14. Every midwife shall take to each case the following equipment: Nail brush. Wooden or bone nail cleaner. Jar of green or soft castile soap. Tube of vaseline. Clinical thermometer. Agate or glass douche reservoir. Two rounded vaginal douche nozzles. One soft-rubber catheter. Blunt scissors for cutting cord. [Lysol. Either Carbolic acid. Bichloride of mercury tablets. Boric-acid powder. One per cent solution of nitrate of silver. Medicine dropper. Narrow tape or soft twine for tying cord. Absorbent cotton (perferably in one-quarter pound packages). No other instruments are to be used, owned, or possessed by a midwife. 15. This equipment shall not be carried, except in a metal case that can be easily boiled or in a bag fitted with an inner lining of washable material that can be easily removed, washed, and boiled. 16. At every case, before using any nail brush, nail cleaner, douche bag and tubing, vaginal nozzle, catheter, scissors, tape, or twine, it shall be boiled for five minutes. When the labor is terminated, the douche bag and tubing. vaginal nozzle, catheter, scissors, nail brush, and nail cleaner shall be washed with soap and boiled before replacing them in the bag or case. 17. Every midwife shall carry out strictly the following directions: a. Before examining a woman in labor, the midwife shall roll up her dress sleeves above the elbow and scrub her hands and forearms in warm water with the nail brush and castile or green soap for at least five minutes; during this washing the skin under and around the nails shall be cleaned with the nail cleaner. The hands of the midwife shall then be scrubbed with the nail brush for five minutes in either the lysol, carbolic, or bichloride of mercury solution. Before passing the catheter, the midwife shall wash and scrub her hands with soap and warm water and afterwards in the antiseptic solution, and the woman's external genitals shall be washed with the antiseptic solution. b. The woman's external genitals, skin over the lower part of the abdomen, and the inner side of the thighs shall then be washed with soap and water and afterwards sponged with absorbent cotton soaked in either: Solution of lysol, 2 per cent. Solution of carbolic, 2 per cent. Solution of bichloride of mercury 1 part bichloride to 5,000 parts water. Note. To make a 2 per cent solution, take 3 teaspoonfuls of either lysol of carbolic acid and add it to 1 pint of boiling water. Directions for bichloride solution are found on bottle containing tablets. A pad of cotton wet with the solution should be left over the vulva. No vaginal douche shall be given before labor. c. As soon as possible after the child's head is born, and if possible before the expulsion of the afterbirth, the eyes of the child shall be washed with borte acid solution. The eyelids must then be separated and one or two drops of a 1 per cent solution of silver nitrate (or some similar solution) dropped in each eye and the lids brought together. These solutions will, if desired, be furnished by the department of health. 18. Should the child not breathe after birth, that fact shall be reported at once by telephone or messenger to the department of health. An inspector will then visit the case and may issue a stillbirth certificate. 19. In caring for a woman after labor and throughout the lying-in period the midwife shall exercise the same care in washing her hands when dressing or catheterizing the patient as is called for in regulations No. 17 above. 20. If during the lying-in period any of the following conditions develop, a physician must be summoned : a. Convulsions. b. Excessive bleeding. c. Foul-smelling discharge (lochia). d. Rise of temperature to 101° F. for 24 hours. e. Swelling and redness of the breasts. f. Severe chill (rigor), with rise of temperature. g. Inability to nurse the child. 21. Every child shall be thoroughly examined after birth, and if the child has or develops any of the following conditions a physician shall be summoned: a. Deformities or malformations or injuries. b. Inability to suckle or nurse. c. Inflammation around or discharge from the navel. d. Swelling and redness of the eyelids, with a discharge of matter from the eyes. e. Bleeding from the mouth, navel, or bowels. 22. Every midwife shall, as soon as she is engaged to attend a case, notify the department of the name and address of the patient and the expected date of confinement, and also of any change in these conditions. Within 24 hours after the birth of a child the midwife shall send a report of the birth to the department of health on one of the blanks provided by the department of health for that purpose. She must also keep on the stubs of her birth-certificate book a record of every birth she attends. 23. In every case after labor the temperature of both mother and child shall be taken morning and night for five days. If during this time, or at any later period of the lying-in, the temperature of either mother or child. reaches 101° F. and continues at this temperature for 24 hours, or again reaches that temperature within the following 24 hours, the case must at once be reported to the department of health. The midwife shall not go from such a case to other cases that are free from fever or to a woman in labor until she has made an entire change of clothing, thoroughly washed her arms, hands, face, and hair with soap and warm water, and washed and boiled her instruments. 24. Additions to or changes in these regulations may be made at any time by the department of health, and such addition or change will be made known to the holders of permits before taking effect. NEWARK, N. J. Midwifery-Regulation of Practice of Registration of Midwives-Regulations Authorized. (Ord. May 16, 1918.) SECTION 1. Any person shall be regarded as practicing midwifery within the meaning of this ordinance who shall publicly profess by advertisement, sign, card, or otherwise to be a midwife, or who shall for a fee attend to women in childbirth. SEC. 2. Before any person, other than a physician duly licensed to practice medicine in this State, begins the practice of midwifery in the city of Newark, she shall be required personally to register her name and address in the office of the health officer of the said city. Any midwife changing her name or address shall forthwith report such change to the said health officer. SEC. 3. No person practicing midwifery in the city of Newark shall prescribe or administer any drug or medicine, except some preparation of ergot, after the birth of the head of the infant, or household remedies, nor shall she attend other than cases of labor. SEC. 4. Every midwife shall immediately upon the passage of this ordinance, and at the expiration of every year thereafter so long as she shall practice midwifery in the city of Newark, register her name and address at the office of the health officer. SEC. 5. No midwife shall in any case of labor use instruments of any kind. nor assist labor by any artificial, forcible, or mechanical means, nor perform version nor to attempt to remove adherent placenta. SEC. 6. Midwives shall always secure the immediate services of a reputable licensed physician whenever any abnormal signs or symptoms appear in mother, infant, or expectant mother. SEC. 7. The director of public affairs of the city of Newark shall have the power to promulgate such rules regulating the practice of midwifery in said city as shall be necessary to safeguard the health of the infants, mothers, or expectant mothers, which rules shall be approved by the board of commissioners of the said city. Copies of such rules shall be served upon persons practicing midwifery in said city. SEC. 8. Any person who shall violate any of the provisions of sections 1, 2, 3, 4, 5, and 6 of this ordinance, or who shall violate any of the rules referred to in section 7 after the service upon her of a copy of such rules, shall, upon conviction, be subject to a fine not to exceed $100 for each offense. Midwifery-Regulation of Practice of-Reports by Midwives. (Reg. May 16, 1918.) RULE 1. Cases in which midwives may practice.-A duly licensed and registered midwife may practice midwifery in cases of normal labor in which there is an uncomplicated vertex (head) presentation, and no others. In all other cases a physician must be summoned by the midwife or family. RULE 2. The home of the midwife, the cases she attends, her equipment, reeord of cases, and register of births shall at all times be open to inspection to the authorized officers, inspectors, and agents of the department of health. RULE 3. Each midwife must be scrupulously clean in every way, including her person, clothing, equipment, and house. She must keep her nails short and keep the skin of her hands, as far as possible, free from cracks and abrasions by use of lanolin or other simple application. When attending a case of labor she must wear a clean dress, preferably white, of washable material which can be boiled, such as linen or cotton, and over it a clean washable spron or overall. The sleeves of the dress must be so made that they can readily be rolled up above the elbows. RULE 4. If, during pregnancy, any of the following symptoms or conditions develop the midwife shall not engage to attend the case: 1. Whenever a patient is a dwarf or is deformed. 2. Whenever there is bleeding or repeated staining in small amounts, 3. Whenever there is a swelling or puffiness of the face, hands, or limbs, 4. Whenever there is excessive vomiting. 5. Whenever there is dimness of vision or dizziness, 6. Whenever there are fits or convulsions. 7. Whenever there is a purulent discharge. 8. Whenever there are sores or warts on the genitals. 9. Whenever the patient is known to have syphilis, or suspected of it. When other signs or symptoms of abnormality develop the midwife shall refer the woman to a physician or clinic for examination. RULE 5. Physician to be summoned during labor.—If, during labor, any of the following conditions or other abnormal signs exist or develop, a physician must be summoned immediately by the midwife or family: 1. Miscarriage. 2. The presenting part is other than an uncomplicated vertex (head). 3. Fits or convulsions. .4. Excessive bleeding. 5. Prolapse of the cord. 6. A swelling or tumor that obstructs the birth of the child. 7. Signs of exhaustion or collapse of the mother. 8. When fœtal heart has been heard and ceases to be heard. 9. Prolonged labor. RULE 6. Under no circumstances shall a midwife introduce her hand into the vagina or uterus to remove either the whole or part of the afterbirth (placenta or membranes). If, after an hour from the birth of the child, the mother being in otherwise good condition, the afterbirth (placenta or membranes) is not expelled or can not be expelled by gentle manipulation of the uterus through the abdominal walls, a physician must be summoned by the midwife or family. RULE 7. Stillbirths.—Should the child not breathe after birth the midwife must send for a physician at once so that he may make out the stillbirth record. RULE 8. Physician to be summoned during lying-in period.-If, during the lying-in period, any of the following conditions develop a physician must be summoned immediately by the midwife or family: 1. Perineal lacerations of second or third degree. 2. Whenever there are convulsions. 3. Whenever there is excessive bleeding. 4. Whenever there is foul smelling discharge (lochia). 5. Whenever there is a rise of temperature to 101° F. for more than 24 hours. 6. Whenever there is swelling or redness of the breasts. 7. Whenever there is a severe chill (rigor) with rise of temperature. 8. Whenever there is inability to nurse the child. 9. Whenever there are severely cracked nipples. RULE 9. Physician to be summoned if child develops certain conditions.-Every child should be thoroughly examined after birth, and if the child has or develops any of the following conditions a physician must be summoned or case reported to the department of health: 1. If baby is premature or immature. 2. Whenever there is any deformity or malformation or injury. 3. Whenever there is inflammation around or discharge from the navel. 4. Whenever there is swelling or redness of the eyelids, with a discharge of matter from the eyes. 5. Whenever there is bleeding from the mouth, navel, or bowels. 6. Whenever there is any rash, sores, or snuffles suggestive of syphilis. 7. Whenever there is any difficulty in nursing. RULE 10. Midwife's equipment.-Every midwife must take to each case the following equipment: Nail brush, wooden or bone nail cleaner, jar of green or soft castile soap, tube of vaseline, clinical thermometer, blunt scissors for cutting cord, bichloride tablets or lysol, boric acid powder, silver nitrate solution, outfit furnished free by the department of health, medicine dropper, narrow tape or soft twine for tying cord, and proper dressing for the cord. No instruments other than those specified in this rule shall be used by a midwife. (Possession of other instruments will be taken to indicate their use.) RULE 11. Container for equipment, how to be kept.-The equipment specified in rule 10 must be carried either in a metal case which can be easily boiled, or in a bag fitted with an inner lining of washable material, which can be easily removed. The bag and its contents must at all times be kept neat and clean. At every case, before using the nail brush, nail cleaner, scissors, and tape or twine, they must be boiled for five minutes; when the labor is terminated the scissors, nail brush, and nail cleaner must be washed with soap and water and boiled. RULE 12. Preparation for internal examinations.-Before making an internal examination or conducting a delivery, a midwife must prepare her hands and the patient as follows: The midwife, after thoroughly washing her hands with warm water and soap, must thoroughly wash the patient's external genitals, the internal surface of thighs, and the lower part of the abdomen with warm water and soap, then rinse them with clean water and a disinfecting solution prepared by adding 1 teaspoonful of lysol to 1 pint of water, or 1 bichloride tablet to 1 quart of water. She must then cover the genitals with a clean towel or cloth or cotton, which has been soaked in the disinfecting solution, and she must allow it to remain there until the examination is made. The midwife's hands must be cleaned and disinfected as follows: Cut the finger nails short with clippers or scissors. Scrub the hands and forearms up to the elbows with the nail brush and green soap and water for five minutes, paying special attention to the nails and inner surface of the fingers. Then soak the hands for three minutes in the disinfecting solution. After having cleaned and disinfected the hands in this way, they must not come in contact with anything before touching the parts of the patient to be examined. Very few vaginal examinations should be made. Progress of labor should be noted by external abdominal examinations. Before each examination the midwife's hands and the patient must be prepared as above described. Hands showing abrasions or other diseases of the skin must be kept covered during the examination of the mother or when handling the cord of the infant No vaginal douche shall be given before or after labor. RULE 13. A midwife must in all cases examine the afterbirth (placenta and membranes) before it is destroyed, and must satisfy herself that it has been completely expelled. RULE 14. Procedure after delivery.—After the labor is over the midwife must clean the skin around the external genitals with the antiseptic solution mentioned above, and then place a dry sterile pad over the vulva. The midwife must bathe and dress the patient in this manner at least once daily for five days after delivery. RULE 15. As soon as the child is born and, if possible, before the expulsion of the afterbirth, its eyes should be washed with boric acid solution. The eyelids must then be separated and 1 drop of 1 per cent solution of silver nitrate dropped in the eyes and the lids brought together. One application only of this silver-nitrate solution should be made, and ordinarily no further attention should be given to the eyes for several hours. Silver-nitrate solution will be furnished free by the department of health. |