Current through Register Vol. 47, No. 17, September 10, 2024
The purpose of this Rule is to define and clarify minimum
practice requirements of safe care for women and infants regarding intrapartum
care pursuant to section
12-225-106, C.R.S., which include
but are not limited to:
A. The
direct-entry midwife is responsible for making arrangements to be with the
client by the time active labor has been established as determined by
contractions occurring every 5 minutes and lasting for 60 seconds or cervical
dilation of 6 cm or more. Once labor has been so established, the direct-entry
midwife shall remain with the client.
B. When membranes rupture, the direct-entry
midwife shall assess fetal wellbeing. In the case of prelabor rupture of the
membranes, no further vaginal checks shall be made until active
labor.
C. Aseptic technique and
universal precautions shall be used while rendering care.
D. The direct-entry midwife is responsible
for monitoring the status of the client and fetus during labor and delivery
including but not limited to:
1. Maternal
vital signs and physical well-being such as:
a. Measurement of maternal temperature,
pulse, respirations, and blood pressure at least every 4 hours; and
b. Checking for bladder distention, signs of
maternal fatigue, and hydration status;
2. Evaluating fetal vital signs and
well-being such as:
a. Fetal heart tones in
response to contractions as well as when the uterus is at rest. These tones
shall be assessed, at a minimum, every hour during early labor, every half-hour
during active labor, and every 5-10 minutes during the second stage of labor,
and
b. Normality of fetal lie,
presentation, attitude and position;
3. Progress of labor including cervical
effacement and dilation, station, presenting part and position;
4. Coaching the birthing family;
5. Checking the placenta and blood vessels
and estimating blood loss;
6.
Checking the perineum and vaginal vault for tears; and
7. Checking the cervix for tears and, if
present, making appropriate referral.
E. The direct-entry midwife shall arrange for
immediate consultation and transport according to the emergency plan if the
following conditions exist:
1. Bleeding other
than capillary bleeding ("show") prior to delivery;
2. Signs of placental abruption including
continuous lower abdominal pain and tenderness;
3. Prolapse of the cord;
4. Any meconium staining without reassuring
fetal heart tones, moderate or greater meconium staining regardless of status
of fetal heart tones;
5.
Significant change in maternal vital signs such as;
a. Temperature greater than
101°F,
b. Pulse over 100 with
decrease in blood pressure, or
c.
Increase in blood pressure greater than 140/90;
6. Failure to progress in labor such as:
a. Lack of steady progress in dilation and
descent after 24 hours in the primipara or 18 hours in the multipara;
b. Second stage of labor without steady
progress of descent through the mid-pelvis and/or pelvic outlet longer than
three hours in the primipara or two hours in the multipara, or
c. Third stage of labor longer than one
hour;
7. Fetal heart
rate below 110 or above 160 between contractions;
8. Protein or glucose in the urine;
9. Seizures;
10. Atonic uterus;
11. Retained placental fragments;
or
12. Client requests
transport.
