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N EWJ ERSEYA DMINISTRATIVEC ODE
T ITLE13
L AWANDP UBLICS AFETY
CHAPTER 35
SUBCHAPTER 2A
LIMITEDLICENSES: MIDWIFERY
LIMITEDLICENSES:MIDWIFERY LAWANDPUBLICSAFETY
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TABLEOFC ONTENTS
SUBCHAPTER 2A. LIMITED LICENSES: MIDWIFERY............................3
13:35-2A.1 PURPOSE AND SCOPE .......................................................................... 3
13:35-2A.2 DEFINITIONS .......................................................................................... 3
13:35-2A.3 MIDWIFERY LIAISON COMMITTEE ......................................................... 4
13:35-2A.4 APPLICATION FOR LICENSURE ............................................................. 4
13:35-2A.5 INDEPENDENT PRACTICE ..................................................................... 5
13:35-2A.6 CONSULTING PHYSICIANS; CLINICAL GUIDELINES ............................. 6
13:35-2A.7 LICENSURE; BIENNIAL LICENSE RENEWAL; LICENSE SUSPENSION;
REINSTATEMENT OF SUSPENDED LICENSE; INACTIVE STATUS; RETURN FROM
INACTIVE STATUS .................................................................................................... 7
13:35-2A.8 ANTEPARTUM MANAGEMENT ............................................................... 9
13:35-2A.9 MANAGEMENT OF ANTEPARTUM WOMEN AT INCREASED RISK ......... 9
13:35-2A.10 INTRAPARTUM MANAGEMENT .......................................................... 12
13:35-2A.11 MANAGEMENT OF INTRAPARTUM WOMEN AT INCREASED RISK .... 13
13.35-2A.12 POSTPARTUM CARE .......................................................................... 14
13:35-2A.13 WELL WOMAN CARE .......................................................................... 15
13:35-2A.14 PRESCRIPTIVE AUTHORIZATION ....................................................... 15
13:35-2A.15 LIMITED ULTRASOUND EXAMINATION .............................................. 17
13:35-2A.16 COLPOSCOPIES ................................................................................. 18
13:35-2A.17 CIRCUMCISIONS ................................................................................ 19
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SUBCHAPTER 2A.
LIMITED LICENSES: MIDWIFERY
13:35-2A.1 PURPOSE AND SCOPE
a) The rules in this subchapter are intended to protect the health and safety of the public
through licensure of midwives, pursuant to N.J.S.A. 45:10-1 et seq.
b) This subchapter prescribes standards for midwifery licensure and for the renewal,
suspension or revocation of that licensure.
13:35-2A.2 DEFINITIONS
The following words and terms, when used in this subchapter, shall have the following
meaning, unless the context clearly indicates otherwise:
"Board" means the New Jersey State Board of Medical Examiners.
"Certified midwife (CM)" means a person who is or ever was certified by the American
Midwifery Certification Board (AMCB) or its successors as a certified midwife.
"Certified nurse midwife (CNM)" means a person who is a registered nurse and who is or
ever was certified by the American College of Nurse Midwives (ACNM) or the AMCB or their
successors as a certified nurse midwife.
"Certified professional midwife (CPM)" means a person who holds certification from the
North American Registry of Midwives (NARM) or its successor.
"Clinical guidelines" means a document, which sets forth patterns of care and which provides
for consultation, collaboration, management and referral as indicated by the health status of a
woman receiving care from a licensee.
"Committee" means the Midwife Liaison Committee of the New Jersey State Board of
Medical Examiners.
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“Consulting physician” means a person who holds a plenary license to practice medicine and
surgery in New Jersey, issued by the Board, who adheres to clinical guidelines with a licensed
midwife.
"Licensee" means any person who holds a license from the Board to practice as a midwife.
"Midwife" means a person licensed by the Board as a certified midwife (CM), certified nurse
midwife (CNM) or certified professional midwife (CPM).
13:35-2A.3 MIDWIFERY LIAISON COMMITTEE
a) The Midwifery Liaison Committee shall consist of eight members who shall serve as
consultants to the Board and who shall be appointed by the Board. The Committee shall
include at least one certified nurse midwife, at least one certified professional midwife, at
least one certified midwife, and two other midwives, all of whom shall hold licensure from the
Board. The Committee shall also include one certified nurse midwife who is a member of the
Board and two physicians, one of whom shall be a member of the Board of Medical
Examiners and one of whom shall be Board-certified by either the American Board of
Obstetrics and Gynecology, the American Osteopathic Board of Obstetrics and Gynecology
or any other certification organization with comparable standards.
b) The Board shall appoint each member for a term of three years. Committee members may
be reappointed.
c) Functions of the Committee shall include the following:
1)
Advising and assisting the Board in the evaluation of applicants for midwifery licensure
and certified nurse midwife applicants for prescriptive authorization;
2)
Investigating complaints against licensees and unlawful conduct by licensees;
3)
Approving professional education programs; and
4)
Advising and assisting the Board in drafting and reviewing rules to govern midwifery
practice.
13:35-2A.4 APPLICATION FOR LICENSURE
a) An applicant for licensure as a midwife shall submit to the Committee:
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1)
A completed application for licensure requesting information regarding the applicant's
address, telephone number, date of birth and social security number;
2)
Proof that the applicant is 18 years old or older;
3)
An official transcript from a midwifery program, accredited by the Accreditation
Commission for Midwifery Education (ACME), ACC or the Midwifery Education
Accreditation Council (MEAC), or their predecessors or successors;
4)
A notarized copy of Certification from either ACNM, AMCB, NARM, or their predecessors
or successors;
5)
The applicant's curriculum vitae;
6)
Three photographs of the applicant, signed, dated and notarized; and
7)
The application fee pursuant to N.J.A.C. 13:35-6.13.
b) Once the applicant has been approved, he or she shall submit the initial license fee pursuant
to N.J.A.C. 13:35-6.13.
13:35-2A.5 INDEPENDENT PRACTICE
a) Certified nurse midwife and certified midwife practice shall include the provision of maternity
care and well woman care within a health care system which provides for consultation,
referral and collaboration, and:
1)
For licensees without prescriptive authority, administering or dispensing those
medications listed in the clinical guidelines; or
2)
For licensees with prescriptive authority pursuant to N.J.A.C. 13:35-2A.14, prescribing,
ordering, administering or dispensing medications.
b) Certified nurse midwives and certified midwives shall conduct their practice pursuant to
standards set forth by the ACNM in Standards for the Practice of Midwifery 2003, as
amended and supplemented, available from the American College of Nurse-Midwives, 8403
Colesville Rd., Suite 1550, Silver Spring, MD 20910, which is incorporated herein by
reference as part of this rule.
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c) Certified professional midwife practice shall include the provision of maternity care within a
health care system which provides for consultation, referral and collaboration with a licensed
physician and the administration or dispensing of those medications listed in the clinical
guidelines.
d) Certified professional midwives shall conduct their practice pursuant to standards set forth in
the Midwives Alliance of North America Core Competencies (2014), available from Midwives
Alliance of North America, PO Box 373, Montvale, NJ 07645, which is incorporated herein by
reference, as amended and supplemented, as part of this rule.
13:35-2A.6 CONSULTING PHYSICIANS; CLINICAL GUIDELINES
a) Prior to beginning practice as a midwife, a licensee shall enter into a consulting agreement
with a physician who is licensed in New Jersey and who:
1)
Holds hospital privileges in operative obstetrics/gynecology;
2)
Has a binding agreement with a physician who holds operative privileges in operative
obstetrics/gynecology; or
3)
Holds hospital privileges in gynecology, if a licensee limits his or her practice to non-
obstetrical.
b) The licensee shall establish written clinical guidelines with the consulting physician which
outlines the licensee's scope of practice.
c) The clinical guidelines shall set forth:
1)
An outline of routine care;
2)
Procedures the licensee will perform or provide;
3)
Procedures to follow if one of the risk factors from N.J.A.C. 13:35-2A.9 and 2A.11 is
encountered;
4)
The circumstances under which consultation, collaborative management, referral and
transfer of care of women between the licensee and the consulting physician are to take
place, and the manner by which each is to occur;
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5)
If the licensee is a certified nurse midwife with prescriptive authority pursuant to N.J.A.C.
13:35-2A.12, a formulary listing the categories of drugs, which may include controlled
dangerous substances, the certified nurse midwife may order, prescribe, administer or
dispense;
6)
If the licensee does not hold prescriptive authority pursuant to N.J.A.C. 13:35-2A.14, a
list of all medications the licensee may dispense or administer pursuant to the directions
of the consulting physician;
7)
A mechanism for determining the availability of the consulting physician, or a substitute
physician, for consultation and emergency assistance or medical management when
needed; and
8)
The manner by which emergency care for newborns will be provided.
d) A licensee shall provide clinical guidelines and the identity of his or her consulting
physician(s) to the Board upon request.
e) The clinical guidelines shall include provisions for periodic conferences with the consulting
physician for review of patient records and for quality improvements.
f) A licensee who practices without establishing clinical guidelines with a consulting physician
commits professional misconduct as proscribed by N.J.S.A. 45:1-21(e).
13:35-2A.7 LICENSURE; BIENNIAL LICENSE RENEWAL; LICENSE SUSPENSION;
REINSTATEMENT OF SUSPENDED LICENSE; INACTIVE STATUS; RETURN FROM
INACTIVE STATUS
a) All licenses issued by the Board shall be issued for a two-year biennial licensure period. A
licensee who seeks renewal of the license shall submit a completed renewal application,
proof that he or she is currently certified by the ACNM, AMCB, or NARM, and the renewal
fee as set forth in N.J.A.C. 13:35-6.13 prior to the expiration date of the license.
b) The Board shall send a notice of renewal to each licensee at the address registered with the
Board at least 60 days prior to the expiration of the license. If the notice to renew is not sent
at least 60 days prior to the expiration date, no monetary penalties or fines shall apply to the
holder for failure to renew.
c) If a licensee does not renew the license prior to its expiration date, the licensee may renew
the license within 30 days of its expiration by submitting a renewal application, a renewal fee
and a late fee, as set forth in N.J.A.C. 13:35-6.13. During this 30-day period, the license
shall be valid, and the licensee shall not be deemed to be practicing without a license.
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d) A license that is not renewed within 30 days of its expiration shall be automatically
suspended. An individual who continues to practice with a suspended license shall be
deemed to be engaged in unlicensed practice and shall be subject to the penalties
prescribed by N.J.S.A. 45:9-22 for practicing without a license.
e) A licensee whose license has been automatically suspended for five years or less for failure
to renew pursuant to (d) above may be reinstated by the Board upon completion of the
following:
1)
Payment of the reinstatement fee and all past delinquent biennial renewal fees pursuant
to N.J.A.C. 13:35-6.13; and
2)
Submission of an affidavit of employment listing each job held during the period of
suspended license which includes the name, address, and telephone number of each
employer.
f) In addition to the fulfilling the requirements set forth in (e) above, a licensee whose license
has been automatically suspended for more than five years who wishes to return to practice
shall reapply for licensure and shall demonstrate that he or she has maintained proficiency.
An applicant who fails to demonstrate to the satisfaction of the Board that he or she has
maintained proficiency while suspended may be subject to an examination or other
requirements as determined by the Board prior to reinstatement of his or her license.
g) Renewal applications shall provide the licensee with the option of either active or inactive
status. A licensee electing inactive status shall pay the inactive license fee set forth in
N.J.A.C. 13:35-6.13 and shall not engage in practice.
A licensee electing inactive status shall
not be required to submit proof that he or she is currently certified by the ACNM, AMCB, or
NARM.
h) A licensee who elected inactive status and has been on inactive status for five years or less
may be reinstated by the Board upon completion of the following:
1)
Payment of the reinstatement fee;
2)
Submission of an affidavit of employment listing each job held during the period the
licensee was on inactive status which includes the name, address, and telephone
number of each employer; and
3)
Submission of proof that he or she is currently certified by ACNM, AMCB, or NARM.
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i) In addition to the fulfilling the requirements set forth in (h) above, a licensee who has been
on inactive status for more than five years who wishes to return to practice shall reapply for
licensure and shall demonstrate that he or she has maintained proficiency. An applicant who
fails to demonstrate to the satisfaction of the Board that he or she has maintained proficiency
while on inactive status may be subject to an examination or other requirements as
determined by the Board prior to reinstatement of his or her license.
13:35-2A.8 ANTEPARTUM MANAGEMENT
a) A licensee's scope of practice during antepartum stages includes:
1)
Ordering medical, therapeutic and diagnostic measures in accordance with clinical
guidelines; and
2)
Identifying women with medical, obstetrical or gynecological risk factors outlined in
N.J.A.C. 13:35-2A.9.
13:35-2A.9 MANAGEMENT OF ANTEPARTUM WOMEN AT INCREASED RISK
a) A licensee may participate in the management of antepartum patients at increased risk under
the following conditions:
1)
The consulting physician and licensee shall have agreed to include the woman at
increased risk in the caseload;
2)
The consulting physician and licensee shall have established and documented a
management plan for all women identified as at increased risk, which shall delineate the
role of both the consulting physician and the licensee in the care of the woman. The
management plan shall set forth the following:
i) Frequency of physician visits;
ii) Timing of indicated diagnostic and evaluative procedures;
iii) Specific parameters for consultation; and
iv) A proposed plan for the birth, including the type, place and provider.
3)
The management plan shall be reviewed periodically by the licensee and the consulting
physician and revised when necessary.
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b) The following are risk factors that require management as outlined in (a) above:
1)
Maternal health status:
i) Acute and/or chronic hypertension;
ii) Congenital or acquired heart disease;
iii) Anti-phospholipid syndrome;
iv) HIV positive or AIDS;
v) Chronic renal disease;
vi) Seizure disorder requiring medications;
vii) Chronic hemoglobinopathy with a history of transfusion;
viii) Diabetes mellitus;
ix) Any psychoactive substance addiction;
x) Psychosis;
xi) Severe asthma as defined in the December 12, 2013 International ERS/ATS
Guidelines on Definition, Evaluation and Treatment of Severe Asthma, published by
the European Respiratory Society/American Thoracic Society, 25 Broadway, New
York, NY 10004, incorporated herein by reference, as amended and supplemented;
xii) Any connective tissue disorder;
xiii) Multiple sclerosis;
xiv) History of cerebrovascular accident;
xv) History of cancer;
xvi) Hepatitis with abnormal liver function and/or detectable viral loads; or
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xvii) Body Mass Index (BMI) over 40.
2)
Maternal reproductive health history:
i) Incompetent cervix;
ii) Two or more second or third trimester fetal losses;
iii) Preterm delivery;
iv) Grand multiparity;
v) Previous cesarean delivery;
vi) Surgery involving the uterine wall;
vii) Previous placental abruption
or accreta;
viii) Previous postpartum blood transfusion;
ix) Previous cervical surgeries including Loop Electrosurgical Excision Procedures
(LEEP), cone biopsies or three or more surgical cervical dilitations unless the patient
has had a subsequent term pregnancy; or
x) Intra-uterine growth restriction.
3)
Current maternal obstetrical status:
i) Obstructive uterine myomata;
ii) Polyhydramnios or oligohydramnios;
iii) Isoimmunization;
iv) Multiple gestation;
v) Intrauterine growth restriction;
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vi) Current evidence of fetal chromosome disorder confirmed by amniocentesis and/or
congenital anomaly;
vii) Gestational diabetes;
viii) Maternal age less than 14 years or more than 40 years;
ix) Cervical dysplasia requiring colposcopy;
x) Placenta previa
persisting past 28 weeks gestation;
xi) Evidence of placenta accreta and/or abruption;
xii) Pre-term labor with cervical change; or
xiii) Preeclampsia.
13:35-2A.10 INTRAPARTUM MANAGEMENT
a) A licensee's scope of practice during intrapartum stages includes:
1)
Managing labor and birth for women not classified as being at increased risk pursuant to
N.J.A.C. 13:35-2A.11, in accordance with clinical guidelines;
2)
Performing immediate screening of the newborn and resuscitation of the newborn when
necessary. The licensee shall refer newborns with acute medical conditions to a
physician trained in the care of a newborn;
3)
Performing an episiotomy;
4)
Repairing first and second degree episiotomies and lacerations; and
5)
Using local anesthesia.
b) Every licensee shall ensure that at the birth site:
1)
There is a person who is certified in Basic Life Support (BLS) and in Neonatal
Resuscitation Program (NRP) by the American Academy of Pediatrics; and
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2)
The following equipment is present:
i) Oxygen;
ii) A neonatal bag and mask;
iii) An adult oxygen mask;
iv) Suction equipment;
v) IV fluids; and
vi) Oxytoxics.
c) In addition to the tasks outlined in (a) above, a Certified Nurse Midwife (CNM) or Certified
Midwife (CM) may:
1)
Repair third degree lacerations upon the direction of the consulting physician;
2)
Repair fourth degree lacerations under the direct supervision of a physician who has
hospital obstetrical privileges; and
3)
Administer pudendal anesthesia in a licensed healthcare facility, which includes birthing
centers. No licensee shall administer pudendal anesthesia in any other setting.
13:35-2A.11 MANAGEMENT OF INTRAPARTUM WOMEN AT INCREASED RISK
a) If a woman receiving care from a licensee evidences any of the following conditions, the
licensee shall only participate in the birth if it takes place in a licensed hospital:
1)
Pre-term labor less than 37 weeks gestation. If pre-term labor is less than 34 weeks
gestation, a consulting physician shall be present at the birth;
2)
Premature rupture of membranes more than 48 hours before onset of regular
contractions;
3)
Assessment of infant weight less than 2,500 grams or more than 4,500 grams;
4)
Vaginal birth after previous cesarean delivery;
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5)
The need for prescriptive medication to induce or augment labor;
6)
Post-datism (greater than 42 weeks gestation);
7)
Multiple gestation;
8)
Non-vertex presentation;
9)
Evidence of chorioamnionitis; or
10)
Hypertensive disorder of pregnancy and/or Hemolysis, Elevated Liver Enzymes, and Low
Platelet (HELLP) syndrome.
b) If a woman receiving care from a licensee evidences the following during the intrapartum
phase the licensee shall arrange for the presence of a consulting physician at the hospital;
or, if the woman is not in a hospital, arrange for the immediate transfer of the woman to a
hospital obstetric unit:
1)
Severe preeclampsia and/or Hemolysis, Elevated Liver Enzymes, and Low Platelet
(HELLP) syndrome;
2)
Non-reassuring fetal heart pattern, unresponsive to conservative measures;
3)
Prolapse of cord;
4)
Intrapartum hemorrhage;
5)
Multiple gestation;
6)
Non-vertex presentation; or
7)
Any condition requiring operative intervention.
13.35-2A.12 POSTPARTUM CARE
a) A licensee's scope of practice during the postpartum stage includes:
1)
Assessment and treatment; and
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2)
Contraceptive services.
13:35-2A.13 WELL WOMAN CARE
a) A certified nurse midwife or certified midwife may provide well woman care throughout the
life cycle which shall include:
1)
Gynecological and primary health care screening, assessment and treatment; and
2)
Contraceptive services.
13:35-2A.14 PRESCRIPTIVE AUTHORIZATION
a) A CNM who is licensed with the Board of Medical Examiners may apply for authorization to
prescribe drugs (as used within this section, the term "drugs" shall include drugs, medicine,
and devices). The CNM shall make application on forms prescribed by the Board and shall
demonstrate:
1)
Current registration with the Board;
2)
A.C.N.M. or A.C.C. certification in good standing; and
3)
Evidence of satisfactory completion of a minimum of 30 contact hours in pharmacology,
which was either part of the midwifery program the CNM completed pursuant ot N.J.A.C.
13:35-2A.4(a)3 or a pharmacology course offered by, or affiliated with, a college or
university accredited by an accrediting association recognized by the U.S. Department of
Education. The 30 contact hours shall include:
i) Instruction in fundamentals of pharmacology and therapeutics, including principles
and terminology of pharmacodynamics and pharmaco-kinetics; and
ii) One contact hour on issues concerning prescription opioid drugs, including
responsible prescribing practices, alternative to opioids for managing and treating
pain, and the risks and signs of opioid abuse, addiction, and diversion.
b) If the 30 contact hours in pharmacology required pursuant to (a)3 above was included as
part of the midwifery program the CNM completed pursuant to N.J.A.C. 13:35-2A.4(a)3, the
CNM shall have graduated from the midwifery program within the two years immediately
preceding the date on which the application for prescriptive authority is made.
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c) If the 30 contact hours in pharmacology required pursuant to (a)3 above was not part of the
midwifery program the CNM completed pursuant to N.J.A.C. 13:35-2A.4(a)3, the CNM shall
have completed the pharmacology course within the two years immediately preceding the
date on which the application for prescriptive authority is filed.
d) Notwithstanding (a), (b) and (c) above, a CNM who holds prescriptive authorization in
another state shall be authorized to prescribe drugs in New Jersey, if the CNM submits proof
to the Committee that he or she:
1)
Holds current prescriptive authorization, without disciplinary restrictions, in another state;
and
2)
Has completed 30 contact hours in pharmacology, which meets the requirements of (a)3
above.
e) Notwithstanding (a), (b) and (c) above, a CNM who also holds certification as an advanced
practice nurse from the New Jersey Board of Nursing shall be authorized to prescribe drugs
pursuant to N.J.S.A. 45:10-17 et seq., if the CNM submits proof to the Committee that he or
she:
1)
Holds current, unencumbered certification as an advanced practice nurse from the New
Jersey Board of Nursing; and
2)
Has completed 30 contact hours in pharmacology, which meets the requirements of (a)3
above.
f) A CNM who is authorized to prescribe drugs may prescribe only those drugs which are
categorized in the formulary of drugs established in the clinical guidelines.
g) A CNM's authorization to prescribe drugs, medicine, or devices may, upon notice and an
opportunity for a hearing pursuant to the Administrative Procedure Act, N.J.S.A. 52.14B-1 et
seq. and 52:14F-1 et seq., be revoked or otherwise limited by the Board if the CNM:
1)
Fails to maintain current licensure and registration with the Board;
2)
Fails to maintain certification in good standing with the ACNM or ACC, or their
successors;
3)
Uses prescriptive authorization for other than therapeutic purposes; or
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4)
Uses prescriptive authorization to prescribe substances or devices not included in the
formulary of drugs established in the CNM's clinical guidelines.
h) Prescriptions written by a CNM shall conform to the dictates of N.J.S.A. 45:14-14 et seq. and
N.J.A.C. 13:35-7.2.
i) When prescribing controlled dangerous substances, a CNM shall comply with all of the
requirements and limitations as set forth in N.J.A.C. 13:35-7.6 and 13:45H.
13:35-2A.15 LIMITED ULTRASOUND EXAMINATION
a) A licensee who has completed a course as required in (b) below may perform a limited
ultrasound examination. For purposes of this section, "limited ultrasound" shall mean the use
of ultrasound to assess any of the following: fetal number, fetal cardiac activity, fetal position
and presentation, placental location, amniotic fluid parameters, biophysical profile
parameters, uterine position, uterine size, the number and size of early gestational sac and
the presence and length of embryonic poles.
b) A licensee who wishes to perform limited ultrasound shall complete a 12-hour course given
by a college or university accredited by an accrediting association recognized by the U.S.
Department of Education or an organization which grants ACNM, American College of
Obstetrics and Gynecology (ACOG), American Osteopathic Association (AOA) or American
Medical Association-Physicians Recognition Award (AMA-PRA) category one continuing
education credits.
c) Limited ultrasound course instruction shall include:
1)
Ultrasound instrumentation;
2)
Accountability of the licensee;
3)
Components of informed consent;
4)
Principles of anatomy and physiology relevant to limited ultrasound examinations;
5)
Elements of antepartum and intrapartum fetal surveillance;
6)
Components of ultrasound examination:
i) Fetal number;
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ii) Fetal cardiac activity;
iii) Fetal position and presentation;
iv) Placental location;
v) Amniotic fluid evaluation; and
vi) Biophysical profile parameters;
7)
Components of gynecological ultrasound examination:
i) Identification of uterine position;
ii) Evaluation of uterine size;
iii) Assessment of number, size and location of early gestational sac(s) and presence
and length of embryonic pole(s); and
iv) Recognition of early fetal cardiac activity; and
8)
Formulation of a plan of care based on assessments made, including the need for
consultation, referral and follow-up.
d) A licensee who intends to perform limited ultrasound examinations pursuant to (a) above
shall amend the clinical guidelines to include circumstances when the licensee may perform
limited ultrasound examinations.
13:35-2A.16 COLPOSCOPIES
a) A CNM or CM who has completed a course as required by (b) below and clinical experience
required by (c) below may perform colposcopies for the purposes of evaluating and
diagnosing abnormal cervical findings.
b) A CNM or CM who wishes to perform colposcopies shall complete a 20-hour colposcopy
course, given by a college or university accredited by an accrediting association recognized
by the U.S. Department of Education or given by an organization recognized by either the
American Society of Colposcopy and Cervical Pathology, the American College of Obstetrics
and Gynecology, the American College of Nurse Midwives or the National Association of
Nurse Practitioners in Women’s Health.
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c) A CNM or CM who intends to perform colposcopies independently shall first complete 50
colposcopies under the supervision of a CNM or CM who has met the requirements of this
section or an individual who has received education and training substantially similar to that
required by this section.
d) A CNM or CM who has successfully completed a colposcopy course shall maintain a
certificate from the sponsor of the colposcopy course indicating that the CNM or CM has
completed the course.
e) A CNM or CM who intends to perform colposcopy pursuant to (a) above shall amend the
clinical guidelines to include circumstances when the midwife may perform colposcopy.
13:35-2A.17 CIRCUMCISIONS
a) A licensee who has completed a course as required by (b) below and clinical experience as
outlined in (c) below may perform circumcisions.
b) A licensee who intends to perform circumcisions shall complete a course given by a licensed
physician or licensed midwife who has privileges to perform circumcisions in a licensed
health care facility. The circumcision course shall include:
1)
The theory of circumcisions, including the procedure's benefits and risks, and
alternatives to the procedure;
2)
Providing informed consent to the parents;
3)
Indications and contraindications for circumcision; and
4)
Potential complications.
c) Prior to performing any circumcisions independently as permitted by this section, the
licensee shall observe five circumcisions and perform 20 circumcisions under the direct
supervision of a licensed physician or a midwife qualified to perform independently pursuant
to this section. For purposes of this subsection, "direct supervision" means the presence of,
and observation of the procedure by, a licensed physician, or midwife qualified to perform
circumcisions, in the location where the circumcision is being performed.
d) A licensee who intends to perform circumcisions pursuant to (a), (b) and (c) above shall
maintain, as part of the licensee's records, documentation which indicates that the licensee
has met the education requirements of (b) and (c) above.
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e) A licensee who intends to perform circumcisions pursuant to (a), (b) and (c) above shall
amend the clinical guidelines to include circumstances when the licensee may perform
circumcisions.