Risk management
Practice Guidelines
Practice guidelines are essential tools for defining the standards of care within your midwifery practice or birth center.
Practice guidelines serve as a foundation for consistent, evidence-informed decision-making, and help ensure that everyone on the team is aligned in both philosophy and clinical approach. Whether you’re starting from scratch or refining existing materials, this page will guide you through the process.
What’s the Difference Between Practice Guidelines and Policies & Procedures?
Key differences:
- Practice Guidelines = Situation-specific
- Procedure = More about how your practice operates
Example:
Practice Guideline: How your practice cares for clients with gestational diabetes
Policy/Procedure: Why & how your practice does informed consent/refusal
Why Practice Guidelines Matter for Risk Management
Clear, well-thought-out practice guidelines can:
- Support consistent clinical decision-making
- Reduce variability in care that can lead to preventable adverse outcomes
- Demonstrate due diligence in case of legal review
- Foster team alignment and professional accountability
- Provide a foundation for peer review and quality improvement
Recommended Practice Guidelines
Below is a list of the core practice guidelines for licensed midwives and birth centers that are recommended by the JUA.
For Licensed Midwives
Must have these practice guidelines:
Legend drugs & devices:
- Indications for and administration of all legend drugs used in your practice (WAC 246-834-250)
- Indications for and use of all legend devices used in your practice (WAC 246-834-250)
Good idea to have these practice guidelines:
Prenatal Conditions:
- Abnormal Amniotic Fluid Levels
- Abnormal Pap Test Results
- Abnormal Ultrasound Findings
- Anemia
- Breast Mass
- Decreased Fetal Movement
- Diagnosis of a Notifiable Condition
- Fetal Demise, antepartum
- Fetal Growth Restriction
- Genital Herpes at Term
- Gestational Diabetes
- Group B Strep
- Hepatitis B Infection
- Hyperemesis
- Hypertensive Disorders
- Lack of Support, prenatal
- Low-Lying Placenta, Previa
- Maternal Death, antepartum
- Multiple Gestation
- Non-reassuring Fetal Surveillance
- Non-vertex Presentation at Term
- Obesity/BMI >35
- Positive Genetic Screen
- Post-Dates Pregnancy
- Post-Term Pregnancy
- Premature Rupture of Membranes
- Preterm Labor
- Rh-Negative Client
- Size/Dates Discrepancy
- Teratogenic Exposure
- Thrombocytopenia
- Thrombophlebitis
- Urinary Tract Infection
- Vaginal Bleeding in Pregnancy
Intrapartum Conditions, including immediate postpartum:
- Abnormal Labor Patterns, including prolonged stages and arrest
- Allergic Response, Anaphylaxis
- Chorioamnionitis, suspected
- Cord Prolapse
- Eclamptic Seizure
- Exhaustion
- Fetal Demise, intrapartum
- GBS-positive Client Desiring Antibiotics in Labor
- GBS-unknown Status
- Hypertension, intrapartum
- Maternal Death, intrapartum
- Meconium-Stained Amniotic Fluid
- Non-Reassuring Fetal Heart Rate Patterns
- Perineal Lacerations
- Placental Abruption, suspected
- Postpartum Hemorrhage
- Prolonged Labor
- Prolonged Rupture of Membranes
- Retained Placenta w/wo Excessive Bleeding
- Seizure
- Shoulder Dystocia
- Surprise Breech or Other Malpresentation
- Surprise Twins or Other Multiple Gestation
- Uterine Inversion
- Uterine Rupture, suspected
- Vaginal Bleeding, intrapartum
- Vaginal Hematoma
Neonatal Conditions:
- Abnormal Bladder/Bowel Activity
- Abnormal CCHD Screen
- Abnormal Hearing Screen (if you are performing hearing screening)
- Abnormal Metabolic Screen Result
- Abnormal Newborn Exam Findings
- Birth Injury
- Cardiac Irregularities
- Congenital Anomaly
- Death
- Hypoglycemia
- Infection, suspected
- Jaundice/Hyperbilirubinemia
- Loss of >10% Birth Weight
- Low APGAR Score
- Respiratory Distress
- Seizure
- Temperature Instability
Postpartum Conditions:
- Bladder or Bowel Dysfunction
- Delayed/Late Postpartum Hemorrhage
- Endometritis, suspected
- Fever
- Hypertension, postpartum
- Lack of Support, postpartum
- Mastitis
- Maternal Death, postpartum
- Postpartum Mood Disorder
- Retained Fragments, suspected
- Thrombophlebitis
- Urinary Tract Infection
- Uterine Prolapse
- Wound Infection
For Licensed Birth Centers
Must have these practice guidelines:
Legend drugs & devices:
- Indications for and administration and use of all legend drugs and devices used in the birth center (WAC 246-329-120)
Good idea to have these practice guidelines:
Intrapartum Conditions, including immediate postpartum:
- Abnormal Labor Patterns, including prolonged stages and arrest
- Allergic Response, Anaphylaxis
- Chorioamnionitis, suspected
- Cord Prolapse
- Exhaustion
- Fetal Demise, intrapartum
- GBS-positive Client Desiring Antibiotics in Labor
- GBS-unknown Status
- Hypertension, intrapartum
- Maternal Death, intrapartum
- Meconium-Stained Amniotic Fluid
- Non-Reassuring Fetal Heart Rate Patterns
- Perineal Lacerations
- Placental Abruption, suspected
- Postpartum Hemorrhage
- Prolonged Labor
- Prolonged Rupture of Membranes
- Retained Placenta w/wo Excessive Bleeding
- Seizure
- Shoulder Dystocia
- Surprise Breech or Other Malpresentation
- Surprise Twins or Other Multiple Gestation
- Uterine Inversion
- Uterine Rupture, suspected
- Vaginal Bleeding, intrapartum
- Vaginal Hematoma
Neonatal Conditions, prior to birth center discharge:
- Abnormal Newborn Exam Findings
- Birth Injury
- Cardiac Irregularities
- Congenital Anomaly
- Death
- Hypoglycemia
- Low APGAR Score
- Respiratory Distress
- Seizure
- Temperature Instability
How to Develop or Revise a Practice Guideline
1
Identify the issue. Focus on clinical areas with high impact, complexity, or regulatory requirements.
2
Review the evidence. Use current best practices, state or national guidelines, and peer-reviewed literature.
3
Draft the practice guideline. Clearly outline your preferred approach, while leaving room for clinical judgment.
- DO make it simple enough that you can write each one from memory; a half-page guideline is sufficient
- DON’T use words like “rule out” unless you are prepared to do all the necessary assessments and tests to rule out each condition every time
4
Review and revise. Share with your team, backup midwives, or a JUA risk consultant for feedback.
5
Implement and train. Ensure all staff and privileged midwives are trained and have easy access to the guidelines.
Templates and Examples
The sample documents, templates, and guidance provided by the Washington JUA are intended for informational and educational purposes only. They do not constitute legal advice, clinical directives, or regulatory requirements. Each midwifery practice is responsible for reviewing and adapting these materials in accordance with current Washington State laws, professional standards, and the specific needs of their practice. The Washington JUA assumes no responsibility for how these resources are used or interpreted.
Templates
Examples
Frequently Asked Questions
Do practice guidelines have to be approved by the Department of Health?
No, but they must be available upon request and should meet professional standards. They are reviewed during inspections and investigations.
Can I use someone else’s practice guideline as a template?
Yes, but make sure to adapt it to reflect your actual practice, scope, and team capabilities.
How often should practice guidelines be updated?
At least every 1–3 years, or whenever there is a major change in clinical evidence, technology, or regulation.
Do solo midwives need written practice guidelines, or are they only for group practices and birth centers?
Yes, solo midwives also need written practice guidelines. Even when practicing alone, having clearly defined guidelines helps ensure consistent, accountable care.
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