Licensed midwives are medically trained within our scope of practice to serve women who are considered “low-risk” (see below on what is considered “low-risk” in pregnancy, labor, postpartum, and newborn) and can safely deliver babies who are 37 weeks’ to 42 weeks’ gestation; outside of those ranges are not considered “low-risk”. They would require an additional higher level of medical care and intervention. We can serve women and their child(ren) up to six weeks postpartum and provide routine screenings such as the Newborn Metabolic Screening (the heel stick) and CCHD screening, and can refer for a hearing screen if desired. Midwives are extensively trained to know what is considered normal, what are warning signs, and what are emergencies. Personally, I have standing orders with a physician that allow me to carry certain medications such as anti-hemorrhage, IV fluids, Vitamin K, Erythromycin, and other drugs that allow me to be adequately prepared for the unexpected. I am also trained in breech, twin birth, shoulder dystocia, and extensive neonatal resuscitation, along with the necessary gear to perform that. Please keep in mind that, if you decide to read the lists below, licensed midwives know how to recognize these high-risk situations and how to handle them. I will remain transparent and continue communication to support you and your baby’s health.

Check out the Texas Department of Licensing and Regulations for updated laws and rules regarding midwifery care: https://www.tdlr.texas.gov/midwives/laws-rules.htm

According to Texas law, midwives can serve women who are considered “low-risk”
and do not show any of the following during their pregnancy:

• (1) placenta previa in the third trimester; (The placenta covering the cervix, which would indicate a c-section)

• (2) Human Immunodeficiency Virus (HIV) positive or Acquired Immunodeficiency Syndrome (AIDS);

• (3) cardio vascular disease, including hypertension, with the exception of varicosities; (Hypertension: high blood pressure of ≥ 140/90)

• (4) severe psychiatric illness;

• (5) history of cervical incompetence with surgical therapy;

• (6) pre-term labor (less than 37 weeks);

• (7) Rh or other blood group isoimmunization;

• (8) previous uterine surgery involving incision into the uterine myometrium, other than a low transverse cesarean section;

• (9) preeclampsia/eclampsia;

• (10) documented oligo-hydramnios or poly-hydramnios;

• (11) any known fetal malformation requiring immediate post-natal hospital care;

• (12) Preterm Premature Rupture of Membranes (PPROM);

• (13) intrauterine growth restriction;

• (14) insulin dependent diabetes;

• (15) triplet or higher order multiple gestation; (excluding twins)

• (16) active cancer or history of ovarian, breast, uterine, or cervical cancer;

• (17) undiagnosed vaginal bleeding lasting longer than two weeks; or

• (18) 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.

According to Texas law, midwives can serve women who are considered “low-risk”
and do not show any of the following during their labor and birth:

• (1) prolapsed cord;

• (2) chorio-amnionitis;

• (3) uncontrolled hemorrhage; (we do carry anti-hemorrhaging medications - ask us about it!)

• (4) gestational hypertension/preeclampsia/eclampsia;

• (5) severe abdominal pain inconsistent with normal labor;

• (6) abnormal fetal heart rate, which includes but is not limited to:(A) bradycardia; (B) tachycardia; (C) abnormal rhythm; or (D) persistent recurrent variable or late decelerations after 30 minutes of intrauterine resuscitative measures;

• (7) seizure;

• (8) thick meconium unless the birth is imminent;

• (9) visible genital lesions suspicious of herpes virus infection;

• (10) evidence of maternal shock;

• (11) preterm labor (less than 37 weeks);

• (12) presentation(s) not compatible with spontaneous vaginal delivery;

• (13) laceration(s) requiring repair beyond the scope of practice of the midwife; (Trained in first and second degree tears - which are the most common)

• (14) failure to progress in labor;

• (15) retained placenta; (unless there is a concern, such as excessive bleeding, typical delivery timing of the placenta ranges from 1 minute after birth up to an hour.)

• (16) uterine tachysystole; or

• (17) 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.

According to Texas law, midwives can serve women who are considered “low-risk”
and do not show any of the following during their postpartum:

• (1) uncontrolled hemorrhage;

• (2) maternal shock;

• (3) any hypertensive disorder, including preeclampsia/eclampsia;

• (4) signs of thrombophlebitis or pulmonary embolism; or

• (5) any other condition or symptom which could threaten the life of the mother, as assessed by a midwife exercising reasonable skill and knowledge.

According to Texas law, midwives can serve newborns up to six weeks postpartum who are considered “low-risk”
and do not show any of the following during their immediate postpartum (first 6 hours of life):

• (1) non-transient respiratory distress;

• (2) non-transient pallor or central cyanosis;

• (3) jaundice; (Jaundice can be common, but NOT in the first 24 hours)

• (4) apgar at 5 minutes less than or equal to 6;

• (5) prolonged apnea;

• (6) hemorrhage;

• (7) signs of infection;

• (8) seizure;

• (9) major congenital anomaly not diagnosed prenatally;

• (10) unstable vital signs;

• (11) prolonged: (A) lethargy; (B) flaccidity; or (C) irritability;

• (12) inability to suck;

• (13) persistent jitteriness;

• (14) hyperthermia;

• (15) hypothermia; or

• (16) other abnormal newborn behavior or appearance which could threaten the life of the newborn, as assessed by a midwife exercising reasonable skill and knowledge.

According to Texas law, midwives can serve newborns up to six weeks postpartum who are considered “low-risk”
and do not show any of the following during their six weeks postpartum:

• (1) respiratory distress;

• (2) pallor or central cyanosis;

• (3) pathological jaundice;

• (4) hemorrhage;

• (5) seizure;

• (6) inability to urinate or pass meconium within 24 hours of birth;

• (7) unstable vital signs;

• (8) lethargy;

• (9) flaccidity;

• (10) irritability;

• (11) inability to feed;

• (12) persistent jitteriness; or

• (13) any other abnormal newborn behavior or appearance which could threaten the life of the newborn, as assessed by a midwife exercising reasonable skill and knowledge.