DEPARTMENT OF HEALTH

[Filed July 5, 2019, 1:31 p.m., effective August 5, 2019]

Effective Date of Rule: Thirty-one days after filing.

Purpose: Chapter 246-834 WAC, Midwifery, the department of health (department) is adopting amendments to rule language that will clarify licensure rules and update the legend drugs and devices section for improved safety of out-of-hospital births. Specific rules amended include WAC 246-834-060 Initial application, 246-834-250 Legend drugs and devices, 246-834-400 Expired license, and 246-834-450 Inactive license.

Citation of Rules Affected by this Order: Amending WAC 246-834-060, 246-834-250, 246-834-400, and 246-834-450.

Statutory Authority for Adoption: RCW 18.50.135 and 18.50.115.

Adopted under notice filed as WSR 19-06-066 on March 5, 2019.

Changes Other than Editing from Proposed to Adopted Version: In WAC 246-834-250 (3)(a) changed language from: Intravenous fluids limited to Lactated Ringers, 5% Dextrose with Lactated Ringers heparin and 0.9% sodium chloride for use in intravenous locks;

Edited language to: Intravenous fluids limited to Lactated Ringers, 5% Dextrose with Lactated Ringers, and 0.9% sodium chloride;

The reason given is because heparin is no longer routinely used by midwives, and emergency medical services only allow sodium chloride as an IV fluid during transport. This is a current community standard.

A final cost-benefit analysis is available by contacting Kathy Weed, P.O. Box 47852, Olympia, WA 98504, phone 360-236-4883, fax 360-236-2901, TTY 360-833-6388 or 711, email kathy.weed@doh.wa.gov, web site doh.wa.gov.

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

Number of Sections Adopted at the Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

Number of Sections Adopted on the Agency's own Initiative: New 0, Amended 4, Repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.

Number of Sections Adopted using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 4, Repealed 0.

Date Adopted: July 3, 2019.

John Weisman, DrPH, MPH

AMENDATORY SECTION(Amending WSR 15-20-049, filed 9/30/15, effective 10/31/15)

WAC 246-834-060Initial application requirements for licensure as a midwife.

(1) An applicant for a midwife license shall submit to the department the following:

(a) Initial application on forms provided by the department.

(b) Fees required in WAC 246-834-990.

(d) Proof of at least three years of midwifery training, per RCW 18.50.040 (2)(a), unless the applicant qualifies for a reduced academic period.

(e) ((A current plan for consultation, emergency transfer and transport.

(f))) Proof of completion of seven clock hours of HIV/AIDS education as required in chapter 246-12 WAC, Part 8.

(((g)))(f) Proof of successful completion of the midwifery jurisprudence exam, as offered by the department.

(2) In addition to the requirements in subsection (1) of this section, an applicant for a midwife license shall also:

(a) Have transcripts sent directly to the department from the applicant's midwifery school demonstrating that the applicant has received a certificate or diploma in midwifery. ((Those))An applicant((s)) applying under WAC 246-834-065 or 246-834-066 ((or 246-834-220)) may be exempted from this requirement.

(b) Have verification of passing the North American Registry of Midwives (NARM) examination. Results must be sent directly to the department from NARM.

(3) Once all application requirements in this section are met, and additional requirements in WAC 246-834-065 or 246-834-066 ((or 246-834-220)) if applicable, the department will schedule the applicant for the Washington state specific component exam.

AMENDATORY SECTION(Amending WSR 05-06-118, filed 3/2/05, effective 4/2/05)

WAC 246-834-250Legend drugs and devices.

(1) Licensed midwives may purchase and use legend drugs and devices as follows:

(a) Dopplers, syringes, needles, phlebotomy equipment, sutures, urinary catheters, intravenous equipment, amnihooks, airway suction devices, electronic fetal ((monitoring, toco monitoring, neonatal and adult resuscitation equipment, oxygen, glucometer, and centrifuge; and

(b)))monitors, tocodynamometer monitors, oxygen and associated equipment, glucose monitoring systems and testing strips, neonatal pulse oximetry equipment, hearing screening equipment, and centrifuges;

(b) Nitrous oxide as an analgesic, self-administered inhalant in a 50 percent blend with oxygen, and associated equipment, including a scavenging system;

(2) Pharmacies may issue breast pumps, compression stockings and belts, maternity belts, diaphragms and cervical caps, glucometers and testing strips, iron supplements, prenatal vitamins, and recommended vaccines as specified in subsection (3)(e) through (j) of this section ordered by licensed midwives.

(((2)))(3) In addition to prophylactic ophthalmic medication, postpartum oxytocic, vitamin K, Rho (D) immune globulin (((human))), and local anesthetic medications as listed in RCW 18.50.115, licensed midwives may obtain and administer the following medications:

(a) Intravenous fluids limited to Lactated Ringers, 5% Dextrose with Lactated Ringers ((heparin)), and 0.9% sodium chloride ((for use in intravenous locks));

(b) Sterile water for intradermal injections for pain relief;

(d) Epinephrine for use in maternal anaphylaxis and resuscitation and neonatal resuscitation, pending transport;

(e) Measles, Mumps, and Rubella (MMR) vaccine to nonimmune postpartum women((, HBIG and HBV for neonates born to hepatitis B+ mothers));

(f) Tetanus, diphtheria, acellular pertussis (Tdap) vaccine for use in pregnancy;

(g) Hepatitis B (HBV) birth dose for any newborn administration;

(h) HBIG and HBV for any neonates born to hepatitis B+ mothers;

(i) Influenza vaccine for use in pregnancy;

(j) Any vaccines recommended by the CDC advisory committee on immunization practices for pregnant or postpartum people or infants in the first two weeks after birth, as it existed on the effective date of this section;

(k) Terbutaline ((for nonreassuring fetal heart tones and/or cord prolapse))to temporarily decrease contractions pending emergent intrapartal transport;

(((g)))(l) Antibiotics for intrapartum prophylaxis of Group B beta hemolytic Streptococcus (GBS) per current CDC guidelines; and

(((h)))(m) Antihemorrhagic drugs to control postpartum hemorrhage((, such as misoprostel per rectum (for use only in postpartum hemorrhage)))including, but not limited to, oxytocin, misoprostol, methylergonovine maleate ((in the absence of hypertension,))(oral or intramuscular), and prostaglandin F2 alpha (((hemobate), intramuscular)).

(((3)))(4) The client's records ((shall))must contain documentation of all medications administered.

(((4)))(5) The midwife must have a procedure, policy or guideline for the use of each drug and device. A midwife may not administer a legend drug or use a legend device for which he or she is not qualified by education, training, and experience.

AMENDATORY SECTION(Amending WSR 17-15-024, filed 7/7/17, effective 8/7/17)

WAC 246-834-400Expired license.

(1) If a midwife's license under this chapter has been expired for less than three years ((or less)), to reinstate the license the practitioner shall meet the requirements of chapter 246-12 WAC, Part 2.

(2) If a midwife's license under this chapter has expired and the practitioner has been engaged in the active practice of midwifery in another United States jurisdiction or territory, or other location approved by the department, to reinstate the license the practitioner shall:

(a) Submit verification of active practice; and

(b) Meet the requirements of chapter 246-12 WAC, Part 2.

(3) If a midwife's license under this chapter has been expired for ((more than)) three years or more but less than five years at time of application, and the practitioner has not been actively engaged in midwifery, the practitioner shall:

(a) Work as a birth assistant under the supervision of a department-approved preceptor for a minimum of ten births; and

(b) Meet the requirements of chapter 246-12 WAC, Part 2.

(4) If a midwife's license under this chapter has been expired for more than five years at time of application, and the practitioner has not been actively engaged in midwifery, the practitioner shall:

(a) Work as a birth assistant under the supervision of a department-approved preceptor for a minimum of fifteen births;

(b) Retake and successfully pass the Washington state licensing examination; and

(5) A proposed preceptor shall:

(a) Hold an active license without restriction, current discipline, or conditions as a midwife under chapter 18.50 RCW, a certified nurse midwife under chapter 18.79 RCW, an allopathic physician under chapter 18.71 RCW, or an osteopathic physician under chapter 18.57 RCW;

(b) Have actively practiced at least three consecutive years or attended at least one hundred fifty births; and

AMENDATORY SECTION(Amending WSR 17-15-024, filed 7/7/17, effective 8/7/17)

WAC 246-834-450Inactive license.

(1) A licensed midwife may obtain an inactive license((. Refer to))by meeting the requirements of chapter 246-12 WAC, Part 4.

(2) An inactive license must be renewed every year on the midwife's birthday according to WAC 246-12-100 and by paying the fee required under WAC 246-834-990.

(3) A midwife with an inactive license may return to active status.

(a) A midwife with an inactive license for three years or less who wishes to return to active status must meet the requirements of chapter 246-12 WAC, Part 4.

(b) A midwife with an inactive license for more than three years, who has been in active practice in another United States jurisdiction or territory or other location approved by the department and wishes to return to active status must:

(i) Submit verification of active practice; and

(ii) Meet the requirements of chapter 246-12 WAC, Part 4.

(c) A midwife with an inactive license for more than three years but less than five, who has not been in active practice and wishes to return to active status must:

(i) Work as a birth assistant under the supervision of a department-approved preceptor for a minimum of ten births; and

(ii) Meet the requirements of chapter 246-12 WAC, Part 4.

(d) A midwife with an inactive license for more than five years who has not been in active practice and wishes to return to active status must:

(i) Work as a birth assistant under the supervision of a department-approved preceptor for a minimum of fifteen births;

(ii) Retake and successfully pass the Washington state licensing examination; and

(iii) Meet the requirements of chapter 246-12 WAC, Part 4.

(4) A proposed preceptor shall:

(b) Have actively practiced at least three consecutive years or attended at least one hundred fifty births; and