332-025-0022 Care Practice Standards (1) The Office and Board adopt by reference the MANA core competencies dated August 4, 2011. A copy can be obtained from the Office. (2) An LDM may: (a) Order and receive laboratory and ultrasound results; and (b) Order and receive fetal surveillance testing and results. (3) Care during pregnancy (antepartum) — the LDM must: (a) Provide a mechanism that ensures 24-hour coverage for the midwifery practice; and (b) Begin fetal surveillance testing no later than 41 weeks and 3 days by arranging one or more of the following: (A) Biophysical profile weekly and non-stress test twice weekly; (B) Biophysical profile weekly and auscultated acceleration testing twice weekly; (C) Amniotic fluid index and non-stress test twice weekly; or (D) Amniotic fluid index and auscultated acceleration testing twice weekly. (c) If the birthing person declines, or the LDM is denied access to fetal surveillance testing in subsection (b) of this rule, the LDM must provide auscultated acceleration testing twice weekly beginning 41 weeks and 3 days until delivery. The LDM must use Board-approved practice for auscultated acceleration testing which can be obtained from the Office. (A) If the birthing person declines fetal surveillance, follow OAR 332-025-0022(7). (B) If the LDM is denied access to fetal surveillance testing, the LDM must document the place, date, time, and name of the individual who denied access in the birthing person’s records. (4) Care During Labor, Birth and Immediately Thereafter (Intrapartum) — the LDM must: (a) During active labor, evaluate the fetal heart rate at least every 30 minutes listening before, during and after contractions or more frequently if indicated; (b) During active pushing auscultate fetal heart tones approximately every 5 to 15 minutes or after every contraction, as indicated; and (c) Before the LDM leaves the LDM must: (A) Deliver the placenta and assess the birthing person’s general condition, and assess and address any abnormalities including, but not limited to, blood pressure, pulse, temperature, fundus, lochia, and ability to ambulate and urinate; (B) Assess and address abnormalities in the newborn’s general condition including, but not limited to temperature, respirations, heart rate, feeding; and (C) Provide the family with written and verbal postpartum instructions. (5) Care After Delivery (Postpartum Care) — The LDM must assess causes of, evaluate and treat problems arising during the postpartum period, consulting as necessary. (6) Newborn Care — The LDM must: (a) Adhere to state guidelines for the administration of vitamin K and ophthalmic prophylaxis pursuant to ORS 433.306 and OAR 333-021-0800; and (b) Ensure infant metabolic screening is performed and documented according to the Department of Human Services recommendations unless the mother declines, as provided in ORS Chapter 433 and OAR 333-024-1000 through 333-024-1110. (7) Declined Procedure: In the event the birthing person refuses any testing or procedures required by administrative rule or recommended by the LDM, the LDM must document the LDM’s discussion with the birthing person of why the test or procedure is required or recommended and document the birthing persons refusal, including obtaining the birthing persons signature in the chart. In addition, the LDM must follow the requirements of ORS Chapter 433 and OAR 333-024-1000 through 333-024-1110 when the mother declines administration of vitamin K or infant metabolic screening. Statutory/Other Authority: ORS 676.615, ORS 687.405 & ORS 687.480 Statutes/Other Implemented: ORS 687.405 & ORS 687.480 History: DEM 5-2011, f. & cert. ef. 9-26-11 DEM 3-2019, amend filed 12/19/2019, effective 01/01/2020 DEM 1-2011(Temp), f. & cert. ef. 4-4-11 thru 9-27-11 DEM 6-2010, f. 12-30-10, cert. ef. 1-1-11 DEM 1-2004, f. 6-29-04, cert. ef. 7-1-04 DEM 1-2002, f. 2-25-02 cert. ef. 3-1-02 DEM 1-2001(Temp), f. & cert. ef. 10-1-01 thru 3-29-02 DEM 3-2000, f. 9-29-00, cert. ef. 10-1-00 DEM 2-2000(Temp), f. 8-22-00, cert. ef. 8-22-00 thru 2-17-01 DEM 2-1999, f. 12-17-99, cert. ef. 12-20-99 DEM 1-1999(Temp), f. 9-1-99, cert. ef. 9-9-99 thru 2-29-00 DEM 2-1998, f. 4-14-98, cert. ef. 4-15-98 DEM 1-1994, f. & cert. ef. 6-15-94 DEM 1-1993(Temp), f. & cert. ef. 12-22-93