{"data":{"id":"us-ky/krs-314.410","jurisdiction":"us-ky","citation":"KRS 314.410","heading":"Board of Nursing to promulgate administrative regulations based upon","body":"recommendations of the council -- Recommendations to include regulatory\nframework to support consultation and collaboration between licensed\ncertified professional midwives and other appropriate licensed health care\nproviders -- Specifications to be included in regulatory framework --\nManagement of clients whose conditions may preclude them from being\nconsidered at low risk -- Board to enforce specified safety precautions before\nadministrative regulations are in place.\n(1) Within one (1) year of June 27, 2019, the council shall make recommendations to\nthe board for the promulgation of administrative regulations by the board regarding\nrequirements for the management of clients wh o may have a condition that\nprecludes the clients from being considered at low risk of an adverse outcome for\nthe mother, her fetus, or her newborn. These recommendations shall include:\n(a) A regulatory framework to support consultation and collaboration b etween\nlicensed certified professional midwives and other appropriate licensed health\ncare providers with expertise in obstetrical and neonatal care, in order to\noptimize obstetrical and neonatal outcomes in whatever setting a client\nchooses for birth. The regulatory framework shall specify:\n1. Processes and infrastructure to facilitate collaboration and consultation\nwith other licensed healthcare providers who possess the appropriate\nmedical expertise;\n2. Processes and infrastructure to facilitate co -management with, or\ntransfer of primary management responsibility to, other licensed\nhealthcare providers who possess the appropriate medical expertise;\n3. Processes and infrastructure for transfer of clients to facilities with a\nhigher level of care, as develo ped by the Transfer Guidelines Work\nGroup established in KRS 314.414, and as updated by the council;\n4. Processes for the provision of required or routinely recommended\nscreening and disease prevention measures, if not provided directly by\nthe licensed certified professional midwife; and\n5. Other collaborative processes deemed necessary by the council or the\nboard to optimize obstetrical and neonatal outcomes;\n(b) A list of conditions or symptoms associated with a risk of death or serious\npermanent harm aff ecting a mother, fetus, or newborn, as assessed by a\nlicensed certified professional midwife exercising reasonable skill and\nknowledge, and:\n1. Requirements for collaborative management with, or referral of primary\nmanagement responsibility to, a physician  or other appropriate licensed\nhealthcare provider, of a client with conditions or symptoms specified\nunder this paragraph, to protect the health and safety of a mother, fetus\nor newborn. Separate regulatory requirements shall be developed for\neach or any condition on the list, if clinically appropriate; and\n2. Requirements for management of a client with conditions or symptoms\nspecified under this paragraph who refuses to consent to\nrecommendations intended to prevent death or serious permanent harm,\nincluding requirements for informed refusal by the client. The\nrequirements for informed refusal shall be tailored to the specific\ncondition or symptom, and shall reflect maximal effort to protect the life\nand health of the mother, her fetus, and her newborn; and\n(c) A list of conditions or symptoms associated with a more than minimal risk of\nadversely affecting a mother, fetus, or newborn, but not a significant risk of\ndeath or serious permanent harm, as assessed by a licensed certified\nprofessional midwife exercising reasonable skill and knowledge, and:\n1. Requirements for consultation, collaborative management, or referral of\nprimary management responsibility of a client with conditions or\nsymptoms specified under this paragraph, for each condition or\nsymptom on the list, to ensure the health and safety of a mother, fetus, or\nnewborn; and\n2. Requirements for documentation of an informed refusal by a client with\nconditions or symptoms specified under this paragraph of recommended\nconsultation, referral of care, or other management, including the\ninformation to be provided to a client that is ne cessary to enable\ninformed refusal of recommended care.\n(2) The council's recommendations shall be considered by the board to form the basis\nfor any requirements or restrictions imposed by the board on the provision of\ncertified professional midwifery serv ices to a client whose condition is not\nclassified as low -risk. The recommendations shall be based on evolving medical\nevidence published in peer -reviewed medical literature and with consideration to\nthe likelihood of serious harm or death to the mother or newborn.\n(3) Until such time as the council has conveyed superseding recommendations to the\nboard and the board has promulgated superseding administrative regulations, the\nfollowing shall be enforced by the board:\n(a) If on initial or subsequent assessmen t, one (1) of the following conditions\nexists, the licensed certified professional midwife shall arrange for\nconsultation and either collaboration or referral in accordance with KRS\n314.400 to 314.414, and document that recommendation in the licensed\ncertified professional midwife's record:\n1. Complete placenta previa, or partial placenta previa persisting after\ntwenty eight (28) weeks;\n2. HIV infection;\n3. Cardiovascular disease, including hypertension;\n4. Severe psychiatric illness that may result in self-harm or harm to others;\n5. History of cervical incompetence;\n6. Pre-eclampsia or eclampsia;\n7. Intrauterine growth restriction, oligohydramnios or polyhydramnios in\nthe current pregnancy;\n8. Known potentially serious anatomic fetal abnormalities;\n9. Any t ype of diabetes requiring insulin or other medication for\nmanagement;\n10. Gestational age greater than forty-three (43) weeks; or\n11. Any other condition or symptom which could threaten the life of the\nmother or fetus, as assessed by a licensed certified p rofessional midwife\nexercising reasonable skill and knowledge;\n(b) The licensed certified professional midwife may continue to participate in the\ncare of a client requiring transfer, in a collaborative fashion and as mutually\nagreed upon with the accepting  physician, to the extent permitted by hospital\nregulations and if it is beneficial to the client. If a client with a condition listed\nin paragraph (a) of this subsection declines to accept a medically indicated\nconsultation or referral, the licensed certi fied professional midwife shall\ndocument such refusal in writing and shall endeavor to transition the client to\nan appropriate higher level of care. If the condition mandating transfer occurs\nduring labor or delivery, or the client is otherwise acutely in jeopardy but\nrefuses transfer, then the midwife shall call 911 and provide care at least until\nrelieved by another appropriate licensed health care provider; and\n(c) If on initial or subsequent assessment, one (1) of the following conditions\nexists, the mi dwife shall arrange for consultation and either collaboration or\nreferral in accordance with KRS 314.400 to 314.414, and document that\nrecommendation in the midwifery record:\n1. Prior cesarean section or other surgery resulting in a uterine scar;\n2. Multifetal gestation;\n3. Non-cephalic presentation after thirty-six (36) weeks gestation; and\n4. History of severe shoulder dystocia as documented by objective\nfindings.\n(4) The board shall, at the earliest opportunity, promulgate administrative regulations\nspecific to the conditions listed in subsection (3)(c) of this section, including the\nminimum requirements for informed refusal by the client of otherwise mandatory\nconsultation and either collaboration or referral.\n(5) If the client has complied with administ rative regulations promulgated by the board\nfor informed refusal, then the licensed certified professional midwife may pursuant\nto subsection (4) of this section, continue to assume primary management\nresponsibility for the client unless and until the clie nt subsequently consents to\ncollaborative care or referral.","path":["KRS Chapter 314"],"source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=48878","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:58:11Z","sha256":"94b855c7b13b1f7a7f35361442f2c5abf6fd8a2ded6f39521fb196bd9e8200ef","source_id":"us-ky","stale":false,"prev":"us-ky/krs-314.408","next":"us-ky/krs-314.412"},"notice":"GroundRules: Original legal text. Not legal advice."}