(1) Every direct-entry midwife shall provide the following information in writing to each client during the initial client contact:
(a) The name, business address, and business phone number of the direct-entry midwife;
(b) A listing of the direct-entry midwife's education, experience, degrees, membership in any professional organization whose membership includes not less than one-third of all registrants, certificates or credentials related to direct-entry midwifery awarded by any such organization, and the length of time and number of contact hours required to obtain the degrees, certificates, or credentials;
(c) A statement indicating whether or not the direct-entry midwife is covered under a policy of liability insurance for the practice of direct-entry midwifery;
(d) A listing of any license, certificate, or registration in the health-care field previously or currently held by the direct-entry midwife and suspended or revoked by any local, state, or national health-care agency;
(e) A statement that the practice of direct-entry midwifery is regulated by the department. The statement must provide the address and telephone number of the office of midwifery registration in the division and shall state that violation of this article 225 may result in revocation of registration and of the authority to practice direct-entry midwifery in Colorado.
(f) A copy of the emergency plan as provided in section 12-225-106 (6);
(g) A statement indicating whether or not the direct-entry midwife will administer vitamin K to the client's newborn infant and, if not, a list of qualified health-care practitioners who can provide that service; and
(h) A statement indicating whether or not the direct-entry midwife will administer Rho(D) immune globulin to the client if she is determined to be Rh-negative and, if not, a list of qualified health-care practitioners who can provide that service.
(2) Any changes in the information required by subsection (1) of this section shall be reflected in the mandatory disclosure within five days after the change.
Source: L. 2019: Entire title R&RE with relocations, (HB 19-1172), ch. 136, p. 1134, � 1, effective October 1.
Editor's note: This section is similar to former � 12-37-104 as it existed prior to 2019.
12-225-106. Prohibited acts - practice standards - informed consent - emergency plan - risk assessment - referral - rules. (1) A direct-entry midwife shall not dispense or administer any medication or drugs except in accordance with section 12-225-107.
(2) A direct-entry midwife shall not perform any operative or surgical procedure; except that a direct-entry midwife may perform sutures of perineal tears in accordance with section 12-225-107.
(3) A direct-entry midwife shall not provide care to a pregnant woman who, according to generally accepted medical standards, exhibits signs or symptoms of increased risk of medical or obstetric or neonatal complications or problems during the completion of her pregnancy, labor, delivery, or the postpartum period. Those conditions include but are not limited to signs or symptoms of diabetes, multiple gestation, hypertensive disorder, or abnormal presentation of the fetus.
(4) A direct-entry midwife shall not provide care to a pregnant woman who, according to generally accepted medical standards, exhibits signs or symptoms of increased risk that her child may develop complications or problems during the first six weeks of life.
(5) (a) A direct-entry midwife shall keep appropriate records of midwifery-related activity, including but not limited to the following:
(I) The direct-entry midwife shall complete and file a birth certificate for every delivery in accordance with section 25-2-112.
(II) The direct-entry midwife shall complete and maintain appropriate client records for every client.
(III) Before accepting a client for care, the direct-entry midwife shall obtain the client's informed consent, which shall be evidenced by a written statement in a form prescribed by the director and signed by both the direct-entry midwife and the client. The form shall certify that full disclosure has been made and acknowledged by the client as to each of the following items, with the client's acknowledgment evidenced by a separate signature or initials adjacent to each item in addition to the client's signature at the end of the form:
(A) The direct-entry midwife's educational background and training;
(B) The nature and scope of the care to be given, including the possibility of and procedure for transport of the client to a hospital and transferral of care prenatally;
(C) A description of the available alternatives to direct-entry midwifery care, including a statement that the client understands the client is not retaining a certified nurse midwife, a nurse midwife, or a certified midwife;
(D) A description of the risks of birth, including those that are different from those of hospital birth and those conditions that may arise during delivery;
(E) A statement indicating whether or not the direct-entry midwife is covered under a policy of liability insurance for the practice of direct-entry midwifery; and
(F) A statement informing the client that, if subsequent care is required resulting from the acts or omissions of the direct-entry midwife, any physician, nurse, certified midwife, prehospital emergency personnel, and health-care institution rendering subsequent care will be held only to a standard of gross negligence or willful and wanton conduct.
(IV) (A) Until the liability insurance required pursuant to section 12-225-112 (2) is available, each direct-entry midwife shall, before accepting a client for care, provide the client with a disclosure statement indicating that the direct-entry midwife does not have liability insurance. To comply with this section, the direct-entry midwife shall ensure that the disclosure statement is printed in at least twelve-point bold-faced type and shall read the statement to the client in a language the client understands. Each client shall sign the disclosure statement acknowledging that the client understands the effect of its provisions. The direct-entry midwife shall also sign the disclosure statement and provide a copy of the signed disclosure statement to the client.
(B) In addition to the information required in subsection (5)(a)(IV)(A) of this section, the direct-entry midwife shall include the following statement in the disclosure statement and shall display the statement prominently and deliver the statement orally to the client before the client signs the disclosure statement: Signing this disclosure statement does not constitute a waiver of any right (insert client's name) has to seek damages or redress from the undersigned direct-entry midwife for any act of negligence or any injury (insert client's name) may sustain in the course of care administered by the undersigned direct-entry midwife.
(b) As used in this subsection (5), full disclosure includes reading the informed consent form to the client, in a language understood by the client, and answering any relevant questions.
(6) A direct-entry midwife shall prepare a plan, in the form and manner required by the director, for emergency situations. The plan must include procedures to be followed in situations in which the time required for transportation to the nearest facility capable of providing appropriate treatment exceeds limits established by the director by rule. A copy of the plan shall be given to each client as part of the informed consent required by subsection (5) of this section.
(7) A direct-entry midwife shall prepare and transmit appropriate specimens for newborn screening in accordance with section 25-4-1004 and shall refer every newborn child for evaluation, within seven days after birth, to a licensed health-care provider with expertise in pediatric care.
(8) A direct-entry midwife shall ensure that appropriate laboratory testing, as determined by the director, is completed for each client.
(9) (a) A direct-entry midwife shall provide eye prophylactic therapy to all newborn children in the direct-entry midwife's care in accordance with section 25-4-301.
(b) A direct-entry midwife shall inform the parents of all newborn children in the direct-entry midwife's care of the importance of critical congenital heart defect screening using pulse oximetry in accordance with section 25-4-1004.3. If a direct-entry midwife is not properly trained in the use of pulse oximetry or does not have the use of or own a pulse oximeter, the direct-entry midwife shall refer the parents to a health-care provider who can perform the screening. If a direct-entry midwife is properly trained in the use of pulse oximetry and has the use of or owns a pulse oximeter, the direct-entry midwife shall perform the critical congenital heart defect screening on newborn children in the direct-entry midwife's care in accordance with section 25-4-1004.3.
(10) A direct-entry midwife shall be knowledgeable and skilled in aseptic procedures and the use of universal precautions and shall use them with every client.
(11) To assure that proper risk assessment is completed and that clients who are inappropriate for direct-entry midwifery are referred to other health-care providers, the director shall establish, by rule, a risk assessment procedure to be followed by a direct-entry midwife for each client and standards for appropriate referral. The assessment shall be a part of each client's record as required in subsection (5)(a)(II) of this section.
(12) Repealed.
(13) A registered direct-entry midwife may purchase, possess, carry, and administer oxygen. The department shall promulgate rules concerning minimum training requirements for direct-entry midwives with respect to the safe administration of oxygen. Each registrant shall complete the minimum training requirements and submit proof of having completed the requirements to the director before administering oxygen to any client.
(14) A registrant shall not practice beyond the scope of the registrant's education and training.
Source: L. 2019: Entire title R&RE with relocations, (HB 19-1172), ch. 136, p. 1135, � 1, effective October 1. L. 2021: (12) repealed, (SB 21-101), ch. 196, p. 1049, � 4, effective September 1. L. 2023: (5)(a)(III)(C) and (5)(a)(III)(F) amended, (SB 23-167), ch. 261, p. 1541, � 41, effective May 25.
Editor's note: This section is similar to former � 12-37-105 as it existed prior to 2019.
12-225-107. Limited use of certain medications - limited use of sutures - limited administration of intravenous fluids - emergency medical procedures - rules. (1) A registrant may obtain prescription medications to treat conditions specified in this section from a registered prescription drug outlet, registered manufacturer, or registered wholesaler. An entity that provides a prescription medication to a registrant in accordance with this section, and who relies in good faith upon the registration information provided by the registrant, is not subject to liability for providing the medication.
(2) Except as otherwise provided in subsection (3) of this section, a registrant may obtain and administer:
(a) Vitamin K to newborns by intramuscular injection;
(b) Rho(D) immune globulin to Rh-negative mothers by intramuscular injection;
(c) Postpartum antihemorrhagic drugs to mothers;
(d) Eye prophylaxis;
(e) Local anesthetics, as specified by the director by rule, to use in accordance with subsection (6) of this section; and
(f) Group B streptococcus (GBS) prophylaxis, subject to the limitations in subsection (7) of this section.
(3) (a) If a client refuses a medication listed in subsection (2)(a) or (2)(b) of this section, the registrant shall provide the client with an informed consent form containing a detailed statement of the benefits of the medication and the risks of refusal, and shall retain a copy of the form acknowledged and signed by the client.
(b) If a client experiences uncontrollable postpartum hemorrhage and refuses treatment with antihemorrhagic drugs, the registrant shall immediately initiate the transportation of the client in accordance with the emergency plan.
(4) A registrant shall, as part of the emergency medical plan required by section 12-225-106 (6), inform the client that:
(a) If she experiences uncontrollable postpartum hemorrhage, the registrant is required by Colorado law to initiate emergency medical treatment, which may include the administration of an antihemorrhagic drug by the registrant to mitigate the postpartum hemorrhaging while initiating the immediate transportation of the client in accordance with the emergency plan.
(b) If she experiences postpartum hemorrhage, the registrant is prepared and equipped to administer intravenous fluids to restore volume lost due to excessive bleeding.
(5) The director shall promulgate rules to implement this section. In promulgating the rules, the director shall seek the advice of knowledgeable medical professionals to set standards for education, training, and administration that reflect current generally accepted professional standards for the safe and effective use of the medications, methods of administration, and procedures described in this section, including a requirement that, to administer intravenous fluids, the registrant complete an intravenous therapy course or program approved by the director. The director shall establish a preferred drug list that displays the medications that a registrant can obtain.
(6) (a) Subject to subsection (6)(b) of this section, a registrant may perform sutures of first-degree and second-degree perineal tears, as defined by the director by rule, on a client and may administer local anesthetics to the client in connection with suturing perineal tears.
(b) In order to perform sutures of first-degree and second-degree perineal tears, the registrant shall apply to the director, in the form and manner required by the director, and pay any application fee the director may impose, for an authorization to perform sutures of first-degree and second-degree perineal tears. As part of the application, the registrant shall demonstrate to the director that the registrant has received education and training approved by the director on suturing of perineal tears within the year immediately preceding the date of the application or within such other time the director, by rule, determines to be appropriate. The director may grant the authorization to the registrant only if the registrant has complied with the education and training requirement specified in this subsection (6)(b).
(7) A registered direct-entry midwife who was initially registered prior to January 1, 2000, must apply to the director and pay any applicable fees before obtaining or administering group B streptococcus (GBS) prophylaxis as part of the registrant's practice of direct-entry midwifery. The director shall verify the qualifications of a registrant applying pursuant to this subsection (7) before granting the registrant the authority to obtain and administer group B streptococcus (GBS) prophylaxis.
(8) A registrant who is granted authority to act pursuant to this section is not required to apply for renewal of the authority or pay any renewal fees pertaining to the authority granted in this section.
Source: L. 2019: Entire title R&RE with relocations, (HB 19-1172), ch. 136, p. 1138, � 1, effective October 1. L. 2021: (2)(d), (2)(e), and (6)(b) amended and (2)(f), (7), and (8) added, (SB 21-101), ch. 196, p. 1050, � 5, effective September 1.
Editor's note: This section is similar to former � 12-37-105.5 as it existed prior to 2019.