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Florida Administrative Code (Last Updated: October 28, 2024) |
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64. Department of Health |
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64B24. Council of Licensed Midwifery |
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64B24-7. Midwifery Practice |
1(1) Upon initial assessment, the midwife shall:
8(a) Determine onset of labor.
13(b) Review patient’s prenatal records.
18(c) Assess condition of the mother and fetus.
26(d) Assess delivery environment.
30(e) Perform sterile vaginal examinations to initially assess cervical dilation and effacement, presentation, position and station of the fetus, and the status of the membranes.
55(2) Throughout active labor the midwife shall:
62(a) Maintain a safe and hygienic environment.
69(b) Provide nourishment, rest and support as indicated by patient’s condition.
80(c) Monitor, assess and record the status of labor and the maternal and fetal condition.
95(d) Measure the blood pressure every hour unless significant changes or symptoms require more frequent assessments.
111(e) Take the patient’s pulse every 2 hours while membranes are intact and temperature is normal, then every hour after rupture of membranes.
134(f) Take the temperature every 4 hours, or more frequently if maternal condition warrants, and every hour if elevated to 100º F or above.
158(g) Estimate fluid intake and urinary output at least every 2 hours.
170(h) Assess for hydration and edema.
176(3) The midwife shall assess and record the status of labor as follows:
189(a) Measure the frequency, duration and intensity of the contractions every half hour and more frequently if indicated.
207(b) Observe and record vaginal discharge.
213(c) Monitor fetal heart tones during and following contractions to assess fetal condition according to the following schedule after admission to care for labor:
2371. Every hour during the latent phase.
2442. Every 30 minutes during the active phase of the first stage.
2563. Every 15 minutes during transition.
2624. Every five minutes during the second stage.
2705. Immediately after the appearance of amniotic fluid in the vaginal discharge.
282(d) Palpate the abdomen for the position and level of the presenting part.
295(e) Perform sterile vaginal examinations to assess cervical dilation and effacement, presentation, position and station of the fetus, and the status of the membranes.
319(4) Risk factors shall be assessed throughout labor to determine the need for physician consultation or emergency transport. The midwife shall consult, refer or transfer to a physician with hospital obstetrical privileges if the following occur during labor, delivery or immediately thereafter:
361(a) Premature labor, meaning labor occurring at less than 37 weeks of gestation.
374(b) Premature rupture of membranes, meaning rupture occurring more than 12 hours before onset of regular active labor.
392(c) Non-vertex presentation.
395(d) Evidence of fetal distress.
400(e) Abnormal heart tones.
404(f) Moderate or severe meconium staining.
410(g) Estimated fetal weight less than 2500 grams or greater than 4000 grams.
423(h) Pregnancy induced hypertension which is defined as 140/90, or an increase of 30 mm hg systolic or 15 mm hg diastolic above baseline.
447(i) Failure to progress in active labor:
4541. First stage: lack of steady progress in dilation and descent after 24 hours in primipara and 18 hours in multipara.
4752. Second stage: more than 2 hours without progress in descent.
4863. Third stage: more than 1 hour.
493(j) Severe vulvar varicosities.
497(k) Marked edema of cervix.
502(l) Active bleeding.
505(m) Prolapse of the cord.
510(n) Active infectious process.
514(o) Other medical or surgical problems.
520(5) The midwife shall not perform any operative procedure other than:
531(a) Artificial rupture of the membranes when the fetal head is engaged and well applied to the cervix in active labor and four or more centimeters dilated.
558(b) Clamping and cutting the umbilical cord.
565(c) Episiotomy when indicated.
569(d) Suture to repair first and second degree lacerations.
578(6) The midwife shall not attempt to correct fetal presentations by external or internal version.
593(7) The midwife shall use only prescription drugs pursuant to Rule 60464B24-7.011, 605F.A.C.
606(8) The midwife shall not use artificial, forcible or mechanical means to assist the birth.
621Specific Authority 623467.005 FS. 625Law Implemented 627467.015 FS. 629History–New 7-14-94, Formerly 61E8-7.008, 59DD-7.008, Amended 9-11-02, 7-21-03.
