COLORADO MIDWIVES REGISTRATION
The Director of Registrations proposes the following amendments to the existing rules pursuant to her rulemaking authority in § 12-37-106(1)(a), C.R.S.
Rule 1  Repealed
RULE 2 - STANDARDS FOR EDUCATION
The purpose of this rule is to establish minimum education requirements to become registered as a direct-entry midwife as required by § 12-37-103(6), C.R.S.
A.	To become registered in Colorado, an applicant will have to have graduated from an accredited midwifery educational program approved by the Midwifery Education and Accreditation Council (“MEAC”).
B.	An applicant may also become registered if such applicant has obtained a “substantially equivalent” education approved by the Director of Registrations.  Substantially equivalent education can be achieved by one of the following methods:
1.	An applicant who is credentialed as a Certified Professional Midwife (“CPM”) as established and administered by the North American Registry of Midwives (“NARM”) will automatically be deemed eligible for registration.
2.	Completion and certification under NARM’s entry-level Portfolio Evaluation Process (“PEP”).  If the PEP determines that the applicant has obtained a substantially equivalent education as that required in Colorado, then such applicant will be eligible for registration.  All expenses associated with PEP are the applicant’s responsibility
3.	Applicants can utilize one of the above methods in addition to having a credential review performed by the International Credentialing Associates (“ICA”) or International Consultants of Delaware (“ICD”).  The Director will not accept a credentials evaluation from an organization not listed in this rule and all expenses associated with the review are borne by the applicant.
C.	Failure to satisfy one of the three methods listed in this rule will result in the Director denying the application.
RULE 4 - PRACTICE RESTRICTIONS 
The purpose of this rule is to define the practice restrictions applicable to a direct-entry midwife.
A.	The direct-entry midwife shall not provide care to any client whose medical history exhibits the following signs or symptoms:
1.	diabetes mellitus or gestational diabetes;
2.	hypertensive disease ( blood pressure greater than 140/90 at rest);
3.	pulmonary disease or cardiac disease which interferes with activities of daily living;
4.	a history of thrombophlebitis or pulmonary embolism;
5.	blood dyscrasia, for example sickle cell anemia;
6.	seizures controlled by medication if the mother has seized within the last year;
7.	Hepatitis B, HIV positive, or AIDS;
8.	current use of psychotropic medications if client is not under the care and monitoring of a physician during the pregnancy;
9.	current substance abuse of drugs or alcohol;
10.	Rh sensitization (positive antibody titre), an incompetent cervix, or previous uncontrollable postpartum hemorrhage; 
11.	Vaginal Birth After Cesarean Section (VBAC) unless compliant with Rule 12or
12.	infants who were premature, stillborn, or neonatal deaths associated with maternal health or genetic anomaly, unless there is a normal amniocentesis ruling out said anomaly, without an intervening normal pregnancy.
B.	The direct-entry midwife shall not:
1.	perform any operative or surgical procedures;
2.	utilize any instruments or mechanical means of delivery, other than hemostats to clamp the cord;
3.	perform versions; or
e.	administer any medications except for eye prophylaxis of the newborn.
RULE 10 -EMERGENCY PLAN
The purpose of this rule is to establish the following emergency plan parameters pursuant to § 12-37-105(6), C.R.S.:
The time required for transportation to the nearest facility capable of providing appropriate treatment shall not exceed 30 minutes unless the emergency plan prepared by the direct-entry midwife and the client, on the form prescribed by the Director, includes an estimate of time for transportation for appropriate treatment for the conditions listed above in Rules 5G, 6E, 7E, 8D, and 8E, and such plan is consented to by both the patient and the direct-entry midwife.  A copy of such plan shall be given to the client.
RULE 12 - STANDARDS FOR VAGINAL BIRTH AFTER CESAREAN SECTION (VBAC)
The purpose of this rule is to establish parameters for VBAC patients seeking midwifery care during pregnancy in order to safeguard the client’s welfare.
A.	A direct-entry midwife shall not assume primary responsibility for prenatal care and birth attendance for women who have had a previous cesarean section unless all of the following conditions are met:
1.	All prospective VBAC women shall sign an informed consent statement, which shall be retained in the client's records and include the following:
(a)	VBAC educational information including history of VBAC and client's own personal information;
(b)	Associated risks and benefits of VBAC at home;
(c)	A workable hospital transport plan;
(d)	Alternatives to VBAC at home; and 
 (e)	Other information as required by the Director.
2.	A workable hospital transport plan must be established for home VBAC.  The plan shall be in writing and include:
(a)	Place of birth within 30 minutes of transport to the nearest hospital or emergency medical center able to perform an emergency cesarean;
(b)	Readily available emergency numbers for the nearest hospital or emergency medical center; and
(c)	Provision for phone contact with nearest hospital or emergency medical center prior to any transport notifying the destination that transport is in progress.
3.	There has been at least 18 months from the client’s cesarean delivery to the due date of the current pregnancy.
4.	The client with 2 or more cesarean deliveries has also had a prior vaginal delivery. 	
B.	Direct-entry midwife shall obtain prior patient cesarean records, in writing, and shall analyze the indication for the previous cesarean, and retain the records along with a written assessment of the physical and emotional considerations in client's files.   If the direct-entry midwife is unable to obtain the written records, the direct-entry midwife shall not retain the woman as a client.
C.	Records that show a previous classical uterine/vertical incision or any previous uterine surgery which required an incision into the uterine fundus are a contraindication to VBAC at home and shall require immediate transfer of care of the patient.
D.	Direct-entry midwife shall not induce or augment labor by the use of chemicals or herbal supplements or nipple stimulation
E.	A direct-entry midwife shall be present and manage the VBAC delivery from the onset of active labor throughout the immediate postpartum period.