Chapter SPS 182

SPS 182.03(4)(b)2.i. i. Signs or symptoms of maternal infection.

SPS 182.03(4)(b)2.j. j. Active genital herpes at onset of labor.

SPS 182.03(4)(b)2.k. k. Fetal heart tones with non-reassuring patterns.

SPS 182.03(4)(b)2.L. L. Signs or symptoms of fetal distress.

SPS 182.03(4)(b)2.m. m. Thick meconium or frank bleeding with birth not imminent.

SPS 182.03(4)(b)2.n. n. Client or licensed midwife desires physician consultation or transfer.

SPS 182.03(4)(b)3. 3. Postpartum.

SPS 182.03(4)(b)3.a. a. Failure to void within 6 hours of birth.

SPS 182.03(4)(b)3.b. b. Signs or symptoms of maternal shock.

SPS 182.03(4)(b)3.c. c. Febrile: 102° F or 39° C and unresponsive to therapy for 12 hours.

SPS 182.03(4)(b)3.d. d. Abnormal lochia or signs or symptoms of uterine sepsis.

SPS 182.03(4)(b)3.e. e. Suspected deep vein thrombosis.

SPS 182.03(4)(b)3.f. f. Signs of clinically significant depression.

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)2. 2. Persistent grunting respirations or retractions.

SPS 182.03(4)(c)3. 3. Persistent cardiac irregularities.

SPS 182.03(4)(c)4. 4. Persistent central cyanosis or pallor.

SPS 182.03(4)(c)5. 5. Persistent lethargy or poor muscle tone.

SPS 182.03(4)(c)6. 6. Abnormal cry.

SPS 182.03(4)(c)7. 7. Birth weight less than 2300 grams.

SPS 182.03(4)(c)8. 8. Jitteriness or seizures.

SPS 182.03(4)(c)9. 9. Jaundice occurring before 24 hours or outside of normal range.

SPS 182.03(4)(c)10. 10. Failure to urinate within 24 hours of birth.

SPS 182.03(4)(c)11. 11. Failure to pass meconium within 48 hours of birth.

SPS 182.03(4)(c)12. 12. Edema.

SPS 182.03(4)(c)13. 13. Prolonged temperature instability.

SPS 182.03(4)(c)14. 14. Significant signs or symptoms of infection.

SPS 182.03(4)(c)15. 15. Significant clinical evidence of glycemic instability.

SPS 182.03(4)(c)16. 16. Abnormal, bulging, or depressed fontanel.

SPS 182.03(4)(c)17. 17. Significant clinical evidence of prematurity.

SPS 182.03(4)(c)18. 18. Medically significant congenital anomalies.

SPS 182.03(4)(c)19. 19. Significant or suspected birth injury.

SPS 182.03(4)(c)20. 20. Persistent inability to suck.

SPS 182.03(4)(c)21. 21. Diminished consciousness.

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(4)(c)24. 24. Abdominal distension or projectile vomiting.

SPS 182.03(4)(c)25. 25. Signs of clinically significant dehydration or failure to thrive.

SPS 182.03(5) (5) Transfer.

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:

SPS 182.03(5)(a)1. 1. Seizures or unconsciousness.

SPS 182.03(5)(a)2. 2. Respiratory distress or arrest.

SPS 182.03(5)(a)3. 3. Evidence of shock.

SPS 182.03(5)(a)4. 4. Psychosis.

SPS 182.03(5)(a)5. 5. Symptomatic chest pain or cardiac arrhythmias.

SPS 182.03(5)(a)6. 6. Prolapsed umbilical cord.

SPS 182.03(5)(a)7. 7. Shoulder dystocia not resolved by Advanced Life Support in Obstetrics (ALSO) protocol.

SPS 182.03(5)(a)8. 8. Symptoms of uterine rupture.

SPS 182.03(5)(a)9. 9. Preeclampsia or eclampsia.

SPS 182.03(5)(a)10. 10. Severe abdominal pain inconsistent with normal labor.

SPS 182.03(5)(a)11. 11. Chorioamnionitis.

SPS 182.03(5)(a)12. 12. Clinically significant fetal heart rate patterns or other manifestation of fetal distress.

SPS 182.03(5)(a)13. 13. Presentation not compatible with spontaneous vaginal delivery.

SPS 182.03(5)(a)14. 14. Laceration greater than second degree perineal or any cervical.

SPS 182.03(5)(a)15. 15. Hemorrhage non-responsive to therapy.

SPS 182.03(5)(a)16. 16. Uterine prolapse or inversion.

SPS 182.03(5)(a)17. 17. Persistent uterine atony.

SPS 182.03(5)(a)18. 18. Anaphylaxis.

SPS 182.03(5)(a)19. 19. Failure to deliver placenta after one hour if there is no bleeding and fundus is firm.

SPS 182.03(5)(a)20. 20. Sustained instability or persistent abnormal vital signs.

SPS 182.03(5)(a)21. 21. Other conditions or symptoms that could threaten the life of the mother, fetus or neonate.

SPS 182.03(5)(b) (b) A licensed midwife may deliver a client with any of the complications or conditions set forth in par. (a), if no physician or other equivalent medical services are available and the situation presents immediate harm to the health and safety of the client; if the complication or condition entails extraordinary and unnecessary human suffering; or if delivery occurs during transport.

SPS 182.03(6) (6) Prohibited practices. A licensed midwife may not do any of the following:

SPS 182.03(6)(a) (a) Administer prescription pharmacological agents intended to induce or augment labor.

SPS 182.03(6)(b) (b) Administer prescription pharmacological agents to provide pain management.

SPS 182.03(6)(c) (c) Use vacuum extractors or forceps.

SPS 182.03(6)(d) (d) Prescribe medications.

SPS 182.03(6)(e) (e) Provide out-of-hospital care to a woman who has had a vertical incision cesarean section.

SPS 182.03(6)(f) (f) Perform surgical procedures including, but not limited to, cesarean sections and circumcisions.

SPS 182.03(6)(g) (g) Knowingly accept responsibility for prenatal or intrapartum care of a client with any of the following risk factors:

SPS 182.03(6)(g)1. 1. Chronic significant maternal cardiac, pulmonary, renal or hepatic disease.

SPS 182.03(6)(g)2. 2. Malignant disease in an active phase.

SPS 182.03(6)(g)3. 3. Significant hematological disorders or coagulopathies, or pulmonary embolism.

SPS 182.03(6)(g)4. 4. Insulin requiring diabetes mellitus.

SPS 182.03(6)(g)5. 5. Known maternal congenital abnormalities affecting childbirth.

SPS 182.03(6)(g)6. 6. Confirmed isoimmunization, Rh disease with positive titer.

SPS 182.03(6)(g)7. 7. Active tuberculosis.

SPS 182.03(6)(g)8. 8. Active syphilis or gonorrhea.

SPS 182.03(6)(g)9. 9. Active genital herpes infection 2 weeks prior to labor or in labor.

SPS 182.03(6)(g)10. 10. Pelvic or uterine abnormalities affecting normal vaginal births, including tumors and malformations.

SPS 182.03(6)(g)11. 11. Alcoholism or abuse.

SPS 182.03(6)(g)12. 12. Drug addiction or abuse.

SPS 182.03(6)(g)13. 13. Confirmed AIDS status.

SPS 182.03(6)(g)14. 14. Uncontrolled current serious psychiatric illness.

SPS 182.03(6)(g)15. 15. Social or familial conditions unsatisfactory for out-of-hospital maternity care services.

SPS 182.03(6)(g)16. 16. Fetus with suspected or diagnosed congenital abnormalities that may require immediate medical intervention.

SPS 182.03 History History: CR 06-096: cr. Register December 2006 No. 612, eff. 5-1-07; renumbers to (4) (b) 1. za., zb. and zc. made under s. 13.93 (2m) (b) 1., Stats., Register November 2007 No. 623.