Regolamenti dwar il-Qwiebel

LE{ISLAZZJONI SUSSIDJARJA 458.04

REGOLAMENTI DWAR QWIEBEL

23 ta’ Ottubru, 1951

IN-NOTIFIKAZZJONI TAL-GVERN 505 ta’ l-1951.

It-titolu ta’ dawn ir-Regolamenti hu Regolamenti dwar

The title of these Regulations is Midwives Regulations.

RE{ISTRU TAL-KA|IJIET

REGISTER OF CASES

Nru. tal-ka\ (kif imiss) ...............................................................

Serial No. of case

Meta tistenna li jkun il-]las ........................................................

Date of expected confinement

Isem it-tabib, jekk ikun hemm, li ji``ertifika t-tqala u d-data ta`-

`ertifikat, jekk ikun hemm ........................................................

Name of doctor, if any, certifying pregnancy and date of such

certificate, if any

Isem l-omm u fejn toqghod .........................................................

Name and address of patient

G]omor ...................

Age

Kemm kellha .........................

Number of previous labours and miscarriages

Data u ]in meta l-qabla tasal fuq il-]las ..................

Date and hour of midwife’s arrival at confinement

Presentazzjoni ............................................................................

Presentation

Data u ]in tat-twelid tat-tarbija ..................................................

Date and hour of child’s birth

Tifel jew tifla ................ Jekk twiledx/twildetx ]aj/]ajja

jew mejjet/mejta ...............

Sex of child

Whether born living or dead

Jekk hix tarbija ta’ \mienha, jew imwielda qabel i\-\mien ..........

Full time or premature

Numru ta’ [img]at ........................

Number of weeks

Isem it-tabib, jekk jissejja] ................................................

Name of doctor if called

Komplikazzjonijiet (jekk jinqalg]u) matul jew wara l-]las ..........

Complications (if any) during or after labour

Meta l-qabla tag]mel l-a]]ar \jara ..............................................

Date of midwife’s last visit

L-istat ta’ l-omm dak in-nhar ......................................................

Condition of mother then

L-istat tat-tarbija dak in-nhar ......................................................

Condition of child then

Rimarki (*)............................................................................

Remarks (*)

QWIEBEL

NOTA: Jekk tkun tajt xi medi`ina, barra minn xi purgant ]afif,

NOTE: If any drugs, except a simple aperient, have been

b’xi mod jew ie]or, g]id hawnhekk l-isem u d-do\a tal-

administered or applied in any way, state here the

medi`ina, il-]in u l-g]aliex tajtha u min ordna li ting]ata.

name and dose of the drug, the time and cause of its

administration or application, and by whom prescribed.

Every woman who holds the licence to practise midwifery

shall, before offering her services as a practising midwife or

commencing to practise as a midwife, give notice in writing of her

intention so to do to the Chief Government Medical Officer. She

shall give a like notice every time she changes her address.

In compliance with Part IV of the Health Care Professions

Act, every midwife should be in possession of a bag or basket lined

with washable linen and containing the following articles

(a) an appliance for vaginal irrigations;

(b) a different appliance for enemata;

(c) a catheter, an obstetrical stethoscope, a clinical

thermometer, a pair of surgical scissors, a pair of

umbilical scissors, and two artery forceps;

(d) sealed sterilized packets containing cotton wool,

aseptic gauze, and aseptic thread for tying the

umbilical cord;

(e) a glass stoppered bottle containing liq. ammon. fort.

oz. ii;

(f)

a collapsible tube containing a disinfectant cream such

as Dettol or any other recognized equivalent;

(g) suitable quantities of

efficient

preparations

for

disinfecting purposes;

(h) at least two white washable aprons made to cover the

whole trunk and the arms;

(i)

a nail brush, a nail cleaner, and a cake of soap;

(j)

two pairs of surgical rubber gloves and two masks of

approved type.

The appliances and instruments mentioned above shall be

of such construction as to be easily cleaned and sterilised and they

must be invariably kept in such a condition as to be always ready

for use.

When called to a confinement the midwife must carry with

her the bag or basket and all its contents.

A midwife attending labour must wear a dress of washable

material and over it an apron, a cap or veil to cover the hair, rubber

gloves and a mask as specified above. When engaged to attend a

labour, the midwife shall visit the patient in her own house to

advise her as to personal and general arrangements for the

confinement. She must see that the room is, as far as practicable, in

a hygenic condition and clean, and that all the linen is clean.

Before touching the genital organs or their neighbourhood,

the midwife must on each occasion wash thoroughly and disinfect

her hands and forearms.

At the commencement of labour, or as soon as she reaches

the woman, the midwife shall wash the patient’s external genitals

and the surrounding parts with soap and sterilised warm water and

shall disinfect the same with an antiseptic solution. This

disinfection shall be repeated -

(i)

before an internal examination is made;

(ii)

after the termination of labour;

(iii)

before passing a catheter; and

(iv)

when necessary, during the lying-in period.

For this purpose, the midwife must on no account use

ordinary sponges or flannels, but only aseptic cotton wool or clean

pads soaked in antiseptic solution.

No vaginal irrigations shall be given either before or after

labour, except when ordered by a doctor.

No midwife shall be in possession of any oxytoxic drugs or

give injections or drugs, except a simple asperient, without a

written order by a doctor.

All instruments and other appliances must be disinfected

by boiling before use.

No more internal examinations shall be made by the

midwife than are absolutely necessary, and from the rupture of the

membranes till the completion of labour the midwife shall

endeavour to keep the parturient woman in a recumbent position.

She is to follow carefully the progress of labour and its effects both

on the mother and on the foetus.

A midwife in charge of a case of labour must not leave the

patient without giving an address at which she can be found

without delay, and she must stay with the woman from the

commencement of the second stage (i.e. the commencement of the

bearing down pains) until at least an hour after the placenta has

been expelled. In cases where a doctor has been called, she must

await his arrival and faithfully carry out his instructions.

The midwife in charge must in all cases of labour examine

the placenta and membranes before they are destroyed, and must

satisfy herself that they have been completely expelled. When she

is in doubt, the placenta and membranes shall be kept for the

doctor’s examination.

After the midwife has made certain that the womb is fully

contracted, she is to wash the external genitals as directed in

regulation 6, and then bandage the abdomen of the woman in

accordance with the rules of practice.

The midwife must cause to be removed all soiled material,

blood, faeces, urine, and the placenta from the neighbourhood of

the patient and from the lying-in room, as soon as possible after

labour and in every case before she leaves the patient’s house.

In the case of a foetus born apparently dead, the midwife

should carry out the methods of resuscitation which have been

taught her, call immediately a doctor and persevere in the treatment

till his arrival or for not less than an hour after the child has ceased

to give any signs of life.

As soon as the child’s head is born, and if possible before

the eyes are opened, its eyelids and the surrounding parts must be

carefully cleansed with boracic acid lotion. Should any irritation or

redness of the eyes of the child develop at any time, the midwife

shall advise the parents and insist on calling in a doctor at once. In

cases of refusal on the part of the parents the medical officer of

health is to be informed by the midwife and meanwhile the washing

of the eyes should be frequently repeated.

On the birth of a child which is in danger of death, the

midwife shall inform the father, or in his absence, one of his

nearest relatives, of the child’s condition, and have a doctor called

in forthwith.

The midwife shall visit the patient at least once daily

during the eight days following labour, in order to take the

temperature of the woman and to enquire into the condition of the

lochia, the involution of the uterus and the condition of the bladder

and bowels, and in general to follow the progress of the

puerperium.

In all cases of illness of the patient or of the child, or of

any abnormality occurring during pregnancy, labour or lying-in,

the attendance of a doctor is essential and must be insisted on by a

midwife if she is called or had already been called, to the case. The

midwife is not allowed to attend, or to continue her attendance, on

such cases except under the direction of a doctor.

This regulation applies in particular -

(a) when during pregnancy, labour or lying-in, a woman

appears to be dying or dead;

(b) when, during pregnancy, there is any abnormality or

complication, such as -

(i)

excessive nausea and vomiting;

(ii)

abortion, actual or threatened;

(iii)

loss of blood;

(iv)

albumin in the urine;

(v)

dyspnoea;

(vi)

puffiness of hands or face;

(vii)

fits of convulsions;

(viii)

purulent discharge;

(ix)

sores of the genitals;

(x)

dangerous varicose veins;

(xi)

deformity or stunted growth or other condition

suggesting disproportion between head and

MIDWIVES

pelvis;

(c) when, during labour, there is any abnormality or

complication, such as -

(i)

fits or convulsions;

(ii)

purulent discharge;

(iii)

sores of the genitals;

(iv)

excessive bleeding;

(v)

malpresentation;

(vi)

presentation other than the uncomplicated head;

(vii) when no presentation can be made out;

(viii) placenta not completely expelled two hours after

the birth of the child;

(ix) rupture of the perineum or other injuries of the

soft parts;

(x) multiple pregnancy;

(xi) if during the two hours following the rupture of

the membranes the foetus is not yet born;

(d) when, during the lying-in, there is any abnormality or

complication, such as -

(i)

fits or convulsions;

(ii)

abdominal swelling and tenderness;

(iii)

offensive lochia;

(iv)

rigor, with raised temperature;

(v)

rise of temperature, lasting for more than

twenty-four hours, or a rise of temperature

above 101° F. as measured by the mouth;

(vi)

steadily rising pulse rate;

(vii)

unusual swelling of the breasts with local

tenderness or pain;

(viii) excessive or prolonged bleeding;

(ix) phoebitis or white leg;

(e) when the child shows any abnornality or complication,

such as -

(i) injuries suffered during birth;

(ii) any malformation or deformity;

(iii) feebleness whether in a premature or a full-time

child;

(iv) inflammation of, or discharge from the eyes,

however slight;

(v) inflammation about, or haemorrhage from the

navel;

(vi) skin eruptions.

This regulation does not exempt the midwife from the duty

of calling in a doctor in accordance with Part IV of the Health Care

Professions Act.

No midwife shall follow any occupation, or reside in a

place which, in the opinion of the medical officer of health, is of its

nature liable to be a source of infection.

Under no circumstances shall a midwife lay out or assist in

laying out a corpse for burial.

A midwife must without delay notify thereof the medical

officer of health in each of the following cases, namely

(i)

when she has been in contact with a person,

whether or not a patient, suffering from

puerperal fever or any other condition which

may raise suspicion of infection;

(ii)

when she is herself liable to be a source of

infection.

In each such case the midwife (unless relieved by the

medical officer of health of that duty) must take the following

special measures against infection before visiting another patient

(i)

she must have herself, her instruments and

appliances, and, when necessary, her dwelling,

disinfected to the satisfaction of the medical

officer of health;

(ii)

unless the medical officer of health otherwise

directs, she must have all washable clothing

boiled, and must send all other clothing to be

disinfected by the Sanitary Authority.

Every midwife, whether practising independently or in

partnership or in an institution, must keep a separate register of

cases in the form shown in the Schedule attached to these

Regulations.

Except in the case of a simple aperient, a midwife must

note in her register on each occasion all those cases in which she

administers or applies in any way any drug, stating the name and

dose of the drug, the time of its administration or application, and

the name of the doctor who ordered it.

REGISTER OF CASES

RE{ISTRU TAL-KA|IJIET

Serial No. of case ....................................................................

Nru. tal-ka\ (kif imiss)

Date of expected confinement .................................................

Meta tistenna li jkun il-]las

Name of doctor, if any, certifying pregnancy and date of such

certificate, if any ...................................................................

Isem it-tabib, jekk ikun hemm, li ji``ertifika t-tqala u d-data ta`-

`ertifikat, jekk ikun hemm

Name and address of patient ....................................................

Isem l-omm u fejn toqg]od

Age ...................

G]omor

Number of previous labours and miscarriages .........................

Kemm kellha

Date and hour of midwife’s arrival at confinement ..................

Data u ]in meta l-qabla tasal fuq il-]las

Presentation ............................................................................

Presentazzjoni

Date and hour of child’s birth ..................................................

Data u ]in tat-twelid tat-tarbija

Sex of child ................. Whether born living or dead ...............

Tifel jew tifla

Jekk twiledx/twildetx ]aj/]ajja

jew mejjet/mejta

Full time or premature ............................................................

Jekk hix tarbija ta’ \mienha, jew imwielda qabel i\-\mien

Number of weeks ........................

Numru ta’ [img]at

Name of doctor if called ..........................................................

Isem it-tabib, jekk jissejja]

Complications (if any) during or after labour ...........................

Komplikazzjonijiet (jekk jinqalg]u) matul jew wara l-]las

Date of midwife’s last visit .....................................................

Meta l-qabla tag]mel l-a]]ar \jara

Condition of mother then ........................................................

L-istat ta’ l-omm dak in-nhar

Condition of child then ...........................................................

L-istat tat-tarbija dak in-nhar

Remarks (*) ............................................................................

Rimarki (*)

MIDWIVES

NOTE: If any drugs, except a simple aperient, have been

NOTA: Jekk tkun tajt xi medi`ina, barra minn xi purgant ]afif, b’xi

administered or applied in any way, state here the

mod jew ie]or, g]id hawnhekk l-isem u d-do\a tal-medi`ina,

name and dose of the drug, the time and cause of its

il-]in u l-g]aliex tajtha u min ordna li ting]ata.

administration or application, and by whom prescribed.