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(d) Supervise delivery of infant and placenta, assess newborn and maternal well being in immediate postpartum, and perform Apgar scores.
(e) Perform routine cord management and inspect for appropriate number of vessels.
(f) Inspect the placenta and membranes for completeness.
(g) Inspect the perineum and vagina postpartum for lacerations and stabilize.
(h) Observe mother and newborn postpartum until stable condition is achieved, but in no event for less than 2 hours.
(i) Instruct the mother, father and other support persons, both verbally and in writing, of the special care and precautions for both mother and newborn in the immediate postpartum period.
(j) Reevaluate maternal and newborn well being within 36 hours of delivery.
(k) Use universal precautions with all biohazard materials.
(L) Ensure that a birth certificate is accurately completed and filed in accordance with state law.
(m) Offer to obtain and submit a blood sample in accordance with the recommendations for metabolic screening of the newborn.
(n) Offer an injection of vitamin K for the newborn in accordance with the indication, dose and administration route set forth in sub. (3).
(o) Within one week of delivery, offer a newborn hearing screening to every newborn or refer the parents to a facility with a newborn hearing screening program.
(p) Within 2 hours of the birth offer the administration of antibiotic ointment into the eyes of the newborn, in accordance with state law on the prevention of infant blindness.
(q) Maintain adequate antenatal and perinatal records of each client and provide records to consulting licensed physicians and licensed certified nurse-midwives, in accordance with HIPAA regulations.
(2)Prescription drugs, devices and procedures. A licensed midwife may administer the following during the practice of midwifery:
(a) Oxygen for the treatment of fetal distress.
(b) Eye prophylactics – 0.5% erythromycin ophthalmic ointment or 1% tetracycline ophthalmic ointment for the prevention of neonatal ophthalmia.
(c) Oxytocin, or pitocin, as a postpartum antihemorrhagic agent.
(d) Methyl-ergonovine, or methergine, for the treatment of postpartum hemorrhage.
(e) Vitamin K for the prophylaxis of hemorrhagic disease of the newborn.
(f) RHo (D) immune globulin for the prevention of RHo (D) sensitization in RHo (D) negative women.
(g) Intravenous fluids for maternal stabilization – 5% dextrose in lactated Ringer’s solution (D5LR), unless unavailable or impractical in which case 0.9% sodium chloride may be administered.
(h) In addition to the drugs, devices and procedures that are identified in pars. (a) to (g), a licensed midwife may administer any other prescription drug, use any other device or perform any other procedure as an authorized agent of a licensed practitioner with prescriptive authority.
Note: Licensed midwives do not possess prescriptive authority. A licensed midwife may legally administer prescription drugs or devices only as an authorized agent of a practitioner with prescriptive authority. For physicians and advanced practice nurses, an agent may administer prescription drugs or devices pursuant to written standing orders and protocols.
Note: Medical oxygen, 0.5% erythromycin ophthalmic ointment, tetracycline ophthalmic ointment, oxytocin (pitocin), methyl-ergonovine (methergine), injectable vitamin K and RHo (D) immune globulin are prescription drugs. See s. SPS 180.02 (1).
(3)Indications, dose, administration and duration of treatment. The indications, dose, route of administration and duration of treatment relating to the administration of drugs and procedures identified under sub. (2) are as follows:
(4)Consultation and referral.
(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.
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.
(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:
1. Antepartum.
a. Pregnancy induced hypertension, as evidenced by a blood pressure of 140/90 on 2 occasions greater than 6 hours apart.
b. Persistent, severe headaches, epigastric pain or visual disturbances.
c. Persistent symptoms of urinary tract infection.
d. Significant vaginal bleeding before the onset of labor not associated with uncomplicated spontaneous abortion.
e. Rupture of membranes prior to the 37th week gestation.
f. Noted abnormal decrease in or cessation of fetal movement.
g. Anemia resistant to supplemental therapy.
h. Fever of 102° F or 39° C or greater for more than 24 hours.
i. Non-vertex presentation after 38 weeks gestation.
j. Hyperemisis or significant dehydration.
k. Isoimmunization, Rh-negative sensitized, positive titers, or any other positive antibody titer, which may have a detrimental effect on mother or fetus.
L. Elevated blood glucose levels unresponsive to dietary management.
m. Positive HIV antibody test.
n. Primary genital herpes infection in pregnancy.
o. Symptoms of malnutrition or anorexia or protracted weight loss or failure to gain weight.
p. Suspected deep vein thrombosis.
q. Documented placental anomaly or previa.
r. Documented low lying placenta in woman with history of previous cesarean delivery.
s. Labor prior to the 37th week of gestation.
t. History of prior uterine incision.
u. Lie other than vertex at term.
v. Multiple gestation.
w. Known fetal anomalies that may be affected by the site of birth.
x. Marked abnormal fetal heart tones.
y. Abnormal non-stress test or abnormal biophysical profile.
z. Marked or severe poly- or oligo-dydramnios.
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.
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Published under s. 35.93, Stats. Updated on the first day of each month. Entire code is always current. The Register date on each page is the date the chapter was last published.