Current through Register No. 12, March 21, 2024
(a) A midwife
shall provide prenatal care to a client at least:
(1) Once a month through the twenty-eighth
week of pregnancy;
(2) Once every 2
weeks from the twenty-eighth through the thirty-sixth week of pregnancy;
and
(3) Once a week from the
thirty-sixth week of pregnancy until the onset of labor.
(b) A midwife shall schedule the initial
prenatal visit with a client in the first or second trimester of
pregnancy.
(c) If a woman
requesting midwifery services does not contact the midwife before the third
trimester of her pregnancy, the midwife shall accept her as a client only if
she:
(1) Has had adequate prenatal care, or
has met the criterion for a low risk birth as defined by an NHCM's scope of
practice; and
(2) Displays adequate
fetal growth, fetal heart rate and fetal movement.
(d) During the initial prenatal visit the
midwife shall:
(1) Obtain a maternal health,
obstetrical, and gynecological history;
(2) Perform a nutritional assessment and
provide nutritional counseling;
(3)
Discuss the availability of options for screening and testing for fetal
abnormalities;
(4) Obtain blood
pressure;
(5) Perform a pelvic
exam, if indicated, including:
a. Uterine
sizing to estimate gestational age;
b. Pelvimetry;
c. A chlamydia and gonorrhea screening test;
and
d. A Pap test;
(6) Either perform or order blood
analysis, including, but not limited to:
a.
Blood group and Rh factor;
b.
Antibody screen;
c. A complete
blood count;
d. Rubella
titre;
e. Syphilis
serology;
f. Hepatitis B surface
antigen;
g. Hepatitis C surface
antigen, if indicated; and
h. HIV
testing, if accepted by the client;
(7) Recommend that the client receive a
general physical exam by a qualified health care provider to screen for general
health problems that have the potential to complicate the pregnancy or
delivery; and
(8) Obtain informed
consent for midwifery care and out-of-hospital birth, to include the following
information:
a. A description of the midwife's
background and credentials;
b.
Whether the midwife has professional liability coverage; and
c. The address and telephone number of the
council, where complaints against the midwife may be filed.
(e) During subsequent
prenatal visits the midwife shall:
(1) Assess
maternal nutrition and weight gain;
(2) Obtain blood pressure;
(3) Test urine for protein and
glucose;
(4) Assess general
well-being;
(5) Check for signs and
symptoms of edema, bleeding, headache, visual disturbances, or unusual vaginal
discharge;
(6) Obtain fundal height
measurement;
(7) Arrange for
periodic hematocrit or hemoglobin testing;
(8) Assess fetal heart rate and fetal
activity;
(9) Assess position and
presentation of the fetus;
(10)
Perform or order the following as necessary:
a. Rh antibody screening;
b. Urinalysis;
c. Microscopic analysis of vaginal
discharges;
d. Obstetric
ultrasound;
e. Prophylactic Rh
immune globulin injection;
f. Blood
sugar screening;
g. Cultures;
and
h. Thyroid screening, if
indicated;
(11) Observe
aseptic technique and standard precautions; and
(12) Discuss:
a. Any recent illnesses, symptoms, social or
emotional problems;
b.
Diet;
c. Medications and
supplements;
d. Reading
suggestions;
e. Exercise;
f. Rest and sleep requirements;
g. Sexuality;
h. Partner's role;
i. Birth preparation;
j. Newborn care;
k. Parenting; and
l. Transportation arrangements.
(f) A midwife shall
advise any client with genital herpes of the ACOG herpes protocol current at
the time of the midwife's conversation with the client.
(g) A midwife shall discuss with clients the
standards of care and recommendations for testing for and treating of group B
streptococcus.
(h) A midwife shall
encourage any client expecting a first child to attend childbirth education
classes.
(i) A midwife shall
discuss with the client, during the prenatal period, the selection of a
pediatrician, family physician, or other health care provider who will assume
care of the newborn.
(i) A midwife
shall alert the client to:
(1) Signs of
complications that necessitate immediate contact with the midwife;
and
(2) Signs of labor and when it
is time to call the midwife.
(j) A midwife shall be on call or make
specific arrangements for on call coverage with another midwife or licensed
health care provider whose scope of practice includes birth.
(k) In the third trimester, a midwife shall
ensure that a client is adequately preparing for birth in an out-of-hospital
location by discussing:
(1) The place of the
birth and the facilities available there;
(2) The availability of adequate heat and
water;
(3) The supplies the client
must procure;
(4) The availability
of a telephone;
(5) Arrangements
for help after the birth;
(6) With
a client preparing for birth in a private home, the importance of keeping
readily available the following written information, as appropriate:
a. The name, location, and phone number of
the nearest ambulance service;
b.
The name, location, and phone number of the nearest hospital;
c. The name and phone number of the newborn's
health care provider; and
d. The
street address of the location of the birth and directions to that location
from the nearest ambulance service; and
(l) The transfer of care to a hospital
setting in an emergency.
#7759, eff 9-7-02
