.05 Required Transfer of Care.
A. Except for §B of this regulation, a licensed direct-entry midwife shall arrange immediate emergency transfer to a hospital if:
(1) The patient requests transfer; or
(2) The patient or newborn is determined to have any of the following conditions during labor, delivery, or the immediate postpartum period:
(a) Unforeseen noncephalic presentation;
(b) Unforeseen multiple gestation;
(c) Nonreassuring fetal heart rate or pattern, including:
(i) Tachycardia
(ii) Bradycardia;
(iii) Significant change in baseline; or
(iv) Persistent late or severe variable decelerations;
(d) Prolapsed cord;
(e) Unresolved maternal hemorrhage;
(f) Retained placenta;
(g) Signs of fetal or maternal infection;
(h) Patient with a third or fourth degree laceration or a laceration beyond the licensed direct-entry midwife's ability to repair;
(i) Apgar of less than seven at 5 minutes;
(j) Obvious congenital anomalies;
(k) Need for chest compressions during neonatal resuscitation;
(l) Newborn with persistent central cyanosis;
(m) Newborn with persistent grunting and retractions;
(n) Newborn with abnormal vital signs;
(o) Gross or thick meconium staining, when discovered; or
(p) Newborn with excessive dehydration due to inability to feed.
B. If transfer is not possible because of imminent delivery, the licensed direct-entry midwife shall consult with a health care provider for guidance on further management of the patient and to determine when transfer may be safely arranged, if required.
C. A licensed direct-entry midwife shall immediately transfer the care of a patient to a health care provider for the treatment of any significant postpartum morbidity, including:
(1) Uncontrolled postpartum hemorrhage;
(2) Preeclampsia;
(3) Thrombo-embolism;
(4) An infection; or
(5) A postpartum mental health disorder.
D. A licensed direct-entry midwife who is required to transfer care of a patient under this regulation may continue other aspects of postpartum care in consultation with the treating health care practitioner.
