Section 12.14.500. Prenatal care.

	(a)  The board recommends that a certified direct-entry midwife make prenatal visits to a client every four weeks until the 28th week of gestation, every two weeks from the 29th through the 35th week of gestation, and weekly from the 36th week of gestation until birth. The midwife shall document a client's refusal of any required or recommended test or visit.  
	(b)  At the initial prenatal visit, the certified direct-entry midwife shall recommend that the client undergo a physical examination as required in AS 08.65.140(1) to screen for health problems that could complicate the pregnancy or delivery and that includes a review of the laboratory studies required in (c) of this section. The certified direct-entry midwife shall obtain a signed written consent from the client reflecting the client's informed choice regarding the recommended physical examination and retain the consent in the client's record.  
	(c)  At the initial prenatal visit, the certified direct-entry midwife shall  
		(1) order the following laboratory tests:  
			(A) a serological test for syphilis, either rapid plasma reagin (RPR) or venereal disease research laboratory (VDRL);  
			(B) blood group;  
			(C) Rh factor and antibody screen;  
			(D) rubella titer;  
			(E) complete blood count;  
			(F) gonorrhea screen;  
			(G) repealed 3/2/2011;  
			(H) urine culture;  
			(I) chlamydia screen;  
			(J) cervical cytology;  
			(K) hepatitis B; and  
		(2) recommend the following laboratory tests:  
			(A) test for tuberculosis;  
			(B) test for hepatitis C and human immune deficiency virus (HIV);  
			(C) ultrasound for size and date discrepancy, unsure dates, or other indications.  
	(d)  At  
		(1) 11 - 13 weeks of gestation, the certified direct-entry midwife shall offer an ultrascreen test;   
		(2) 15 - 20 weeks of gestation, the certified direct-entry midwife shall discuss with the client the availability of maternal fetal screening;  
		(3) 24 - 28 weeks of gestation, the certified direct-entry midwife shall recommend  
			(A) a 50-gram glucose tolerance test for gestational diabetes;  
			(B) a hemoglobin or hematocrit test; and  
			(C) an antibody screen and rhogam injection for a woman with RH negative type blood;  
		(4) 35 - 37 weeks of gestation, the certified direct-entry midwife shall order  
			(A) a hemoglobin or hematocrit test, if indicated; and  
			(B) a culture for Group B Streptococci in accordance with Prevention of Perinatal Group B Streptococcal Disease: Revised Guidelines from CDC, adopted by reference in 12 AAC 14.570(9).  
	(e)  The certified direct-entry midwife shall order, if indicated, the analysis of a clean catch urine sample for glucose and protein.  
	(f)  The certified direct-entry midwife shall comply with AS 08.65.140(2) in obtaining a signed informed consent before the onset of labor.  
	(g)  During the third trimester, the certified direct-entry midwife shall consult with the client concerning selection of a pediatrician, family physician, or other health care provider who will assume responsibility for the infant. The certified direct-entry midwife shall record the client's choice in the client's record. If the client cannot or will not select a provider for the infant, the certified direct-entry midwife shall document this information in the client's record.  
	(h)  The certified direct-entry midwife shall consult with a physician or certified nurse midwife if, during the prenatal period, the client  
		(1) develops 2 + or greater pitting edema on the face and hands;  
		(2) develops proteinuria of 1 + or greater;  
		(3) has marked or severe polyhydramnios or oligohydramnios;  
		(4) before 37 weeks gestation, has regular contractions with cervical change;  
		(5) repealed 3/2/2011;  
		(6) develops blood pressure of 140/90 or an increase of 30 mm Hg systolic or 15 mm Hg diastolic over the usual blood pressure;  
		(7) develops severe, persistent headaches, epigastric pain, or visual disturbances;  
		(8) has symptoms of urinary tract infection, including a fever of 100.5 degrees Fahrenheit or 38 degrees Celsius, kidney or flank pain, or hematuria;  
		(9) has rupture of membranes before 37 weeks gestation;  
		(10) has marked decrease or cessation of fetal movement;  
		(11) has fetal heart tones of less than 100 or more than 170 per minute;  
		(12) has inappropriate gestational size;  
		(13) has a fever of 100.5 degrees Fahrenheit or 38 degrees Celsius for 24 hours or more;  
		(14) has severe or ongoing medical complications;  
		(15) has demonstrated anemia by blood test (hematocrit 27 percent or hemoglobin 9 grams);  
		(16) is found to have a positive antibody screen;  
		(17) has unexplained or concerning vaginal bleeding;  
		(18) fails a three-hour oral glucose tolerance test; or  
		(19) has a positive purified protein derivative (PPD) test, hepatitis screen, or human immune deficiency virus (HIV) test.  
	(i)  If, following the consultation set out in (h) of this section, the consulting provider recommends referral for immediate medical care, the certified direct-entry midwife shall refer the client for immediate medical care. A referral for immediate medical care does not preclude the possibility of an out-of-hospital delivery if, following the referral, the client does not have any of the conditions set out in 12 AAC 14.150.  
	(j)  During the third trimester, the certified direct-entry midwife shall ensure that the home-birth client is adequately prepared for a home-birth by discussing issues such as sanitation, facilities, adequate heat, availability of telephone and transportation, plans for emergency evacuation to a hospital, and the skills and equipment that the midwife will bring to the birth.  
	(k)  A certified direct-entry midwife shall make a home visit three to five weeks before the estimated date of confinement to assess the physical environment, to determine whether the home-birth client has the necessary supplies, to prepare the family for the birth, and to instruct the family in correction of problems or deficiencies.  

Authorities

08.65.030;08.65.140;08.65.190

Notes

Authority

AS 08.65.030 AS 08.65.140 AS 08.65.190

History

Eff. 5/11/94, Register 130; am 5/2/2004, Register 170; am 10/18/2007, Register 184; am 3/2/2011, Register 197; am 8/10/2011, Register 199; am 9/9/2016, Register 219