| 1894 | GOVERNMENT GAZETTE, WA | 14 ,June 2019 |
These regulations are the Health (Notifications by Midwives)
Amendment Regulations 2019. | |
HE301
Health (Miscellaneous Provisions) Act 1911
Health (Notifications by Midwives) Amendment
Regulations 2019
Made by the Governor in Executive Council.
1. Citation
| 14 June 2019 | GOVERNMENT GAZETTE, WA | 1895 |
2. Commencement
These regulations come into operation as follows -
| (a) | regulations I and 2—on the day on which these regulations are published in the Gazette; |
| (b) | | the rest of the regulations - | on 1 July 2019. | |
3. Regulations amended
These regulations amend the Health (Notifications by Midwives)
Regulations 1994. |
4. Schedule amended
In the Schedule delete Form 2 and insert:
Form 2
[r. 4]
lOeahPr (Not.fscat.oeu by Mfdwlon) R.g*.l.tiotn 1994 F.rny 2 NOTIFICATION OF CASE ATTENDED - PREGNANCY DETAILS MR15
11100
| Last name | 0.00 R.med Na | - | I | IN |
Sbd,dM.(M,,the,)
| 04dm. 04 uSual ff01.00. | - | - - | Modal slat., |
| Nmb.easds*tn, | Imnur000ottt ?.ayde,.ed 1.40.1cM |
d.tepatctt-d Sonloned Intl. Detotol
| T.wfl .0 .oba.b | 1101454 | • wn | Llhniu.taIss01 elImt |
| MaId,,, nanas | I CaygiflIa.. I1.mId.saa.Ot n.h |
| (nml | T.I.plton. | HI1fl | l2.ISImcVbasro..hch U,00onarM,ndTSI |
| Int..p.etn .are mq.slmd | Mothee, Ia.t(0.(. | Dr OOP,,. |
| DITALS | T Vt 4d loot da6n4 PftVkOCyi |
| P*IVIOUS P*(GNNIO(S- | PREGNANCY | It I'aIvOra,SdwMg I lri.nO. | 5.40.0,1 Pettasu,s |
| Total number lNaIadrN ISO pmaamy), | 02 VOrtnaf004oPrQt' |
| Pur Oy (0 51 lud:n4 | 50 p.07,,. | my) | 01 | Io,00.Ot000oOn5 3Ioarlpoapr |
| totaio,t p..nastny tionasi | Ga V0,cMatfl0000.rO.eItine,ln |
| lomboyn rwlMo.4 | 00 tOo.pasorcu'd |
| |
| l,o | .born. tram OeM |
| 00,fl | Pr.adaen/tnatm.ats. | |
| Numb.. of prevIous casarnn, | I | brIAry tc.at,rohnts | |
2 -al -M
| Canal..tr last dekviry | S ..i | lynn | I - | CVS/pla,pet.I hoycy |
| Pres,ouseruIVpl*bonlu l.a. 2..a | ii | 4 | alTtroaCInI&0t |
| 10.1 PREGNANCY: | S | At,aco.oa |
| (closeted 4n* St at 1 antenatal VisIt | O | - Cit amtya.t.cen |
| tOtal nunbat Of afl,an.M urn,. alit. | a | 7 | CTGI.t..patur, |
| Oat. .4 IMP | •auuuuu | lokMd.d alas. of bOth | at | .ns | .t of about. |
| In., date cegan | I 'on 2 | 2Ooy•h 2 Ga'(OOta.0.Lr00. |
| Fepestad dl.. dat.: |
| tarpon. I.vMme'potu/dores | LONDON DI Talk |
| 2.vV't,00.d .20005 | 00,04.4 aba... |
| I - arlv',ou. I'ndaIeo I... | labour | |
tn.Oo,d 20 .0,
| Stnokfr | P,hnuipaI roaso,, foe .td.a,t.oe .41.00., I |
| Numb., 01 tobacco cIgarettes usually smoked |
| purb day AIdeS I lot 20 ..oPkt 0-F prelnanry | bugnne.tation (loGos, l.a. Gegsth): |
| Numb.. Dl tobasuoc.arettes usually smoked |
coon.,
| Pollt day .4tee 20 weelcof p.e40in0 |
| i1.wmo.. 0.O'o,oworo:o, o,,00e0. 0.0p VIC | p.eIaglae0:s |
| 00405.4.0010. of n.nnb.aoe, |
| 010oltoldosngpoey.a.toy: ltsn0..l. 01.050000 | 000.. |
| ttmremy.tdmomc.0 | l,.da011O. (be/mo 1000ie begun): |
r I
000,sthn
p.oct.Øaedot,
| NoeS..., ,tOOt..d | .k.e.otddot | a.tdoIaHuo9cbpnfo.perb..npc |
| oo.ty54TM day | dlaf.bor da,.0. .. PoltyCatheto |
War ,nonnáeg to. dep.esW../.st.cety om.d.d.d-
| ?u,rtMtrted I.deti.,.-d t..anlno.t. | .etaogestcr. mdep.nlone |
War additional IDlI.wop Indicated F.. pe.loflal
| mortal health nih tador,? | Analgesia (d.thGl009ccot. |
| *1 ~;r Y-nnlavpluable | tookoas. |
| Cootyclic.lImts01 pregnancy: | PP.60.1200540 |
| I | Itrea(.e.d .bc,l.0 l.Ooyau,l |
.Inrn.eyed peetttmIlbOat lofloall
| c'taItUaulef.cuOO | IntIctr.c 0o.O.t |
| coerblned .pk,.1/epawcl |
| I | coo flIaOpna |
| - .M,P.noe unnnu,na. luPHl $O.rta |
| |
| p. IabOu.nvrtat.n.t.nuray.. | [- | H | o | |
| gecIaOO.Iald.ab.teu | o,bnasaI Wad lA,sine.to | |
| :1 | | .enMIocS (0-pen...,, | : | I I | I | |
| U | | ptemIa,tp.a.upe,npocod omessLrasMItyyeUn.Ca | hoyt,.. of bob... SOre ad..'.. pwpoascordy) | |
| 90- | ott,. l.enPyl |
Medal Condition:
| • | cennfwton | ,11w |
| O | 1ype2 dolt.,., | 0001l.t.tt ,e.oa.ancylonena.Io. .admenoel.Oitb.a.d |
| S | typ.ld.abptr, | •yb000.OI0b.fonofV, eaohbabybyn. |
| 0 | otrmI.eotl |
| 1896 | GOVERNMENT GAZETTE, WA | 14 June 2019 |
Health (Notifications by Midwives) Regulations 1994 Form 2 NOTIFICATION OF CASE ATTENDED - BABY DETAILS
| Mothet hbv | fott nee, | Unit At< rio-------- I | (.0 |
| DIAN DETAILS | Born before arrival: | types 2mo |
| Anaesthesia | (during delivery): |
Birth date:
none
| Birth time: | (240r clock) | " IT! I |
2 local anaesthesia to perineum
| Plurality: | (number of babies this birth) |
3 pudendal
4 Birth order:
| epidural/caudal | (specify tho baby, eg, 2.1" boby Warn 2,e) |
| 5 | spinal | Presentation: |
| 6 | general | 1.venex 2-breech 3-face 4.13row 8.ottser |
| 7 | combined spinaVeprdurel |
| • | |
| 8 | other |
| • | Method of birth: |
| Complications of labour and birth | I | spontaneous |
| linclude the reason for instrument &livery,: |
| precipitate delivery | 1 | vacuum successful
vacuum unsuccessful |
| 2 | fetal distress | 4 | forceps successful |
| 3 | prolapsed cord |
5 — forceps unsuccessful
| 4 | cord tight around neck | 6 | breech iyobinon |
| 5 | cephalopelvic disproportion |
| 7 | elective caesarean |
| 7 | retained placenta - manual removal |
| 8 | emergency caesarean |
| 8 | nto, | d, | c, | cropcii. | to posterior |
| it | shoulder | Accoircheur(sl: |
| 10 failure to progress or 3cm | 1 | obstetrician |
| 11 | failure to progress o 3cm | 2 | . other medical officer |
| 12 | previous caesarean section | 3 'midwife |
| 13 | other (specify) | |
| Principal reason for Caesarean Section: MO one box only) | self/no attendant |
| 1 | fetal compromise | 8 | 'other |
| 2 | Suspected fetal macrosomla | Sex: | 1=male | 2. female 3.indeterminate |
| 3 | maipresentation |
Status of baby at birth: Izliveboin 2-stillborn (unspecified)
4 lack of progress <ri 3cm
3.antepartum stillborn 4.Intrapdltunl stillborn
| 5 | lack of progress in the 2st stage, 4cm to < 10cm | . . |
Intern weight: /whole gram)
6 lack of progress In the 2nd stage
7 placenta praevia
| 8 | | placental abruption | Head circumference: | (whole cm) | |
| 9 | | vasa praevra | Time to establish unassisted regular breathing: | (whole min) | |
| 1 | | anteparturn/intrapartum haemorrhage | Resuscitation: nUI methods weal | |
| 11 | |
| 12 | | unsuccessful attempt at assisted deltvery | 2 | suction | |
| 1 | | unsuccessful induction | 3 | . oxygen | |
| 14 | | cord prolapse | 4 | continuous positive airway pressure (OAP) | |
| 1 | | previous caesarean section | 6 '—endotracheal intubation | |
| 1 | | previous shoulder dpstocia | ID— | Intermittent positive pressure ventilation (IPPV) | |
| previous perineal trauma/4" degree tear | II —external cardiac compressions | | previous adverse fetal/neonatal outcome | 88 other | |
other obstetric, medical, surgical, psychological
indications
701 maternal choice In the absence of any obstetric,
| medical, surgical, psychological Indications | Estimated gestation: | (whole weeks) | |
| 1 | intact | Binh trauma: | (specify) |
| 2 | 1" degree tear/vaginal tear |
BABY SEPARATION DETAILS
3 2" degree tear
| Separation data: | Lui_naLL |
4 3" degree tear
Mode of separation:
5 rip<hotomy
| 7 | | 4" degree tear | 1•transferred | 8-died 9.discharged home | |
| 8 | | other | Transferred to: | hospltoVservice | |
Special care number of days:
(Excludes Level 2. whole days only)
| ABORIGINAL STATUS OF BABY | (lick one box only) |
Name
1 - Aboriginal but not Torres Strait Islander
| 2Torres Strait islander but not Aboriginal | Date | I III | 2 oi 1 1 |
| 3 — Aboriginal and Torres Strait islander |
Complete this Baby lam once for each baby tom. and suerrrit with
4 Other
Pregnancy form
| M. INGLIS, Clerk of the Executive Council. |