.04 Required Consultation.

A. A licensed direct-entry midwife shall consult with a health care practitioner and document:

(1) The consultation;

(2) The recommendations of the consultation; and

(3) The discussion of the consultation with the client if any of the following conditions are present during prenatal care:

(a) Significant mental disease, including depression, bipolar disorder, schizophrenia, and other conditions that impair the ability of the patient to participate effectively in the patient's​ care or that require the use of psychotropic drugs to control the condition;

(b) Second or third trimester bleeding;

(c) Intermittent use of alcohol into the second trimester;

(d) Asthma;

(e) Diet-controlled gestational diabetes;

(f) History of genetic problems, intrauterine death after 20 weeks’ gestation, or stillbirth;

(g) Abnormal Pap smear;

(h) Possible ectopic pregnancy;

(i) Tuberculosis;

(j) Controlled hypothyroidism, being treated with thyroid replacement and euthyroid, and with thyroid test numbers in the normal range;

(k) Rh sensitization with positive antibody titer;

(l) Breech presentation between 35 and 38 weeks;

(m) Transverse lie or other abnormal presentation between 35 and 38 weeks;

(n) Premature rupture of membranes at 37 weeks or less;

(o) Small for gestational age or large for gestational age fetus;

(p) Polyhydramnios or oligohydramnios;

(q) Previous LEEP procedure or cone biopsy;

(r) Previous obstetrical problems, including uterine abnormalities, placental abruption, placenta accreta, obstetric hemorrhage, incompetent cervix, or preterm delivery for any reason;

(s) Post-term maturity (41 0/7 to 6/7 weeks gestational age);

(t) Inflammatory bowel disease, in remission; or

(u) Primary herpes simplex virus, infection or any active infection at time of delivery.

B. Any changes in the plan of care following a consultation in accordance with §A of this regulation shall be documented in the patient's plan of care.