Virginia Administrative Code › Title 18 - PROFESSIONAL AND OCCUPATIONAL LICENSING › Agency 85 - BOARD OF MEDICINE › Chapter 130 - REGULATIONS GOVERNING THE PRACTICE OF LICENSED MIDWIVES › Part III - Practice Standards › Section 18VAC85-130-81 - Disclosures on health risks

Current through Register Vol. 40, No. 24, July 15, 2024
A. Upon
				  initiation of care, a midwife shall review the client's medical history in
				  order to identify pre-existing conditions or indicators that require disclosure
				  of risk for home birth. The midwife shall offer standard tests and screenings
				  for evaluating risks and shall document client response to such
				  recommendations. The midwife shall also continually assess the pregnant woman
				  and baby in order to recognize conditions that may arise during the course of
				  care that require disclosure of risk for birth outside of a hospital or
				  birthing center.
B. If any of the
				  following conditions or risk factors are presented, the midwife shall request
				  and review the client's medical history, including records of the current or
				  previous pregnancies; disclose to the client the risks associated with a birth
				  outside of a hospital or birthing center; and provide options for consultation
				  and referral. If the client is under the care of a physician for any of the
				  following medical conditions or risk factors, the midwife shall consult with or
				  request documentation from the physician as part of the risk assessment for
				  birth outside of a hospital or birthing center.
1. Antepartum risks:
Conditions requiring ongoing medical supervision or ongoing
					 use of medications;
Active cancer;
Cardiac disease;
Severe renal disease -- active or chronic;
Severe liver disease -- active or chronic;
HIV positive status with AIDS;
Uncontrolled hyperthyroidism;
Chronic obstructive pulmonary disease;
Seizure disorder requiring prescriptive medication;
Psychiatric disorders;
Current substance abuse known to cause adverse
					 effects;
Essential chronic hypertension over 140/90;
Significant glucose intolerance;
Genital herpes;
Inappropriate fetal size for gestation;
Significant 2nd or 3rd trimester bleeding;
Incomplete spontaneous abortion;
Abnormal fetal cardiac rate or rhythm;
Uterine anomaly;
Platelet count less than 120,000;
Previous uterine incision and/or myomectomy with review of
					 surgical records and/or subsequent birth history;
Isoimmunization to blood factors;
Body mass index (BMI) equal to or greater than 30;
History of hemoglobinopathies;
Acute or chronic thrombophlebitis;
Anemia (hematocrit less than 30 or hemoglobin less than 10
					 at term);
Blood coagulation defect;
Pre-eclampsia/eclampsia;
Uterine ablation;
Placental abruption;
Placenta previa at onset of labor;
Persistent severe abnormal quantity of amniotic
					 fluid;
Suspected chorioamnionitis;
Ectopic pregnancy;
Pregnancy lasting longer than 42 completed weeks with an
					 abnormal nonstress test;
Any pregnancy with abnormal fetal surveillance
					 tests;
Rupture of membranes 24 hours before the onset of
					 labor;
Position presentation other than vertex at term or while in
					 labor; or
Multiple gestation.
2. Intrapartum risks:
Current substance abuse;
Documented intrauterine growth retardation (IUGR)/small for
					 gestational age (SGA) at term;
Suspected uterine rupture;
Active herpes lesion in an unprotectable area;
Prolapsed cord or cord presentation;
Suspected complete or partial placental abruption;
Suspected placental previa;
Suspected chorioamnionitis;
Pre-eclampsia/eclampsia;
Thick meconium stained amniotic fluid without reassuring
					 fetal heart tones and birth is not imminent;
Position presentation other than vertex at term or while in
					 labor;
Abnormal auscultated fetal heart rate pattern unresponsive
					 to treatment or inability to auscultate fetal heart tones;
Excessive vomiting, dehydration, or exhaustion unresponsive
					 to treatment;
Blood pressure greater than 140/90 that persists or rises
					 and birth is not imminent;
Maternal fever equal to or greater than 100.4°F;
					 or
Labor or premature rupture of membrane (PROM) less than 37
					 weeks according to due date.
3. If a risk factor first develops when birth
				  is imminent, the individual midwife must use judgment taking into account the
				  health and condition of the mother and baby in determining whether to proceed
				  with a home birth or arrange transportation to a hospital.