Wisconsin Legislature: SPS 182.03(4)(c)4.

za. Evidence of intrauterine growth restriction.

zb. Significant abnormal ultrasound findings.

zc. Gestation beyond 42 weeks by reliable confirmed dates.

2. Intrapartum.

a. Rise in blood pressure above baseline, more than 30/15 points or greater than 140/90.

b. Persistent, severe headaches, epigastric pain or visual disturbances.

c. Significant proteinuria or ketonuria.

d. Fever over 100.6° F or 38° C in absence of environmental factors.

e. Ruptured membranes without onset of established labor after 18 hours.

f. Significant bleeding prior to delivery or any abnormal bleeding, with or without abdominal pain; or evidence of placental abruption.

g. Lie not compatible with spontaneous vaginal delivery or unstable fetal lie.

h. Failure to progress after 5 hours of active labor or following 2 hours of active second stage labor.

i. Signs or symptoms of maternal infection.

j. Active genital herpes at onset of labor.

k. Fetal heart tones with non-reassuring patterns.

L. Signs or symptoms of fetal distress.

m. Thick meconium or frank bleeding with birth not imminent.

n. Client or licensed midwife desires physician consultation or transfer.

3. Postpartum.

a. Failure to void within 6 hours of birth.

b. Signs or symptoms of maternal shock.

c. Febrile: 102° F or 39° C and unresponsive to therapy for 12 hours.

d. Abnormal lochia or signs or symptoms of uterine sepsis.

e. Suspected deep vein thrombosis.

f. Signs of clinically significant depression.

(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:

1. Apgar score of 6 or less at 5 minutes without significant improvement by 10 minutes.

2. Persistent grunting respirations or retractions.

3. Persistent cardiac irregularities.

4. Persistent central cyanosis or pallor.

5. Persistent lethargy or poor muscle tone.

6. Abnormal cry.

7. Birth weight less than 2300 grams.

8. Jitteriness or seizures.

9. Jaundice occurring before 24 hours or outside of normal range.

10. Failure to urinate within 24 hours of birth.

11. Failure to pass meconium within 48 hours of birth.

12. Edema.

13. Prolonged temperature instability.

14. Significant signs or symptoms of infection.

15. Significant clinical evidence of glycemic instability.

16. Abnormal, bulging, or depressed fontanel.

17. Significant clinical evidence of prematurity.

18. Medically significant congenital anomalies.

19. Significant or suspected birth injury.

20. Persistent inability to suck.

21. Diminished consciousness.

22. Clinically significant abnormalities in vital signs, muscle tone or behavior.

23. Clinically significant color abnormality, cyanotic, or pale or abnormal perfusion.

24. Abdominal distension or projectile vomiting.

25. Signs of clinically significant dehydration or failure to thrive.

(5) Transfer.

(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:

1. Seizures or unconsciousness.

2. Respiratory distress or arrest.

3. Evidence of shock.

4. Psychosis.

5. Symptomatic chest pain or cardiac arrhythmias.

6. Prolapsed umbilical cord.

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

8. Symptoms of uterine rupture.

9. Preeclampsia or eclampsia.

10. Severe abdominal pain inconsistent with normal labor.

11. Chorioamnionitis.

12. Clinically significant fetal heart rate patterns or other manifestation of fetal distress.

13. Presentation not compatible with spontaneous vaginal delivery.

14. Laceration greater than second degree perineal or any cervical.

15. Hemorrhage non-responsive to therapy.

16. Uterine prolapse or inversion.

17. Persistent uterine atony.

18. Anaphylaxis.

19. Failure to deliver placenta after one hour if there is no bleeding and fundus is firm.

20. Sustained instability or persistent abnormal vital signs.

21. Other conditions or symptoms that could threaten the life of the mother, fetus or neonate.

(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.

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

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

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

(d) Prescribe medications.

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

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

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

1. Chronic significant maternal cardiac, pulmonary, renal or hepatic disease.

2. Malignant disease in an active phase.

3. Significant hematological disorders or coagulopathies, or pulmonary embolism.

4. Insulin requiring diabetes mellitus.

5. Known maternal congenital abnormalities affecting childbirth.

6. Confirmed isoimmunization, Rh disease with positive titer.