N.H. Admin. Code § Mid 502.03

Current through Register No. 45, November 7, 2024

Section Mid 502.03 - Requirements for Prenatal Care

(a) A midwife shall provide prenatal care to a client at least:

(1) Once a month through the twenty-eighth week of pregnancy;

(2) Once every 2 weeks from the twenty-eighth through the thirty-sixth week of pregnancy; and

(3) Once a week from the thirty-sixth week of pregnancy until the onset of labor.

(b) A midwife shall schedule the initial prenatal visit with a client in the first or second trimester of pregnancy.

(c) If a woman requesting midwifery services does not contact the midwife before the third trimester of her pregnancy, the midwife shall accept her as a client only if she:

(1) Has had adequate prenatal care, or has met the criterion for a low risk birth as defined by an NHCM's scope of practice; and

(2) Displays adequate fetal growth, fetal heart rate and fetal movement.

(d) During the initial prenatal visit the midwife shall:

(1) Obtain a maternal health, obstetrical, and gynecological history;

(2) Perform a nutritional assessment and provide nutritional counseling;

(3) Discuss the availability of options for screening and testing for fetal abnormalities;

(4) Obtain blood pressure;

(5) Perform a pelvic exam, if indicated, including:

a. Uterine sizing to estimate gestational age;

b. Pelvimetry;

c. A chlamydia and gonorrhea screening test; and

d. A Pap test;

(6) Either perform or order blood analysis, including, but not limited to:

a. Blood group and Rh factor;

b. Antibody screen;

c. A complete blood count;

d. Rubella titre;

e. Syphilis serology;

f. Hepatitis B surface antigen;

g. Hepatitis C surface antigen, if indicated; and

h. HIV testing, if accepted by the client;

(7) Recommend that the client receive a general physical exam by a qualified health care provider to screen for general health problems that have the potential to complicate the pregnancy or delivery; and

(8) Obtain informed consent for midwifery care and out-of-hospital birth, to include the following information:

a. A description of the midwife's background and credentials;

b. Whether the midwife has professional liability coverage; and

c. The address and telephone number of the council, where complaints against the midwife may be filed.

(e) During subsequent prenatal visits the midwife shall:

(1) Assess maternal nutrition and weight gain;

(2) Obtain blood pressure;

(3) Test urine for protein and glucose;

(4) Assess general well-being;

(5) Check for signs and symptoms of edema, bleeding, headache, visual disturbances, or unusual vaginal discharge;

(6) Obtain fundal height measurement;

(7) Arrange for periodic hematocrit or hemoglobin testing;

(8) Assess fetal heart rate and fetal activity;

(9) Assess position and presentation of the fetus;

(10) Perform or order the following as necessary:

a. Rh antibody screening;

b. Urinalysis;

c. Microscopic analysis of vaginal discharges;

d. Obstetric ultrasound;

e. Prophylactic Rh immune globulin injection;

f. Blood sugar screening;

g. Cultures; and

h. Thyroid screening, if indicated;

(11) Observe aseptic technique and standard precautions; and

(12) Discuss:

a. Any recent illnesses, symptoms, social or emotional problems;

b. Diet;

c. Medications and supplements;

d. Reading suggestions;

e. Exercise;

f. Rest and sleep requirements;

g. Sexuality;

h. Partner's role;

i. Birth preparation;

j. Newborn care;

k. Parenting; and

l. Transportation arrangements.

(f) A midwife shall advise any client with genital herpes of the ACOG herpes protocol current at the time of the midwife's conversation with the client.

(g) A midwife shall discuss with clients the standards of care and recommendations for testing for and treating of group B streptococcus.

(h) A midwife shall encourage any client expecting a first child to attend childbirth education classes.

(i) A midwife shall discuss with the client, during the prenatal period, the selection of a pediatrician, family physician, or other health care provider who will assume care of the newborn.

(i) A midwife shall alert the client to:

(1) Signs of complications that necessitate immediate contact with the midwife; and

(2) Signs of labor and when it is time to call the midwife.

(j) A midwife shall be on call or make specific arrangements for on call coverage with another midwife or licensed health care provider whose scope of practice includes birth.

(k) In the third trimester, a midwife shall ensure that a client is adequately preparing for birth in an out-of-hospital location by discussing:

(1) The place of the birth and the facilities available there;

(2) The availability of adequate heat and water;

(3) The supplies the client must procure;

(4) The availability of a telephone;

(5) Arrangements for help after the birth;

(6) With a client preparing for birth in a private home, the importance of keeping readily available the following written information, as appropriate:

a. The name, location, and phone number of the nearest ambulance service;

b. The name, location, and phone number of the nearest hospital;

c. The name and phone number of the newborn's health care provider; and

d. The street address of the location of the birth and directions to that location from the nearest ambulance service; and

(l) The transfer of care to a hospital setting in an emergency.

N.H. Admin. Code § Mid 502.03

#7759, eff 9-7-02

Amended by Volume XXXVI Number 49, Filed December 8, 2016, Proposed by #12040, Effective 11/10/2016, Expires 11/10/2026.