Health (Notifications by Midwives) Amendment Regulations 2021 (WA)

1819 GOVERNMENT GAZETTE, WA 21 May 2021

HE 302

Health (Miscellaneous Provisions) Act 1911

Health (Notifications by Midwives) Amendment

Regulations 2021

SL 2021/62

(a)	regulations 1 and 2— on the day on which these regulations are published in the Gazette;
(b)	the rest of the regulations — on 1 July 2021.

Made by the Governor in Executive Council.

1.            Citation

These regulations are the Health (Notifications by Midwives)

Amendment Regulations 2021.

2.             Commencement

These regulations come into operation as follows —

21 May 2021 GOVERNMENT GAZETTE, WA 1813

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]

Heal h (Notifications by Midwives) Regulations 1994 Form 2 NOTIFICATION OF CASE ATTENDED - PREGNANCY DETAILS MR15

Last name	Unit Record No	IIIIIIII	I	E"'b
Ward

First narne Birth date (Mother) !IIIIIII

Address of usual residence Marital status 0

I H I 1- newr owned 2.wkiewed 3.divorced

Number and street State Post code

4Yseparated Svnerried find. Detente)

. unknown

Town or suburb Height 1 . I I Weight = 6 Ethnic status of InOthIlf LU

Maiden name (whole tin) _,__,...1 „ ,.._ el, ftreAl — IsCaucasian 10•Aborginal not 111

Entail Telephone I I II I I I I IM 11.151ren Aboriginal 12:Aboriginal and 1St

Interpreter service required 1 Mother's language Or Other

( l•res 2.w) Ireouning interpreter)

BE G ha Ert Pig/ A al Vaccinations during pregnancy:

PREVIOUS PREGNANCIES:	,	01 Vaccinated	&Mogi.	utmester Influenza Pertussis
total number (excluding this pregmacy):	I	I	I	02 Vaccinated during 1". noncom
Parity (excluding this pregnancy):	I	I	1	03 Voceinoted during 3^. trimester
Previous pregnancy outcomes:	04 Vaccinated in unknown trimester
• liveborn, now living	OS  Nor cerebrated
- livebrun now dead	99 Unknown If vordnoted
Procedures/treatments:
-	stillborn
1 . fertility treatments (include drum)
Number of previous caesareans	. --
2 'cervical  suture

Caesarean last delivery ('Rot 2.00

E ! 3 . , - (VS/placental biopsy

Previous multiple births 1 eyes 2e00 4 amniaentesis

THIS PREGNANCY:  .. 5 ultrasound

Estimated gest wk at 1° antenatal visit	,11111.	..	6 COG	antepenults
Total number of antenatal care visits	num	7 Coo	intranantun

Date of (MP:	NOM 2 GM	Primary maternity model of care:	IMF
This date certain 1 -ayes 2m0	Ll	intended place of birth at onset of labour:	Li

1 .-h osptal 2.bir th ne attached to hospital ton

Expected due date:  I I I I. 12101-1ri-I 3. birth centre free standing 4.1sorne 8.other

Based on 2 nirelskuss/detes

7=u1rrosounde.70 Ms	LABOUR DETAILS
.7 =ohrosound>.201vks	Maternity model of care at onset

Snsoldng:	of labour or non-labour caesarean: IIIIIII
Number of tobacco cigarettes usually smoked	Onset of labour:
each day during first 20 weeks of pregnancy	Isspontaneous 2sinduced Into labour  0
Number of tobacco cigarettes usually smoked	Principal reason for Induction of labour g /Induced):
each day after 20 weeks of pregnancy
(# none use1990':“<oponolor smoked, late 59.3';	Augmentation  Induction
undetermJned use 999)	(labour hen begun): (before labour begun):
Akohol during pregnancy: Rest lamb After 20wks	1 none  1 L none

Frequency of drinkinc an 2 _logytocin

akoholic drink	ril 111	—	2	°'''''''
3	prosta9lanthns 4 prostaglandins

0,	new	Pl. 21o3Umela week
on	•

mono* 03. ito tomes. month 5,. OS • 4 armor* thnes•week 4 artificial rupture S artificial rupture of membranes

unknown of membranes 6 n dilatation device i.e. Foley Catheter

Numbered standard alcohol drinks Fri i 1 ! g _other 7 Eantiprogestegen i.e. mitepristone

ona typkal day

WM Mreerdng for depression/anxiety conducted:0 8 Luther

1 .ues 2snot offered 3. declined 9. unknown Malteds (during labour):

Was additional followup Indicated for perinatal 1 =1) none 6 Esysternic opioids

mental health risk factors? 0 2 ..._] nitrous oxide 7 DO:whined soneVepidurni

1 .yes 2.00 7. net appkable 9. unknown 4 lepidwalicaudal 8 [lather

Was family violence screening conducted: 0 5 ... J spinal —,

1 ,yes 2.not offered 7. declined 9 = unknown	000.601, 01 labour	hr min
Complications of pregnancy:

I jthreatened abortion (elOorks) 1. stage (hour & min): LID I I I

2 'threatened preterm labour (<17syks) 2. stage (hour & min): i=1 ED

1 __I urinary tract infecticn	Postnatal blood loss In Ms:
4 : jpre•edampsia	Fr TTT1

Number of babies born (admin purposes only): 0

5 lantePartum haemorrhage IAPI1) dacenta manna	Mi0WiSE
6 APH - placental abrupoon	Mune

7 APH- other Sigmture

8 pre.labour rupture of membranes [ I Li. 2 f.0 I

Date

9 gestational	diabetes	Reg. too I	N IM 1w1	1 I IT	I
11 gestational	hypertension

12 pre-eclampsia superimposed. essential hypertension

99 lather (specify)

Medical Conditions:

1 lessential hypertension 5 type 1 diabetes

3 asthma	6 type	2	diabetes	Complete this Preananw knn once for exhwornan greing birth. end
4 :	genital	herpes 8 other	(specify)	submit ene Baby form for each baby born

1814 GOVERNMENT GAZETTE, WA 21 May 2021

Health (Notifications by Midwives) Regulations 1994 Form 2 NOTIFICATION OF CASE ATTENDED — BABY DETAILS

1.1othrx last name Flranamok ....n-miltrii.

BIRTH DETAILS Born before ertNal: 14yes gurso E

Anaesthesia	(during delivery):	Birth date:
1	I	Inone

Birth rime: (24hr clock)

2         local anaesthesia to perineum

Plurality:  (number of bobies this birth) LI

3         pudendal

4	epidural/caudal Binh order: (WON this baby. ep, 1=1° baby been, 2.21 El
5	spinal Presentation: E

6	1=vertex	2=breech 3=face 4=brow 8=other
LJB.meral

7	combined spinal/epidural	Water	birth: 1.yet 2=no	L
8	other	Method	of birth:
_

Complcations of labour and birth 1 spontaneous

tinctudt the reason for instrument delivery):

2 L vacuum successful

1	' precipitate delivery	3 I	vacuum unsuccessful
2	fetal distress
4 Ii	fOrcOPs successful
3	prolapsed cord
511	forceps unsuccessful
4	cord tight around neck
6 0	breech (vaginal)

S . cephalopelvic disproportion

7 I elective caesarean

7 11. retained placenta —manual removal a emergency caesarean

8          persistent occipito posterior

9	shoulder dystocia Accoucheuris):
1r	failure to progress cii 3cm 1 L obstetrician
11	failuretoprogressn3cm 2 1 other medical officer
1	III previous caesarean section	3	midwife
1	other (specify)	4	student
Pn	nape! reason for Caesarean Section: (Mane brutally)	5	self/no attendant

1	lfetal compromise	8 LJothw
2	suspected fetal macrosomia	Gender tamale 2= female 3=indeterminate 0
3	malpresentation
Status of baby at birth: liiiliveborn 2cstillborn (unspecified) 0
4	Jlackof progress cii 3cm	3=antepartum stillborn 4.intrapartum stillborn
5	lack of progress in the 1st stage, 4rm to c 10crn
Infant weight: (whale gram)
6	lack of progress in the 2nd stage	Inn

Length:  (whole cm)

7       J placenta praevia

8	placental abruption Head circumference: (whole cm) LL1
9	vase praevia lime to establish unassisted regular breathing: (whore mini]]

10	— antepartum/intrapartum haemorrhage	Resuscitation:	(Mmahods used)
iiImuitipie	pregnancy	1	none
1	unsuccessful attempt at assisted delivery	2 I	suction
1	unsuccessful induction	3	oxygen
1	cord prolapse	4	continuous positive airway pressure (CPA?)
15Jereoious	caesarean section	6 L..ondattacl	intubation
16Jpreoious	shoulder dystocia	10	intermittent positive pressure ventilation (IN.!)

17	previous perineal trauma/40	degree tear	1Cexternal	cardiac compressions
1	previous adverse fetal/neonatal outcome	813	,	other

I6Josher obstetric, medical, surgical, psychological

Indications	Anger	SCOre: 1	minute
5 minutes 1---li

2on	maternal choice in the absence of any obstetric,
medical, surgical, psychological indications Estimated gestation: (whole weeks) El- :
Perinea!	status:  Birth defects: (specify)
1	' intact  Birth trauma: (specify)
2	110  degree tear/vaginal tear BABY SEPARATION DETAILS
3	J2adegreetear

Separation date:

4 3° degree tear •111 • 2 DI

Mode of separation:  _

5          episiotomy

7	4 5 degree tear latransferred Bodied 9=discharged home
8	jother Transferred to: hospital/service

Special care number of days:	I
(ExCludes level 1; whole days Only)

BABY DETAILS MIDWIFE

ABORIGINAL STATUS OF BABY trick one boy only)	Name
1	flAboriginal but not Torres Strait Islander

2 Tortes Strait Islander but not Aboriginal Date LLLI_P I f_l_LI

3	Aboriginal and Torres Strait Islander	Complete this Baby fonn once breach baby born, and subrrit virdi
4	other	Pregnancy lorm

N. HAGLEY, Clerk of the Executive Council.