Missouri Midwifery Community Standards

During the course of care, the midwife should respect and utilize principles of informed decision-making, including documentation of refusal or consent, as appropriate.
The midwife offers or refers for generally accepted laboratory testing, reviews the test results, and reports them to the client. The midwife makes a plan with the client for any results that are out of normal range, as defined by the midwife's individual practice guidelines, scope, and experience.
- The client will be informed of any tests required by state law and the midwife will document the client's choice.
The midwife will promptly refer to a hospital when severe pre-eclampsia OR hemolysis, elevated liver enzymes, low platelet (HELLP) syndrome, is identified.

The midwife will not perform medical induction of labor using pharmaceutical drugs out of the hospital, including but not limited to misoprostol and pitocin.
Except for unforeseen emergencies, the midwife should plan to be available for call 24/7 during the clients’ term window (37 weeks until delivery).
- The midwife should arrange for an appropriate provider or alternative care plan to cover any period of time they anticipate being unavailable during any client’s term window and notify clients of any anticipated period of unavailability, as far in advance as is practical. If the client makes a plan for the midwife’s absence, the midwife is released from responsibility of finding an appropriate provider.
- A student midwife is not an appropriate back-up provider.
The midwife should be prepared to recognize and treat postpartum hemorrhage using effective therapeutic methods, including pharmaceutical, herbal, or other clinically appropriate interventions, in alignment with the care preferences, cultural traditions, and values of the client.

After a birth that occurs out of the hospital, the midwife will assess, assign, and record APGAR scores at 1 and 5 minutes, and again at 10 minutes, when indicated.
After a birth that occurs out of the hospital, the midwife will assess and document the estimated maternal blood loss (EBL), including EBL in the third stage and upon conclusion of labor care.
After a birth that occurs out of the hospital and does not end in urgent transfer, the midwife will assess maternal perineum and vagina for lacerations. The midwife will repair any laceration that is not hemostatic, not well-approximated, or would likely cause pain or morbidity if not repaired, documenting any refusal. If the laceration is not within the midwife's scope and training, the midwife will promptly refer the client to an appropriate provider for repair.
After a birth that occurs out of hospital and does not end in the transfer of the neonate, the midwife will perform a head to toe assessment of the newborn, including length and weight and signs of normal transition. Clients will be educated about any procedure required by state law and their consent or refusal will be documented.

After each birth that occurs out of hospital, the midwife will offer an in-person visit with mother and baby within the first 24 - 72 hours postpartum for newborn screenings, if parents desire, and to assess physical, nutritional, and socio-psychological well-being of both mother and baby.
Further postpartum care visits will be offered to continue to assess physical, nutritional, and socio-psychological well-being of the mother and baby until completion of care, according to the individual midwife's practice schedule or through 6 weeks postpartum.

Peer review should consist of at least 3 midwives.
As soon as is reasonable and within 45 days of a sentinel event, a midwife should present the case at peer review.