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.
Failure to deliver placenta after one hour if there is no bleeding and fundus is firm.
Other conditions or symptoms that could threaten the life of the mother, fetus or neonate.
A licensed midwife may deliver a client with any of the complications or conditions set forth in par. (a)
, if no physician or other equivalent medical services are available and the situation presents immediate harm to the health and safety of the client; if the complication or condition entails extraordinary and unnecessary human suffering; or if delivery occurs during transport.
(6) Prohibited practices.
A licensed midwife may not do any of the following:
Administer prescription pharmacological agents intended to induce or augment labor.
Administer prescription pharmacological agents to provide pain management.
Provide out-of-hospital care to a woman who has had a vertical incision cesarean section.
Perform surgical procedures including, but not limited to, cesarean sections and circumcisions.
Knowingly accept responsibility for prenatal or intrapartum care of a client with any of the following risk factors:
Chronic significant maternal cardiac, pulmonary, renal or hepatic disease.
Significant hematological disorders or coagulopathies, or pulmonary embolism.
Pelvic or uterine abnormalities affecting normal vaginal births, including tumors and malformations.
Social or familial conditions unsatisfactory for out-of-hospital maternity care services.