{"data":{"id":"us-va/18vac85-130-81","jurisdiction":"us-va","citation":"18VAC85-130-81","heading":"Disclosures on health risks","body":"A. Upon initiation of care, a midwife shall review the client's medical history in order to identify pre-existing conditions or indicators that require disclosure of risk for home birth. The midwife shall offer standard tests and screenings for evaluating risks and shall document client response to such recommendations. The midwife shall also continually assess the pregnant woman and baby in order to recognize conditions that may arise during the course of care that require disclosure of risk for birth outside of a hospital or birthing center.\n\nB. If any of the following conditions or risk factors are presented, the midwife shall request and review the client's medical history, including records of the current or previous pregnancies; disclose to the client the risks associated with a birth outside of a hospital or birthing center; and provide options for consultation and referral. If the client is under the care of a physician for any of the following medical conditions or risk factors, the midwife shall consult with or request documentation from the physician as part of the risk assessment for birth outside of a hospital or birthing center.\n\n1. Antepartum risks:\n\nConditions requiring ongoing medical supervision or ongoing use of medications;\n\nActive cancer;\n\nCardiac disease;\n\nSevere renal disease -- active or chronic;\n\nSevere liver disease -- active or chronic;\n\nHIV positive status with AIDS;\n\nUncontrolled hyperthyroidism;\n\nChronic obstructive pulmonary disease;\n\nSeizure disorder requiring prescriptive medication;\n\nPsychiatric disorders;\n\nCurrent substance abuse known to cause adverse effects;\n\nEssential chronic hypertension over 140/90;\n\nSignificant glucose intolerance;\n\nGenital herpes;\n\nInappropriate fetal size for gestation;\n\nSignificant 2nd or 3rd trimester bleeding;\n\nIncomplete spontaneous abortion;\n\nAbnormal fetal cardiac rate or rhythm;\n\nUterine anomaly;\n\nPlatelet count less than 120,000;\n\nPrevious uterine incision and/or myomectomy with review of surgical records and/or subsequent birth history;\n\nIsoimmunization to blood factors;\n\nBody mass index (BMI) equal to or greater than 30;\n\nHistory of hemoglobinopathies;\n\nAcute or chronic thrombophlebitis;\n\nAnemia (hematocrit less than 30 or hemoglobin less than 10 at term);\n\nBlood coagulation defect;\n\nPre-eclampsia/eclampsia;\n\nUterine ablation;\n\nPlacental abruption;\n\nPlacenta previa at onset of labor;\n\nPersistent severe abnormal quantity of amniotic fluid;\n\nSuspected chorioamnionitis;\n\nEctopic pregnancy;\n\nPregnancy lasting longer than 42 completed weeks with an abnormal nonstress test;\n\nAny pregnancy with abnormal fetal surveillance tests;\n\nRupture of membranes 24 hours before the onset of labor;\n\nPosition presentation other than vertex at term or while in labor; or\n\nMultiple gestation.\n\n2. Intrapartum risks:\n\nCurrent substance abuse;\n\nDocumented intrauterine growth retardation (IUGR)/small for gestational age (SGA) at term;\n\nSuspected uterine rupture;\n\nActive herpes lesion in an unprotectable area;\n\nProlapsed cord or cord presentation;\n\nSuspected complete or partial placental abruption;\n\nSuspected placental previa;\n\nSuspected chorioamnionitis;\n\nPre-eclampsia/eclampsia;\n\nThick meconium stained amniotic fluid without reassuring fetal heart tones and birth is not imminent;\n\nPosition presentation other than vertex at term or while in labor;\n\nAbnormal auscultated fetal heart rate pattern unresponsive to treatment or inability to auscultate fetal heart tones;\n\nExcessive vomiting, dehydration, or exhaustion unresponsive to treatment;\n\nBlood pressure greater than 140/90 that persists or rises and birth is not imminent;\n\nMaternal fever equal to or greater than 100.4°F; or\n\nLabor or premature rupture of membrane (PROM) less than 37 weeks according to due date.\n\n3. If a risk factor first develops when birth is imminent, the individual midwife must use judgment taking into account the health and condition of the mother and baby in determining whether to proceed with a home birth or arrange transportation to a hospital.\n\nC. If the risks factors or criteria have been identified that may indicate health risks associated with birth of a child outside of a hospital or birthing center, the midwife shall provide evidence-based information on such risks. Such information shall be specified by the board in guidance documents and shall include evidence-based research and clinical expertise from both the medical and midwifery models of care.\n\nD. The midwife shall document in the client record the assessment of all health risks that pose a potential for a high risk pregnancy and, if appropriate, the provision of disclosures and evidence-based information.","path":["Title 18. Professional And Occupational Licensing","Agency 85. Board of Medicine","Chapter 130. Regulations Governing the Practice of Licensed Midwives","Part III. Practice Standards"],"source_url":"https://law.lis.virginia.gov/admincode/title18/agency85/chapter130/section81/","current_through":"2026 Regular Session (effective July 1, 2026)","vintage":"","retrieved_at":"2026-09-14T04:52:49Z","sha256":"6391303d4a44b6e3f5856a16e65f9b60ed2e210186e7406455efa75bf212edf1","source_id":"us-va-vac","stale":false,"prev":"us-va/18vac85-130-80","next":"us-va/18vac85-130-90"},"notice":"GroundRules: Original legal text. Not legal advice."}