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fed9194b8d8b0d15 | #### **7. Clinical Indications...** *continuation*
| 7.1.14 | Hypertension | |
|--------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------|
| | HSV2 – active lesions in late ... |
be2f14df786a97c3 | #### **7. Clinical Indications...** *continuation*
| | Gonorrhoea | B |
|--------|-------------------------------------------------------------------|-----|
| | HIV infection | |
| | Newly diagnosed in pregnancy | C |
| | High viral load | C |
| | Low viral load | B |
| | Human Papilloma Virus (HPV) | A/B |
| | Lister... |
9589ca185cddb712 | #### **7. Clinical Indications...** *continuation*
| | Gonorrhoea | B |
|--------|-------------------------------------------------------------------|-----|
| | Acquired in third trimester | C |
| | Parvovirus | B |
| | Rubella | |
| | Primary infection | C |
| | Recurrent infection | B |
| | Syphilis | B/C |
| | Toxo... |
73609e4ca03aba62 | #### **7. Clinical Indications...** *continuation*
| | Gonorrhoea | B |
|--------|-------------------------------------------------------------------|-----|
| | Acute or recent infection in first trimester | C |
| | Acute infection in second or third trimester | B |
| | Tuberculosis | |
| | Active | B |
| | Past histo... |
d6c760c40ef615bb | #### **7. Clinical Indications...** *continuation*
| | Gonorrhoea | B |
|--------|-------------------------------------------------------------------|-----|
| | Other infection of no familiarity | B |
| 7.1.17 | Intrauterine fetal demise | C |
| 7.1.18 | Malpresentation/non cephalic presentation at full term | |
| | B... |
21b6a77ebc30dc41 | #### **7. Clinical Indications...** *continuation*
| | Brow, face or shoulder presentation | B/C |
|--------|---------------------------------------------------------------|-----|
| | Unstable lie | B/C |
| 7.1.19 | Multiple pregnancy | C |
| 7.1.20 | Neurological | |
| | Migraines | B |
| | Carpal tunnel syndrome | A... |
5bb560a8d7a640f5 | #### **7. Clinical Indications...** *continuation*
| | Brow, face or shoulder presentation | B/C |
|--------|---------------------------------------------------------------|-----|
| | New onset of seizures | C |
| | Neuropathies or palsies | B/C |
| | Other neurological conditions first diagnosed in pregnancy | B |
| ... |
0cc8d7e636f665d0 | #### **7. Clinical Indications...** *continuation*
| | Brow, face or shoulder presentation | B/C |
|--------|---------------------------------------------------------------|-----|
| | Placenta praevia | C |
| | Vasa praevia | C |
| | Single umbilical artery | B |
| 7.1.23 | Post-term or post-dates pregnancy | |
| | Po... |
5ac059779b1e9af7 | #### **7. Clinical Indications...** *continuation*
| | Brow, face or shoulder presentation | B/C |
|--------|---------------------------------------------------------------|-----|
| | Threatened preterm labour | B |
| | Preterm labour 34 weeks | B/C | |
2d72f2593d2f25b0 | #### **7. Clinical Indications...** *continuation*
| 7.1.25 | Preterm prelabour rupture of membranes | | |
|--------|---------------------------------------------------------------------------------------------|-------|--|
| | 34 weeks | B | |
| 7.1.26 | Psychological or perinatal mental health concerns (diagnosis in ... |
45a1d2bae3b42bff | #### **7. Clinical Indications...** *continuation*
| 7.1.25 | Preterm prelabour rupture of membranes | | |
|--------|---------------------------------------------------------------------------------------------|-------|--|
| | EPDS >12 OR positive response to Q10 self-harm during pregnancy (intention to self-harm) | B... |
5d6a02d5d02279f6 | #### **7. Clinical Indications...** *continuation*
| 7.1.25 | Preterm prelabour rupture of membranes | | |
|--------|---------------------------------------------------------------------------------------------|-------|--|
| | Asthma poorly controlled | C | |
| | Influenza (A or B) | B/C | |
| | H1N1 | C | |
| | Pneum... |
b046e7ec522f5f7f | #### **7. Clinical Indications...** *continuation*
| 7.1.29 | Sepsis | C |
|--------|--------------------------------------------------|-----|
| 7.1.30 | Surgery during pregnancy | |
| | Minor surgery | B |
| | Major surgery | C |
| 7.1.31 | Symphysis pubis dysfunction (pelvic instability) | A |
| 7.1.32 | Trophoblast... |
54970629ea3ad1c1 | #### **7. Clinical Indications...** *continuation*
| 7.1.29 | Sepsis | C |
|--------|--------------------------------------------------|-----|
| 7.1.34 | Vaginal blood loss | |
| | Recurring loss prior to 12 weeks | A/B |
| | Recurring loss at or after 12 weeks | B |
| | Antepartum haemorrhage | B/C | |
db122b3cb26f2c86 | ### **8 CLINICAL INDICATIONS DURING THE INTRAPARTUM PERIOD**
| 8.1.1 | Amniotic fluid embolism | | | | | |
|--------|-------------------------------------------------------------------------------------|-----|--|--|--|--|
| 8.1.2 | Artificial rupture/release of membranes (ARM) | | | | | |
| | Induction of labour/augme... |
d4f7e66950b53a10 | ### **8 CLINICAL INDICATIONS DURING THE INTRAPARTUM PERIOD**
| 8.1.1 | Amniotic fluid embolism | | | | | |
|--------|-------------------------------------------------------------------------------------|-----|--|--|--|--|
| 8.1.3 | Breech presentation | | | | | |
| | Diagnosed prior to labour – maternal choice for vag... |
1d320c9153b5f21a | ### **8 CLINICAL INDICATIONS DURING THE INTRAPARTUM PERIOD**
| 8.1.1 | Amniotic fluid embolism | | | | | |
|--------|-------------------------------------------------------------------------------------|-----|--|--|--|--|
| | Undiagnosed with good progress in labour, frank or complete breech | B/C | | | | |
| | Undiag... |
176d4ff33351ffc6 | ### **8 CLINICAL INDICATIONS DURING THE INTRAPARTUM PERIOD**
| 8.1.1 | Amniotic fluid embolism | | | | | |
|--------|-------------------------------------------------------------------------------------|-----|--|--|--|--|
| 8.1.5 | Cord prolapse or presentation | C | | | | |
| 8.1.6 | Fetal death during labour/stillbi... |
1e1abede3b076ad8 | ### **8 CLINICAL INDICATIONS DURING THE INTRAPARTUM PERIOD**
| 8.1.1 | Amniotic fluid embolism | | | | | |
|--------|-------------------------------------------------------------------------------------|-----|--|--|--|--|
| 8.1.9 | Haemoglobin <110g/L in labour | C | | | | |
| 8.1.10 | Haemorrhage | | | | | |
| | Intr... |
6baed7020310916b | ### **8 CLINICAL INDICATIONS DURING THE INTRAPARTUM PERIOD**
| 8.1.1 | Amniotic fluid embolism | | | | | |
|--------|-------------------------------------------------------------------------------------|-----|--|--|--|--|
| | Symptomatic and/or >50mL | C | | | | |
| | Postpartum haemorrhage | | | | | |
| | Estimated b... |
9d5a945411e0d7ee | ### **8 CLINICAL INDICATIONS DURING THE INTRAPARTUM PERIOD**
| | EBL >500ml and symptomatic | | | |
|--------|-----------------------------------------------------------------------------------------------------------------------------------|-----|--|--|
| | EBL >1000ml and/or symptomatic | B/C | | |
| | EBL >2000mL +... |
b8a8f168c154da29 | ### **8 CLINICAL INDICATIONS DURING THE INTRAPARTUM PERIOD**
| | EBL >500ml and symptomatic | | | |
|--------|-----------------------------------------------------------------------------------------------------------------------------------|-----|--|--|
| | Gestational | B/C | | |
| | Pre-eclampsia | B/C | | |
| | Ec... |
172aa66ca84b0ff3 | ### **8 CLINICAL INDICATIONS DURING THE INTRAPARTUM PERIOD**
| | EBL >500ml and symptomatic | | | |
|--------|-----------------------------------------------------------------------------------------------------------------------------------|-----|--|--|
| 8.1.12 | Maternal collapse/shock | C | | |
| 8.1.13 | Maternal... |
ea9122fd749917ac | ### **8 CLINICAL INDICATIONS DURING THE INTRAPARTUM PERIOD**
| | EBL >500ml and symptomatic | | | |
|--------|-----------------------------------------------------------------------------------------------------------------------------------|-----|--|--|
| | Non-significant (defined as pale green/yellow thin diluted n... |
ccd4054b3c2a03a8 | ### **8 CLINICAL INDICATIONS DURING THE INTRAPARTUM PERIOD**
| | EBL >500ml and symptomatic | | | |
|--------|-----------------------------------------------------------------------------------------------------------------------------------|-----|--|--|
| 8.1.16 | Non-vertex presentation other than breech Including b... |
16165210ab4e3570 | ### **8 CLINICAL INDICATIONS DURING THE INTRAPARTUM PERIOD**
| | EBL >500ml and symptomatic | | | |
|--------|-----------------------------------------------------------------------------------------------------------------------------------|-----|--|--|
| | Suspicious with abnormal features, possible fetal compromise... |
eff6b0b14b21831b | ### **8 CLINICAL INDICATIONS DURING THE INTRAPARTUM PERIOD**
| | EBL >500ml and symptomatic | | | |
|--------|-----------------------------------------------------------------------------------------------------------------------------------|-----|--|--|
| 8.1.18 | Induction of labour | B/C | | |
| 8.1.19 | Instrument... |
2f4696f82b9a397b | #### **8. Clinical Indications During the Intrapartum Period** *continuation*
| 8.1.20 | Maternal vital signs Persistent deviation from normal including: Bradycardia Tachycardia Hypertension Hypotension Tachypnoea Pyrexia >38 (2 consecutive readings at least an hour apart) | B/C |
|--------|---------------------------... |
afde61f58cebd91f | #### **8. Clinical Indications During the Intrapartum Period** *continuation*
| 8.1.20 | Maternal vital signs Persistent deviation from normal including: Bradycardia Tachycardia Hypertension Hypotension Tachypnoea Pyrexia >38 (2 consecutive readings at least an hour apart) | B/C |
|--------|---------------------------... |
bc7b617329ffc0c9 | #### **8. Clinical Indications During the Intrapartum Period** *continuation*
| 8.1.20 | Maternal vital signs Persistent deviation from normal including: Bradycardia Tachycardia Hypertension Hypotension Tachypnoea Pyrexia >38 (2 consecutive readings at least an hour apart) | B/C |
|--------|---------------------------... |
6e823e788973639a | #### **8. Clinical Indications During the Intrapartum Period** *continuation*
| 8.1.20 | Maternal vital signs Persistent deviation from normal including: Bradycardia Tachycardia Hypertension Hypotension Tachypnoea Pyrexia >38 (2 consecutive readings at least an hour apart) | B/C |
|--------|---------------------------... |
0b35028d417ee489 | #### **8. Clinical Indications During the Intrapartum Period** *continuation*
| 8.1.20 | Maternal vital signs Persistent deviation from normal including: Bradycardia Tachycardia Hypertension Hypotension Tachypnoea Pyrexia >38 (2 consecutive readings at least an hour apart) | B/C |
|--------|---------------------------... |
59dc652ef8131a30 | #### **8. Clinical Indications During the Intrapartum Period** *continuation*
| 8.1.20 | Maternal vital signs Persistent deviation from normal including: Bradycardia Tachycardia Hypertension Hypotension Tachypnoea Pyrexia >38 (2 consecutive readings at least an hour apart) | B/C |
|--------|---------------------------... |
9d7d485f054aed63 | #### **8. Clinical Indications During the Intrapartum Period** *continuation*
| 8.1.20 | Maternal vital signs Persistent deviation from normal including: Bradycardia Tachycardia Hypertension Hypotension Tachypnoea Pyrexia >38 (2 consecutive readings at least an hour apart) | B/C |
|--------|---------------------------... |
90aae782401829a0 | #### **8. Clinical Indications During the Intrapartum Period** *continuation*
| 8.1.20 | Maternal vital signs Persistent deviation from normal including: Bradycardia Tachycardia Hypertension Hypotension Tachypnoea Pyrexia >38 (2 consecutive readings at least an hour apart) | B/C |
|--------|---------------------------... |
02f89a0eabf80d96 | #### **8. Clinical Indications During the Intrapartum Period** *continuation*
| 8.1.20 | Maternal vital signs Persistent deviation from normal including: Bradycardia Tachycardia Hypertension Hypotension Tachypnoea Pyrexia >38 (2 consecutive readings at least an hour apart) | B/C |
|--------|---------------------------... |
d526ba6d473166ca | #### **8. Clinical Indications During the Intrapartum Period** *continuation*
| 8.1.20 | Maternal vital signs Persistent deviation from normal including: Bradycardia Tachycardia Hypertension Hypotension Tachypnoea Pyrexia >38 (2 consecutive readings at least an hour apart) | B/C |
|--------|---------------------------... |
8f6be173cb259270 | #### **8. Clinical Indications During the Intrapartum Period** *continuation*
| 8.1.20 | Maternal vital signs Persistent deviation from normal including: Bradycardia Tachycardia Hypertension Hypotension Tachypnoea Pyrexia >38 (2 consecutive readings at least an hour apart) | B/C |
|--------|---------------------------... |
756a944285e32cfc | #### **8. Clinical Indications During the Intrapartum Period** *continuation*
| 8.1.20 | Maternal vital signs Persistent deviation from normal including: Bradycardia Tachycardia Hypertension Hypotension Tachypnoea Pyrexia >38 (2 consecutive readings at least an hour apart) | B/C |
|--------|---------------------------... |
2c33178b3f1c96ed | #### **8. Clinical Indications During the Intrapartum Period** *continuation*
| 8.1.20 | Maternal vital signs Persistent deviation from normal including: Bradycardia Tachycardia Hypertension Hypotension Tachypnoea Pyrexia >38 (2 consecutive readings at least an hour apart) | B/C |
|--------|---------------------------... |
c0bace1828c7f842 | #### **8. Clinical Indications During the Intrapartum Period** *continuation*
| 8.1.20 | Maternal vital signs Persistent deviation from normal including: Bradycardia Tachycardia Hypertension Hypotension Tachypnoea Pyrexia >38 (2 consecutive readings at least an hour apart) | B/C |
|--------|---------------------------... |
1c88d22ace54007e | #### **8. Clinical Indications During the Intrapartum Period** *continuation*
| 8.1.20 | Maternal vital signs Persistent deviation from normal including: Bradycardia Tachycardia Hypertension Hypotension Tachypnoea Pyrexia >38 (2 consecutive readings at least an hour apart) | B/C |
|--------|---------------------------... |
3569c529161cde3f | #### **8. Clinical Indications During the Intrapartum Period** *continuation*
| 8.1.20 | Maternal vital signs Persistent deviation from normal including: Bradycardia Tachycardia Hypertension Hypotension Tachypnoea Pyrexia >38 (2 consecutive readings at least an hour apart) | B/C |
|--------|---------------------------... |
3be7a43fad36123d | #### **8. Clinical Indications During the Intrapartum Period** *continuation*
| 8.1.20 | Maternal vital signs Persistent deviation from normal including: Bradycardia Tachycardia Hypertension Hypotension Tachypnoea Pyrexia >38 (2 consecutive readings at least an hour apart) | B/C |
|--------|---------------------------... |
49194689634c4a40 | #### **8. Clinical Indications During the Intrapartum Period** *continuation*
| 8.1.24 | Prolonged labour Consider ease of access and/or transfer to referral services | B/C | | |
|--------|----------------------------------------------------------------------------------------------------------------------------------... |
a6f240eb91371520 | #### **8. Clinical Indications During the Intrapartum Period** *continuation*
| 8.1.24 | Prolonged labour Consider ease of access and/or transfer to referral services | B/C | | |
|--------|----------------------------------------------------------------------------------------------------------------------------------... |
59200a36f2faac9d | #### **8. Clinical Indications During the Intrapartum Period** *continuation*
| 8.1.24 | Prolonged labour Consider ease of access and/or transfer to referral services | B/C | | |
|--------|----------------------------------------------------------------------------------------------------------------------------------... |
94cf66e37e386d96 | #### **8. Clinical Indications During the Intrapartum Period** *continuation*
| 8.1.24 | Prolonged labour Consider ease of access and/or transfer to referral services | B/C | | |
|--------|----------------------------------------------------------------------------------------------------------------------------------... |
ee720e3a96dd9b8d | #### **8. Clinical Indications During the Intrapartum Period** *continuation*
| 8.1.24 | Prolonged labour Consider ease of access and/or transfer to referral services | B/C | | |
|--------|----------------------------------------------------------------------------------------------------------------------------------... |
94a36b2c812a8d78 | #### **8. Clinical Indications During the Intrapartum Period** *continuation*
| 8.1.24 | Prolonged labour Consider ease of access and/or transfer to referral services | B/C | | |
|--------|----------------------------------------------------------------------------------------------------------------------------------... |
480910d5801792e6 | #### **8. Clinical Indications During the Intrapartum Period** *continuation*
| 8.1.24 | Prolonged labour Consider ease of access and/or transfer to referral services | B/C | | |
|--------|----------------------------------------------------------------------------------------------------------------------------------... |
c3caff70c4e26b5d | #### **8. Clinical Indications During the Intrapartum Period** *continuation*
| 8.1.24 | Prolonged labour Consider ease of access and/or transfer to referral services | B/C | | |
|--------|----------------------------------------------------------------------------------------------------------------------------------... |
a92a423299269c9c | #### **8. Clinical Indications During the Intrapartum Period** *continuation*
| 8.1.24 | Prolonged labour Consider ease of access and/or transfer to referral services | B/C | | |
|--------|----------------------------------------------------------------------------------------------------------------------------------... |
97d4db1e7ff37d29 | #### **8. Clinical Indications During the Intrapartum Period** *continuation*
| 8.1.24 | Prolonged labour Consider ease of access and/or transfer to referral services | B/C | | |
|--------|----------------------------------------------------------------------------------------------------------------------------------... |
6cf5e404dc448863 | #### **8. Clinical Indications During the Intrapartum Period** *continuation*
| 8.1.24 | Prolonged labour Consider ease of access and/or transfer to referral services | B/C | | |
|--------|----------------------------------------------------------------------------------------------------------------------------------... |
c7a215a5c5ca793a | #### **8. Clinical Indications During the Intrapartum Period** *continuation*
| | Rupture of membranes >24 hours associated with abnormal fetal heart rate, meconium stained liquor, signs of infection as examples | | |
|--------|-------------------------------------------------------------------------------------------... |
1c3c74a1dc034a88 | #### **8. Clinical Indications During the Intrapartum Period** *continuation*
| | Rupture of membranes >24 hours associated with abnormal fetal heart rate, meconium stained liquor, signs of infection as examples | | |
|--------|-------------------------------------------------------------------------------------------... |
8839191075ade888 | #### **8. Clinical Indications During the Intrapartum Period** *continuation*
| | Rupture of membranes >24 hours associated with abnormal fetal heart rate, meconium stained liquor, signs of infection as examples | | |
|--------|-------------------------------------------------------------------------------------------... |
4d005ff5d99e0876 | ### **9 CLINICAL INDICATIONS DURING THE POSTPARTUM PERIOD**
Postpartum/Postnatal from 1st hour post birth until 6 weeks post birth |
9e5664ce4edcc009 | #### **9.1 Maternal**
| 9.1.1 | Lactation | | | |
|-------|----------------------------------------------------------------------------------|---------|--|--|
| | Engorgement | A*, A/B | | |
| | Under supply | A*, A/B | | |
| | Over supply | A*, A/B | | |
| | Suppression | A*, A/B | | |
| 9.1.2 | Hypertension | | | | |
3ac34894481d032b | #### **9.1 Maternal**
| 9.1.1 | Lactation | | | |
|-------|----------------------------------------------------------------------------------|---------|--|--|
| | Persistent hypertension | C | | |
| | Postpartum preeclampsia | C | | |
| | Postpartum eclampsia | C | | |
| 9.1.3 | Incontinence | | | |
| | Faecal | C | |... |
0438ef5826eb3068 | #### **9.1 Maternal**
| 9.1.1 | Lactation | | | |
|-------|----------------------------------------------------------------------------------|---------|--|--|
| | Urinary | A/A*/B | | |
| 9.1.4 | Psychological or perinatal mental health concerns | | | |
| | History of antenatal depression/anxiety during pregnancy | A/... |
04c1b0922c9706bb | #### **9.1 Maternal**
| 9.1.1 | Lactation | | | |
|-------|----------------------------------------------------------------------------------|---------|--|--|
| | Puerperal psychosis | C | | |
| | Psychological birth trauma | A/B/C | | |
| | Other serious psychological disturbance | C | | |
| 9.1.5 | Post-dural headac... |
baa1cc6e88a4fee9 | #### **9.1 Maternal**
| 9.1.1 | Lactation | | | |
|-------|----------------------------------------------------------------------------------|---------|--|--|
| | Primary postpartum haemorrhage – dependent on symptoms and clinical condition | A/B/C | | |
| | Secondary postpartum haemorrhage - asymptomatic | B/C | | |
... |
b6f6ffb917aa20a1 | #### **9. Clinical Indications During the Postpartum Period** *continuation*
| 9.1.7 | Prolapse | |
|--------|---------------------------------------------------------------------|--------------|
| | Uterine | C |
| | Cystocele | C |
| | Rectocele | C |
| 9.1.8 | Pulmonary embolism | C |
| 9.1.9 | Stroke | C |
| 9.1.1... |
aa5b2c32c5946137 | #### **9. Clinical Indications During the Postpartum Period** *continuation*
| 9.1.7 | Prolapse | |
|--------|---------------------------------------------------------------------|--------------|
| 9.1.11 | Suspected or actual maternal infection | |
| | Pyrexia >38°C | A*/B |
| | Mastitis | A*/B |
| | Urinary tract in... |
e8d7addbe71c0657 | #### **9. Clinical Indications During the Postpartum Period** *continuation*
| 9.1.7 | Prolapse | |
|--------|---------------------------------------------------------------------|--------------|
| | Suspected retained placenta | B/C |
| | Sepsis | C |
| 9.1.12 | Thrombophlebitis or thromboembolism | C | |
d37461a97a402f1d | #### **9.2 Newborn**
| 9.2.4 | Congenital abnormalities | C |
|--------|----------------------------------------------------------------------------------------------|--------------|
| 9.2.5 | Failure to pass urine or meconium within 24 hours of birth | A/B |
| 9.2.6 | Failure to pass urine or meconium within 36 hours... |
473662348f4eca7e | #### **9.2 Newborn**
| 9.2.4 | Congenital abnormalities | C |
|--------|----------------------------------------------------------------------------------------------|--------------|
| 9.2.9 | Jaundice | |
| | 14 days | C |
| | >24 hours but <14 days | A/A*/B |
| 9.2.10 | Cyanosis or pallor | B/C | |
3034eaf472ce69a9 | #### **9.2 Newborn**
| 9.2.4 | Congenital abnormalities | C |
|--------|----------------------------------------------------------------------------------------------|--------------|
| 9.2.11 | Preterm birth <37 weeks | B/C |
| 9.2.12 | Seizure activity, observed or suspected | C |
| 9.2.13 | Temperature instability |... |
ed97d4d63c17c538 | #### **9.2 Newborn**
| 9.2.4 | Congenital abnormalities | C |
|--------|----------------------------------------------------------------------------------------------|--------------|
| 9.2.15 | Neonatal abstinence syndrome/substance withdrawal | B/C |
| 9.2.16 | Vomiting Green, bile stained Projectile Excessive | A*, ... |
dce80c34601105c5 | ### **10 SOCIAL INDICATIONS**
| 10.1.1 | Adoption | A/B |
|---------|-----------------------------------------------|---------|
| 10.1.2 | Current or previous child protection concerns | A*, A/B |
| 10.1.3 | Family/domestic violence | B |
| 10.1.4 | Financial issues | B |
| 10.1.5 | Identified asylum seeker status | A... |
dd21bf1104994874 | #### **Background**
- clearly describing the scope of their practice and any limitations
- providing advice and care that is consistent with the Guidelines
- providing information about the risks and benefits of any aspect of care being provided and any alternative approaches
- providing information that is sourced fr... |
704fa0c64cc8fd5d | #### **Background**
This document is designed to act as a guideline only. It is not meant to be prescriptive. You should seek advice from ACM, your insurer or your employer if you are still not sure how to proceed. This document was informed by the College of Midwives of Ontario 'When A Client Chooses Care Outside Mi... |
651c4c6bc50dc681 | #### **In the first instance**
When a woman chooses care outside the recommendations provided in the Guidelines, the midwife must attempt to discuss with the woman (and with any hospital staff through identified channels where applicable) the risks and benefits of the woman's decision. As part of that discussion, it i... |
a073674545aacd22 | #### **If the matter remains unresolved**
If a midwife advises a woman that a certain course of action should be followed in order to comply with midwifery standards of practice, and the woman declines to follow that advice, the midwife should:
- 1. **Advise** the woman about the recommended guideline and the reasoni... |
a98b0e2841578107 | #### **If the matter remains unresolved**
Consultation should include discussion of the appropriate next steps if the woman continues to choose care outside the recommended guideline. It should also identify the safest and most ethical course of action given these circumstances, i.e. continuation of care (which may or... |
07676bc94f0f0e2d | #### **If the matter remains unresolved**
- 4. Share the advice of the consultation with the woman and ask the woman to share any advice she has received.
- 5. Document the advice, process and outcomes of the decision, and record relevant details. The ACM recommends using the 'record of understanding' provided in Appe... |
fc0330a8de3a79e5 | #### **Continuing or discontinuing care when a woman chooses a course of action outside the guidelines**
The decision to continue or discontinue care when a woman has chosen a course of action outside midwifery standards of practice is a serious one.
The midwife's decision must be informed by his/her:
- ethical judg... |
1ae2f83adaf85adc | #### **If care continues**
If the midwife decides to continue care, the midwife must:
- a. Continue to inform the woman about changes in indications health and wellbeing for her and/or her baby(s).
- b. Continue to make recommendations for safe care consistent with the Guidelines and any relevant broader evidence bas... |
36dedf690915807f | #### **If care is discontinued**
- a. As soon as possible, clearly communicate his or her inability to continue to provide care to the woman, and the reasons why that midwifery care is being discontinued.
- b. Follow this discussion with written advice to the woman confirming the reasons why that midwifery care is bei... |
96c41a8484050923 | #### **If care is discontinued**
- c. Send a written referral (see Appendix C) to the registered maternity care provider identified in (b) above, confirming the date on which the midwife will discontinue midwifery care of the woman. In the event that no registered maternity care provider has been identified, seek the ... |
e3b30eb3dd2acbd0 | #### **If care is discontinued**
Again, it is important that all discussions and decisions are documented. In relation to any advice or referrals which are sent, these should be sent in such a way that the sending and receiving can be confirmed (such as by registered post). |
b8bf1ce3654eeb13 | #### **When an emergency or issues arise in labour**
If issues arise during labour or in urgent or emergency circumstances, the midwife is obliged to attend to the woman.
Where a woman has refused emergency transport or transfer of care during active labour, the midwife must remain in attendance as the primary care p... |
8e0efb1aba55e884 | ## **12 APPENDIX B: RECORD OF UNDERSTANDING14**
- 2. If in a hospital setting, inform the midwife in charge and/or call a medical practitioner.
- 3. Continue to inform the woman about any changes in indications of her or her baby's health and wellbeing.
- 4. Call the second midwife to attend. The second midwife should... |
9001d38107266d51 | #### **PART 1: Record of advice/discussions**
| Did you discuss your maternity care option(s) with your midwife and/ or other care providers? Why/why not? | Summarise those discussions, including: the safest and most ethical course under these circumstances discussion of appropriate next steps if the woman continues t... |
d845c4c2e0b953c9 | #### **PART 2: Management Plan**
This management plan should be reviewed regularly or whenever there is a change of circumstances. The maternity care record should reflect all decisions relating to this plan.
Medical practitioner
Other [state type] |
f8a9a7e71b920ca3 | ## **13 APPENDIX B: MAKING A REFERRAL**
It is strongly recommended that midwives provide a referral letter either in the clinical record or separately by letter when making a referral. It is expected that healthcare providers will communicate with the midwife in writing about their findings including the provision of ... |
1eb1f3be940b8c05 | #### **SAMPLE referral letter**
Date:
Obstetric Clinic/Hospital Address:
Dear Consultant
Re: Woman's name ("Jennifer Jones") DOB: \_\_/\_\_ /\_\_ ID #
Address:
Phone number:
Thank you for seeing "Jennifer Jones" who is now ## weeks pregnant. She requires review because of her previous caesarean section. Her hist... |
2f39a19e3c091f9c | #### **SAMPLE referral letter**
This time Jennifer spontaneously conceived, and her due date is xx/xx/xx. She is keen to pursue VBAC for this birth but was told at a consultation very early in this pregnancy that she should have elective LSCS at 38 weeks.
*[Include any further relevant information.]*
We look forward... |
c8fccd6991e66bac | #### **SAMPLE referral letter**
Midwife's signature Midwife's name, Midwife's registration number Contact details.16
This sample letter is based on an example in Pairman S, Tracy SK, Thorogood C, Pincombe J. (2018). Midwifery: Preparation for Practice. p. 344-5. |
6f8bb6d7aaa98692 | # Prepregnancy Counseling
ABSTRACT: The goal of prepregnancy care is to reduce the risk of adverse health effects for the woman, fetus, and neonate by working with the woman to optimize health, address modifiable risk factors, and provide education about healthy pregnancy. All those planning to initiate a pregnancy sh... |
c1314bdc6f5c6ab7 | # Prepregnancy Counseling
riate whether the reproductive-aged patient is currently using contraception or planning pregnancy. Because health status and risk factors can change over time, prepregnancy counseling should occur several times during a woman's reproductive lifespan, increasing her opportunity for education ... |
e37dedde248bf9cb | # Prepregnancy Counseling
exually transmitted infection screening should be performed at the time of prepregnancy counseling. Women who present for prepregnancy counseling should be offered screening for the same genetic conditions as recommended for pregnant women. All patients should be routinely asked about their u... |
537f004d45bf2748 | #### Recommendations and Conclusions
The American College of Obstetricians and Gynecologists (ACOG) and the American Society for Reproductive Medicine (ASRM) make the following recommendations and conclusions:
- Any patient encounter with nonpregnant women or men with reproductive potential (eg, not posthysterectomy ... |
b24cfb686f228092 | #### Recommendations and Conclusions
- The goal of prepregnancy care is to reduce the risk of adverse health effects for the woman, fetus, and neonate by working with the woman to optimize health, address modifiable risk factors, and provide education about healthy pregnancy.
- Women should be counseled to seek medica... |
164a2d5d28398bb2 | #### Recommendations and Conclusions
- have implications for pregnancy outcomes and should be optimally managed before pregnancy.
- All prescription and nonprescription medications should be reviewed during prepregnancy counseling. This review also should include nutritional supplements and herbal products that patien... |
06cac7e647db628f | #### Recommendations and Conclusions
- All patients should receive an annual influenza vaccination; those women who are or will be pregnant during influenza season will have additional benefits.
- Assessment of the need for sexually transmitted infection (STI) screening should be performed at the time of prepregnancy ... |
138a7b5bd8ea0c5f | #### Recommendations and Conclusions
- Screening for intimate partner violence should occur during prepregnancy counseling.
- Female prepregnancy folic acid supplementation should be encouraged to reduce the risk of neural tube defects (NTDs).
- Patients should be screened regarding their diet and vitamin supplements ... |
29003ebdf517daa8 | #### Introduction
Obstetrician–gynecologists have a prime opportunity to improve maternal and fetal outcomes through prepregnancy counseling. Like a well-woman visit, the prepregnancy visit (when the patient presents to discuss a potential future pregnancy) provides an excellent opportunity to counsel patients about m... |
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