Current through Register Vol. 46, No. 3, March 25, 2022
1. Purpose and Scope. The
purpose of this regulation is to provide requirements for licensure, education,
minimum standards of care and practice to individuals who desire to practice
midwifery in the State of South Carolina.
Definitions. For the purposes of these
regulations the following definitions apply:
a. Apprentice Midwife. A person authorized by
the Department to engage in a course of study, to include clinical experience
under the supervision of a physician, certified nurse-midwife, certified
professional midwife, or midwife licensed in the State of South Carolina, who
will prepare that person to become a licensed midwife.
b. Apprentice Midwife License. A license
issued by the Department to authorize a person desiring to become a midwife to
obtain clinical experience under supervision of a physician, certified
nurse-midwife, certified professional midwife, or midwife licensed in the State
of South Carolina. This license is not transferable.
c. Certified Nurse-Midwife. A registered
nurse licensed to practice in this state that has been certified by the
American College of Nurse-Midwives and officially recognized by the State Board
of Nursing for South Carolina.
Community Health Center. A not-for-profit organization which receives federal
funding to operate a local health center.
e. Contact Hour. A unit of measurement to
describe 50-60 minutes of an approved, organized learning experience or two
hours of planned and supervised clinical practice which is designed to meet
professional educational objectives.
f. Continuing Education. Participation in an
organized learning experience under responsible sponsorship or supervised
clinical practice, capable direction and qualified instruction and approved by
the Department for the purpose of meeting requirements for renewal of licensure
under these regulations.
Certified Professional Midwife (CPM). A professional midwifery practitioner who
has met the standards for certification set by the North American Registry of
h. Department. The
S.C. Department of Health and Environmental Control.
i. Health Care Provider. A physician or nurse
j. License. A
document issued by the Department which authorizes an individual to practice
midwifery within the scope of these regulations. The license is not
k. Licensee. A
licensed midwife or a licensed apprentice midwife.
l. Midwife. A person licensed by the State of
South Carolina who provides midwifery services as defined below.
m. Midwifery Instructor. A physician,
certified nurse-midwife or licensed midwife, licensed in the State of South
Carolina, who has a supervisory relationship with an apprentice
n. Midwifery Services.
Those services provided by a person who is not a medical or nursing
professional licensed by an agency of the State of South Carolina, for the
purpose of giving primary assistance in the birth process either free, for
trade, or for money, provided, however, that this shall not preclude any
medical or nursing professional from being licensed in accordance with this
regulation. This definition shall not be interpreted to include emergency
services provided by lay persons or emergency care providers under emergency
o. North American
Registry of Midwives (NARM). National organization which provides and maintains
an evaluative process for multiple routes of midwifery education and training,
and develops and administers a standardized examination system for CPM
Practitioner. A registered nurse licensed to practice in this state and
registered with the S.C. State Board of Nursing. A certified nurse-midwife is
accepted by the Board of Nursing as meeting these requirements.
q. Physician. A person who is licensed to
practice medicine in the State of South Carolina.
r. Supervision. Coordination of learning
experiences, direction, and continued evaluation of the practice of an
1. License. It shall be unlawful to conduct
midwifery services within South Carolina without possessing a valid license
issued by the Department.
Issuance of License.
a. A license is issued
pursuant to the provisions of Section
of the South Carolina Code of Laws of 1976, as amended, and the standards
promulgated thereunder. The issuance of a license does not guarantee adequacy
of individual care, treatment, personal safety, or the well-being of any
b. A license is not
assignable or transferable and is subject to revocation by the Department for
failure to comply with the laws and regulations of the State of South
c. The license must be
posted in a conspicuous place visible to patients.
3. Effective Date and Term of License. A
license for a midwife shall be effective for a 24-month period following the
date of issue. An apprentice midwife license shall be effective for a one year
period following the date of issue.
4. Fees. The license fee for each midwife
license is one hundred fifty dollars ($150) per 24-month licensing period. The
annual license fee for an apprentice midwife shall be fifty dollars ($50). The
license fees shall be payable to the Department and shall be used exclusively
in support of activities pursuant to this regulation. Fees are not
5. Initial License. A
person who has not been continuously licensed under these or prior standards
shall not provide care to patients until issued an initial license.
6. Inspections. The Department is authorized
to inspect records of mothers and newborns delivered by midwives at any
7. Noncompliance. When
noncompliance with the licensing standards exists, the licensee shall be
notified by the Department of the violations and required to provide
information as to how and when such an item will be corrected.
8. Exceptions to Licensing Standards. The
Department may make exceptions to these standards where it is determined that
the health and welfare of the community require the services of the licensee
and that the exception, as granted, will have no significant impact on the
safety, security or welfare of the licensee's patients.
9. Change of License. A licensee shall
request to the Department by letter issuance of an amended license prior to a
change in the licensee's name or address.
Revocation of License. The Department may
refuse to issue, suspend for a definite period, or revoke a license for any of
the following causes:
a. Dereliction of any
duty imposed by law;
Incompetence as determined by the Department;
c. Conviction of a felony;
d. Practicing under a false name or
e. Violation of any of the
provisions of this regulation;
Obtaining any fee by fraud or misrepresentation;
g. Knowingly employing, supervising, or
permitting (directly or indirectly) any person or persons not licensed as
apprentice or midwife to perform any work covered by these
h. Using, causing, or
promoting the use of any advertising matter, promotional literature,
testimonial, or any other representation however disseminated or published,
which is misleading or untruthful;
i. Representing that the service or advice of
a person licensed to practice medicine or nursing will be used or made
available when that is not true, or using the words, "doctor" or "nurse," or
similar words, abbreviations or symbols implying involvement by the medical or
nursing professions when such is not the case;
j. Permitting another to use the license;
k. Revocation of certification
by NARM or other Department approved organization(s).
Hearings and Appeals.
a. A Department decision involving the
issuance, denial, or revocation of a license may be appealed by an affected
person with standing pursuant to applicable law, including S.C. Code Title 44,
Chapter 1; and Title 1, Chapter 23.
b. Any person to whom an order is issued may
appeal it pursuant to applicable law, including S.C. Code Title 44, Chapter 1;
and Title 1, Chapter 23.
Requirements for Licensure. No person may
provide midwifery services or represent that s/he is a midwife without first
possessing a license issued by the Department in accordance with the provisions
of these regulations. Licensure as a midwife shall be by certification by NARM
or other Department approved organization(s). Midwives requesting initial
licensure will receive a license, provided they have evidence of certification
by NARM or other Department approved organization(s) and have also met other
requirements as established by the Department.
EXCEPTION: Individuals licensed by the Department prior to the
publication date of this regulation will not be required to obtain
certification by NARM or other Department approved organization(s). However, if
a midwife is delinquent in submitting her/his license renewal application and
the delinquency period exceeds 30 days the midwife must obtain certification by
NARM or other similar Department approved organization(s) and also meet the
requirements outlined in this section.
Midwife Apprentice License. Upon
application, an apprentice license may be issued. An apprentice license
authorizes the person to obtain the required clinical experience under
supervision of a physician, certified nurse-midwife, certified professional
midwife, or licensed midwife. Applications for renewal of apprentice licenses
must be submitted at least 90 days prior to the expiration of the initial
license. A licensed apprentice midwife may apply for renewal of an apprentice
license three times before obtaining certification by NARM or other Department
approved organization(s). Under extenuating circumstances, one additional
renewal may be granted at the discretion of the Department on a case-by-case
basis. The applicant for an apprentice midwife license must:
a. Provide written verification of
apprentice/supervisor relationship from the person(s) supervising the applicant
and their verified relationship(s) when the apprentice license is
b. Be enrolled in an
approved course of education, or have submitted evidence of a planned course of
education, subject to the approval of the Department;
c. Show evidence that s/he has had negative
testing for tuberculosis or is noninfectious for the same;
d. Be able to read and write
Midwife License. A licensed midwife may provide care only as allowed by these
regulations. In order to apply to become a licensed midwife, a person must
a. Application for a midwife
b. Evidence of completion
of certification by NARM or other Department approved
c. Evidence of
completion of an educational program to be evaluated by NARM or other
Department approved organization;
d. Evidence of completed apprenticeship and a
recommendation by the supervising person (clinical experience shall be
supervised by a licensed midwife, a certified nurse-midwife, a certified
professional midwife, or a physician active in perinatal care) to be submitted
to the certifying agency;
Evidence of valid Healthcare Provider cardiopulmonary resuscitation (CPR)
certificate by the American Red Cross or American Heart Association and
Neonatal Resuscitation Program (NRP) certificate in accordance with current
NARM or other Department approved organization standards;
f. Evidence that the person has had negative
testing for tuberculosis or is noninfectious for the same.
a. Upon approval of the above documentation
by the Department the applicant may sit for the examination, and upon
successfully passing the examination, may be licensed as a midwife.
b. Applicants for licensure as a midwife who
lack apprenticeship in South Carolina but who have equivalent experience from
another jurisdiction may apply for a midwife license and sit for the qualifying
examination after submitting evidence of experience and of all other
requirements to the Department. Action will be taken on each request on an
Limitations. A licensed midwife may sponsor a maximum of three apprentice
of Midwife License. Licenses must be renewed every 24 months. An applicant for
renewal of a midwife license must submit at least 60 days prior to the
expiration of his/her license:
a. A midwife
license renewal application;
Evidence of completion of certification by NARM or other Department approved
c. Evidence of
completion of 30 contact hours of continuing education during the licensing
d. Evidence of
certification from the American Red Cross or American Heart Association in
cardiopulmonary resuscitation of adult and newborn within the previous
e. Evidence of participation
in an annual peer review;
Evidence of an annual negative skin test for tuberculosis or is noninfectious
for the same.
Individuals licensed by the Department prior to the publication date of this
regulation and not certified by NARM or other Department approved
organization(s) must submit the following to the Department:
(1) Evidence of completion of 30 contact
hours of continuing education during the licensing period;
(2) Evidence of valid Healthcare Provider
cardiopulmonary resuscitation (CPR) certificate by the American Red Cross or
American Heart Association and Neonatal Resuscitation Program (NRP) certificate
in accordance with current NARM or other Department approved organization
(3) Evidence of
participation in an annual peer review.
Tuberculin Skin Test Requirements. Within
three months prior to initial application and annually thereafter, midwives and
apprentices shall have a tuberculin skin test, unless a previously positive
reaction can be documented. The intradermal (Mantoux) method, using five
tuberculin units of stabilized purified protein derivative (PPD) is to be used.
Persons with tuberculin test reactions of 10mm or more of induration should be
referred to a physician for appropriate evaluation. The two-step procedure (one
Mantoux test followed one week later by another) is required for initial
testing in order to establish a reliable baseline.
a. Persons with reactions of 10mm and over to
the initial application tuberculin test, those who have previously-documented
positive reactions, those with new positive reactions to the skin tests, and
those with symptoms suggestive of TB (e.g., cough, weight loss, night sweats,
fever, etc.), shall be given a chest X-ray to determine whether TB is present.
If TB is diagnosed, the person shall be referred to a physician for appropriate
treatment and contacts examined.
There is no need to conduct an initial or routine chest X-ray on persons with
negative tuberculin tests who are asymptomatic.
c. Persons with negative tuberculin skin
tests shall have an annual tuberculin skin test.
d. No person who has a positive reaction to
the skin test shall have patient contact until certified non-contagious by a
e. New applicants who
have a history of TB shall be required to have certification by a physician
that they are non-contagious prior to patient contact.
f. Applicants who are known or suspected to
have TB shall be required to be evaluated by a physician and will not be
allowed to have patient contact until they have been certified non-contagious
by the physician.
treatment of personnel with new positive reactions is essential, and shall be
considered for all infected applicants who have patient contact, unless
specifically contraindicated. Persons who complete treatment may be exempt from
further routine chest X-rays unless they have symptoms of TB. Routine annual
chest X-rays of persons with positive reactions do little to prevent TB and
therefore are not a substitute for preventive treatment.
h. Post exposure skin tests should be
provided for tuberculin negative persons within 12 weeks after termination of
contact for any suspected exposure to a documented case of TB.
7. Delinquency Period. Delinquency
in renewal of licensure of 30 days after the license expiration date shall
result in a delinquency fee of $25 in addition to the licensure fees noted in
Section B.4. If after that period of time application has not been received,
the applicant will be required to retake the midwife examination, to include
payment of the examination fee.
Scope of Practice. The licensed midwife
may provide care to low-risk women and neonates determined by medical
evaluation to be prospectively normal for pregnancy and childbirth (see
Sections J., K. and L.), and may deliver only women who have completed between
37 to 42 weeks of gestation, except under emergency circumstances. Care
1. Prenatal supervision and
2. Preparation for
3. Supervision and care
during labor and delivery and care of the mother and newborn in the immediate
postpartum, so long as progress meets criteria generally accepted as
Requirements. The Department shall set minimum educational standards and
requirements. The Department may suggest or require specific topics for
continuing education based on any problem areas indicated by midwives'
quarterly reports, consumer feedback, or on advances in available knowledge.
The Department shall keep all applicants for licensure or renewal fully
informed of requirements for attaining, demonstrating and upgrading knowledge
1. Required Visits. The midwife shall, upon
acceptance of a woman for care, require her to have two visits with a
physician, community health center or health department. One of these visits
must be in the final six weeks of pregnancy. The midwife shall make entries in
the patient's record of the physician, health center, or health department
2. Scheduled Visits. During
pregnancy, the patient shall be seen by the midwife or other appropriate health
care provider according to the following schedule: at least once every four
weeks until 32 weeks gestation, once every two weeks from 32 until 36 weeks,
and weekly after 36 weeks.
Visit. At least one prenatal visit shall be made to each woman's home during
the last six weeks of pregnancy.
Nature of Care. Each prenatal visit shall include the following care:
a. Assessment of general health and obstetric
d. Gross urinalysis: dip
stick for sugar and protein;
f. Gestational age
h. Palpation of abdomen,
Auscultation of FHT after 20 weeks;
j. Assessment of psychological
k. Education as to cause,
treatment, and prognosis of any symptoms, problems, or concerns;
l. Information regarding childbirth classes
and other community resources; and
m. Hematocrit and/or hemoglobin shall be
assessed at approximately three and eight months gestation.
5. Informed Consent. The midwife
shall assure that all women under his/her care understand that s/he is a
midwife licensed by this Department to perform midwifery services by virtue of
approved education, clinical experience, and examination, but is not a nurse or
physician, and are advised of the risks, responsibilities and alternatives for
care. In consultation with the expectant parents, s/he shall, prior to the
expected date of confinement, plan a strategy for backup medical care for
mother and infant, and for transportation to medical facilities in case of
emergency, and shall coordinate such arrangements with the backup health care
providers. The midwife shall obtain a signed informed consent form to keep in
his/her permanent records.
Parent Education. The midwife shall assure that natural childbirth and
breastfeeding education in some form is available to all of his/her patients,
and that they are aware of their rights and responsibilities as consumers of
Duties. During labor, the midwife's duties are to support the natural process
and the mother's own efforts, in an attitude of appropriate observation and
patience, as well as alertness to the parameters of normality. These duties
include, but are not limited to:
Ascertaining that labor is in progress;
b. Assessing and monitoring maternal and
c. Monitoring the
progress of labor;
with labor coaching;
the emotional atmosphere;
Delivering the baby and placenta; and
g. Managing any problems in accordance with
the guidelines cited elsewhere in these regulations and in accord with sound
obstetric and neonatal practice.
2. Examination in Labor. The midwife will not
perform any vaginal examinations on a woman with ruptured membranes and no
labor, other than an initial sterile examination to be certain there is no
prolapsed cord. Once active labor is assuredly in progress, exams may be made
3. Sanitation. The
midwife will conduct all applicable clinical procedures and maintain all
equipment used in practice in an aseptic manner.
4. Operative Procedures. The midwife will not
perform routinely any operative procedure other than artificial rupture of
membranes at the introitus and/or clamping and cutting the umbilical
Medications. Drugs or
medications shall be administered only after consultation with and prescription
by, a physician. The midwife shall not administer any drugs or medications
a. For control of postpartum
b. When administering
medication in accordance with regulations governing the prevention of infant
c. When administering
RhoGam in accordance with accepted standards of professional
Immediate Care. The
midwife must remain with the mother and infant for a minimum of two hours after
the birth or until s/he is certain that both are in stabilized condition,
whichever is longer. S/he shall leave clear instructions for self-care until
his/her next visit. Immediate postpartum duties include:
a. Monitoring the physical status of mother
and infant, and offering any necessary routine comfort measures;
b. Facilitation of maternal-infant bonding
and family adjustment; and
Inspection of the placenta and membranes.
2. Subsequent Checkups. Within 24 to 36 hours
after delivery, the midwife shall visit the mother and neonate; however, if the
midwife is present for the first 20 to 24 hours after delivery, the visit at 24
to 36 hours is not considered mandatory.
3. RhoGam Requirements. Women needing RhoGam
should be evaluated and treated by the midwife or a health care provider within
72 hours of delivery.
Care of the Newborn.
1. Immediate Care.
Immediate care includes assuring that the airways are clear, Apgar scoring,
maintenance of warmth, clamping and cutting of umbilical cord, eye care,
establishment of feeding and physical assessment.
2. Eye Care. The midwife shall instill into
each of the eyes of the newborn, within one hour of birth, a prophylactic agent
such as silver nitrate or a suitable substitute.
3. Metabolic Screening. All requirements for
metabolic screening shall be made clear to parents. The midwife shall notify
the county health department in the county where the infant resides within
three days of delivery in order for a specimen to be obtained.
4. Subsequent Care. In the days and weeks
following birth, care includes monitoring jaundice, counseling for feeding,
continued facilitation of the attachment and parenting process, cord care,
5. Infant Care. In
consultation with parents, the midwife shall encourage that the infant be seen
by a health care provider within two weeks of birth.
6. Provision of Information. The midwife
shall assure that the parents are fully informed as to available community
resources for emergency medical care for infants, well-baby care, or other
Referral to Physician.
1. Recognition of
Problems. The midwife must be able at all times to recognize the warning signs
of abnormal or potentially abnormal conditions necessitating referral to a
physician. It shall be the midwife's duty to consult with a physician whenever
there are significant deviations from the normal. The midwife's training and
practice must reflect a particular emphasis on thorough risk
2. Continuity of Care.
When referring a patient to a physician, the midwife shall remain in
consultation with the physician until the resolution of the situation. It is
appropriate for the midwife to maintain care of her patient to the greatest
degree possible, in accordance with the patient's wishes, remaining present
through delivery if possible.
Maternal Conditions Requiring Physician
Referral or Consultation. At any time in the maternity cycle, the midwife shall
obtain medical consultation, or refer for medical care, any woman who:
1. Has a history of serious problems not
discovered at the initial visit with a health care provider;
2. Develops a blood pressure of 141/89 or
more, or a persistent increase of 30 systolic or 15 diastolic over her usual
3. Develops marked
edema of face and hands;
Develops severe persistent headaches, epigastric pain, or visual
proteinuria or glycosuria;
convulsions of any kind;
not gain at least 14 pounds by 30 weeks gestation or at least four pounds per
month in the last trimester, or gains more than six pounds in any two-week
8. Has vaginal bleeding
before the onset of labor;
symptoms of kidney or urinary tract infection;
10. Has symptoms of vaginitis;
11. Has symptoms of gonorrhea, syphilis or
12. Smokes more
than 10 cigarettes per day and does not decrease usage;
13. Appears to abuse alcohol or
14. Does not improve
nutrition within satisfactory limits;
15. Is anemic (Hematocrit under 32;
Hemoglobin under 11.5);
Develops symptoms of diabetes;
Has excessive vomiting;
"morning sickness" (nausea) continuing past 24 weeks gestation;
19. Develops symptoms of pulmonary
20. Has polyhydramnios or
21. Is Rh negative
for periodic blood testing;
severe varicosities of the vulva or extremities;
23. Has inappropriate gestational
24. Has suspected multiple
25. Has suspected
26. Has marked
decrease in or cessation of fetal movements;
27. Has rupture of membranes or other signs
of labor before completion of 37 weeks gestation;
28. Is past 42 weeks gestation by estimated
date of confinement and/or examination;
29. Has a fever of 100.4 for 24
30. Demonstrates serious
psychiatric illness or severe psychological problems;
31. Demonstrates unresolved fearfulness
regarding home birth or midwife care, or otherwise desires consultation or
32. Develops respiratory
distress in labor;
33. Has ruptured
membranes without onset of labor within 12 hours;
34. Has meconium-stained amniotic
35. Has more than capillary
bleeding in labor prior to delivery;
36. Has persistent or recurrent fetal heart
tones significantly above or below the baseline, or late or irregular
decelerations which do not disappear permanently with change in maternal
position, or abnormally slow return to baseline after contractions;
37. Has excessive fetal movements during
38. Develops ketonuria or
other signs of exhaustion;
Develops pathological retraction ring;
40. Does not progress in dilation, effacement
or station in any two-hour period in active labor;
41. Does not show continued progress to
delivery after two hours in second stage (primigravida); one hour for
42. Has a partially
separated placenta or atonic uterus;
43. Has bleeding of over three cups before or
after delivery of placenta;
firm uterus with no bleeding but retained placenta more than one
45. Has significant change in
blood pressure, pulse over 100, or is pale, cyanotic, weak or dizzy;
46. Retains placental or membrane
47. Has laceration
48. Has a greater
than normal lochial flow;
not void urine within six hours of birth;
50. Develops a fever greater than 100.4 on
any two of the first ten days postpartum excluding the first day;
51. Develops a foul-smelling or otherwise
abnormal lochial flow;
a breast infection;
53. Has signs
of serious postpartum depression; and
54. Develops any other condition about which
the midwife feels concern, at the midwife's discretion.
Neonatal Conditions Requiring Physician
Referral. The midwife shall obtain medical consultation from a physician for,
or shall refer for medical care, any infant who:
1. Has an Apgar score of less than seven at
2. Has any obvious
anomaly or suspected disorder, abnormal facies, etc.;
3. Develops grunting respirations, chest
retractions, or cyanosis;
5. Has a
pale, cyanotic or gray color;
Develops jaundice in the first 36 hours;
7. Develops an unusual degree of jaundice at
8. Has an abnormal
9. Has skin lesions suggesting
10. Has eye discharge
excessive moulding of head, large cephalhematoma, excessive bruising, apparent
fractures, dislocations, or other injuries;
12. Weighs less than five and one-half
13. Weighs more than nine
pounds, if maternal diabetes or infant birth trauma is suspected;
14. Shows signs of hypoglycemia,
hypocalcemia, or other metabolic disorders;
15. Shows signs of postmaturity;
16. Has meconium staining;
17. Has edema;
18. Does not urinate or pass meconium in
first 12 hours after birth;
lethargic, weak or flaccid or does not feed well;
20. Has rectal temperature below 97 degrees
F. or above 100.6 degrees F.;
Has full, bulging or abnormally sunken fontanel; and
22. Appears abnormal in any other
Measures. The midwife must be able to carry out emergency measures in the
absence of medical help. S/he must be trained to deal effectively with those
life-threatening complications most likely to arise in the course of
Examples of Emergency
Situations. These are:
a. Respiratory or
circulatory failure in mother or infant;
b. Postpartum hemorrhage;
c. Cord prolapse;
d. Tight nuchal cord;
e. Multiple births and
g. Gross prematurity or
intra-uterine growth retardation; and
h. Serious congenital anomalies.
Examples of Emergency Measures.
a. Episiotomy; and
b. Intramuscular administration of Pitocin
for the control of postpartum hemorrhage.
Prohibitions in the Practice of Midwifery.
1. Medications. The midwife shall not
administer any drugs or injections of any kind, except as indicated in Sections
G.5 and M.2.b.
Procedures. The midwife shall not perform any operative procedures or surgical
repairs other than artificial rupture of membranes at the introitus, and
clamping and cutting of the umbilical cord or as noted above in an
3. Artificial Means. The
midwife shall not use any artificial, forcible or mechanical means to assist
4. Induced Abortion.
The midwife shall not perform nor participate in induced abortions.
Record Keeping and Report
Record Keeping. The midwife
shall maintain records of each mother and neonate which shall contain
information as described below. All notes shall be legibly written or typed,
dated and signed.
The mother's record
shall include as a minimum:
(1) Face Sheet:
Name, address (including county), telephone number, age, race, date of birth,
occupation, marital status, religion, social security number, name of baby's
father, midwife in attendance, apprentice midwife (if present), address and
telephone number of person(s) to be contacted in the event of emergency, and
name and address of physician to be contacted in the event of
(2) History of
hereditary conditions in mother's and/or father's family;
(3) First day of the last menstrual period
and estimated day of confinement;
(4) Blood group and Rh type;
(5) Serological test for syphilis (including
duration and outcome of previous pregnancies, with dates;
(7) Drugs taken during pregnancy, labor and
(8) Duration of ruptured
membranes and labor, including length of second stage;
(9) Complications of labor, e.g., hemorrhage
or evidence of fetal distress;
Description of placenta at delivery, including number of umbilical vessels;
(11) Estimated amount and
description of amniotic fluid.
The neonate's record shall include at a
(1) Name, sex, race, date of birth,
place of birth, parents' names, address and telephone number, midwife in
attendance, and apprentice midwife (if present).
(2) Results of measurements of fetal maturity
(3) Apgar scores at
one and five minutes of age;
Description of resuscitations, if required;
(5) Detailed description of abnormalities and
problems occurring from birth until transfer to a referral facility;
(6) Care of the umbilical cord;
(7) Eye care; and
(8) Counseling to the mother regarding
feeding, community resources for emergency medical care, well-baby care, or
other needed services, and metabolic screening.
c. Records shall be maintained for no less
than 25 years. All records are subject to review by the Department.
2. Registration of
Birth. The midwife shall assure that the registration of the baby's birth with
the County Health Department is made within five days of birth.
a. Quarterly Reports. Each midwife shall file
quarterly reports with the Department on forms provided by the Department. This
report includes an Individual Data Sheet which shall be completed for each
mother delivered by the midwife. This form includes such information as
delivery date, parity, antepartum, labor, newborn, and postpartum statistics,
as well as conditions which required consultation by a health care provider. A
Summary Sheet is also submitted as a part of the quarterly report. This sheet
contains a summary of the mothers cared for during the quarter, e.g., number of
undelivered women registered for care with the midwife at the beginning and end
of the quarter, women transferred out during antepartum, and women delivered
during the quarter.
Reports. When any of the emergency measures listed in Section M. are utilized,
a special report must be filed with the quarterly report to the Department,
describing in detail the emergency situation, the measure(s) taken, and the
c. Consumer Reports. The
midwife shall ask all mothers to complete a Consumer Feedback Form after the
delivery experience and mail to the Department. These forms, which are provided
to the midwives by the Department, request the mother to furnish information
regarding certain statistics about the baby, e.g., name, sex, weight, date and
place of delivery, and other information such as types of care the midwife
provided and whether or not the mother was satisfied with that care.
d. Reporting Mortalities. The midwife shall
report any maternal or infant death on a Report of Fetal Death Form (DHEC 665)
to the Department, Attn: Vital Records and Public Health Statistics, within 48
hours. This report requires information concerning the death, to include sex,
weight, date and place of delivery, pregnancy history, obstetric procedures,
complications of labor and/or delivery, method of delivery, congenital
anomalies of the fetus, and cause of death.
Midwifery Advisory Council.
a. The Commissioner of DHEC shall appoint a
Midwifery Advisory Council which shall meet at least annually for the purpose
of reviewing and advising the Department regarding matters pertaining to
b. The Council shall establish
a committee for peer review to consult with midwives in questions of ethics,
competency and performance, and to serve as an appeal committee when
disciplinary action has been taken. The committee may recommend denying,
suspending, or revoking a license, or may recommend specific educational
objectives, apprenticeship or other improvement measures as
a. As part of the monitoring
process, the Department shall evaluate consumer feedback forms issued through
midwives to all consumers of midwifery care. The Department shall also issue
to, collect, and evaluate quarterly forms from midwives regarding their
b. The Department shall
ensure that high quality services are provided by midwives and apprentice
midwives in this State through compliance with the standards in these
Q. General. Conditions arising which have not
been addressed in these regulations shall be managed in accordance with the
best practices as determined by the Department.