Midwife / Physician Agreement

Transcription

1 Midwife / Physician Agreement This agreement between (the midwife) and (Affiliated Physician) executed this date sets forth the agreement between the parties, patterns of care between the parties and patterns of care provided by the Midwife. This agreement delineates consultation, collaborative management, and which clients will be referred to the physician as indicated by the health status of the woman receiving care from the Midwife. The Midwife will work within a framework of approved policies The Midwifery Policies and Procedure Manual will serve as the guidelines for individualizing the care of each patient and defines the limits of the midwifery management process. This agreement between the Certified Nurse Midwife ( CNM ) and the Affiliated Physician (a person who holds a plenary license to practice medicine and surgery in New Jersey, issued by the Board, who adheres to clinical guidelines with a licensed midwife) provides: a. An outline of routine care. b. Procedures that will be performed. c. Procedures to follow if risk factors are encountered. d. The circumstances under which consultation, collaborative management, referral and transfer of care are to take place, and the manner by which each is to occur. e. Establishment of a formulary listing the categories of drugs, which may include controlled dangerous substances the CNM may order, prescribe, administer or dispense. f. A mechanism for determining the availability of the Affiliated Physician or substitute physician, for consultation and emergency assistance or medical management when needed. g. The manner by which emergency care for newborns will be provided. h. Provisions for periodic conferences between the CNM and the Affiliated Physician. Midwifery practice is the independent management of women s health care, focusing on pregnancy, childbirth, the postpartum period, care of the newborn, the family planning and gynecological needs of women. The CNM practices within a health care system that provides for consultation, collaborative management or referral as indicated by the health status of the client. A CNM supports women as partners in health care choices and practice in accord with the Standards for the Practice of Nurse-Midwifery, as defined by the American College of Nurse-Midwives and NJSA 45:10-1 et seq. Midwifery care is primarily intended for healthy women. However, when women experience medical, gynecological and/or obstetrical complications, the midwife can continue to be instrumental in their care. This collaboration (co-management) provides for the following patterns of care for the high risk client. This agreement establishes a professional relationship to accomplish the following.

2 1. Consultation is the process whereby a CNM, who maintains primary management responsibility for the woman s care, seeks the advice or opinion of a physician or another member of the health care team. 2. Collaboration is the process whereby a CNM and physician jointly manage the care of a woman or newborn who has become medically, gynecologically or obstetrically complicated. The scope of collaboration may encompass the physical care of the client, including delivery, by the CNM, according to mutually agreedupon plan of care. When the physician must assume a dominant role in the care of the client due to increased risk status, the CNM may continue to participate in physical care, counseling, guidance, teaching and support. Effective communication between the CNM and physician is essential for ongoing collaborative management. 3. Referral is the process by which the CNM directs the client to a physician or another health care professional for management of a particular problem or aspect of the clients care. Antepartum Management: The CNM s scope of practice during the antepartum stage includes: 1. Ordering medical, therapeutic and diagnostic measures in accordance with clinical guidelines 2. Identifying women with medical, obstetrical or gynecological risk factors and participating in their care in accordance with the guidelines set forth below. The CNM may participate in the management of antepartum patients at increased risk under the following conditions: 1. The midwife-physician team shall have both agreed to include the patient at risk in the caseload. 2. The midwife-physician team shall have established a management plan for all patients identified as at risk. This plan shall delineate: a. Frequency of physician visits b. Timing of appropriate diagnostic and evaluation procedures. c. Specific parameters for consultation, d. A proposed plan for birth including the type, place and provider. 3. The management plan shall be reviewed periodically by the midwife and the affiliated physician and revised when necessary The following are risk factors that require management as outlined above: A. Maternal health status: 1. Acute and/or chronic hypertension 2. Congenital or acquired heart disease 3. Antiphospholipids syndrome 4. HIV positive or AIDS 5. Chronic Renal disease 6. Seizure disorder requiring medication 7. Chronic anemia and/or hemoglobinopathy

3 8. Diabetes Mellitus 9. Drug addiction 10. Psychosis 11. Asthmatic on daily oral medication 12. Any connective tissue disorder 13. Multiple Sclerosis 14. History of cerebrovascular accident or 15. History of cancer B. Maternal reproductive health history: 1. Incompetent cervix 2. Two or more second or third trimester fetal losses 3. Pre-term labor or delivery 4. Parity of six or more 5. Previous cesarean delivery 6. Surgery involving the uterine wall 7. Previous abruption 8. Previous PP blood transfusion 9. Previous cervical surgeries including Loop Electrosurgical Excision Procedures (Leep), cone biopsies, or three or more surgical dilitations 10. Intra-uterine growth restriction and/or delivery of an infant weighing less than 2500 grams at 36 weeks or more. C. Current maternal obstetrical status 1. Obstructive uterine myomata 2. Polyhydramnios or oligohydramnios 3. Isoimmunization 4. Multiple gestation 5. Intrauterine growth restriction 6. Current evidence of fetal chromosome disorder confirmed by amniocentesis and or congenital anomaly 7. Gestational diabetes 8. Maternal age less than 14 or more than 40 years 9. Pap smear indicating dysplasia 10. Placenta previa 11. Medicated pre-term labor, or 12. Preeclampsia Intrapartum Management: The CNM s scope of practice during the Intrapartum stage includes: 1. Managing labor and birth for women not classified as being at increased risk in accordance with the Policies and Procedure Manual. 2. Performing immediate screening of newborn and resuscitation of the newborn when necessary and referring newborns with acute medical conditions to a physician trained in the care of newborns. 3. Performing an episiotomy as needed 4. Repairing first and second degree episiotomies and lacerations as necessary

4 5. Using local anesthesia 6. Repairs third degree lacerations upon the direction of the Affiliated Physician 7. Repair fourth degree lacerations under the direct supervision of a physician 8. Administer pudendal anesthesia as needed 9. Assisting with Cesarean sections If the woman receives care from the midwife and evidences any of the following conditions, the midwife shall only participate in the birth if it takes place in a licensed hospital. 1. Preterm labor less than 37 weeks. If labor is less than 34 weeks, affiliating physician must be present at the birth. 2. Premature rupture of membranes more than 24 hours before the onset of regular contractions. 3. Assessment of infant weight less than 2,500 grams or more than 4,500 grams 4. Vaginal birth after previous cesarean delivery 5. The need for prescriptive medication to induce or augment labor 6. Post-datism ( greater than 42 weeks completed gestation ) 7. Multiple gestation 8. Malpresentation 9. Evidence of chorioamnionitis If a woman receiving care from a midwife evidences the following during the intrapartum phase the midwife shall arrange for the presence of an affiliated physician at the hospital. 1. Development of hypertension or preeclampsia 2. Non-reassuring fetal heart pattern, unresponsive to conservative measures 3. Prolapse of cord 4. Intrapartum hemorrhage 5. Multiple gestation 6. Malpresentation 7. Any condition requiring operative intervention Postpartum Care: The CNM s scope of practice during the postpartum stage includes: 1. Assessment and treatment 2. Contraceptive services 3. The midwife manages the postpartum care of the woman and will do postpartum rounds and discharge the following patients: a. Patients delivered by the CNM. b. Vaginal deliveries co-managed with the Affiliated Physician. c. Patients delivered by cesarean section Well Woman Care: A CNM may provide well woman care throughout the life cycle which includes: 1. Gynecological and primary health screening, assessment and treatment. 2. Contraceptive services.

5 Prescriptive Authorization: The Midwife who holds prescriptive authorization shall comply with N.J.A.C. 13:35-2A.14. Limited Ultrasound: The midwife may perform limited ultrasound examination in accordance with N.J. A.C. 13:35-2A.15. The clinical guidelines which include when the Midwife may perform limited ultrasound are provided in the Policies and Procedure Manual. Colposcopies: A CNM who wishes to perform colposcopies shall comply with N.J.A.C. 13:35-2A.16. The clinical guidelines which include when the Midwife may perform colposcopies are provided in the Policies and Procedure Manual. Circumcision: A midwife who performs circumcisions shall comply with NJ Statute 13:35-2A.17. The clinical guidelines which include when the Midwife may perform circumcisions are provided in the Policies and Procedure Manual. In witness whereof, the parties hereto have executed this agreement the day and year frist above written. Physician Witness Nurse-Midwife Witness