Health (Notifications by Midwives) Amendment Regulations 2023 (WA)

30 June 2023 GOVERNMENT GAZETTE, WA 2123

HE305

Amendment Regulations 2023.

Health (Miscellaneous Provisions) Act 1911

Health (Notifications by Midwives) Amendment

Regulations 2023

SL 2023/104

Made by the Governor in Executive Council.

1.   Citation

These regulations are the Health (Notifications by Midwives)

2124 GOVERNMENT GAZETTE, WA 30 June 2023

2.   Commencement

These regulations come into operation as follows —

(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 2023.

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]

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

Last	name	unftm50edr.°	1 I I I I I I I I I I l'um
First	name

Binh dote (Moth") I I I I I I I I I ""

Address of usual residence Merital status

Number and street Ride Post code I I I I I 1=neyer married 2=widowed 3adIvorceP

4=separated 5=married (Ind. Delano)

Town or suburb Neigh' I I l I wFAChi I I 1 I Ethnk status of mother I I I

Maiden name (whole cm) f kilogram)

Email 1=Caucaslan 10=Abonginal not 7SI

T FI"Ph.). 1 I 11 II 1 I 1 11 I 11 T51 not Aboriginal 12=Abortgnal and TSI

interpreter semke required MotMr's language

Or Other

(1-y3 =m)	(requiring Interpreter)
PREGNANCY DETAILS	Veccinetions during pregnency:

PREVIOUS PREGNANCIESz 01 Vaccinated &Irmo I. trunester Influenza Pertussis

ME 02 Vo“inated dunned 2' trimester III

Total number (excluding this pregnancy), H I

ME 03 Vaccinated during 3.• trimester

Partly I exclud ing this pregnancy):

Previous pregnency outcomes:	04 Vaednated in unknown trimester
05 Not  vaccinated

-	lvbbo	r	n,	ow	liv	in	99 Unknown If	vaccinated
•	o	m	d	e	d

Was syphilis Kroening conducted during the following periods:

• stillborn

— 1=yes 2=not offered 3= ckellned libunknown

Number of re o pvim camareans 1.-- At first antenatal contact before 28 weeks —

Cmwrean last delivery 1 =yes 2=no —,

ii-v Between 28 weeks and 35 weeks —

Previous multiple births 1 =yes 2=no — Between 36 weeks and birth

THIS PREGNANCY:  Procedures/Umtments:

Estimated gest wk at 1" antenatal visit	MB	1 d	fertility treatments (include dnigs)
Total number of antemtal care visits	MB	2 cervical	suture

Clete of DAP:  MMEMEICIN N 3 A NS/placental biopsy

This date cenain 1 =yes 2=no • 4 amniocentesis

Expected due date:  MENNEILIIME s 0 ultrasound

Based on / clinical signs/dates = 6 0 CTG antepartum

2 . ultrasound <I0 wks	7 D CIG intraparturn
3 =	ultrasound >&20 wks

Primary modernity model of care:

Smoldng:  1111111

Number of tobacco cigarettes usually smoked I I I I Intended place of birth at onset of labour: 0

each day during first 20 weeks of pregnancy 1=hosta0al 2.1firth centre attached to hospital

Number of tobacco cigarettes usually smoked ii 1 1 1-birth centre free standing 4=honte 8 it m tu be; Ans

each	day otter 20 weeks of pregnancy
(P1 none	00 000, occosbnol or smoked < I use '998'; Maternity model of care at onset

of labour or non-labour caesarean: I I I I I I I

undetermined 0. 999)

Akohol during pregnancy: First 20 wio After 20 wks Onset of labour:

Frequency of drinidng an I li I 1=spontaneous 2=induced 3=no labour El

I I I

akoholk drink Principal meson foe induction of Lebow (If induced): m

01 = neve.	at.	0t03 tiooto•weak
0.7 = month!,	05.	a or more tones a week

3. 7 to 4 times a month 99. toOtnown Augmentation (labour has begun): Induction)before labour begun):

Number of standard skolsol drinks I I I 1 ID none

I I 1 111^- =

on a Woke, day 2 LA ooun wt e 2 El owtocin

Was Kreening for depression/anxiety conducted: I-1

9 = unknown LA 3 D prostaglandins 4 [I] prostaglandins

1 =yes 2=not oll ered 3 = declined

4 111 artificial rupture of 5 0 anifictal rupture of membranes

Was additionel follow." Indicated for

membranes 6 U dilatation devge i.e. Foley Catheter

perinatal	mentel heehh risk factors?	0	8	D other
1 =yes	2=no 7 = not applicaNe	9 = unknown	7 annprogestogen	i.e. indepristone
Was family	violence screening	conducted:	8	other
=yes	2=not offered 3 . declined	9,	unknown III	Analigeste (during labour):

Complications of pregnancy: 1 III none 6 0 systemic opioids

L j	threatened abortion (<20wkS)	2 0	nitrous oxide	7 0 cornlaned spenal/epidural
0	threatened preterm labour (.31wks)

4 epidural/caudal 8 El 0 other

—	urinary tract Infection
pre-eclampsia 0 spinal

Duration of labour hr min

'—' anteparturn haemorrhage (AN) placenta preetria

—	APO - placental abniebon	1. stage (hour & min):	••1 ME
—
—,	APN -other	2. stage (hour & rnin):	•• 1•1•
Pre-labour rupture of membranes	Postnatal blood loss in ras:
—i	IIIIII

gestational diabetes	Number of babies born (admin purposes only):	0
1—gestational	hypertension	MIDWIFE

2	pte-eciampsta superimposed	on essential hypertension	Name
Signature
99	other (specify)
Date 2 0 I
Medical	Conditions:
Reg. No.

essential hypertension 5 0 type 1 diabmes I NIMIWI I I

3 asthma 6 — type 2 diabetes

Complete thls Magmata, form once fa each woman giving birth, and

4 C genital herpes 8 other ( specify) submit one Baby form kw each baby born

30 June 2023 GOVERNMENT GAZETTE, WA 2125

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

thor laSt nmo crstr.an,n Unit Rev No I I I I I I I II I I I Estab

BIRTH DETAILS BABY DETAILS

ABORIGINAL STATUS Of BABY (Tick one box only)

Anaesthesia (during delivery):

I Aboriginal but not Torres Strait Islander

1	none	-
-	2 Turret Strait Islander but not Aboriginal
2	local anaesthesia to perineum	-
3	pudendal	3 - Aboriginal and Torres Strait Islander
4	epidural/caudal	4 _other
S	-	spinal
Sex:  lornale 2= female 3=indeterminate
6	-	general
Status  of baby at birth: 1=liveborn 2=stillborn (unspecified) •
7	combined spinal/epidural
3=antepartum  stillborn 4=intrapartum stillborn
8	other
-	infant weight:  (whole gram)

Complication, of labour and birth

(Include the ,eaoonfor Instrument delivery): Length: (whole cm)

1 - precipitate delivery Head circumference: (whole cm)

2	fetal distress	Time	to establish unassisted regular breathing:	(whole min,
3	-	prolapsed cord	Resuscitation:	(All rr,ethods used)
4	-	cord tight around neck	ri

1     none

S cephalopelvic disproportion 2 hjsuction

7 - retained placenta - manual removal 3 oxygen

8	-	persistent occipito posterior	4	r1OStIrrO5 positive airway pressure (CPAP)
9	shoulder dystocia	6	Ilendotracheal intubation
10	failure to progress it= 3cm	sari intermittent positive pressure ventilation IIPPVI
11	failure to progress ,3cm	sirl external cardiac compressions
12	previous caesarean sfltiOfl
88I other
13	other (specify)
Apgar score:  1 minute No

Principal reason for Caesarean Section: (specify)

5 minutes

Estimated gestation:	(whole weeks)
Birth defects:	(specify)
Birth trauma:	(specify)

Pei'lneal status:

1	intact	BABY SEPARATION DETAILS
2	10	degree tear/vaginal tear

Separation date:  0

3 2' degree tear j I I I 2

Mode of separation:

I	3eree tear
S	episiotomy 1=trarrsferred 8=died 9=discharged home
40

7 degree tear Transferred to: hospital/service

8 - other Special cure number of days:

Boris before arrival:  1=yeu 2=00 Ll (Fiirlsdrs Level 1; whole days only)

Birth date:  I I I I J20

Birth time:	(24hr clock)
Plurality:	(number of babies this birth)  E

Birth order: (specify this baby, eg, 1=1° baby born. 2=2'51l[7

Presentation:

1=vertex 2=breech 3=face 4=brow 8=other

Water	birth:	1-yes 2—
Method	of birth:
-	spontaneous
2	vacuum successful
3	vacuum unsuccessful
4	-	forceps successful
5	forceps unsuccessful

6 - breech (vaginal)

7	-	elective caesarean
8	-	emergency caesarean

Accoucheur(s):	MIDWIFE
1 obstetrician
Name

2	-	other medical officer
3	-	midwife Date I II I 2 1 91

4 student

5 - self/no attendant Complete this Baby loon once for each baby born, and tubnal with

B other Pterancyfcsrrt

K. COLLERAN, Clerk of the Executive Council.