key=us-nh-regs-official--agency-mid--Mid 103.01}

N.H. Code Admin. R. Ann. Mid 103.02 Responsibilities of the Council {#sec-mid-103.02 omnilex-key=us-nh-regs-official--agency-mid--Mid 103.02}

N.H. Code Admin. R. Ann. Mid 103.03 Council Meetings and Quorum {#sec-mid-103.03 omnilex-key=us-nh-regs-official--agency-mid--Mid 103.03}

N.H. Code Admin. R. Ann. Mid 103.04 Ineligibility of Council Members to Vote On Certain Matters and Participate in Certain Deliberations {#sec-mid-103.04 omnilex-key=us-nh-regs-official--agency-mid--Mid 103.04}

N.H. Code Admin. R. Ann. Mid 103.05 Attendance at Meetings By Members of the Public {#sec-mid-103.05 omnilex-key=us-nh-regs-official--agency-mid--Mid 103.05}

N.H. Code Admin. R. Ann. Mid 103.06 Notice of Meetings {#sec-mid-103.06 omnilex-key=us-nh-regs-official--agency-mid--Mid 103.06}

N.H. Code Admin. R. Ann. Mid 103.07 Minutes of Council Meetings {#sec-mid-103.07 omnilex-key=us-nh-regs-official--agency-mid--Mid 103.07}

Part Mid 104 Public Requests for Information

N.H. Code Admin. R. Ann. Mid 104.01 Office Location and Mailing Address, Telephone Number, and Number for TTY Users {#sec-mid-104.01 omnilex-key=us-nh-regs-official--agency-mid--Mid 104.01}

N.H. Code Admin. R. Ann. Mid 104.02 Communication with the Council {#sec-mid-104.02 omnilex-key=us-nh-regs-official--agency-mid--Mid 104.02}

N.H. Code Admin. R. Ann. Mid 104.03 Public Access to Records {#sec-mid-104.03 omnilex-key=us-nh-regs-official--agency-mid--Mid 104.03}

Chapter Mid 200 Procedural Rules

Part Mid 201 Applicability and Waiver of Substantive Rules

N.H. Code Admin. R. Ann. Mid 201.01 Applicability of Plc 200 {#sec-mid-201.01 omnilex-key=us-nh-regs-official--agency-mid--Mid 201.01}

Chapter Mid 300 Certification Requirements

Part Mid 301 Definitions

N.H. Code Admin. R. Ann. Mid 301.01 Definitions {#sec-mid-301.01 omnilex-key=us-nh-regs-official--agency-mid--Mid 301.01}

Part Mid 302 Application Procedure

N.H. Code Admin. R. Ann. Mid 302.01 Application Process for Initial Certification {#sec-mid-302.01 omnilex-key=us-nh-regs-official--agency-mid--Mid 302.01}

N.H. Code Admin. R. Ann. Mid 302.02 Application Review and Notification Procedure {#sec-mid-302.02 omnilex-key=us-nh-regs-official--agency-mid--Mid 302.02}

N.H. Code Admin. R. Ann. Mid 302.03 Application Form for Initial Certification {#sec-mid-302.03 omnilex-key=us-nh-regs-official--agency-mid--Mid 302.03}

N.H. Code Admin. R. Ann. Mid 302.04 Meaning of Signature {#sec-mid-302.04 omnilex-key=us-nh-regs-official--agency-mid--Mid 302.04}

N.H. Code Admin. R. Ann. Mid 302.05 Documentation Required to Support An Application for Initial Certification {#sec-mid-302.05 omnilex-key=us-nh-regs-official--agency-mid--Mid 302.05}

Part Mid 303 Qualifications

N.H. Code Admin. R. Ann. Mid 303.01 Eligibility for Initial Certification {#sec-mid-303.01 omnilex-key=us-nh-regs-official--agency-mid--Mid 303.01}

N.H. Code Admin. R. Ann. Mid 303.02 Laceration Repairs {#sec-mid-303.02 omnilex-key=us-nh-regs-official--agency-mid--Mid 303.02}

Part Mid 304 Examination and Examination Fee

N.H. Code Admin. R. Ann. Mid 304.01 Examination Requirements {#sec-mid-304.01 omnilex-key=us-nh-regs-official--agency-mid--Mid 304.01}

Part Mid 305 Reserved

N.H. Code Admin. R. Ann. Mid 305.01 Certification Requirements {#sec-mid-305.01 omnilex-key=us-nh-regs-official--agency-mid--Mid 305.01}

Part Mid 306 Duration of Certifications and Fees

N.H. Code Admin. R. Ann. Mid 306.01 Duration of Certifications {#sec-mid-306.01 omnilex-key=us-nh-regs-official--agency-mid--Mid 306.01}

N.H. Code Admin. R. Ann. Mid 306.02 Certification Fees {#sec-mid-306.02 omnilex-key=us-nh-regs-official--agency-mid--Mid 306.02}

N.H. Code Admin. R. Ann. Mid 306.03 Fee Schedule {#sec-mid-306.03 omnilex-key=us-nh-regs-official--agency-mid--Mid 306.03}

Chapter Mid 400 Continued Status

Part Mid 401 Definitions

N.H. Code Admin. R. Ann. Mid 401.01 Definitions {#sec-mid-401.01 omnilex-key=us-nh-regs-official--agency-mid--Mid 401.01}

Part Mid 402 Renewal and Lapse of Certificates

N.H. Code Admin. R. Ann. Mid 402.01 Term of Certificates; Lapse of Certificates {#sec-mid-402.01 omnilex-key=us-nh-regs-official--agency-mid--Mid 402.01}

N.H. Code Admin. R. Ann. Mid 402.02 Eligibility for Renewed Certificate {#sec-mid-402.02 omnilex-key=us-nh-regs-official--agency-mid--Mid 402.02}

N.H. Code Admin. R. Ann. Mid 402.03 Application Process for Certificate Renewal {#sec-mid-402.03 omnilex-key=us-nh-regs-official--agency-mid--Mid 402.03}

N.H. Code Admin. R. Ann. Mid 402.04 Application Review and Notification Procedure {#sec-mid-402.04 omnilex-key=us-nh-regs-official--agency-mid--Mid 402.04}

N.H. Code Admin. R. Ann. Mid 402.05 Application Form for Renewal of Certificate {#sec-mid-402.05 omnilex-key=us-nh-regs-official--agency-mid--Mid 402.05}

N.H. Code Admin. R. Ann. Mid 402.06 Effect of Signature {#sec-mid-402.06 omnilex-key=us-nh-regs-official--agency-mid--Mid 402.06}

N.H. Code Admin. R. Ann. Mid 402.07 Documentation Required to Support an Application for Renewal of Certificate {#sec-mid-402.07 omnilex-key=us-nh-regs-official--agency-mid--Mid 402.07}

Part Mid 403 Reinstatement of Certification

N.H. Code Admin. R. Ann. Mid 403.01 Definitions {#sec-mid-403.01 omnilex-key=us-nh-regs-official--agency-mid--Mid 403.01}

N.H. Code Admin. R. Ann. Mid 403.02 Recertification After Expiration of Certificate {#sec-mid-403.02 omnilex-key=us-nh-regs-official--agency-mid--Mid 403.02}

N.H. Code Admin. R. Ann. Mid 403.03 Recertification After Maximum 90 Day Lapse of Certificate Because of Hardship {#sec-mid-403.03 omnilex-key=us-nh-regs-official--agency-mid--Mid 403.03}

N.H. Code Admin. R. Ann. Mid 403.04 Recertification of Midwives When the Certificate Has Been Expired for No More Than 3 Consecutive Years {#sec-mid-403.04 omnilex-key=us-nh-regs-official--agency-mid--Mid 403.04}

N.H. Code Admin. R. Ann. Mid 403.05 Application Form for Recertification After Lapse of the Certificate to Practice Midwifery {#sec-mid-403.05 omnilex-key=us-nh-regs-official--agency-mid--Mid 403.05}

N.H. Code Admin. R. Ann. Mid 403.06 Recertification of Midwives Ineligible for Recertification Under Mid 403.04 {#sec-mid-403.06 omnilex-key=us-nh-regs-official--agency-mid--Mid 403.06}

N.H. Code Admin. R. Ann. Mid 403.07 Provisional Certification {#sec-mid-403.07 omnilex-key=us-nh-regs-official--agency-mid--Mid 403.07}

N.H. Code Admin. R. Ann. Mid 403.08 Practice by a Provisionally Certified Midwife {#sec-mid-403.08 omnilex-key=us-nh-regs-official--agency-mid--Mid 403.08}

N.H. Code Admin. R. Ann. Mid 403.09 Supervision of Midwifery Practiced by a Provisionally Licensed Midwife {#sec-mid-403.09 omnilex-key=us-nh-regs-official--agency-mid--Mid 403.09}

Part Mid 404 Revocation, Suspension and Other Sanctions

N.H. Code Admin. R. Ann. Mid 404.01 Definitions {#sec-mid-404.01 omnilex-key=us-nh-regs-official--agency-mid--Mid 404.01}

N.H. Code Admin. R. Ann. Mid 404.02 Misconduct {#sec-mid-404.02 omnilex-key=us-nh-regs-official--agency-mid--Mid 404.02}

N.H. Code Admin. R. Ann. Mid 404.03 Sanctions {#sec-mid-404.03 omnilex-key=us-nh-regs-official--agency-mid--Mid 404.03}

N.H. Code Admin. R. Ann. Mid 404.04 Procedure for Imposition of Sanctions {#sec-mid-404.04 omnilex-key=us-nh-regs-official--agency-mid--Mid 404.04}

N.H. Code Admin. R. Ann. Mid 404.05 Determinations Required for Sanctions {#sec-mid-404.05 omnilex-key=us-nh-regs-official--agency-mid--Mid 404.05}

Part Mid 405 Continuing Education

N.H. Code Admin. R. Ann. Mid 405.01 Continuing Education Requirements {#sec-mid-405.01 omnilex-key=us-nh-regs-official--agency-mid--Mid 405.01}

N.H. Code Admin. R. Ann. Mid 405.02 Participation in Courses, Classes, Seminars, Workshops, Distance Learning Courses and Journal Study {#sec-mid-405.02 omnilex-key=us-nh-regs-official--agency-mid--Mid 405.02}

N.H. Code Admin. R. Ann. Mid 405.03 Informal Independent Study {#sec-mid-405.03 omnilex-key=us-nh-regs-official--agency-mid--Mid 405.03}

N.H. Code Admin. R. Ann. Mid 405.04 Publication of Midwife's Writing Related to Midwifery {#sec-mid-405.04 omnilex-key=us-nh-regs-official--agency-mid--Mid 405.04}

N.H. Code Admin. R. Ann. Mid 405.05 Public Professional Presentations Relating to Midwifery {#sec-mid-405.05 omnilex-key=us-nh-regs-official--agency-mid--Mid 405.05}

N.H. Code Admin. R. Ann. Mid 405.06 Teaching Midwifery {#sec-mid-405.06 omnilex-key=us-nh-regs-official--agency-mid--Mid 405.06}

N.H. Code Admin. R. Ann. Mid 405.07 Participation in the Work of Midwifery-Related Professional Boards or Committees and Participation in the Work of Midwifery-Related Governmental Regulatory Agencies {#sec-mid-405.07 omnilex-key=us-nh-regs-official--agency-mid--Mid 405.07}

N.H. Code Admin. R. Ann. Mid 405.08 Product Development {#sec-mid-405.08 omnilex-key=us-nh-regs-official--agency-mid--Mid 405.08}

Part Mid 406 Documentation of Continuing Education

N.H. Code Admin. R. Ann. Mid 406.01 Participation in Courses, Classes, Seminars, Workshops, Distance Learning Courses and Journal Study {#sec-mid-406.01 omnilex-key=us-nh-regs-official--agency-mid--Mid 406.01}

N.H. Code Admin. R. Ann. Mid 406.02 Informal Independent Study {#sec-mid-406.02 omnilex-key=us-nh-regs-official--agency-mid--Mid 406.02}