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.
Clinically significant abnormalities in vital signs, muscle tone or behavior.
Clinically significant color abnormality, cyanotic, or pale or abnormal perfusion.
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:
Shoulder dystocia not resolved by Advanced Life Support in Obstetrics (ALSO) protocol.
Clinically significant fetal heart rate patterns or other manifestation of fetal distress.