Section I–G Restrictions and Prohibitions relative to the Community-based (OOH) Practice of Midwifery
The following restrictions and prohibitions specifically pertain to the routine out-of-hospital administration of medications, surgical procedures and instrumental deliveries.**
A. The licensed midwife shall not routinely administer or inject any prescription drugs except as authorized by the LMPA and its amendments or under written or verbal order from a licensed physician or mid-level practitioner such as a certified nurse midwife, registered nurse practitioner or physician assistant practicing in association with a licensed physician. ^O^ fg
B. Administration of labor-stimulating prescription drugs prohibited
1. The out-of-hospital administration of synthetic prostaglandin compounds for cervical ripening such as, but not limited to, Cervidil, Prepidil, or Cytotec, is prohibited for out-of-hospital use, even when prescribed by a physician or physician associate.
2. The out-of-hospital administration of artificial oxytocics, such as Pitocin, to induce or augment labor, is prohibited through all routes, even when prescribed by a physician or physician associate.
C. Permitted surgical procedures ~ a licensed midwife shall not perform any routine operative procedures or surgical repairs except for the following:
1. Artificial rupture of membranes (AROM)
2. Clamping and cutting of the newborn’s umbilical cord
3. Episiotomy
4. Perineal/vaginal repair after delivery
D. Instrumental delivery ~ a licensed midwife shall not use forceps and/or vacuum extraction in any OOH setting to assist the vaginal birth of the baby
** Please note that the emergency exceptions clause (section 2063) of the California Medical Practices Act negates some or all of these restrictions, thus authorizing first-responders to resolve a bona fide emergency in which effective medical care cannot be accessed in the timeframe necessary to save a life, prevent permanent disability and/or extreme suffering. However, the emergency exemptions clause would only apply to actions for which the midwife, as a first responder, was trained, equipped and able to perform. Therefore, it would not extend to performing an emergent Cesarean section on a living mother, as this would exchange the original life-threatening situation for another of equal danger.