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Code of Practice for Midwives | | | |
| 1 | Introduction | | The practice of midwifery has been regulated by the Nurses and Midwives Act 1975. With the revocation of this Act and the enactment of the Nurses and Midwives Act 1999 and the Nurses and Midwives Regulations 2000, the Code of Practice for Midwives formulated by the Singapore Nursing Board will regulate the practice of midwifery. This Code takes into account social and demographic changes, and trends and advances in midwifery practice both locally and internationally. The Code of Practice for Midwives sets the Board's standards and expectations for midwives who practise inSingapore . |
| 2 | Interpretation | | Midwife | means a registered midwife who attends professionally to a woman during the antenatal, intranatal and/or postnatal period. | | | Independently practising midwife | means a registered midwife who practices on her own account or in partnership with another. | | | Postnatal Period | means a period being not less than 28 days after the end of labour. | | | Postnatal infections | means a rise of oral temperature above 37.5 degree celsius excluding the first 24 hours after delivery. | | | Stillbirth | means the birth of a baby after 28 weeks gestation, who has not at any time, after being expelled completely from its mother, breathed or shown any sign of life; |
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| 3 | Scope of Practice | | 3.1 | Midwives are accountable for their defined scope of practice. The needs of the mother and baby must be the primary focus of midwifery practice. Midwives can practise in hospitals, birthing centres or homes. Midwives practising in hospitals must comply with the Code of Practice for Midwives as well as the organisation's policies and procedures. The Code of Practice for Midwives regulates those in independent practice. | | | 3.2 | Midwives in independent practice should manage only normal pregnancies and deliveries. They should be affiliated to a hospital with an obstetric unit. When a problem is anticipated, appropriate referrals must be made immediately to the medical practitioner. | | | 3.3 | It is recommended that midwives practising independently deliver only the second and third babies. | | | 3.4 | Under no circumstances shall a midwife use obstetric forceps or undertake any operative procedure. | | | 3.5 | It shall be the duty of the midwife to care for and assist a patient throughout labour until one hour after the placenta has been expelled. | | | 3.6 | It shall be the duty of a midwife to request the presence of a medical practitioner when it has been disclosed by a patient that she has a history of stillbirth or abortion, previous hypertensive disorders of pregnancy or postpartum haemorrhage. In such a situation the midwife shall explain that a registered medical practitioner is required and advise that one be called or that the patient be referred to hospital |
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| 4 | Notification of Intention to Practise Independently | | 4.1 | Regulation 41 (2) of the Nurses and Midwives Regulations 2000 states that no registered midwife may practise midwifery on her own account or in partnership with another except with the prior written consent of the Board. A midwife who intends to practise independently shall make an application to the Board for a certificate entitling her to practise. Her application should be accompanied by the following: 4.1.1 | certificate of midwifery registration; and | | | 4.1.2 | evidence that she has been practising as a midwife for 3 years prior to her application, of which 6 months preceding the application involves conducting deliveries in the home or birthing centre. |
| 4.2 | The Board may in its discretion refuse to grant such certificate to a midwife. |
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| 5 | Pre-Requisite for Independent Practice | | 5.1 | Midwives wishing to set up independent practice in Singapore should have experience in the following: | | | | 5.1.1 | assessing and establishing the suitability of the woman for management by a midwife; | | | 5.1.2 | accepting responsibility for the well-being of the woman and pregnancy once the pregnancy is confirmed; | | | 5.1.3 | making professional decisions and implementing appropriate actions, including consultation or referrals to the obstetrician where necessary; | | | 5.1.4 | accepting responsibility for the conduct of all stages of labour; | | | 5.1.5 | performing maternal and neonatal resuscitation; and | | | 5.1.6 | performing repair of episiotomy and simple perineal tear. |
| | | 5.2 | Midwives in independent practice should participate in continuing midwifery education to ensure that their knowledge and skills remain current. |
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| 6 | Records and Retention of Records | | 6.1 | Every midwife shall keep a record of all cases attended by her in a format approved by the Board. It shall be the duty of the midwife to maintain a record of the observations, care given and medication or other forms of pain relief administered. Such records shall be available for inspection when required. | | | 6.2 | It shall be the duty of a midwife practising independently to document the following cases within 24 hours of their occurrence: - all cases in which the death of the mother or of the child occurs before or after attendance of a registered medical practitioner;
- all cases of stillbirth;
- all cases where medical aid is sought; and
- all cases where the midwife has been brought into contact with infection or if she herself is liable to be a source of infection.
| | | 6.3 | A midwife must not destroy or arrange for the destruction of official records that have been made in her course of work. If a self-employed midwife ceases to practise, the official records shall remain in her safe keeping. |
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| 7 | Premises of an Independently Practising Midwife | | The premises of an independently practising midwife including her equipment and records shall be available for inspection when required. | |
| 8 | Administration of Medicines and Other Forms of Pain Relief | | 8.1 | A midwife shall not administer or apply any drug unless she is certified competent in its use and is familiar with the dosage and its methods of administration or application. She shall make a proper record of the name and dose of the drug and the date and time of its administration or application in a record as required to be kept. | | | 8.2 | A midwife shall only administer inhalational analgesia by means of an apparatus only if the equipment has been properly maintained. |
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| 9 | Responsibilities of a Midwife | | 9.1 | Antenatal period | | | | 9.1.1 | When engaged to attend to a pregnant woman, it shall be the duty of the midwife to advise her as to personal arrangements for the delivery of the baby and other arrangements that may be necessary for the confinement. | | | 9.1.2 | It shall be the duty of the midwife to perform the necessary examination for the monitoring and development of normal pregnancies. | | | 9.1.3 | It shall be the duty of the midwife to obtain previous obstetric and medical history of the patient, which may impact on the wellbeing of the mother and the fetus, for example where - - the patient is unusually short or deformed;
- there is vaginal bleeding;
- there is any abnormality or complication such as anaemia, excessive vomiting, oedema, fits or convulsions, severe varicose veins, purulent vaginal discharges or sores of the genitalia;
- there is albumin or sugar in urine; or
- there is an increase in blood pressure.
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| 9.2 | Intranatalperiod | | | | 9.2.1 | It shall be the duty of every midwife to take all precautions to prevent sepsis when attending to a patient. It shall be her responsibility to see to it that all instruments, and any other equipment that are to be used by her shall be in sterile condition before use, where applicable. It shall be her duty to be appropriately attired and equipped when attending to a case. The midwife shall present herself and her equipment for inspection when required. | | | 9.2.2 | It shall be the duty of every midwife to inform the doctor where there is any abnormality or complication such as - - meconium stained liquor;
- fits or convulsions;
- malpresentation can be made out;
- no presentation can be made out;
- labour is prolonged after the commencement of the second stage;
- placenta and membranes have not been completely expelled after 30 minutes after the birth of the child;
- vaginal bleeding;
- in cases of second and third degree tears of the perineum or other injuries to the genitalia; or
- infections of the genitalia.
| | | 9.2.3 | The independently practising midwife must be able to recognise warning signs of abnormality and make arrangements for an obstetrician to take over or transfer the patient to a hospital for further management. | | | 9.2.4 | When a midwife has requested the presence of a registered medical practitioner, it shall be the duty of the midwife to remain with the patient until the medical practitioner arrives and shall so remain as required. The midwife shall make record of such cases. |
| | | 9.3 | Postanatalperiod | | | | 9.3.1 | Whenever a midwife has been in attendance upon a patient suffering from postnatal infection or any other illness which is infectious, she shall make arrangements for her patient to receive medical attention. She shall take all measures considered necessary for preventing the spread of infection and allow herself to be medically examined when needed. | | | 9.3.2 | It shall be the duty of the midwife to request the presence of a medical practitioner in the case of a woman during the postnatal period, where there is any abnormality or complication such as - - fits or convulsions;
- rigor with raised temperature;
- rise of oral temperature above 37.5 degree celsius after the first 24 hours;
- unusual swelling of the breasts, with local tenderness or pain;
- abdominal swelling and tenderness;
- excessive bleeding; or
- offensive lochia.
| | | 9.3.3 | It shall be the duty of the midwife to request the presence of a medical practitioner in the case of a baby where there is any abnormality or complication such as - - injuries received during birth;
- any malformation or deformity;
- respiratory distress;
- jaundice, however slight;
- inflammation of, or discharge from the eyes, however slight;
- any infections such as oral thrush, skin eruptions or diarrhoea;
- cord sepsis;
- baby weighs less than 2,270 grams at birth; or
- where for any reason the baby appears likely to die.
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| 10 | Home Births | | 10.1 | When attending to a woman for a home birth, the independently practising midwife shall assess the suitability of the home. | | | 10.2 | It shall be the duty of the independently practising midwife to make arrangements for an obstetrician to be available for referral, to attend to or to be on call if required. |
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| 11 | Birthing Centres | | Independently practising midwives conducting deliveries in birthing centres shall make arrangements for an obstetrician to be available for referral, to attend to or to be on call if required. | |
| 12 | Complementary and Alternative Therapies | | Midwives who have gained a qualification in a complementary or alternative therapy and wish to offer this to the patient must obtain prior consent. It is essential that the practice be based upon sound principles, knowledge and skills. The midwife shall be professionally accountable for the use of such therapies. | |
| 13 | Notification of Birth | | It shall be the duty of a midwife to report all births to the registry of birth in such form as may be required within 24 hours of their occurrence. | |
| 14 | Maternal Death, Stillbirth or Neonatal Death | | 14.1 | In the event of a maternal death, stillbirth or neonatal death, it shall be the duty of the midwife to arrange for a doctor to examine the body. | | | 14.2 | The body cannot be cremated or buried until a certificate for cremation or burial has been obtained from the registrar of deaths or the coroner. |
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| 15 | Babies Born Dead Before The Legal Age of Viability | | It shall be the duty of the midwife who delivers a baby born dead before the legal age of viability (before 28 weeks) to assist the patient to obtain the certificate for cremation or burial. | |
| 16 | Other Relevant Legislation | | 16.1 | Midwives must comply with the Singapore Nursing Board's Code of Ethics and Professional Conduct and Standards of Practice for Nurses and Midwives. | | | 16.2 | It shall be the duty of a midwife to draw the attention of parents or guardians to the law requiring the registration of birth and for their baby to receive the necessary vaccinations. | | | 16.3 | Midwives shall familiarise themselves with any other legislation relevant to their practice. |
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| 17 | Insurance | | It is recommended that the independently practising midwife ensure that there is a satisfactory arrangement in place for her professional indemnity insurance. | |
| 18 | References | | Accreditation of the Independently Practising Midwife, Australian College of Midwives Incorporated, 1999. Code of Practice for Midwives in Victoria, Nurses Board of Victoria , February 1999. Competency Standards for Midwives, Australian College of Midwives Incorporated, July 1998. Midwives rules and code of practice, United Kingdom Central Council for Nursing, Midwifery and Health Visiting, 1998. Nurses and Midwives Regulations Parts VI and VII (1990 Ed.) | |
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