4 Colo. Code Regs. § 739-1.6

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

Section 4 CCR 739-1.6 - MINIMUM PRACTICE REQUIREMENTS REGARDING SAFE INTRAPARTUM CARE

The purpose of this Rule is to define and clarify minimum practice requirements of safe care for women and infants regarding intrapartum care pursuant to section 12-225-106, C.R.S., which include but are not limited to:

A. The direct-entry midwife is responsible for making arrangements to be with the client by the time active labor has been established as determined by contractions occurring every 5 minutes and lasting for 60 seconds or cervical dilation of 6 cm or more. Once labor has been so established, the direct-entry midwife shall remain with the client.

B. When membranes rupture, the direct-entry midwife shall assess fetal wellbeing. In the case of prelabor rupture of the membranes, no further vaginal checks shall be made until active labor.

C. Aseptic technique and universal precautions shall be used while rendering care.

D. The direct-entry midwife is responsible for monitoring the status of the client and fetus during labor and delivery including but not limited to:

1. Maternal vital signs and physical well-being such as:

a. Measurement of maternal temperature, pulse, respirations, and blood pressure at least every 4 hours; and

b. Checking for bladder distention, signs of maternal fatigue, and hydration status;

2. Evaluating fetal vital signs and well-being such as:

a. Fetal heart tones in response to contractions as well as when the uterus is at rest. These tones shall be assessed, at a minimum, every hour during early labor, every half-hour during active labor, and every 5-10 minutes during the second stage of labor, and

b. Normality of fetal lie, presentation, attitude and position;

3. Progress of labor including cervical effacement and dilation, station, presenting part and position;

4. Coaching the birthing family;

5. Checking the placenta and blood vessels and estimating blood loss;

6. Checking the perineum and vaginal vault for tears; and

7. Checking the cervix for tears and, if present, making appropriate referral.

E. The direct-entry midwife shall arrange for immediate consultation and transport according to the emergency plan if the following conditions exist:

1. Bleeding other than capillary bleeding ("show") prior to delivery;

2. Signs of placental abruption including continuous lower abdominal pain and tenderness;

3. Prolapse of the cord;

4. Any meconium staining without reassuring fetal heart tones, moderate or greater meconium staining regardless of status of fetal heart tones;

5. Significant change in maternal vital signs such as;

a. Temperature greater than 101°F,

b. Pulse over 100 with decrease in blood pressure, or

c. Increase in blood pressure greater than 140/90;

6. Failure to progress in labor such as:

a. Lack of steady progress in dilation and descent after 24 hours in the primipara or 18 hours in the multipara;

b. Second stage of labor without steady progress of descent through the mid-pelvis and/or pelvic outlet longer than three hours in the primipara or two hours in the multipara, or

c. Third stage of labor longer than one hour;

7. Fetal heart rate below 110 or above 160 between contractions;

8. Protein or glucose in the urine;

9. Seizures;

10. Atonic uterus;

11. Retained placental fragments; or

12. Client requests transport.

4 CCR 739-1.6

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