Okla. Admin. Code § 310:395-5-7

Current through Vol. 42, No. 4, November 1, 2024

Section 310:395-5-7 - Assessments and care antepartum and intrapartum

(a)Antepartum. The responsibilities of the Licensed Midwife shall include, but are not limited to:

(1) Initial Prenatal Visit:

(A) A Licensed Midwife shall perform a history, physical exam, and laboratory studies for risk evaluation including:

(i) Complete history (medical, surgical, family, psychosocial, obstetrical, gynecological);

(ii) Evaluation of medications: including prescriptions, over the counter, including homeopathic treatments or supplements, and illegal drugs;

(iii) Evaluation of allergies including medications, foods, or environmental factors; and

(iv) A physical exam:

(I) Height;

(II) Weight;

(III) Blood pressure;

(IV) Pulse;

(V) Temperature;

(VI) Breasts, including teaching on self-exam;

(VII) Abdomen, including fundal height, fetal heart tones;

(VIII) Estimation of gestational age by physical findings; and

(IX) Assessment of varicosities, edema, and reflexes;

(v) Laboratory tests and screenings: The following laboratory tests/screens shall be required:

(I) Blood group type, Rhesus (Rh) type, Antibody Screen;

(II) Complete Blood Count (CBC);

(III) Rubella Titer;

(IV) Hepatitis B Surface Antigen;

(V) Syphilis serology;

(VI) Human Immunodeficiency Screening; and

(VII) Urinalysis (culture if indicated);

(vi) Recommended laboratory tests and screenings: The following laboratory tests/screens shall be recommended:

(I) Genetic Screening;

(II) Chlamydia Trachomatis;

(III) Neisseria gonorrhoeae;

(IV) Trichomonas; and

(V) Drug screen with testing if indicated.

(B) A Client has the option to refuse any test or screening offered by the Licensed Midwife. Any refusal should be documented by the Licensed Midwife and placed in the Client's file. Client refusal of any test or screening that is necessary to determine any condition precluding midwifery care shall require transfer of care.

(2) Ongoing Prenatal Care:

(A) Maternal assessments to be completed at each visit shall include:

(i) General well-being;

(ii) Psychosocial health status;

(iii) Maternal vital signs;

(iv) Nutrition and Hydration status;

(v) Weight gain or loss;

(vi) Presence of edema;

(vii) Fundal height measurement;

(viii) Fetal assessment of position and presentation; and

(ix) Fetal assessment of heart tones.

(B) Prenatal visits may include, but are not limited to:

(i) Discussions and offers of tests and screenings at appropriate times, including but not limited to: Ultrasound, Gestational Diabetes Screening, Genetic Screening, HIV, HBsAg, GBS culture, Anemia Screening, STI Screening, Pap Smear, need for Rhogam prophylaxis;

(ii) Signatures for any test or screening the Client consents to or refuses;

(iii) Assessments of the pelvic cavity for cervical dilation, effacement, fetal station, or evaluation for abnormality; and

(iv) Review of plans for medical Referral and transfer of mother or infant, prior to onset of labor.

(C) Laboratory tests and screenings: The following laboratory tests/screens shall be required:

(i) Gestational diabetes screening at 24-28 weeks; and

(ii) Group B strep screening at 35-37 weeks of pregnancy.

(D) A physical or virtual home visit to assess the home environment is mandatory, if the birth is to occur at the Client's house.

(3) Recommended prenatal schedule:

(A) Monthly until 28 weeks;

(B) Every two weeks from 28 - 36 weeks;

(C) Weekly from 36 weeks until delivery; and

(D) Major deviations from this schedule should be documented in the Client's file.

(b)Intrapartum. During active labor, the Licensed Midwife shall monitor and support the natural process of labor and birth, assessing mother and baby throughout the birthing process. Responsibilities of the Licensed Midwife shall include, but are not limited to:

(1) Assessments:

(A) The Licensed Midwife shall make an initial exam during labor, which consists of an assessment of maternal blood pressure, pulse, temperature, edema, fetal position and presentation, noting membranes status, presence or absence of meconium, and fetal heart tones (FHT); and strongly recommend an internal vaginal examination to determine cervical dilation, effacement and station;

(B) The Licensed Midwife shall monitor fetal heart tones upon arrival. Intermittent monitoring may include assessing FHT every:

(i) At least every 15- 30 minutes in Active First Stage; and

(ii) 5-15 minutes in Second Stage.

(C) When present with the mother, the Licensed Midwife will check FHT immediately after the following: Rupture of membranes, sudden pain, excessive bleeding, sudden or marked change in labor pattern, mother reports concern in fetal movement;

(D) The Licensed Midwife shall perform an internal vaginal examination to determine cervical dilation, effacement and station immediately after the following: Abnormal FHT, suspected malpresentation, sudden pain, excessive bleeding, sudden or marked change in labor pattern, mother reports concern in fetal movement;

(E) The Licensed Midwife shall remain with the Client at all times once contractions are well-established at a regular frequency of four to five (4-5) minutes with dilation of six (6) centimeters, or the Client requests need for the Licensed Midwife to be present; and

(F) The Licensed Midwife shall monitor maternal vital signs every 4 hours after onset of active labor.

(G) Placenta Exam.

(i) The Licensed Midwife shall examine the placenta and membranes for completeness, unusual coloration, or odor; and

(ii) The Licensed Midwife shall examine the umbilical cord for the appropriate number of vessels.

(2)A Licensed Midwife shall not use forceps, a vacuum extractor or any prescription drug to advance or retard labor or delivery [59 O.S. § 3040.7].

Okla. Admin. Code § 310:395-5-7

Adopted by Oklahoma Register, Volume 38, Issue 06, December 1, 2020, eff. 11/2/2020

Adopted by Oklahoma Register, Volume 38, Issue 12, March 1, 2021, eff. 2/2/2021

Adopted by Oklahoma Register, Volume 38, Issue 24, September 1, 2021, eff. 9/11/2021