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.