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Chapter SPS 182
STANDARDS OF PRACTICE
SPS 182.01   Standards.
SPS 182.02   Informed consent.
SPS 182.03   Practice.
Ch. SPS 182 Note Note: Chapter RL 182 was renumbered chapter SPS 182 under s. 13.92 (4) (b) 1., Stats., Register November 2011 No. 671.
SPS 182.01 SPS 182.01Standards. Licensed midwives shall comply with the standards of practice of midwifery established by the National Association of Certified Professional Midwives.
SPS 182.01 Note Note: The standards of the National Association of Certified Professional Midwives are set forth in ch. SPS 183 Appendix I. The National Association of Certified Professional Midwives may be contacted at 234 Banning Road, Putney, VT 05346, (866) 704-9844.
SPS 182.01 History History: CR 06-096: cr. Register December 2006 No. 612, eff. 5-1-07.
SPS 182.02 SPS 182.02Informed consent.
SPS 182.02(1)(1) Disclosure of information to client. A licensed midwife shall, at an initial consultation with a client, provide a copy of the rules promulgated by the department under subch. XII of ch. 440, Stats., and disclose to the client orally and in writing on a form provided by the department all of the following:
SPS 182.02(1)(a) (a) The licensed midwife's experience and training.
SPS 182.02(1)(b) (b) Whether the licensed midwife has malpractice liability insurance coverage and the policy limits of the coverage.
SPS 182.02(1)(c) (c) A protocol for medical emergencies, including transportation to a hospital, particular to each client.
SPS 182.02(1)(d) (d) A protocol for and disclosure of risks associated with vaginal birth after a cesarean section.
SPS 182.02(1)(e) (e) The number of babies delivered and the number of clients transferred to a hospital since the time the licensed midwife commenced his or her practice of midwifery.
SPS 182.02(1)(f) (f) A statement that the licensed midwife does not have the equipment, drugs or personnel available to perform neonatal resuscitations that would normally be available in a hospital setting.
SPS 182.02 Note Note: Forms are available from the Department of Safety and Professional Services, Division of Professional Credential Processing, 1400 East Washington Avenue, P.O. Box 8935, Madison, Wisconsin 53708-8935, or from the department's website at: http://dsps.wi.gov.
SPS 182.02(1m) (1m)Disclosure of information by temporary permit holder. A temporary permit holder shall inform a client orally and in writing that the temporary permit holder may not engage in the practice of midwifery unless he or she practices under the direct supervision of a licensed midwife.
SPS 182.02(2) (2)Acknowledgement by client. A licensed midwife shall, at an initial consultation with a client, provide a copy of the written disclosures required under sub. (1), to the client and obtain the client's signature acknowledging that she has been informed, orally and in writing, of the disclosures required under sub. (1).
SPS 182.02 History History: CR 06-096: cr. Register December 2006 No. 612, eff. 5-1-07.
SPS 182.03 SPS 182.03Practice.
SPS 182.03(1)(1) Testing, care and screening. A licensed midwife shall:
SPS 182.03(1)(a) (a) Offer each client routine prenatal care and testing in accordance with current American College of Obstetricians and Gynecologists guidelines.
SPS 182.03(1)(b) (b) Provide all clients with a plan for 24 hour on-call availability by a licensed midwife, certified nurse-midwife or licensed physician throughout pregnancy, intrapartum, and 6 weeks postpartum.
SPS 182.03(1)(c) (c) Provide clients with labor support, fetal monitoring and routine assessment of vital signs once active labor is established.
SPS 182.03(1)(d) (d) Supervise delivery of infant and placenta, assess newborn and maternal well being in immediate postpartum, and perform Apgar scores.
SPS 182.03(1)(e) (e) Perform routine cord management and inspect for appropriate number of vessels.
SPS 182.03(1)(f) (f) Inspect the placenta and membranes for completeness.
SPS 182.03(1)(g) (g) Inspect the perineum and vagina postpartum for lacerations and stabilize.
SPS 182.03(1)(h) (h) Observe mother and newborn postpartum until stable condition is achieved, but in no event for less than 2 hours.
SPS 182.03(1)(i) (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.
SPS 182.03(1)(j) (j) Reevaluate maternal and newborn well being within 36 hours of delivery.
SPS 182.03(1)(k) (k) Use universal precautions with all biohazard materials.
SPS 182.03(1)(L) (L) Ensure that a birth certificate is accurately completed and filed in accordance with state law.
SPS 182.03(1)(m) (m) Offer to obtain and submit a blood sample in accordance with the recommendations for metabolic screening of the newborn.
SPS 182.03(1)(n) (n) Offer an injection of vitamin K for the newborn in accordance with the indication, dose and administration route set forth in sub. (3).
SPS 182.03(1)(o) (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.
SPS 182.03(1)(p) (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.
SPS 182.03(1)(q) (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.
SPS 182.03(2) (2)Prescription drugs, devices and procedures. A licensed midwife may administer the following during the practice of midwifery:
SPS 182.03(2)(a) (a) Oxygen for the treatment of fetal distress.
SPS 182.03(2)(b) (b) Eye prophylactics – 0.5% erythromycin ophthalmic ointment or 1% tetracycline ophthalmic ointment for the prevention of neonatal ophthalmia.
SPS 182.03(2)(c) (c) Oxytocin, or pitocin, as a postpartum antihemorrhagic agent.
SPS 182.03(2)(d) (d) Methyl-ergonovine, or methergine, for the treatment of postpartum hemorrhage.
SPS 182.03(2)(e) (e) Vitamin K for the prophylaxis of hemorrhagic disease of the newborn.
SPS 182.03(2)(f) (f) RHo (D) immune globulin for the prevention of RHo (D) sensitization in RHo (D) negative women.
SPS 182.03(2)(g) (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.
SPS 182.03(2)(h) (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.
SPS 182.03 Note 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.
SPS 182.03 Note 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).
SPS 182.03(3) (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: - See PDF for table PDF
SPS 182.03(4) (4)Consultation and referral.
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. 1. Antepartum.
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.b. b. Persistent, severe headaches, epigastric pain or visual disturbances.
SPS 182.03(4)(b)1.c. c. Persistent symptoms of urinary tract infection.
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.e. e. Rupture of membranes prior to the 37th week gestation.
SPS 182.03(4)(b)1.f. f. Noted abnormal decrease in or cessation of fetal movement.
SPS 182.03(4)(b)1.g. g. Anemia resistant to supplemental therapy.
SPS 182.03(4)(b)1.h. h. Fever of 102° F or 39° C or greater for more than 24 hours.
SPS 182.03(4)(b)1.i. i. Non-vertex presentation after 38 weeks gestation.
SPS 182.03(4)(b)1.j. j. Hyperemisis or significant dehydration.
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.L. L. Elevated blood glucose levels unresponsive to dietary management.
SPS 182.03(4)(b)1.m. m. Positive HIV antibody test.
SPS 182.03(4)(b)1.n. n. Primary genital herpes infection in pregnancy.
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.p. p. Suspected deep vein thrombosis.
SPS 182.03(4)(b)1.q. q. Documented placental anomaly or previa.
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)1.s. s. Labor prior to the 37th week of gestation.
SPS 182.03(4)(b)1.t. t. History of prior uterine incision.
SPS 182.03(4)(b)1.u. u. Lie other than vertex at term.
SPS 182.03(4)(b)1.v. v. Multiple gestation.
SPS 182.03(4)(b)1.w. w. Known fetal anomalies that may be affected by the site of birth.
SPS 182.03(4)(b)1.x. x. Marked abnormal fetal heart tones.
SPS 182.03(4)(b)1.y. y. Abnormal non-stress test or abnormal biophysical profile.
SPS 182.03(4)(b)1.z. z. Marked or severe poly- or oligo-dydramnios.
SPS 182.03(4)(b)1.za. za. Evidence of intrauterine growth restriction.
SPS 182.03(4)(b)1.zb. zb. Significant abnormal ultrasound findings.
SPS 182.03(4)(b)1.zc. zc. Gestation beyond 42 weeks by reliable confirmed dates.
SPS 182.03(4)(b)2. 2. Intrapartum.
SPS 182.03(4)(b)2.a. a. Rise in blood pressure above baseline, more than 30/15 points or greater than 140/90.
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