1. (a) Initial labor assessment. As soon as possible but within one (1) hour following the onset of active labor (five to six centimeters (5 – 6 cm) with regular and painful contractions) or as soon as possible but within one (1) hour following the prelabor rupture of membranes, the LLM must assess and record:

   1. (1) Physical conditions including temperature, pulse, respiration, blood pressure, and urinalysis for glucose and protein;

   2. (2) Labor status including:

      1. (A) Assessment of contractions;
      2. (B) Status of membranes;
      3. (C) Cervical dilatation; and
      4. (D) Effacement;

   3. (3)

      1. (A) Fetal position, station, size, presenting part, and heart rate.
      2. (B) Establish a fetal heart rate baseline by checking rate and rhythm every fifteen (15) minutes for the first hour of observation; and

   4. (4)

      1. (A) In case of suspected prelabor rupture of membranes, avoid digital exams unless the client is in active labor or delivery is imminent.
      2. (B) A sterile speculum examination is advised to inspect for umbilical cord prolapse and to assess the cervix.

2. (b) Management of labor.

   1. (1) First stage. The LLM must assess and record:

      1. (A) Fetal heart rate and rhythm (immediately following a contraction):

3. (i) At least every hour until five to six centimeters (5-6 cm), then at least every thirty (30) minutes until cervix is completely dilated;

   1. (ii) Immediately after rupture of membranes and during and after the next two (2) contractions to rule out prolapsed cord;

      1. (iii) After any treatment, procedure, or intervention;

         1. (iv) When there is a change in contractions or labor pattern; and
         2. (v) When there is any indication that a medical or obstetric complication is developing;
      2. (B) Duration, interval, and intensity of uterine contractions at least every two (2) hours or more frequently if indicated;

      3. (C) Maternal blood pressure and heart rate in active labor:

         1. (i) Every two (2) hours, or more frequently if indicated;
         2. (ii) Blood pressure every fifteen (15) minutes when there is a systolic reading of greater than or equal to one hundred forty (≥140) or a diastolic of greater than or equal to ninety (≥90); and
         3. (iii) Heart rate every fifteen (15) minutes when maternal heart rate is fewer than seventy beats per minute (<70 bpm) or greater than one hundred ten beats per minute (>110 bpm); and

      4. (D) Temperature:

         1. (i) Every two (2) hours in active labor;
         2. (ii) Every two (2) hours following rupture of membranes; and
         3. (iii) Every thirty (30) minutes when oral temperature is ninety-nine and one half degrees Fahrenheit (99.5º F) or higher.

   2. (2) Second stage and third stage. The LLM’s duties include but are not limited to:

      1. (A) Assessing and documenting:

         1. (i) That labor is progressing; and
         2. (ii) Maternal and fetal well-being, including fetal heart rate at least every fifteen (15) minutes, or more frequently if indicated; and

      2. (B) Delivering the newborn and placenta.

         1. (c) All services should be provided in a supportive manner and in accordance with this part.

Codification Notes: "LLM" means licensed lay midwife.