4 Colo. Code Regs. § 739-1.5

Current through Register Vol. 47, No. 22, November 25, 2024

Section 4 CCR 739-1.5 - MINIMUM PRACTICE REQUIREMENTS REGARDING ANTEPARTUM CARE

The purpose of this Rule is to define and clarify the minimum requirements of safe care for women and infants regarding antepartum care pursuant to sections 12-225-106 and 25-4-201, C.R.S., which include but are not limited to:

A. The direct-entry midwife shall schedule client visits at least once a month beginning in the first trimester through 28 weeks; every 2 weeks from 28 weeks through 35 weeks; and weekly from 36 weeks to delivery.

B. At the time of the initial visit, the direct-entry midwife shall at a minimum:

1. Obtain a medical, obstetrical, family and nutritional history;

2. Screen for diabetes if the mother has a previous history of gestational diabetes;

3. Determine the estimated due date and perform a baseline physical examination;

4. Arrange to or obtain laboratory testing including but not limited to: blood group and Rh type, if unknown; an antibody screen test for all Rh negative mothers; CBC with differential; rubella titre; serology for syphilis; hepatitis B screen; urine for protein and glucose, culture if indicated; Gonococcal Culture screen and Chlamydia culture if needed based on social history; ultrasound imaging, if indicated. Additionally, the blood specimen obtained shall be submitted to an approved laboratory for a standard serological test for syphilis and HIV. If the client refuses consent for syphilis or HIV testing the direct-entry midwife shall document such refusal in the client record;

5. Discuss home birth, alternatives to home birth, risk assessment, and referral procedures;

6. Complete the emergency plan.

7. [Expired 05/15/2018 per House Bill 18-1253]

C. Safe care for women and infants during each prenatal visit shall, at a minimum, include but not be limited to:

1. Obtaining vital signs and weight;

2. Performing a urine dipstick for protein and glucose;

3. Assessing for:

a. Edema, headaches, visual disturbances, dizziness or sharp pains in legs, abdomen, chest or head and reflexes if indicated;

b. Mother's psychological and emotional status;

c. Nutritional status;

d. Fundal height; and

e. Fetus for gestational age, presentation and position; estimated fetal weight; fetal activity, listen for fetal heart tones and record when first audible;

4. Record all findings, interventions, and outcomes including the quickening date;

5. Provide teaching, guidance, and referral as appropriate; and

6. Discuss the emergency plan, and revise if needed.

D. Laboratory studies that should be obtained during pregnancy include:

1. An antibody screen test at 28 weeks, if indicated;

2. A Hemoglobin or Hematocrit screening at 28 and 36 weeks;

3. An oral gestational diabetes screening with a minimum of a 50 Gram glucose loading dose shall be offered to the client at 26-28 weeks; and

4. A culture for Group B Streptococci at 35 to 37 weeks, and, if the culture is positive, inform the client about antibiotic treatment options and recommend an appropriate health care provider.

E. At least one home visit shall be made during the third trimester to assure that environmental conditions are appropriate, supplies are procured, and birth participants are prepared for the home birth.

F. The direct-entry midwife shall refer clients for evaluation by a qualified licensed health care provider, and shall not continue as the care provider, when a multiple gestation or a presentation other than vertex at the onset of labor are noted.

G. The direct-entry midwife shall refer a client for evaluation by a qualified licensed health care provider, and shall not continue as the primary care provider when any of the following conditions are noted:

1. Urine glucose of 2+ or greater on two sequential visits or if other signs or symptoms of gestational diabetes occur with the urine glucose;

2. Hyperemesis requiring medical treatment;

3. Hypertension- blood pressure greater than 140/90;

4. Signs and symptoms of preeclampsia including but not limited to persistent edema, increased blood pressure or proteinuria, increased reflexes, persistent headaches, epigastric pain, visual disturbances;

5. Seizures;

6. Vaginal bleeding other than spotting after 20 weeks; or

7. Signs and symptoms of sexually transmitted disease;

8. Oral temperature in excess of 101° F for more than 24 hours accompanied by other signs or symptoms of clinically significant infection or which does not resolve within 72 hours;

9. Laboratory results indicating need for medical treatment, for example, urinary tract or yeast infections not responding to non-prescription treatment;

10. Anemia not responding to over the counter iron therapy as measured by Hemoglobin below 11 grams or Hematocrit below 34% at term;

11. Signs and symptoms of polyhydramnios or oligohydramnios;

12. Suspected fetal demise- lack of fetal movement, inability to auscultate fetal heart tones;

13. Decreased fetal movements;

14. Gestation longer than 42 weeks;

15. Rupture of membranes for:

a. Longer than 12 hours without labor for Group B Streptococci positive clients and unknown Group B Streptococci status; or

b. Longer than 18 hours without labor for Group B Streptococci negative clients;

16. Premature labor- less than 37 completed weeks gestation;

17. Active herpes;

18. Intrauterine growth restriction; or

19. Suspected abnormality of pelvis;

H. Once any of the conditions provided in paragraph G. are noted, the direct-entry midwife shall not resume care for the client until a qualified health care provider assesses the client and determines that the client is not exhibiting signs or symptoms of increased risk of medical, obstetrical, or neonatal complications, or problems during the completion of the pregnancy, labor, delivery, or the postpartum period, and is not exhibiting signs and symptoms of increased risk that the infant may develop complications or problems during the first six weeks of life.

I. The registered direct-entry midwife shall perform pelvimetry by 36 weeks gestation.

4 CCR 739-1.5

40 CR 12, June 25, 2017, effective 8/1/2017

41 CR 01, January 10, 2018, effective 1/30/2018

43 CR 03, February 10, 2020, effective 1/1/2020

43 CR 07, April 10, 2020, effective 4/30/2020

43 CR 22, November 25, 2020, effective 12/15/2020

44 CR 09, May 10, 2021, effective 5/30/2021

44 CR 20, October 25, 2021, effective 11/14/2021

45 CR 17, September 10, 2022, effective 8/15/2022

45 CR 21, November 10, 2022, effective 11/30/2022