| (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;
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
as defined in §831.52 of this title (relating to Inter-professional
Care) 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) of this section);
(10) multiple gestation;
(11) history of prior antepartum or neonatal death;
(12) history of prior infant with a genetic disorder;
(13) significant vaginal bleeding;
(14) maternal age less than 15 at EDC;
(15) cancer or history of cancer;
(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 with §831.52 of this title 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) any previous cesarean section with a vertical or
classical incision, or any previous uterine surgery which required
an incision in the uterine fundus;
(9) preeclampsia/eclampsia;
(10) documented oligo-hydramnios or poly-hydramnios;
(11) any known fetal malformation;
(12) preterm premature rupture of membranes (PPROM);
(13) intrauterine growth restriction;
(14) insulin dependent diabetes; or
(15) 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) In lieu of referral or transfer, the midwife may
manage the client in collaboration with an appropriate health care
professional as defined in §831.52 of this title.
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| Source Note: The provisions of this §831.60 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 |
