[ S.L.458.04 MIDWIVES 1 SUBSIDIARY LEGISLATION 458.04 MIDWIVES REGULATIONS 23rd October, 1951 GOVERNMENT NOTICE 505 of 1951. 1. The title of these Regulations is Midwives Regulations. Title. 2. Every woman who holds the licence to practise midwifery shall, before offering her services as a practising midwife or commencing to practise as a midwife, give notice in writing of her intention so to do to the Chief Government Medical Officer. She shall give a like notice every time she changes her address. Licence to practice midwifery. 3. In compliance with Part IV of the Health Care Professions Act, every midwife should be in possession of a bag or basket lined with washable linen and containing the following articles: Possession of articles. Cap. 464. (
- a)an appliance for vaginal irrigations; (
- b)a different appliance for enemata; (
- c)a catheter, an obstetrical stethoscope, a clinical thermometer, a pair of surgical scissors, a pair of umbilical scissors, and two artery forceps; (
- d)sealed sterilized packets containing cotton wool, aseptic gauze, and aseptic thread for tying the umbilical cord; (
- e)a glass stoppered bottle containing liq. ammon. fort. oz. ii; (
- f)a collapsible tube containing a disinfectant cream such as Dettol or any other recognized equivalent; (
- g)suitable quantities of disinfecting purposes; efficient preparations for (
- h)at least two white washable aprons made to cover the whole trunk and the arms; (
- i)a nail brush, a nail cleaner, and a cake of soap; (
- j)two pairs of surgical rubber gloves and two masks of approved type. The appliances and instruments mentioned above shall be of such construction as to be easily cleaned and sterilised and they must be invariably kept in such a condition as to be always ready for use. When called to a confinement the midwife must carry with her the bag or basket and all its contents. 4. A midwife attending labour must wear a dress of washable material and over it an apron, a cap or veil to cover the hair, rubber gloves and a mask as specified above. When engaged to attend a labour, the midwife shall visit the patient in her own house to advise her as to personal and general arrangements for the Dress to be worn. 2 [ S.L.458.04 MIDWIVES confinement. She must see that the room is, as far as practicable, in a hygenic condition and clean, and that all the linen is clean. Disinfection of hands. 5. Before touching the genital organs or their neighbourhood, the midwife must on each occasion wash thoroughly and disinfect her hands and forearms. Commencement of labour. 6. At the commencement of labour, or as soon as she reaches the woman, the midwife shall wash the patient’s external genitals and the surrounding parts with soap and sterilised warm water and shall disinfect the same with an antiseptic solution. This disinfection shall be repeated (
- i)(
- ii)(iii) (
- iv)before an internal examination is made; after the termination of labour; before passing a catheter; and when necessary, during the lying-in period. For this purpose, the midwife must on no account use ordinary sponges or flannels, but only aseptic cotton wool or clean pads soaked in antiseptic solution. No vaginal irrigations shall be given either before or after labour, except when ordered by a doctor. Prohibition of giving of injections. 7. No midwife shall be in possession of any oxytoxic drugs or give injections or drugs, except a simple asperient, without a written order by a doctor. Disinfection of instruments. 8. All instruments and other appliances must be disinfected by boiling before use. Internal examinations. 9. No more internal examinations shall be made by the midwife than are absolutely necessary, and from the rupture of the membranes till the completion of labour the midwife shall endeavour to keep the parturient woman in a recumbent position. She is to follow carefully the progress of labour and its effects both on the mother and on the foetus. Prohibition of leaving of patient. 10. A midwife in charge of a case of labour must not leave the patient without giving an address at which she can be found without delay, and she must stay with the woman from the commencement of the second stage (i.e. the commencement of the bearing down pains) until at least an hour after the placenta has been expelled. In cases where a doctor has been called, she must await his arrival and faithfully carry out his instructions. Examination of placenta. 11. The midwife in charge must in all cases of labour examine the placenta and membranes before they are destroyed, and must satisfy herself that they have been completely expelled. When she is in doubt, the placenta and membranes shall be kept for the doctor’s examination. Washing of external genitals. 12. After the midwife has made certain that the womb is fully contracted, she is to wash the external genitals as directed in regulation 6, and then bandage the abdomen of the woman in accordance with the rules of practice. Removal of soiled material. 13. The midwife must cause to be removed all soiled material, blood, faeces, urine, and the placenta from the neighbourhood of MIDWIVES [ S.L.458.04 3 the patient and from the lying-in room, as soon as possible after labour and in every case before she leaves the patient’s house. 14. In the case of a foetus born apparently dead, the midwife should carry out the methods of resuscitation which have been taught her, call immediately a doctor and persevere in the treatment till his arrival or for not less than an hour after the child has ceased to give any signs of life. Foetus born apparently dead. 15. As soon as the child’s head is born, and if possible before the eyes are opened, its eyelids and the surrounding parts must be carefully cleansed with boracic acid lotion. Should any irritation or redness of the eyes of the child develop at any time, the midwife shall advise the parents and insist on calling in a doctor at once. In cases of refusal on the part of the parents the medical officer of health is to be informed by the midwife and meanwhile the washing of the eyes should be frequently repeated. Eyelids and surrounding parts to be cleansed. 16. On the birth of a child which is in danger of death, the midwife shall inform the father, or in his absence, one of his nearest relatives, of the child’s condition, and have a doctor called in forthwith. Child in danger of death. 17. The midwife shall visit the patient at least once daily during the eight days following labour, in order to take the temperature of the woman and to enquire into the condition of the lochia, the involution of the uterus and the condition of the bladder and bowels, and in general to follow the progress of the puerperium. Visit to patient. 18. In all cases of illness of the patient or of the child, or of any abnormality occurring during pregnancy, labour or lying-in, the attendance of a doctor is essential and must be insisted on by a midwife if she is called or had already been called, to the case. The midwife is not allowed to attend, or to continue her attendance, on such cases except under the direction of a doctor. Cases of illness. This regulation applies in particular (
- a)when during pregnancy, labour or lying-in, a woman appears to be dying or dead; (
- b)when, during pregnancy, there is any abnormality or complication, such as (
- i)(
- ii)(iii) (
- iv)(
- v)(
- vi)excessive nausea and vomiting; abortion, actual or threatened; loss of blood; albumin in the urine; dyspnoea; puffiness of hands or face; (vii) (viii) (
- ix)(
- x)(
- xi)fits of convulsions; purulent discharge; sores of the genitals; dangerous varicose veins; deformity or stunted growth or other condition suggesting disproportion between head and 4 [ S.L.458.04 MIDWIVES pelvis; (
- c)when, during labour, there is any abnormality or complication, such as (
- i)(
- ii)(iii) (
- iv)(
- v)(
- vi)fits or convulsions; purulent discharge; sores of the genitals; excessive bleeding; malpresentation; presentation other than the uncomplicated head; (vii) when no presentation can be made out; (viii) placenta not completely expelled two hours after the birth of the child; (
- ix)rupture of the perineum or other injuries of the soft parts; (
- x)multiple pregnancy; (
- xi)if during the two hours following the rupture of the membranes the foetus is not yet born; (
- d)when, during the lying-in, there is any abnormality or complication, such as (
- i)(
- ii)(iii) (
- iv)(
- v)(
- vi)fits or convulsions; abdominal swelling and tenderness; offensive lochia; rigor, with raised temperature; rise of temperature, lasting for more than twenty-four hours, or a rise of temperature above 101° F. as measured by the mouth; steadily rising pulse rate; (vii) unusual swelling of the breasts with local tenderness or pain; (viii) excessive or prolonged bleeding; (
- ix)phoebitis or white leg; (
- e)when the child shows any abnornality or complication, such as (
- i)injuries suffered during birth; (
- ii)any malformation or deformity; (iii) feebleness whether in a premature or a full-time child; (
- iv)inflammation of, or discharge from the eyes, however slight; (
- v)inflammation about, or haemorrhage from the navel; (
- vi)skin eruptions. Cap. 464. This regulation does not exempt the midwife from the duty of calling in a doctor in accordance with Part IV of the Health Care Professions Act. MIDWIVES [ S.L.458.04 5 19. No midwife shall follow any occupation, or reside in a place which, in the opinion of the medical officer of health, is of its nature liable to be a source of infection. Occupation or place liable to be a source of infection. 20. Under no circumstances shall a midwife lay out or assist in laying out a corpse for burial. Corpse for burial. 21. A midwife must without delay notify thereof the medical officer of health in each of the following cases, namely: Notification to medical officer of health. (
- i)(
- ii)when she has been in contact with a person, whether or not a patient, suffering from puerperal fever or any other condition which may raise suspicion of infection; when she is herself liable to be a source of infection. In each such case the midwife (unless relieved by the medical officer of health of that duty) must take the following special measures against infection before visiting another patient: (
- i)(
- ii)she must have herself, her instruments and appliances, and, when necessary, her dwelling, disinfected to the satisfaction of the medical officer of health; unless the medical officer of health otherwise directs, she must have all washable clothing boiled, and must send all other clothing to be disinfected by the Sanitary Authority. 22. Every midwife, whether practising independently or in partnership or in an institution, must keep a separate register of cases in the form shown in the Schedule attached to these Regulations. Except in the case of a simple aperient, a midwife must note in her register on each occasion all those cases in which she administers or applies in any way any drug, stating the name and dose of the drug, the time of its administration or application, and the name of the doctor who ordered it. Register of cases. 6 [ S.L.458.04 MIDWIVES SCHEDULE REGISTER OF CASES RE{ISTRU TAL-KA|IJIET Serial No. of case .................................................................... Nru. tal-ka\ (kif imiss) Date of expected confinement ................................................. Meta tistenna li jkun il-]las Name of doctor, if any, certifying pregnancy and date of such certificate, if any ................................................................... Isem it-tabib, jekk ikun hemm, li ji``ertifika t-tqala u d-data ta``ertifikat, jekk ikun hemm Name and address of patient .................................................... Isem l-omm u fejn toqg]od Age ................... G]omor Number of previous labours and miscarriages ......................... Kemm kellha Date and hour of midwife’s arrival at confinement .................. Data u ]in meta l-qabla tasal fuq il-]las Presentation ............................................................................ Presentazzjoni Date and hour of child’s birth .................................................. Data u ]in tat-twelid tat-tarbija Sex of child ................. Whether born living or dead ............... Tifel jew tifla Jekk twiledx/twildetx ]aj/]ajja jew mejjet/mejta Full time or premature ............................................................ Jekk hix tarbija ta’ \mienha, jew imwielda qabel i\-\mien Number of weeks ........................ Numru ta’ [img]at Name of doctor if called .......................................................... Isem it-tabib, jekk jissejja] Complications (if any) during or after labour ........................... Komplikazzjonijiet (jekk jinqalg]
- u)matul jew wara l-]las Date of midwife’s last visit ..................................................... Meta l-qabla tag]mel l-a]]ar \jara Condition of mother then ........................................................ L-istat ta’ l-omm dak in-nhar Condition of child then ........................................................... L-istat tat-tarbija dak in-nhar Remarks (*) ............................................................................ Rimarki (*) MIDWIVES NOTE: If any drugs, except a simple aperient, have been NOTA: Jekk tkun tajt xi medi`ina, barra minn xi purgant ]afif, b’xi administered or applied in any way, state here the mod jew ie]or, g]id hawnhekk l-isem u d-do\a tal-medi`ina, name and dose of the drug, the time and cause of its il-]in u l-g]aliex tajtha u min ordna li ting]ata. administration or application, and by whom prescribed. [ S.L.458.04 7