The following definitions regarding inter-professional care
of women within a midwifery model of care apply to this chapter.
(1) Consultation is the process by which a midwife,
who maintains primary management responsibility for the woman's care,
seeks the advice of another health care professional or member of
the health care team.
(2) Collaboration is the process in which a midwife
and a health care practitioner of a different profession jointly manage
the care of a woman or newborn who needs joint care, such as one who
has become medically complicated. The scope of collaboration may encompass
the physical care of the client, including delivery, by the midwife,
according to a mutually agreed-upon plan of care. If a physician must
assume a dominant role in the care of the client due to increased
risk status, the midwife may continue to participate in physical care,
counseling, guidance, teaching, and support. Effective communication
between the midwife and the health care professional is essential
to ongoing collaborative management.
(3) Referral is the process by which a midwife directs
the client to a health care professional who has current obstetric
or pediatric knowledge and is either a physician licensed in the United
States; or working in association with a licensed physician. The client
and the physician (or associate) shall determine whether subsequent
care shall be provided by the physician or associate, the midwife,
or through collaboration between the physician or associate and midwife.
The client may elect not to accept a referral or a physician or associate's
advice, and if such is documented in writing, the midwife may continue
to care for the client.
(4) Transfer is the process by which a midwife relinquishes
care of the client for pregnancy, labor, delivery, or postpartum care
or care of the newborn to another health care professional who has
current obstetric or pediatric knowledge and is either a physician
licensed in the United States; or working in association with a licensed
physician. If a client elects not to accept a transfer, the midwife
shall terminate the midwife-client relationship according to §831.57
of this title (relating to Termination of the Midwife-Client Relationship).
If the transfer recommendation occurs during labor, delivery, or the
immediate postpartum period, and the client refuses transfer; the
midwife shall call 911 and provide further care as indicated by the
situation. If the midwife is unable to transfer to a health care professional,
the client will be transferred to the nearest appropriate health care
facility. The midwife shall attempt to contact the facility and continue
to provide care as indicated by the situation.
(5) Standing orders from a physician licensed in Texas
must be obtained if a midwife provides any prescription medication
to a client or her newborn other than oxygen and eye prophylaxis.
The orders must be current (renewed annually) and must comply with
the rules of the Texas Medical Board. Midwives have the responsibility
not to comply with an outdated order.
|Source Note: The provisions of this §831.52 adopted to be effective April 24, 2003, 28 TexReg 3327; amended to be effective September 2, 2007, 32 TexReg 5371; amended to be effective March 11, 2013, 38 TexReg 1689