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Delaware Code Title 24. Professions and Occupations § 1799JJ. Client screening for homebirth delivery services

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The provisions of this section shall apply only to a midwife while providing home birth delivery services. For the purposes of obtaining informed consent as governed by this section, the mother that is part of the client shall give informed consent on behalf of herself and the newborn.

(1) When accepting a client for care, a midwife shall obtain the client’s informed consent, which shall be evidenced by a written statement signed by both the midwife and the client which shall contain the following elements, in a form drafted by the Council and adopted by the Board, if the midwife offers home birth services:

a. An acknowledgement that home birth can include increased risk of death and disability for mother and child;

b. A clear statement that the risks have been explained and understood by the client;

c. A clear statement that the client is aware that the midwife is not a licensed physician or nurse, nor are they seeking the services of one for their home birth;

d. A newborn checklist describing the services and care of the newborn; and

e. Information regarding procedures in the event a transfer becomes necessary and that a transfer may be required to protect the safety of the client if signs or symptoms are observed by the midwife that necessitate such transfer that includes:

1. Estimated distance between the planned birth site and the receiving facility; and

2. Information regarding concurrent care policies at the receiving facility. The statement on concurrent care will be repeated orally to the client or, if the client is incapacitated, the client’s designated agent, in the event of a transfer.

(2) When accepting a client for care, a midwife shall obtain in addition to the client’s informed consent, a written statement in a form proposed by the Council and adopted by the Board, and signed by both the 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 acknowledgement evidenced by a separate signature adjacent to each item in addition to the client’s signature and the date at the end of the form:

a. The name, address, telephone number, and license number of the licensed midwife;

b. A description of the midwife’s education, training, and experience in midwifery in relation to both the mother and the newborn;

c. The nature and scope of the care to be given, including a description of the ante partum, intrapartum, and postpartum conditions requiring consultation, transfer of care, or transport to a hospital;

d. A copy of the written plan described in paragraph (3) of this section below which is particular to each client;

e. An explanation that in the event of an emergency or voluntary transfer that no liability from the actions of the midwife are assignable to the receiving facility or medical professional;

f. An explanation of the right of the client to file a complaint with the Council and instructions on how to file a complaint with the Council;

g. A statement indicating that the client's records and any transaction with the midwife are confidential pursuant to the federal Health Insurance Portability and Accountability Act [P.L. 104-191];

h. A disclosure of whether the midwife carries malpractice or liability insurance; and

i. Any further information as required by the Council.

(3) A midwife shall prepare, in a form proposed by the Council and adopted by the Board, a written plan for the appropriate delivery of emergency care and provide the client with a copy of the plan as provided in paragraph (2) of this section. The plan shall address the following:

a. Consultation with other health-care providers;

b. Emergency transfer;

c. Access to neonatal intensive care units and obstetrical units or other patient care areas;

(4) A midwife shall provide an initial screening to ensure that each client receives safe and appropriate care and to determine whether any contraindications are present. A midwife will also perform ongoing screening and maintain, beginning at the time of the initial screening, a detailed health history in a form prescribed by the Council and adopted by the Board.

(5) Upon transfer of a client, emergency or otherwise, a midwife shall provide all records described in this section to the receiving care provider or facility and remain available to speak with the receiving health-care provider at the point of transfer about the course of care provided to the client.

(6) A midwife offering home birth services shall only accept and provide care to those women who are classified as eligible for a home birth or midwife-assisted birth in accordance with evidence based standards proposed by the Council and adopted by the Board as being low risk pregnancy, labor, and delivery, which includes but is not limited to:

a. There is no preexisting maternal disease or condition likely to affect the pregnancy, such as uterine surgeries including Caesarean procedures and others, as recommended by the Council and approved by the Board;

b. There is no significant disease arising from the pregnancy;

c. There is a singleton fetus;

d. There appears to be a cephalic presentation prior to delivery;

e. The onset of labor occurs when the fetus has a gestational age greater than 37 weeks and less than 42 weeks, which period can be expanded or contracted if the Council and Board determine that it would be in the best interests of clients to do so; and

f. Labor is most likely to be spontaneous.

(7) The midwife must be able at all times to recognize the warning signs of conditions that render the woman ineligible for a midwife-assisted home birth. If a midwife determines at any time during the course of the pregnancy that a woman’s condition may preclude attendance by the midwife, the client shall be informed that she should transfer to an appropriate, licensed, health-care provider. A midwife may and shall, at any time, terminate a relationship with a client if that midwife deems the woman is or has become ineligible for a midwife-assisted birth or home birth. The cause for termination must be documented and included in the health history described in paragraph (4) of this section. Such midwife shall inform the client of such termination in writing and recommend transfer to an appropriate licensed health-care provider.

(8) If a midwife identifies that the client demonstrates a high risk condition as defined by the Council and approved by the Board, the midwife shall refer the client to a physician with obstetrical hospital privileges for client assessment and/or screening, at the time the condition is noted by the midwife. In the event of an emergency, if the midwife determines that immediate termination of the relationship pursuant to paragraph (7) of this section would increase or create risk of death or injury to the mother or her infant, the midwife will immediately engage emergency medical services, and may continue to assist in the emergency.

Cite this article: - Delaware Code Title 24. Professions and Occupations § 1799JJ. Client screening for homebirth delivery services - last updated January 01, 2019 |

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