V. Prenatal Care

During prenatal care, the client may be seen by the Midwife or other appropriate health care provider monthly until 32 weeks, every 2-3 weeks from 32 weeks to 37 weeks, and weekly after 37 weeks gestation, or as appropriate. The responsibilities of the Midwife shall include, but are not limited to:

A.   Initial Prenatal Visit

1.   History/assessment of general health.

2.   History/assessment of obstetric status.

3.   History/assessment of psychosocial status.

4.   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.   hemoglobin and/or hematocrit or CBC;

b.   gross urinalysis for protein and glucose;

c.   blood group, Rh type, and antibody screen;

d.   syphilis serology, pursuant to TCA 68-5-602;

e.   hepatitis B surface antigen, pursuant to TCA 68-5-602;

f.    rubella screen, pursuant to TCA 68-5-602;

g.   genetic screening tests;

h.   gonorrhea test, if at risk;

i.     chlamydia test, if at risk;

j.     HIV test, pursuant to TCA 68-5-703.

B.   On-going Prenatal Care

1.   Assessment of general health.

2.   Assessment of psychosocial health.

3.   Nutritional counseling.

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

a.   blood pressure;

b.   pulse, (optional);

c.   weight;

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

e.   estimation of gestational age by physical findings;

f.    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.   hemoglobin, hematocrit, or CBC between 28 and 32 weeks;

b.   gross urinalysis for protein and glucose at each visit;

c.   Glucose Tolerance Test (GTT), if indicated;

d.   Group B strep (GBS) culture, pursuant to TCA 68-5-401;

e.   Herpes (HSV 1 and/or HSV 2) cultures(s), if indicated;

f.    HIV after 28 weeks, pursuant to TCA 68-5-703.

6.   Prophylactic Rhogam information for Rh negative clients, as indicated.