Informed Disclosure of Practice

IC 25-23.4-4 lays out the requirements for informed consent and disclosure of practice.  The Committee cannot provide specific guidance.  If you have questions regarding these requirements please consult with private counsel.

     Sec. 1. (a) All the following must occur before a certified direct entry midwife may accept a client for midwifery care:

(1) The certified direct entry midwife must provide the potential client with an informed disclosure of practice form.

(2) The potential client must sign and date the form.

(3) The certified direct entry midwife must sign and date the form.

(4) If the potential client refuses a procedure or treatment required by law, the potential client must so indicate on a separate procedure or treatment form.

(5) The certified direct entry midwife must have an emergency plan for the care of the client if an emergency arises. As part of the emergency plan, the client must sign a release of the client's medical records that allows the certified direct entry midwife to provide the client's medical records to a physician if an emergency arises.

(6) Subject to rules adopted under IC 25-23.4-2-6(b)(5), the certified direct entry midwife must have a collaborative agreement with a physician to provide for consultation and care for the client. The physician shall examine the client at least one (1) time during the client's first trimester and one (1) time during the client's third trimester. The collaborating physician should be located in an area close to where the delivery will occur.

(7) The certified direct entry midwife must provide the client with a list of options for additional screening and assessments, including visits to a physician.

(8) The certified direct entry midwife must maintain medical records on the client through the entire course of care and transfer the medical records to a treating physician if an emergency arises. The medical records must contain all the forms that are required under this subsection.

     (b) A certified direct entry midwife may not have a minor as a client unless the minor's parent or guardian has agreed in writing to use the certified direct entry midwife and all other requirements of this article have been met.

     Sec. 2. (a) A certified direct entry midwife may not perform on a client a specific procedure or treatment that is not described on the informed disclosure of practice form described in section 1 of this chapter until both of the following occur:

(1) The specific procedure or treatment is disclosed to the client in writing on a form that is separate from the informed disclosure of practice form.

(2) The client agrees to the procedure or treatment by signing the procedure or treatment form.

     (b) If the potential client refuses a procedure or treatment required by law, the client must so indicate on a separate procedure or treatment form, which must be maintained in the client's medical records.

     Sec. 3. The informed disclosure of practice form must be in writing and must contain the following information:

(1) A description of the certified direct entry midwife's education and training in midwifery, including completion of continuing education courses and participation in the peer review process.

(2) The certified direct entry midwife's experience level in the field of midwifery.

(3) The certified direct entry midwife's philosophy of practice.

(4) Antepartum, intrapartum, and postpartum period conditions requiring consultation, transfer of care, and transport to a hospital.

(5) The emergency medical backup plan, including the emergency plan and the collaborative agreement with a physician for backup care required under section 1 of this chapter.

(6) The services to be provided to the client by the certified direct entry midwife and that a physician is required to examine the client at least one (1) time during the client's first trimester and one (1) time during the client's third trimester.

(7) The certified direct entry midwife's current status of certification under this article.

(8) A detailed explanation of treatments and procedures.

(9) A detailed description of the risks and expected benefits of midwifery care.

(10) The availability of a grievance process in a case in which a client is dissatisfied with the performance of the certified direct entry midwife.

(11) A statement that if the client is advised by the certified direct entry midwife or a collaborating physician that the client is or has become at risk (as described in IC 25-23.4-6), the certified direct entry midwife:

(A) shall refer the client to a physician for consultation;

(B) may refuse to provide or continue care; and

(C) may transfer care of the client to a physician.

(12) A statement disclosing whether or not the certified direct entry midwife maintains liability insurance.

(13) That state certification of a certified direct entry midwife does not ensure that a home setting for delivery of a child is safe.

(14) A statement that the client understands that the client is waiving the right to sue a physician or health care provider for the following:

(A) The acts or omissions of the client's certified direct entry midwife.

(B) For collaboration or work with a certified direct entry midwife except for in cases of gross negligence or willful or wanton misconduct by the physician or health care provider.

     Sec. 5. (a) Except as provided in subsection (b), a certified direct entry midwife may not dispense or administer prescription drugs.

     (b) A certified direct entry midwife may carry and administer the following medications under a protocol issued and agreed to by a physician licensed under IC 25-22.5:

(1) Postpartum antihemorrhagic drugs in emergency situations.

(2) Local anesthetics by infiltration or topical application, only for postpartum repair of lacerations, tears, and episiotomy.

(3) Oxygen.

(4) Prophylactic antibiotics for Group B Strep (also known as Beta Strep).

     (c) A certified direct entry midwife may not administer a drug intravenously and may, with a physician's order, administer the following:

(1) Vitamin K, either orally or through intramuscular injection.

(2) Rhogam.

(3) Prophylactic ophthalmic antibiotics.

 specifying the circumstances under which a certified direct entry midwife may administer the substances listed in this subsection.