(a) Using reasonable skill and knowledge, the midwife
shall collect, assess, and document maternal care data through a detailed
obstetric, gynecologic, medical, social, and family history and a
complete prenatal physical exam and appropriate laboratory testing,
including antenatal testing if necessary; develop and implement a
plan of care; thereafter evaluate the client's condition on an ongoing
basis; and modify the plan of care as necessary. Health education/counseling
shall be provided by the midwife as appropriate.
(b) If on initial or subsequent assessment, one of
the following conditions exists, the midwife shall recommend referral
and document that recommendation in the midwifery record:
(1) infection requiring antimicrobial therapy;
(2) Hepatitis;
(3) non-insulin dependent diabetes;
(4) thyroid disease;
(5) current drug or alcohol abuse;
(6) asthma;
(7) abnormal pap smear (consistent with malignancy
or pre-malignancy) during the current pregnancy;
(8) seizure disorder;
(9) prior cesarean section (except for prior classical
or vertical incision, which will require transfer in accordance with
subsection (c)(8));
(10) twin gestation;
(11) history of prior antepartum or neonatal death;
(12) history of prior infant with a genetic disorder;
(13) abnormal vaginal bleeding;
(14) maternal age less than 15 at estimated date of
delivery;
(15) history of cancer (except for ovarian, breast,
uterine, or cervical cancer which will require transfer in accordance
with subsection (c)(16));
(16) psychiatric illness; or
(17) any other condition or symptom which could adversely
affect the mother or fetus, as assessed by a midwife exercising reasonable
skill and knowledge.
(c) If on initial or subsequent assessment, one of
the following conditions exists, the midwife shall recommend transfer
in accordance and document that recommendation in the midwifery record:
(1) placenta previa in the third trimester;
(2) Human Immunodeficiency Virus (HIV) positive or
Acquired Immunodeficiency Syndrome (AIDS);
(3) cardio vascular disease, including hypertension,
with the exception of varicosities;
(4) severe psychiatric illness;
(5) history of cervical incompetence with surgical
therapy;
(6) pre-term labor (less than 37 weeks);
(7) Rh or other blood group isoimmunization;
(8) previous uterine surgery involving incision into
the uterine myometrium, other than a low transverse cesarean section;
(9) preeclampsia/eclampsia;
(10) documented oligo-hydramnios or poly-hydramnios;
(11) any known fetal malformation requiring immediate
post-natal hospital care;
(12) Preterm Premature Rupture of Membranes (PPROM);
(13) intrauterine growth restriction;
(14) insulin dependent diabetes;
(15) triplet or higher order multiple gestation;
(16) active cancer or history of ovarian, breast, uterine,
or cervical cancer;
(17) undiagnosed vaginal bleeding lasting longer than
two weeks; or
(18) any other condition or symptom which could threaten
the life of the mother or fetus, as assessed by a midwife exercising
reasonable skill and knowledge.
(d) If a client has reached 42.0 weeks gestation and
is not yet in labor, the midwife shall immediately either:
(1) collaborate with a physician and obtain appropriate
antenatal testing, in order to continue midwifery care; or
(2) initiate transfer and document that action in the
midwifery record.
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