(1) The terms "direct supervision", "indirect supervision", and "personal supervision" used herein are defined in ARM 24.111.301.

(2) The direct-entry midwife apprenticeship license program shall be that instructional period composed of practical experience time obtained under the personal supervision of a supervisor approved by the board.

(3) Applicants for a direct-entry midwife apprenticeship license shall submit a completed application with the proper fee, a current CPR card indicating certification to perform adult and infant cardiopulmonary resuscitation, a supervision agreement, and a curriculum outline or method of academic learning that meets the board's educational rule requirements for licensure. A supervision agreement shall include:

(a) name of supervisor who shall be a licensed direct-entry midwife, a certified nurse midwife, a licensed naturopathic physician who is certified for the specialty practice of childbirth attendance or a physician licensed under Title 37, chapter 3, MCA;

(b) agreement of parties that supervision shall be provided which is consistent with these rules; and

(c) agreement of supervisor to supervise no more than four direct-entry midwife apprentices at the same time.

(4) A Level I direct-entry midwife apprenticeship is served under the direct supervision of the licensed supervisor, with a focus on prenatal care. To complete Level I, the direct-entry midwife apprentice shall:

(a) observe 40 births;

(b) provide 20 prenatal examinations;

(c) complete Level I skills checklist; and

(d) submit a positive evaluation of skills and educational progress form and written verification by supervisor of completion of Level I.

(5) A Level II direct-entry midwife apprenticeship is served under the direct supervision of the licensed supervisor, with a focus on birth, postpartum, and newborn care. To complete Level II, the direct-entry midwife apprentice shall:

(a) attend ten births as primary birth attendant. Five of the ten births, as primary birth attendant in Level II, must be supervised by a licensed direct-entry midwife. The births must be verified by:

(i) signed birth certificates;

(ii) signed affidavits from the birthing mothers; or

(iii) documented records from the person who supervised the births to include prenatal records, birth records, and postpartum records;

(b) provide 40 prenatal examinations;

(c) submit prenatal protocols;

(d) complete Level II skills checklist;

(e) submit a positive evaluation of skills and educational progress form and written verification by supervisor of completion of Level II; and

(f) obtain approval from the board to proceed to Level III.

(6) A Level III direct-entry midwife apprenticeship is served as either Level III-A or III-B, as defined below. The focus of Level III shall be continuous prenatal, perinatal, and postnatal care. To complete Level III, the direct-entry midwife apprentice shall:

(a) complete 15 continuous-care births as the primary attendant:

(i) Eight of the 15 continuous-care births in Level III must be supervised by a Montana-licensed direct-entry midwife. The births must be verified by:

(A) signed birth certificates;

(B) signed affidavits from the birthing mothers; or

(C) documented records from the person who supervised the births to include prenatal records, birth records, and postpartum records;

(ii) Five of the 15 continuous-care births must include prenatal exams, one of which must have been performed before the beginning of the 28th week of gestation, as determined by last menstrual period or sonogram, and include one postpartum exam;

(iii) Ten of the 15 continuous-care births must have been performed under the personal supervision of a qualified supervisor;

(iv) At least one of the 15 continuous-care births must include a postpartum exam;

(b) provide 40 prenatal examinations;

(c) submit protocols for birth, postpartum, and newborn care;

(d) complete Level III skills checklist; and

(e) submit a positive evaluation of skills and educational progress form and written verification by supervisor of completion of Level III.

(7) Level III-A and Level III-B direct-entry midwife apprentices are distinguished as follows:

(a) A Level III-A direct-entry midwife apprentice shall require direct supervision by the licensed supervisor;

(b) A Level III-B direct-entry midwife apprentice shall require indirect supervision by the licensed supervisor when, in the professional judgment of the supervisor, with concurrence of the board, the Level III-B apprentice is capable of safely and competently performing midwifery services under indirect supervision after the following requirements have been met:

(i) verification of completion of ten directly supervised continuous-care births which include five prenatal exams, one of which must have been performed before the beginning of the 28th week of gestation, as determined by last menstrual period or sonogram, and include one postpartum exam;

(ii) verification of completion of at least 75 percent of educational/academic requirements for full licensure; and

(iii) a formal outline of the method of indirect supervision communication shall be submitted in writing to the board for approval, which shall include supervisor chart review and telephone contact supervision.

(8) Direct-entry midwife apprenticeship applicants who have at the time of application, through an apprenticeship or other supervisory setting, participated as the primary birth attendant at 25 births, 15 of which included continuous care, may enter directly into direct-entry midwife apprenticeship license Level III-B. To complete Level III-B, at least eight continuous-care births must be supervised by a Montana-licensed direct-entry midwife.

(a) The 25 births and 15 continuous-care births shall be evidenced by:

(i) the signed birth certificate as primary birth attendant;

(ii) an affidavit from the birth mother; or

(iii) documented records from the person who supervised the births to include prenatal records, birth records, and postpartum records.

(b) Documentation of each of the 15 continuous care births as defined in 37-27-103, MCA, must include at least five prenatal exams, one of which must have been performed before the beginning of the 28th week of gestation, as determined by last menstrual period or sonogram, and include one postpartum exam. Ten of the 15 continuous care births must have been performed under the direct supervision of a qualified supervisor.

(9) To be approved by the board as a supervisor of a direct-entry midwife apprentice, each supervisor applicant must submit an application on a form provided by the department and shall:

(a) hold a current, unencumbered Montana license as a direct-entry midwife, a certified nurse midwife, a licensed naturopathic physician who is certified for the specialty practice of naturopathic childbirth attendance, or a physician as defined in 37-3-102, MCA:

(i) A licensed direct-entry midwife who has not completed 20 postlicensure continuous care births may only supervise Level I apprentices;

(ii) A licensed direct-entry midwife who has completed 20 postlicensure continuous-care births as primary attendant may apply to supervise Level II and III apprentices;

(b) review and sign all documents required by the board under the direct-entry midwife apprenticeship program;

(c) supervise no more than four direct-entry midwife apprentices at the same time;

(d) notify the board in writing of any change in the supervisory relationship, including advancement from direct to indirect supervision, termination of the supervisory relationship, or any other relevant changes, and submit supervision change notification to the board so that it is received on or before the day that supervised tasks are performed in order for them to count toward licensure requirements; and

(e) be directly responsible for all activities undertaken by the apprentice(s) under their supervision agreement.

(10) Violation of the board statutes or rules may result in license discipline action against the direct-entry midwife apprentice, or supervisor, or both.