Health (Notifications by Midwives) Amendment Regulations (No. 2) 2011 (WA)

30 December 2011 GOVERNMENT GAZETTE, WA 5577

HE303*

Health Act 1911

Health (Notifications by Midwives) Amendment

Regulations (No. 2) 2011

Made by the Governor in Executive Council.

1.            Citation

These regulations are the Health (Notifications by Midwives)
Amendment Regulations (No. 2) 2011.

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 the day after that day.

5578 GOVERNMENT GAZETTE, WA 30 December 2011

3.             Regulations amended

These regulations amend the I-lea/i/i (Notflcations by Midwives)
Regulations 1994.

4.            Schedule amended

In the Schedule delete Form 2 and insert:

FORM 2

[r. 4]

Health (Notifications by Mdwrse) Regulations 1994 Form 2 NOTIFICATION OF CASE ATTENDED MRIS

n.m. Unit
Ri000d

First name

Birth date (U.fuerII	I	I	I	I	I	MarllaIetatu$
1 =never married 2nwdowod 3'divorced 0

Addr... eaea

5=d hind. defacio)

Number sot of . I

Height 0001 weight: [1100] Ethnic status

Town or suburb 6-110,10 09 (04010 IdOgeat) 1=Caucasian 2=AbonginaUlSl fl

M.ldenn.n.e T.lephnn.IIIIII!I!1I0,j0c ___

PREGNANCY DETAILS LABOUR DETAILS BABY DETAILS

0] lPtaarn 0000 009a,aln non 000.009 900yl

PREVIOUS PREGNANCIES:  Onset of labour,

110181 number (0001,0109 040 0009naocpl EL 1Ion000taneous 2londuced 3eeo labour Adoption: iyos 2no 0]

Previous pregnancy outcomes:  Atagton 00' irea be9icr). Eon, before arrival: lyos 2no 0]

- Irveborn. now lying I C] none Birth dot*: 2 °IED

- tieebOrmt. now dead enins

4 attlOcal rupture 01 membranes Birth tins. (200, oboe) jJfl

- stillborn

other

Number 01pre000scaesuroaos PlootI comber otnuabmeu tOO birth) 0]

2— Birth order El

Pmnruos multiple births	iyes	200	2	0	00510405	lnPou(y tom baby. 09. tt boby 00cr. 2r20 baby
3	0	proStaglasd:OS	bonn. 010).
THIS PREGNANCY:	4	artificial mnptureotwombnanes
0	Presentation:

AntenatOl:	-
Eslimnaled gestation w00ks at first ant008tal VISIt	lecerten 200,enth 3tucn 4brwe 94otlter

A.n.lg.$la (4000,918900,) Method of birth:

Total number of anlortatal corn valts EEl 1 0 none

2           vacourt, 500ceSStul

Date of LMP:
This data certain 12101 LI ar narcotics

vey.a	2-no El 4	0	epldotatrcaudal	4	0	forceps successful
5	0	lorcePs unsuccessful

Expected due date:	I	I	12101	I	I	n	spiml
combined spmnayepal rat  6 0 brooch (vaginal)
-
based on loctinnial

2-ult,asonnd 020 ohs Duration of labour: hr 0*t 8 0 emergency caesarean

LIII] A000acltaur)s):

Number of tobacco cigarettes usoany 00] 1 $tage (scrod ore,). 1 obstetrician

LIE]

smoked each day daring 1100120 weeks 2° stage I000d non): LLJ LLJ 2 other mnonicol 01900,

Number of tobacco cigarettes usually	DELIVERY DETAILS	3	midwife
4	student
smoked each day after 20 works 01 pregnancy.

(nero. one O O 0000nrl ornr. e VO An.eetheele (thobpda*mory): b 500/o attendant

u d,u I 1 none 0 OthOr

9997 2 local anaesthesia to lressenm

Complications of pregnancy:	Gender:
1=rnale  2=fernale 3=iodelemrrsinate 0

4            OPofblaV000dal

:::  spinal Status of baby at birth:

3 0 urinary tract infection € general lotivebomn 2egtillbOnt (nospecihed)

4	o	pre.ectarnpsma	Aotepumtumn haemorrhage (APH) -	7	cornl000d sp.navepejoral	3= astepartuos slrllbnrn	4=:strayarturn olden,..
5	0	S	borer
placenta praeola	Infant weIght (=0010 9r000,

6 0 APH - placental abmnplion Complications of labour and delivery (imclud.a 0:0,0.00., toe 000,0000 dnOuwy)

7	0	APH -	other	Length	ote,e, dry.
8	0	pm-labour roptbre of nrernbeane$	I	0	precipitate dol:nety
9	0	goslalinsaldiobntea	2	0	fetal distress Head circumference (uicn10nw) EL
10 0	bItter (specify)	3	0	prnlapsed cord
4	0	cord tight around neck Time to establish onaael$ted regular

1 I I I 5 0 cnpfralopelsicdisprnpnmtinn breathing (noniolmua):

Medical conditions:  6 0 PPHth500rrrlsl Resuscitation: (eenord0000c9r- The nowbrvaorro me

essential hypertension 7 0 retained placenta- manual removal

2 pre-enisting diabetes mellitus 5 0 persistent ncc.p:tn postenor 1 none

3	asthma	9	0	sirooliler itystocia	2	0	900trbtl only
4	genital herpes	10 0	failnre to progress 53001	0	onen therapy only
8	-	other (specify)_	II 0	feilure to progress u zoos	4	0	bag and mask (IPPR)
12 0	previous caesarean section

I	I	I	13 0 Other (0005.1,.)	5	0	endotravaraeal :etubat:nn
6	0	ent. cardiac nrassogo and ventilation

P.rocedt.r051healnsents:  I

I	Other
-	8

1	LI	Fertility treatments (include drags)
2	0	comical suture PefIrnal Statue: Apgar score: r rrsnule
3	0	CVS/ylacon/al biopsy t=inladl 2=1degree lear/nagirrul lea: 5 minutes

3;2° degree tear

S 0 01050usd yirs toe, Estiirratod gestation (000lero&a): [110

0Pl1 700' degree tear 8velhnr Birth defects (rpeOYpl:____________________

7 0 CTG - Birth trauma (apeode:______________________

Intondedplace of birth at onset of labour:	ABORIGINAL STATUS OF BABY
t.ftonpoal 2°birth centre attached to hospital	BABY SEPARATION DETAILS

3bltth centre free standing dnhonse Smother (TOO 000 bne Oct/i) Separation date: 12101 I

I I I I

I Abur:gviO but not 121

MIDWIFE Mndo of separation:

2 (SI ku flu AbO vol 0

"o lolranslermed Bodied 9-discharged ibm.

Name 3 Abo,,gnal 054 TSI - Transferred to:

nature ________- 4 Other l000utycstcbarhwnetbOda)

Dale	LEn	210 ]	i	Special care: /enu0400L000lr,0101e ft. 0e9')
Reg. No. I	Coder ID:  I I I I I I I

By Command of the Governor,

R. KENNEDY, Clerk of the Executive Council.