SPS 182.03(4)(a)
(a) A licensed midwife shall consult with a licensed physician or a licensed certified nurse-midwife providing obstetrical care, whenever there are significant deviations, including abnormal laboratory results, relative to a client's pregnancy or to a neonate. If a referral to a physician is needed, the licensed midwife shall refer the client to a physician and, if possible, remain in consultation with the physician until resolution of the concern.
SPS 182.03 Note
Note: Consultation does not preclude the possibility of an out-of-hospital birth. It is appropriate for the licensed midwife to maintain care of the client to the greatest degree possible, in accordance with the client's wishes, during the pregnancy and, if possible, during labor, birth and the postpartum period.
SPS 182.03(4)(b)
(b) A licensed midwife shall consult with a licensed physician or certified nurse-midwife with regard to any mother who presents with or develops the following risk factors or presents with or develops other risk factors that in the judgment of the licensed midwife warrant consultation:
SPS 182.03(4)(b)1.a.
a. Pregnancy induced hypertension, as evidenced by a blood pressure of 140/90 on 2 occasions greater than 6 hours apart.
SPS 182.03(4)(b)1.d.
d. Significant vaginal bleeding before the onset of labor not associated with uncomplicated spontaneous abortion.
SPS 182.03(4)(b)1.k.
k. Isoimmunization, Rh-negative sensitized, positive titers, or any other positive antibody titer, which may have a detrimental effect on mother or fetus.
SPS 182.03(4)(b)1.o.
o. Symptoms of malnutrition or anorexia or protracted weight loss or failure to gain weight.
SPS 182.03(4)(b)1.r.
r. Documented low lying placenta in woman with history of previous cesarean delivery.
SPS 182.03(4)(b)2.a.
a. Rise in blood pressure above baseline, more than 30/15 points or greater than 140/90.
SPS 182.03(4)(b)2.f.
f. Significant bleeding prior to delivery or any abnormal bleeding, with or without abdominal pain; or evidence of placental abruption.
SPS 182.03(4)(b)2.h.
h. Failure to progress after 5 hours of active labor or following 2 hours of active second stage labor.
SPS 182.03(4)(c)
(c) A licensed midwife shall consult with a licensed physician or licensed certified nurse-midwife with regard to any neonate who is born with or develops the following risk factors:
SPS 182.03(4)(c)1.
1. Apgar score of 6 or less at 5 minutes without significant improvement by 10 minutes.
SPS 182.03(4)(c)22.
22. Clinically significant abnormalities in vital signs, muscle tone or behavior.
SPS 182.03(4)(c)23.
23. Clinically significant color abnormality, cyanotic, or pale or abnormal perfusion.
SPS 182.03(5)(a)
(a) Transport via private vehicle is an acceptable method of transport if it is the most expedient and safest method for accessing medical services. The licensed midwife shall initiate immediate transport according to the licensed midwife's emergency plan; provide emergency stabilization until emergency medical services arrive or transfer is completed; accompany the client or follow the client to a hospital in a timely fashion; provide pertinent information to the receiving facility and complete an emergency transport record. The following conditions shall require immediate physician notification and emergency transfer to a hospital:
