1. (a) Using reasonable skill and knowledge, the midwife shall collect, assess, and document maternal care data through a detailed obstetric, gynecologic, medical, social, and family history and a complete prenatal physical exam and appropriate laboratory testing; develop and implement a plan of care; thereafter evaluate the client's condition on an ongoing basis; and modify the plan of care as necessary. Health education/counseling shall be provided by the midwife as appropriate.

2. (b) If on initial or subsequent assessment, one of the following conditions exists, the midwife shall recommend referral and document that recommendation in the midwifery record:

   1. (1) infection requiring antimicrobial therapy;
   2. (2) Hepatitis;
   3. (3) non-insulin dependent diabetes;
   4. (4) thyroid disease;
   5. (5) current drug or alcohol abuse;
   6. (6) asthma;
   7. (7) abnormal pap smear (consistent with malignancy or pre-malignancy) during the current pregnancy;
   8. (8) seizure disorder;
   9. (9) prior cesarean section (except for prior classical or vertical incision, which will require transfer in accordance with subsection (c)(8));
   10. (10) multiple gestation;
   11. (11) history of prior antepartum or neonatal death;
   12. (12) history of prior infant with a genetic disorder;
   13. (13) significant vaginal bleeding;
   14. (14) maternal age less than 15 at EDC;
   15. (15) cancer or history of cancer;
   16. (16) psychiatric illness; or
   17. (17) any other condition or symptom which could adversely affect the mother or fetus, as assessed by a midwife exercising reasonable skill and knowledge.

3. (c) If on initial or subsequent assessment, one of the following conditions exists, the midwife shall recommend transfer in accordance and document that recommendation in the midwifery record:

   1. (1) placenta previa in the third trimester;
   2. (2) Human Immunodeficiency Virus (HIV) positive or Acquired Immunodeficiency Syndrome (AIDS);
   3. (3) cardio vascular disease, including hypertension, with the exception of varicosities;
   4. (4) severe psychiatric illness;
   5. (5) history of cervical incompetence with surgical therapy;
   6. (6) pre-term labor (less than 37 weeks);
   7. (7) Rh or other blood group isoimmunization;
   8. (8) any previous cesarean section with a vertical or classical incision, or any previous uterine surgery which required an incision in the uterine fundus;
   9. (9) preeclampsia/eclampsia;
   10. (10) documented oligo-hydramnios or poly-hydramnios;
   11. (11) any known fetal malformation;
   12. (12) Preterm Premature Rupture Of Membranes (PPROM);
   13. (13) intrauterine growth restriction;
   14. (14) insulin dependent diabetes; or
   15. (15) any other condition or symptom which could threaten the life of the mother or fetus, as assessed by a midwife exercising reasonable skill and knowledge.
4. (d) In lieu of referral or transfer, the midwife may manage the client in collaboration with an appropriate health care professional of this title.

Source Note:The provisions of this §115.114 adopted to be effective October 1, 2016, 41 TexReg 4477.