64B24-7.007. Responsibilities of Midwives During the Antepartum Period

(1) The licensed midwife shall:

(a) Require each patient to have a complete history and physical examination which includes:

1. Pap smear.

2. Serological screen for syphilis.

3. Gonorrhea and chlamydia screening.

4. Blood group including Rh factor and antibody screen.

5. Complete blood count (CBC).

6. Rubella titer.

7. Urinalysis with culture.

8. Sickle cell screening for at risk population.

9. Screen for hepatitis B surface antigen (HBsAG).

10. Screen for HIV/AIDS.

(b) Conduct the Healthy Start Prenatal Screen interview or assure that each patient has been previously screened.

(c) Provide counseling and offer screening related to the following:

1. Neural tube defects.

2. Group B Streptococcus.

3. CVS or genetic amniocentesis for women 35 years of age or older at the time of delivery.

4. Nutritional counseling.

5. Childbirth preparation.

6. Risk Factors.

7. Common discomforts of pregnancy.

8. Danger signs of pregnancy.

(d) Follow-up screening:

1. Hematocrit or hemoglobin levels at 28 and 36 weeks gestation.

2. Diabetic screening between 24 and 28 weeks gestation.

3. Antibody screen for Rh negative mothers, at 28 weeks gestation. Counsel and encourage RhoGAM prophylaxis. In those clients declining RhoGAM prophylaxis repeat antibody screen at 36 weeks.

(e) Require prenatal visits every four weeks until 28 weeks gestation, every two weeks from 28 to 36 weeks gestation and weekly from 36 weeks until delivery.

(2) The following procedures and examinations shall be completed and recorded at each prenatal visit:

(a) Weight.

(b) Blood pressure.

(c) Urine dip stick for protein and glucose each visit with leukocytes, ketones, and nitrites as indicated.

(d) Fundal height measurements.

(e) Fetal heart tones and rate.

(f) Assessment of edema and patellar reflexes, when indicated.

(g) Indication of weeks’ gestation and size correlation.

(h) Determination of fetal presentation after 28 weeks of gestation.

(i) Nutritional assessment.

(j) Assessment of subjective symptoms of PIH, UTI and preterm labor.

(3) An assessment of the Expected Date of Delivery (EDD) and gestational age shall be done by 20 weeks, if practical, according to:

(a) Last normal menstrual period.

(b) Reference to the statement of uterine size recorded during the initial exam.

(c) Hearing fetal heart tones at eleven weeks with a Doppler unit, if one is available, and patient gives consent.

(d) Recording of quickening date.

(e) Recording weeks of gestation by dates and measuring in centimeters the height of the uterine fundus.

(f) Hearing the fetal heart tones at twenty weeks with a fetoscope.

(4) If a reliable EDD cannot be established by the above criteria, then the licensed midwife shall encourage the patient to have an ultrasound for EDD.

(5) The midwife shall refer a patient for consultation to a physician with hospital obstetrical privileges if any of the following conditions occur during the pregnancy:

(a) Hematocrit of less than 33% at 37th week gestation or hemoglobin less than 11 gms/100 ml.

(b) Unexplained vaginal bleeding.

(c) Abnormal weight change defined as less than 12 or more than 50 pounds at term.

(d) Non-vertex presentation persisting past 37th week of gestation.

(e) Gestational age between 41 and 42 weeks.

(f) Genital herpes confirmed clinically or by culture at term.

(g) Documented asthma attack.

(h) Hyperemesis not responsive to supportive care.

(i) Any other severe obstetrical, medical or surgical problem.

(6) The midwife shall transfer a patient if any of the following conditions occur during the pregnancy:

(a) Genetic or congenital abnormalities or fetal chromosomal disorder.

(b) Multiple gestation.

(c) Pre-eclampsia.

(d) Intrauterine growth retardation.

(e) Thrombophlebitis.

(f) Pyelonephritis.

(g) Gestational diabetes confirmed by abnormal glucose tolerance test.

(h) Laboratory evidence of Rh sensitization.

(7) If the conditions listed pursuant to this section are resolved satisfactorily and the physician and midwife deem that the patient is expected to have a normal pregnancy, labor and delivery, then the care of the patient shall continue with the licensed midwife.

Specific Authority 456.004(5), 467.005 FS. Law Implemented 467.015 FS. History–New 7-14-94, Formerly 61E8-7.007, 59DD-7.007, Amended 9-11-02, 7-21-03, 9-18-06.