Testing, care and screening.
A licensed midwife shall:
Offer each client routine prenatal care and testing in accordance with current American College of Obstetricians and Gynecologists guidelines.
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.
Provide clients with labor support, fetal monitoring and routine assessment of vital signs once active labor is established.
Supervise delivery of infant and placenta, assess newborn and maternal well being in immediate postpartum, and perform Apgar scores.
Perform routine cord management and inspect for appropriate number of vessels.
Inspect the perineum and vagina postpartum for lacerations and stabilize.
Observe mother and newborn postpartum until stable condition is achieved, but in no event for less than 2 hours.
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.
Reevaluate maternal and newborn well being within 36 hours of delivery.
Ensure that a birth certificate is accurately completed and filed in accordance with state law.
Offer to obtain and submit a blood sample in accordance with the recommendations for metabolic screening of the newborn.
Offer an injection of vitamin K for the newborn in accordance with the indication, dose and administration route set forth in sub. (3)
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.
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.
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:
Eye prophylactics – 0.5% erythromycin ophthalmic ointment or 1% tetracycline ophthalmic ointment for the prevention of neonatal ophthalmia.
Oxytocin, or pitocin, as a postpartum antihemorrhagic agent.
Methyl-ergonovine, or methergine, for the treatment of postpartum hemorrhage.
Vitamin K for the prophylaxis of hemorrhagic disease of the newborn.
RHo (D) immune globulin for the prevention of RHo (D) sensitization in RHo (D) negative women.
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.
In addition to the drugs, devices and procedures that are identified in pars. (a)
, 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
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: - See PDF for table
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.
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:
Pregnancy induced hypertension, as evidenced by a blood pressure of 140/90 on 2 occasions greater than 6 hours apart.
Significant vaginal bleeding before the onset of labor not associated with uncomplicated spontaneous abortion.
Isoimmunization, Rh-negative sensitized, positive titers, or any other positive antibody titer, which may have a detrimental effect on mother or fetus.
Symptoms of malnutrition or anorexia or protracted weight loss or failure to gain weight.
Documented low lying placenta in woman with history of previous cesarean delivery.
Rise in blood pressure above baseline, more than 30/15 points or greater than 140/90.
Significant bleeding prior to delivery or any abnormal bleeding, with or without abdominal pain; or evidence of placental abruption.
Failure to progress after 5 hours of active labor or following 2 hours of active second stage labor.
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:
Apgar score of 6 or less at 5 minutes without significant improvement by 10 minutes.