California College of Midwives
State chapter ~ American College of Community Midwives

Section 3 E

Minimum Practice Requirements ~ ANTEPARTUM CARE

~ to define and clarify minimum practice requirements for the safe care of women and infants during the ANTEPARTUM period of care

e During prenatal care, the client shall be seen by the midwife or other appropriate health care provider at least once every four weeks until 30 weeks gestation, once every two weeks from 30 until 36 weeks gestation, and weekly after 36 weeks gestation, or as appropriate or unless the client declines specific visits due to personal or family reasons.

A. Initial Prenatal Visit

1. Medical history / assessment of general health.

2. Obstetrical history / assessment of obstetric status.

3. History / assessment of psychosocial status.

4. A baseline physical exam to include, but not limited to:

a. height

b. weight

c. blood pressure

d. pulse

e. breasts, to include teaching on self exam (may be deferred)

f. abdomen, to include fundal height, fetal heart tones, fetal lie, and presentation

g. estimation of gestational age by physical findings

h. assessment of varicosities, edema and reflexes

5. Laboratory Tests. The client will be offered the following laboratory tests to include but not limited to:

a. CBC with differential

b. urinalysis with microscopic

c. syphilis serology

d. blood group, Rh type, and antibody screen

e. hepatitis B surface antigen

f. rubella screen

g. genetic screening tests

h. gonorrhea test, if at risk

i. chlamydia test, if at risk

j. HIV test, if at risk

k. tuberculosis, if at risk

B. On-going Prenatal Care

1. Assessment of the mother’s general physical health

2. Assessment of psychosocial health

3. Nutritional assessment & counseling if indicated

4. Physical exam to include, but not limited to:

a. blood pressure & pulse

b. weight

c. abdomen, to include fundal height, fetal heart tones, fetal lie, and presentation

d. estimation of fetal size & gestational age by physical findings

e. assessment of varicosities, edema and DTR reflexes

5. Additional lab tests and genetic screening -- the following laboratory tests will be explained and recommended as indicted, including but not limited to:

a. gross urinalysis for protein and glucose at each visit

b. ultrasound during the first trimester to determine viability, number of fetuses &/or date the pregnancy; during second or third trimester to diagnosis congenital anomalies, confirm fetal position or evaluate amniotic fluid levels and fetal breathing movement and other parameters of well-being

c. maternal serum alpha-feto protein (AFP) screening at 15 to 20 weeks of gestation

d. glucose tolerance test (GTT) at 16-28 wks, if indicated

e. hemoglobin & hematocrit after 28 weeks or CBC for platelet count

f. antibody titer for RhNeg mothers

g. prophylactic Rhogam information for Rh negative clients at 28 wks, as indicated

h. group beta strep (GBS) culture(s) at 35-37 wks, according to CDC Guidelines