(a) Using reasonable skill and knowledge, the midwife shall evaluate the client when the midwife arrives for labor and delivery, by obtaining a history, performing a physical exam, and collecting laboratory specimens.     
      (b) The midwife shall monitor the client's progress in labor by monitoring vital signs, contractions, fetal heart tones, cervical dilation, effacement, station, presentation, membrane status, input/output and subjective status as indicated.     
      (c) The midwife shall assist only in normal, spontaneous vaginal deliveries as allowed by the Act or this chapter.     
      (d) The midwife shall not engage in the following:      
        (1) application of fundal pressure on abdomen or uterus during first or second stage of labor;       
        (2) administration of oxytocin, ergot, or prostaglandins prior to or during first or second stage of labor; or       
        (3) any other prohibited practice as delineated by the Act, §203.401 (relating to Prohibited Practices).       
      (e) If on initial or subsequent assessment during labor or delivery, one of the following conditions exists, the midwife shall initiate immediate emergency transfer in accordance with §115.113 and document that action in the midwifery record:      
        (1) prolapsed cord;       
        (2) chorio-amnionitis;       
        (3) uncontrolled hemorrhage;       
        (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;       
        (14) failure to progress in labor;       
        (15) retained placenta;       
        (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.       
      (f) If intermittent auscultation is used to determine the fetal heart rate, the intermittent auscultation shall be performed as recommended by the American College of Nurse-Midwives.     
     Source Note:        The provisions of this §115.115 adopted to be effective October 1, 2016, 41 TexReg 4477; amended to be effective May 1, 2019, 44 TexReg 1849; amended to be effective December 30, 2021, 46 TexReg 9028