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(1) A licensed direct-entry midwife shall not assume primary responsibility for prenatal care and/or birth attendance for women who have had a previous cesarean section, unless all of the following conditions are met:

(a) An informed consent statement, on a form furnished by the board, shall be signed by all prospective VBAC parents and the licensee, and retained in the licensee's records. The form shall include:

(i) VBAC educational information, including history of VBAC and client's own personal information;

(ii) associated risks and benefits of VBAC at home;

(iii) a workable hospital transport plan;

(iv) alternatives to VBAC at home;

(v) other information as required by the board.

(b) A workable hospital transport plan must be established for home VBAC. The plan shall include:

(i) provision for physician/hospital backup, e.g., through the physician/hospital policy on backup;

(ii) place of birth within 30 minutes of transport to the nearest hospital able to perform an emergency cesarean;

(iii) readily available phone numbers for physician backup and nearest hospital, in writing, in client's records;

(iv) phone contact with nearest hospital at onset of labor and prior to any transport to notify that transport is in progress; and at conclusion of home birth if no transport is necessary.

(c) Licensee shall obtain prior doctor/hospital cesarean records, in writing, prior to acceptance of the woman as a client, and shall analyze the indication for the previous cesarean, and retain the records and a written assessment of the physical and emotional considerations in licensee's files. Records which show a previous classical uterine/vertical incision, any other uterine scars into the endometrium, or less than 18 months between last surgery to the next delivery are contraindications to VBAC at home, and shall require immediate transfer of care of the client. If a licensee is unable to obtain written records, the licensee shall not retain the woman as a client.

(d) VBAC deliveries shall be performed by a fully licensed midwife (not an apprentice licensee), skilled with VBAC support, able to assess true complications and emergencies, to be present from the onset of active labor, throughout the immediate postpartum period.

(2) The board shall conduct a "sunset" review, including the necessity for and safety of the VBAC rule, on or about May, 2001, or five years from the effective date of this rule.

History: 37-27-105, MCA; IMP, 37-27-105, 37-27-311, MCA; NEW, 1996 MAR p. 1829, Eff. 7/4/96; TRANS, from Commerce, 2001 MAR p. 1642; AMD, 2003 MAR p. 2873, Eff. 12/25/03; AMD, 2007 MAR p. 263, Eff. 2/23/07.

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