Florida Administrative Code (Last Updated: September 2, 2024) |
64. Department of Health |
64B24. Council of Licensed Midwifery |
64B24-7. Midwifery Practice |
1(1) For each patient, the licensed midwife shall assess risk status criteria for acceptance and continuation of care. The general health status and risk assessment shall be determined by the licensed midwife by obtaining a detailed medical history, performing a physical examination, and taking into account family circumstances along with social and psychological factors. The licensed midwife shall risk screen potential patients using the criteria in this section. If the risk factor score reaches 3 points the midwife shall consult with a physician who has obstetrical hospital privileges and if there is a joint determination that the patient can be expected to have a normal pregnancy, labor and delivery the midwife may provide services to the patient. 118When a client has a risk score of 3 or higher and has previously had a physician consultation for the identical risk factors in a prior pregnancy with no current changes in health or risk factors another consultation is not required.
159(2) The licensed midwife shall continue to evaluate a patient during the antepartum, intrapartum and postpartum. If the cumulative risk score reaches three points or higher and the patient is not expected to have a normal pregnancy, labor and delivery, the midwife shall transfer such patient out of his or her care. The midwife may provide collaborative care to the patient pursuant to Rule 22364B24-7.010, 224F.A.C.
225(3) The risk factors shall be scored as follows:
234Score
235(a) Socio-Demographic Factors.
2381. Chronological age under 16, or older than 40.
2471
2482. Residence of anticipated birth more than 30 minutes from emergency care.
2603
261(b) Documented Problems in Maternal Medical History.
2681. Cardiovascular System
271a. Chronic hypertension.
2743
275b. Heart disease.
2783
279c. Heart disease assessed by a cardiologist which places the mother or fetus at no risk.
2951
296d. Pulmonary embolus.
2993
300e. Congenital heart defects.
3043
305(i) Congenital heart defects assessed by a cardiologist which places the mother or fetus at no risk.
3221
3232. Urinary System
326a. Renal disease.
3293
330b. History of pyelonephritis.
3341
3353. Psycho-Neurological
337a. History of psychotic episode adjudged by psychiatric evaluation and which required use of drugs related to its management, but not currently on medication.
3611
362b. Current mental health problems
367requiring drug therapy.
3703
371c. Epilepsy or seizures in the last two years.
3803
381d. Required use of anticonvulsant drugs.
3873
388e. During the current pregnancy, drug or alcohol addiction, use of addicting drugs.
4013
402f. Severe undiagnosed headache.
4063
4074. Endocrine System
410a. Diabetes mellitus.
4133
414b. History of gestational diabetes.
4191
420c. Current thyroid disease.
424(i) Euthyroid.
4261
427(ii) Non-Euthyroid
4293
4305. Respiratory System
433a. Chronic bronchitis.
4361
437(i) Current or chronic or with medication.
4443
445(ii) Without medication or current problems.
4511
452b. Smoking.
454(i) 10 or less cigarettes per day.
4611
462(ii) More than 10 cigarettes per day.
4693
4706. Other Systems
473a. Bleeding disorder or hemolytic disease.
4793
480b. Cancer of the breast in the past five years.
4903
4917. Documented Problems in Obstetrical History
497a. Expected Date of Delivery (EDD) less than 12 months from date of previous delivery.
5121
513b. Previous Rh sensitization.
5173
518c. 5 or more term pregnancies.
5243
525d. Previous abortions.
528(i) 3 or more consecutive spontaneous abortions.
5353
536(ii) Two consecutive spontaneous abortions or more than three spontaneous abortions.
5471
548(iii) 1 septic abortion.
5523
553e. Uterus.
555(i) Incompetent cervix, with related medical treatment.
5623
563(ii) Prior uterine surgery
5673
568(iii) Prior uterine surgery followed by an uncomplicated vaginal birth.
5782
579f. Previous placenta abruptio.
5833
584g. Previous placenta previa.
5881
589h. Severe pregnancy induced hypertension during last pregnancy.
5972
598i. Postpartum hemorrhage apparently unrelated to management.
6053
6068. Physical Findings of Previous Births
612a. Stillbirth occurring at more than 20 weeks gestation or neonatal loss (other than cord accident).
6283
629b. Birthweight.
631(i) Less than 2500 grams or two or more previous premature labors without a subsequent low risk pregnancy and full term appropriate for gestational age (AGA) infant.
6583
659(ii) Less than 2500 grams or two or more previous premature labors with one or more full term AGA infant(s) subsequently delivered, after a low risk pregnancy.
6861
687(iii) More than 4000 grams.
6921
693c. Major congenital malformations, genetic, or metabolic disorder.
7013
7029. Maternal Physical Findings
706a. Gestation.
708(i) Of more than 22 weeks in the patient’s first pregnancy (nullipara), unless the patient provides a copy of a medical record documenting a prenatal physical examination and prenatal care by a licensed physician, advanced registered nurse practitioner, or licensed midwife trained in obstetrics and gynecology who regularly provides maternity care.
7593
760(ii) Of more than 28 weeks if the patient has had at least one previous viable birth (multipara), unless the patient provides a copy of a medical record documenting a prenatal physical examination and prenatal care by a licensed physician, advanced registered nurse practitioner, or licensed midwife trained in obstetrics and gynecology who regularly provides maternity care.
8173
818b. Prepregnant weight is not within the range of the following weights by height:
8322
833Height in Inches
836Prepregnant Minimum
838Prepregnant Maximum
840Without Shoes
842Weight in Pounds
845Weight in Pounds
84856
84983
850143
85157
85285
853146
85458
85586
856150
85759
85889
859153
86060
86192
862157
86361
86495
865161
86662
86797
868166
86963
870100
871170
87264
873103
874175
87565
876106
877180
87866
879110
880185
88167
882113
883190
88468
885117
886196
88769
888121
889202
89070
891124
892208
89371
894128
895212
89672
897131
898217
89973
900135
901222
902c. Evidence of clinically diagnosed pathological uterine myoma or malformations, abdominal or adnexal masses.
9163
917d. Polyhydramnios or oligohydramnios.
921(i) Prior pregnancy.
9242
925(ii) Current pregnancy.
9283
929e. Cardiac diastolic murmur, systolic murmur grade III or above, or cardiac enlargement.
9423
94310. Current Laboratory Findings
947a. Hematocrit/Hemoglobin.
949(i) Less than 31% or 10.3 gm/100 ml.
9571
958(ii) Less than 28% or 9.3 gm/100 ml.
9663
967b. Sickle cell anemia.
9713
972c. Pap smear suggestive of dysplasia.
9783
979d. Evidence of active tuberculosis.
9843
985e. Positive serologic test for syphilis confirmed active.
9933
994f. HIV positive.
9973
998Rulemaking 999Authority 1000456.004(5), 1001467.005 FS. 1003Law Implemented 1005467.015 FS. 1007History–New 7-14-94, Formerly 61E8-7.004, 59DD1012-7.004, Amended 9-11-02, 2-2-06, 4-1-09.