Iowa Code r. 655-16.3 - Practice standards
A CPM shall practice within the legal boundaries for certified professional midwifery as set forth in Iowa Code chapter 148I, this chapter, and any other pertinent law or regulation. A licensed CPM shall:
(1) Comply with the practice standards
accepted by the North American Registry of Midwives as defined by the National
Association of Certified Professional Midwives (NACPM) or its successor
organization, as of February 1, 2024, found at nacpm.org.
(2) Demonstrate professionalism and
accountability in the practice of certified professional midwifery, including:
a. Demonstrating honesty and integrity in
practice.
b. Basing decisions in
practice on knowledge, judgment, skills, and the needs of clients.
c. Maintaining competence through completion
of the continuing education requirements in subrule 16.2(2) and application of
such education in practice.
d.
Reporting to appropriate authorities instances of unsafe practice by a
CPM.
e. Being accountable for
judgments and individual actions as a CPM and competence, decisions, and
behaviors in the practice of certified professional midwifery.
(3) Maintain a record of, and
provide to each client orally and by written consent form, all information and
consents in accordance with Iowa Code section
148I.4(1)
"h."
(4) Comply
with Iowa Code sections
136A.6 and
136A.5A.
(5) File a birth certificate for each birth
in accordance with Iowa Code section
148I.4.
(6) Consult with a licensed physician or
certified nurse midwife for high-risk pregnancies and births.
a. A CPM shall consult with a licensed
physician or a certified nurse midwife providing obstetrical care whenever
there are significant deviations, including but not limited to abnormal
laboratory results, relative to a client's pregnancy or to a neonate. If a
referral to a physician is needed, the CPM shall refer the client to a
physician and, if possible, remain in consultation with the physician until
resolution of the concern.
b. A CPM
shall consult with a licensed physician or certified nurse midwife with regard
to any mother who presents with or develops the following risk factors or
presents with or develops other risk factors that in the judgment of the CPM
warrant consultation:
(1) Antepartum.
1. Pregnancy-induced hypertension, as
evidenced by a blood pressure of at least 140/90 on two occasions greater than
six hours apart.
2. Persistent,
severe headaches; epigastric pain; or visual disturbances.
3. Persistent symptoms of urinary tract
infection.
4. Significant vaginal
bleeding before the onset of labor not associated with uncomplicated
spontaneous abortion.
5. Rupture of
membranes prior to the thirty-seventh week of gestation.
6. Noted abnormal decrease in or cessation of
fetal movement.
7. Anemia resistant
to supplemental therapy.
8. Fever
of 102°F or 39°C or greater for more than 24 hours.
9. Nonvertex presentation after 38 weeks of
gestation.
10. Hyperemesis or
significant dehydration.
11.
Isoimmunization, Rh-negative sensitized, positive titers, or any other positive
antibody titer that may have a detrimental effect on mother or fetus.
12. Elevated blood glucose level unresponsive
to dietary management.
13. Positive
HIV antibody test.
14. Primary
genital herpes infection in pregnancy.
15. Symptoms of malnutrition, anorexia,
protracted weight loss or failure to gain weight.
16. Suspected deep vein thrombosis.
17. Documented placental anomaly or
previa.
18. Documented low-lying
placenta in a woman with a history of previous cesarean delivery.
19. Labor prior to the thirty-seventh week of
gestation.
20. History of prior
uterine incision.
21. Lie other
than vertex at term.
22. Known
fetal anomalies that may be affected by the site of birth.
23. Marked abnormal fetal heart
tones.
24. Abnormal nonstress test
or abnormal biophysical profile.
25. Marked or severe polyhydramnios or
oligohydramnios.
26. Evidence of
intrauterine growth restriction.
27. Significant abnormal ultrasound
findings.
28. Gestation beyond 42
weeks by reliable confirmed dates.
(2) Intrapartum.
1. Rise in blood pressure above baseline,
more than 30/15 points or greater than 140/90.
2. Persistent, severe headaches; epigastric
pain; or visual disturbances.
3.
Significant proteinuria or ketonuria.
4. Fever over 100.6°F or 38°C in
absence of environmental factors.
5. Ruptured membranes without onset of
established labor after 18 hours.
6. Significant bleeding prior to delivery or
any abnormal bleeding, with or without abdominal pain; or evidence of placental
abruption.
7. Lie not compatible
with spontaneous vaginal delivery or unstable fetal lie.
8. Failure to progress after five hours of
active labor or following two hours of active second-stage labor.
9. Signs and symptoms of maternal
infection.
10. Active genital
herpes at onset of labor.
11. Fetal
heart tones with nonreassuring patterns.
12. Signs or symptoms of fetal
distress.
13. Thick meconium or
frank bleeding with birth not imminent.
14. Client or CPM desires physician
consultation or transfer.
(3) Postpartum.
1. Failure to void within six hours of
birth.
2. Signs or symptoms of
maternal shock.
3. Febrile:
102°F or 39°C and unresponsive to therapy for 12 hours.
4. Abnormal lochia or signs or symptoms of
uterine sepsis.
5. Suspected deep
vein thrombosis.
6. Signs of
clinically significant depression.
c. A CPM shall consult with a licensed
physician or certified nurse midwife with regard to any neonate who is born
with or develops the following risk factors:
(1) Apgar score of six or less at five
minutes without significant improvement by ten minutes.
(2) Persistent grunting respirations or
retractions.
(3) Persistent cardiac
irregularities.
(4) Persistent
central cyanosis or pallor.
(5)
Persistent lethargy or poor muscle tone.
(6) Abnormal cry.
(7) Birth weight less than 2,300
grams.
(8) Jitteriness or
seizures.
(9) Jaundice occurring
before 24 hours or outside of normal range.
(10) Failure to urinate within 24 hours of
birth.
(11) Failure to pass
meconium within 48 hours of birth.
(12) Edema.
(13) Prolonged temperature
instability.
(14) Significant signs
or symptoms of infection.
(15)
Significant clinical evidence of glycemic instability.
(16) Abnormal, bulging, or depressed
fontanel.
(17) Significant clinical
evidence of prematurity.
(18)
Medically significant congenital anomalies.
(19) Significant or suspected birth
injury.
(20) Persistent inability
to suck.
(21) Diminished
consciousness.
(22) Clinically
significant abnormalities in vital signs, muscle tone or behavior.
(23) Clinically significant color
abnormality, cyanotic, or pale or abnormal perfusion.
(24) Abdominal distension or projectile
vomiting.
(25) Signs of clinically
significant dehydration or failure to thrive.
(7) Not use forceps or a vacuum extractor in
accordance with Iowa Code section
148I.4.
Notes
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