Current through Reg. 50, No. 187; September 24, 2024
(1) Upon initial assessment, the midwife
shall:
(a) Determine onset of labor.
(b) Review patient's prenatal
records.
(c) Assess condition of
the mother and fetus.
(d) Assess
delivery environment.
(e) Perform
sterile vaginal examinations to initially assess cervical dilation and
effacement, presentation, position and station of the fetus, and the status of
the membranes.
(2)
Throughout active labor the midwife shall:
(a)
Maintain a safe and hygienic environment.
(b) Provide nourishment, rest and support as
indicated by patient's condition.
(c) Monitor, assess and record the status of
labor and the maternal and fetal condition.
(d) Measure the blood pressure every hour
unless significant changes or symptoms require more frequent
assessments.
(e) Take the patient's
pulse every 2 hours while membranes are intact and temperature is normal, then
every hour after rupture of membranes.
(f) Take the temperature every 4 hours, or
more frequently if maternal condition warrants, and every hour if elevated to
100º F or above.
(g) Estimate
fluid intake and urinary output at least every 2 hours.
(h) Assess for hydration and
edema.
(3) The midwife
shall assess and record the status of labor as follows:
(a) Measure the frequency, duration and
intensity of the contractions every half hour and more frequently if
indicated.
(b) Observe and record
vaginal discharge.
(c) Monitor
fetal heart tones during and following contractions to assess fetal condition
according to the following schedule after admission to care for labor:
1. Every hour during the latent
phase.
2. Every 30 minutes during
the active phase of the first stage.
3. Every 15 minutes during
transition.
4. Every five minutes
during the second stage.
5.
Immediately after the appearance of amniotic fluid in the vaginal
discharge.
(d) Palpate
the abdomen for the position and level of the presenting part.
(e) Perform sterile vaginal examinations to
assess cervical dilation and effacement, presentation, position and station of
the fetus, and the status of the membranes.
(4) Risk factors shall be assessed throughout
labor to determine the need for physician consultation or emergency transport.
The midwife shall consult, refer or transfer to a physician with hospital
obstetrical privileges if the following occur during labor, delivery or
immediately thereafter:
(a) Premature labor,
meaning labor occurring at less than 37 weeks of gestation.
(b) Premature rupture of membranes, meaning
rupture occurring more than 12 hours before onset of regular active
labor.
(c) Non-vertex
presentation.
(d) Evidence of fetal
distress.
(e) Abnormal heart
tones.
(f) Moderate or severe
meconium staining.
(g) Estimated
fetal weight less than 2, 500 grams or greater than 4, 000 grams.
(h) Pregnancy induced hypertension which is
defined as 140/90, or an increase of 30 mm hg systolic or 15 mm hg diastolic
above baseline.
(i) Failure to
progress in active labor:
1. First stage: lack
of steady progress in dilation and descent after 24 hours in primipara and 18
hours in multipara.
2. Second
stage: more than 2 hours without progress in descent.
3. Third stage: more than 1
hour.
(j) Severe vulvar
varicosities.
(k) Marked edema of
cervix.
(l) Active
bleeding.
(m) Prolapse of the
cord.
(n) Active infectious
process.
(o) Other medical or
surgical problems.
(5)
The midwife shall not perform any operative procedure other than:
(a) Artificial rupture of the membranes when
the fetal head is engaged and well applied to the cervix in active labor and
four or more centimeters dilated.
(b) Clamping and cutting the umbilical
cord.
(c) Episiotomy when
indicated.
(d) Suture to repair
first and second degree lacerations.
(6) The midwife shall not attempt to correct
fetal presentations by external or internal version.
(7) The midwife shall use only prescription
drugs pursuant to Rule
64B24-7.011, F.A.C.
(8) The midwife shall not use artificial,
forcible or mechanical means to assist the birth.
Rulemaking Authority 467.005 FS. Law Implemented 467.015
FS.
New 7-14-94, Formerly 61E8-7.008, 59DD-7.008, Amended
9-11-02, 7-21-03.
