Current through Register Vol. 24, December 22, 2023
(1) If the
following conditions are present in a client, the direct-entry midwife shall
attempt to consult a physician and/or transfer care to a physician. A certified
nurse midwife or licensed direct-entry midwife shall also be consulted if
appropriate attempts to consult a physician have been unsuccessful.
Documentation of the condition, recommendation (including continuation of care
by the licensed direct-entry midwife, if appropriate) and treatment must be
maintained in the client records. Conditions include, but are not limited to
the following:
(a) prenatal factors:
(i) severe hyperemesis;
(ii) rubella contracted in the first or
second trimester;
(iii) maternal
anemia (hemoglobin less than ten, hematocrit less than 30) unresponsive within
one month of treatment;
(iv)
oligohydramnios (suspected);
(v)
polyhydramnios (suspected);
(vi)
premature rupture of membranes at less than 36 1/2 weeks;
(vii) post term at 42 weeks by dates and
physical exam;
(viii) large for
gestational age (LGA) or small for gestational age (SGA) (suspected);
(ix) Rh sensitization in present pregnancy
(not resulting from recent Rhogam);
(x) history of severe postpartum hemorrhage
requiring transfusion;
(xi) known
serious maternal viral/bacterial infection at term;
(xii) blood pressure greater than 140/90 or
increase of 30 mm Hg systolic or 15 mm Hg diastolic over baseline, that is
unresolved within seven days;
(xiii) develops signs and symptoms of
preeclampsia;
(xiv) develops signs
and symptoms of gestational diabetes;
(xv) has unresolved vaginitis that requires
antibiotic treatment;
(xvi) has
unresolved urinary tract infection;
(xvii) continued vaginal bleeding before
onset of labor;
(xviii) signs of
fetal distress including prolonged fetal tachycardia (more than 170) or
prolonged fetal bradycardia (less than 100), or fetal demise;
(xix) persistent fever;
(xx) history of preterm delivery (less than
36 1/2 weeks);
(xxi) positive
maternal diagnosis of HIV;
(xxii)
abnormal Pap smear (showing atypia or CIN);
(xxiii) all condylomas;
(xxiv) grand multiparity;
(xxv) maternal age less than 16 or greater
than 40;
(xxvi) history of previous
stillbirth;
(xxvii) history of
incompetent cervix;
(xxviii)
history of previous birth with Erb's Palsy or fractured clavicle or
humerus;
(xxix) history of neonatal
anomaly; or
(xxx) history of
previous cesarean birth.
(b) labor, birth risks, and postpartum
factors:
(i) significant fetal distress
including prolonged fetal tachycardia (more than 170) or prolonged fetal
bradycardia (less than 100);
(ii)
unengaged vertex above -3 station in primipara in active labor;
(iii) fever of 102 degrees Fahrenheit or
greater;
(iv) prolonged rupture of
membranes (greater than 24 hours with no progress of labor);
(v) meconium stained fluid with delivery not
imminent;
(vi) severe bleeding
prior to or during delivery;
(vii)
maternal respiratory distress;
(viii) mother desires consult or
transfer;
(ix) uncontrolled
maternal hemorrhage;
(x) third or
fourth degree perineal laceration;
(xi) signs of infection;
(xii) evidence of thrombophlebitis.
(c) newborn risk factors:
(i) less than three vessels in umbilical
cord;
(ii) Apgar score less than
seven at five minutes;
(iii) fails
to urinate or move bowels within 24 hours;
(iv) obvious anomaly;
(v) respiratory distress;
(vi) cardiac irregularities;
(vii) pale cyanotic or gray color;
(viii) abnormal cry;
(ix) jaundice within 24 hours of
birth;
(x) signs of prematurity,
dysmaturity, or postmaturity;
(xi)
lethargic;
(xii) has
edema;
(xiii) signs of
hypoglycemia;
(xiv) abnormal facial
expression;
(xv) abnormal body
temperature (outside the 97-100 degrees Fahrenheit range, not resolved within
one hour);
(xvi) abnormal
neurological signs, including jitteriness, decreased tones, seizures or poor
sucking reflex; or
(xvii) inability
to nurse after 12 hours.
NEW, 1993 MAR p. 1639,
Eff. 7/30/93; AMD, 1994 MAR p. 386, Eff. 2/25/94; AMD, 1995 MAR p. 2684, Eff.
12/8/95; TRANS, from Commerce, 2001 MAR p. 1642; AMD,2018
MAR p. 976, Eff.5/12/2018; AMD,
2023
MAR p. 886, Eff.
8/26/2023
