SECTION 115.114. Prenatal Care

(a) Using reasonable skill and knowledge, the midwife shall collect, assess, and document maternal care data through a detailed obstetric, gynecologic, medical, social, and family history and a complete prenatal physical exam and appropriate laboratory testing, including antenatal testing if necessary; develop and implement a plan of care; thereafter evaluate the client's condition on an ongoing basis; and modify the plan of care as necessary. Health education/counseling shall be provided by the midwife as appropriate.

(b) If on initial or subsequent assessment, one of the following conditions exists, the midwife shall recommend referral and document that recommendation in the midwifery record:

(1) infection requiring antimicrobial therapy;

(2) Hepatitis;

(3) non-insulin dependent diabetes;

(4) thyroid disease;

(5) current drug or alcohol abuse;

(6) asthma;

(7) abnormal pap smear (consistent with malignancy or pre-malignancy) during the current pregnancy;

(8) seizure disorder;

(9) prior cesarean section (except for prior classical or vertical incision, which will require transfer in accordance with subsection (c)(8));

(10) twin gestation;

(11) history of prior antepartum or neonatal death;

(12) history of prior infant with a genetic disorder;

(13) abnormal vaginal bleeding;

(14) maternal age less than 15 at estimated date of delivery;

(15) history of cancer (except for ovarian, breast, uterine, or cervical cancer which will require transfer in accordance with subsection (c)(16));

(16) psychiatric illness; or

(17) any other condition or symptom which could adversely affect the mother or fetus, as assessed by a midwife exercising reasonable skill and knowledge.

(c) If on initial or subsequent assessment, one of the following conditions exists, the midwife shall recommend transfer in accordance and document that recommendation in the midwifery record:

(1) placenta previa in the third trimester;

(2) Human Immunodeficiency Virus (HIV) positive or Acquired Immunodeficiency Syndrome (AIDS);

(3) cardio vascular disease, including hypertension, with the exception of varicosities;

(4) severe psychiatric illness;

(5) history of cervical incompetence with surgical therapy;

(6) pre-term labor (less than 37 weeks);

(7) Rh or other blood group isoimmunization;

(8) previous uterine surgery involving incision into the uterine myometrium, other than a low transverse cesarean section;

(9) preeclampsia/eclampsia;

(10) documented oligo-hydramnios or poly-hydramnios;

(11) any known fetal malformation requiring immediate post-natal hospital care;

(12) Preterm Premature Rupture of Membranes (PPROM);

(13) intrauterine growth restriction;

(14) insulin dependent diabetes;

(15) triplet or higher order multiple gestation;

(16) active cancer or history of ovarian, breast, uterine, or cervical cancer;

(17) undiagnosed vaginal bleeding lasting longer than two weeks; or

(18) any other condition or symptom which could threaten the life of the mother or fetus, as assessed by a midwife exercising reasonable skill and knowledge.

(d) If a client has reached 42.0 weeks gestation and is not yet in labor, the midwife shall immediately either:

(1) collaborate with a physician and obtain appropriate antenatal testing, in order to continue midwifery care; or

(2) initiate transfer and document that action in the midwifery record.

Source Note: The provisions of this §115.114 adopted to be effective October 1, 2016, 41 TexReg 4477; amended to be effective May 1, 2019, 44 TexReg 1849