Current through Reg. 50, No. 187; September 24, 2024
(1) The licensed midwife shall:
(a) Require each patient to have a complete
history and physical examination which includes:
1. Pap smear.
2. Serological screen for syphilis.
3. Gonorrhea and chlamydia
screening.
4. Blood group including
Rh factor and antibody screen.
5.
Complete blood count (CBC).
6.
Rubella titer.
7. Urinalysis with
culture.
8. Sickle cell screening
for at risk population.
9. Screen
for hepatitis B surface antigen (HBsAG).
10. Screen for HIV/AIDS.
(b) Conduct the Healthy Start Prenatal Screen
interview or assure that each patient has been previously screened.
(c) Provide counseling and offer screening
related to the following:
1. Neural tube
defects.
2. Group B
Streptococcus.
3. CVS or genetic
amniocentesis for women 35 years of age or older at the time of
delivery.
4. Nutritional
counseling.
5. Childbirth
preparation.
6. Risk
Factors.
7. Common discomforts of
pregnancy.
8. Danger signs of
pregnancy.
(d) Follow-up
screening:
1. Hematocrit or hemoglobin levels
at 28 and 36 weeks gestation.
2.
Diabetic screening between 24 and 28 weeks gestation.
3. Antibody screen for Rh negative mothers,
at 28 weeks gestation. Counsel and encourage RhoGAM prophylaxis. In those
clients declining RhoGAM prophylaxis repeat antibody screen at 36
weeks.
(e) Require
prenatal visits every four weeks until 28 weeks gestation, every two weeks from
28 to 36 weeks gestation and weekly from 36 weeks until
delivery.
(2) The
following procedures and examinations shall be completed and recorded at each
prenatal visit:
(a) Weight.
(b) Blood pressure.
(c) Urine dip stick for protein and glucose
each visit with leukocytes, ketones, and nitrites as indicated.
(d) Fundal height measurements.
(e) Fetal heart tones and rate.
(f) Assessment of edema and patellar
reflexes, when indicated.
(g)
Indication of weeks' gestation and size correlation.
(h) Determination of fetal presentation after
28 weeks of gestation.
(i)
Nutritional assessment.
(j)
Assessment of subjective symptoms of PIH, UTI and preterm
labor.
(3) An assessment
of the Expected Date of Delivery (EDD) and gestational age shall be done by 20
weeks, if practical, according to:
(a) Last
normal menstrual period.
(b)
Reference to the statement of uterine size recorded during the initial
exam.
(c) Hearing fetal heart tones
at eleven weeks with a Doppler unit, if one is available, and patient gives
consent.
(d) Recording of
quickening date.
(e) Recording
weeks of gestation by dates and measuring in centimeters the height of the
uterine fundus.
(f) Hearing the
fetal heart tones at twenty weeks with a fetoscope.
(4) If a reliable EDD cannot be established
by the above criteria, then the licensed midwife shall encourage the patient to
have an ultrasound for EDD.
(5) The
midwife shall refer a patient for consultation to a physician with hospital
obstetrical privileges if any of the following conditions occur during the
pregnancy:
(a) Hematocrit of less than 33% at
37th week gestation or hemoglobin less than 11 gms/100 ml.
(b) Unexplained vaginal bleeding.
(c) Abnormal weight change defined as less
than 12 or more than 50 pounds at term.
(d) Non-vertex presentation persisting past
37th week of gestation.
(e)
Gestational age between 41 and 42 weeks.
(f) Genital herpes confirmed clinically or by
culture at term.
(g) Documented
asthma attack.
(h) Hyperemesis not
responsive to supportive care.
(i)
Any other severe obstetrical, medical or surgical problem.
(6) The midwife shall transfer a patient if
any of the following conditions occur during the pregnancy:
(a) Genetic or congenital abnormalities or
fetal chromosomal disorder.
(b)
Multiple gestation.
(c)
Pre-eclampsia.
(d) Intrauterine
growth retardation.
(e)
Thrombophlebitis.
(f)
Pyelonephritis.
(g) Gestational
diabetes confirmed by abnormal glucose tolerance test.
(h) Laboratory evidence of Rh
sensitization.
(7) If the
conditions listed pursuant to this section are resolved satisfactorily and the
physician and midwife deem that the patient is expected to have a normal
pregnancy, labor and delivery, then the care of the patient shall continue with
the licensed midwife.
Rulemaking Authority 456.004(5), 467.005 FS. Law
Implemented 467.015 FS.
New 7-14-94, Formerly 61E8-7.007, 59DD-7.007, Amended
9-11-02, 7-21-03, 9-18-06.
