Title 12 . Professional and Vocational Regulations

Chapter 14 . Big Game Guides and Transporters

Section 500. Prenatal care

12 AAC 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.

(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 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 veneral disease research laboratory (VDRL);

(B) blood group;

(C) Rh factor and screen;

(D) rubella titer;

(E) complete blood count;

(F) gonorrhea screen;

(G) urinalysis;

(H) urine culture

(I) chlamydia screen; and

(J) cervical cytology; and

(2) recommend the following laboratory tests:

(A) test for tuberculosis; and

(B) test for hepatitis and human immune deficiency virus (HIV).

(d) At 15 - 20 weeks of gestation, the certified direct-entry midwife shall discuss with the client the availability of maternal serum alphafetoprotein screening.

(e) At 24 - 28 weeks of gestation, the certified direct-entry midwife shall recommend a 50 gm glucose tolerance test for gestational diabetes.

(f) The certified direct-entry midwife shall order

(1) at 28 and 36 weeks of gestation

(A) a hemoglobin or hematocrit test; and

(B) for a woman with Rh negative type blood, an antibody screen; and

(2) a culture for Group B Streptococci at 35 - 37 weeks of gestation.

(g) At each prenatal visit, the certified direct-entry midwife shall order the analysis of a clean catch urine sample for glucose and protein.

(h) The certified direct-entry midwife shall comply with AS 08.65.140 (b) in obtaining a signed informed consent for home delivery.

(i) 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.

(j) The certified direct-entry midwife shall consult with a physician if, during the prenatal period, the client

(1) develops 2 + or greater pitting edema on the face and hands;

(2) develops consistent glucosuria or proteinuria of 1 + or greater;

(3) has marked or severe polyhydramnios or oligohydramnios;

(4) prior to 37 weeks gestation, has six or greater contractions per hour not resolved with hydration or rest, or has effacement or dilation of the cervix;

(5) has severe protruding varicose veins of the extremities or vulva;

(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 such as a rise in temperature, kidney or flank pain, urinary frequency, or dysuria;

(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 fever of 100.4ΓΈ F. or 38ΓΈ C. 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 vaginal bleeding other than show before the onset of labor;

(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.

(k) If, following the consultation set out in (j) of this section, the physician 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 a home delivery if, following the referral, the client does not have any of the conditions set out in AS 08.65.140 (d).

( l ) During the third trimester, the certified direct-entry midwife shall ensure that the 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.

(m) 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 client has the necessary supplies, to prepare the family for the birth, and to instruct the family in correction of problems or deficiencies.

History: Eff. 5/11/94, Register 130; am 5/2/2004, Register 170

Authority: AS 08.65.030

AS 08.65.140

AS 08.65.190