(Section scheduled to be repealed on January 1, 2027) Sec. 75. Consultation and referral. (a) A licensed certified professional midwife shall consult with a licensed physician or a 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 or certified nurse midwife is needed, the licensed certified professional midwife shall refer the client to a physician or certified nurse midwife and, if possible, remain in consultation with the physician until resolution of the concern. Consultation does not preclude the possibility of an out-of-hospital birth. It is appropriate for the licensed certified professional 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. (b) A licensed certified professional midwife shall consult with a licensed physician or a certified nurse midwife with regard to any childbearing individual who presents with or develops the following risk factors or presents with or develops other risk factors that, in the judgment of the licensed certified professional midwife, warrant consultation: (1) Antepartum: (A) pregnancy induced hypertension, as evidenced by a blood pressure of 140/90 on 2 occasions greater than 6 hours apart; (B) persistent, severe headaches, epigastric pain, or visual disturbances; (C) persistent symptoms of urinary tract infection; (D) significant vaginal bleeding before the onset of labor not associated with uncomplicated spontaneous abortion; (E) rupture of membranes prior to the 37th week gestation; (F) noted abnormal decrease in or cessation of fetal movement; (G) anemia resistant to supplemental therapy; (H) fever of 102 degrees Fahrenheit or 39 degrees Celsius or greater for more than 24 hours; (I) non-vertex presentation after 38 weeks gestation; (J) hyperemesis or significant dehydration; (K) isoimmunization, Rh-negative sensitized, positive titers, or any other positive antibody titer, which may have a detrimental effect on the childbearing individual or fetus; (L) elevated blood glucose levels unresponsive to dietary management; (M) positive HIV antibody test; (N) primary genital herpes infection in pregnancy; (O) symptoms of malnutrition or anorexia or protracted weight loss or failure to gain weight; (P) suspected deep vein thrombosis; (Q) documented placental anomaly or previa; (R) documented low-lying placenta in a childbearing individual with history of previous cesarean delivery; (S) labor prior to the 37th week of gestation; (T) history of prior uterine incision; (U) lie other than vertex at term; (V) multiple gestation; (W) known fetal anomalies that may be affected by the site of birth; (X) marked abnormal fetal heart tones; (Y) abnormal non-stress test or abnormal biophysical profile; (Z) marked or severe polyhydramnios or oligohydramnios; (AA) evidence of intrauterine growth restriction; (BB) significant abnormal ultrasound findings; or (CC) gestation beyond 42 weeks by reliable confirmed dates; (2) Intrapartum: (A) rise in blood pressure above baseline, more than 30/15 points or greater than 140/90; (B) persistent, severe headaches, epigastric pain or visual disturbances; (C) significant proteinuria or ketonuria; (D) fever over 100.6 degrees Fahrenheit or 38 degrees Celsius in absence of environmental factors; (E) ruptured membranes without onset of established labor after 18 hours; (F) significant bleeding prior to delivery or any abnormal bleeding, with or without abdominal pain or evidence of placental abruption; (G) lie not compatible with spontaneous vaginal delivery or unstable fetal lie; (H) failure to progress after 5 hours of active labor or following 2 hours of active second stage labor; (I) signs or symptoms of maternal infection; (J) active genital herpes at onset of labor; (K) fetal heart tones with non-reassuring patterns; (L) signs or symptoms of fetal distress; (M) thick meconium or frank bleeding with birth not imminent; or (N) client or licensed certified professional midwife desires physician consultation or transfer; (3) Postpartum: (A) failure to void within 6 hours of birth; (B) signs or symptoms of maternal shock; (C) fever of 102 degrees Fahrenheit or 39 degrees Celsius and unresponsive to therapy for 12 hours; (D) abnormal lochia or signs or symptoms of uterine sepsis; (E) suspected deep vein thrombosis; or (F) signs of clinically significant depression. (c) A licensed certified professional midwife shall consult with a licensed physician or certified nurse midwife with regard to any neonate who is born with or develops the following risk factors: (1) Apgar score of 6 or less at 5 minutes without significant improvement by 10 minutes; (2) persistent grunting respirations or retractions; (3) persistent cardiac irregularities; (4) persistent central cyanosis or pallor; (5) persistent lethargy or poor muscle tone; (6) abnormal cry; (7) birth weight less than 2,300 grams; (8) jitteriness or seizures; (9) jaundice occurring before 24 hours or outside of normal range; (10) failure to urinate within 24 hours of birth; (11) failure to pass meconium within 48 hours of birth; (12) edema; (13) prolonged temperature instability; (14) significant signs or symptoms of infection; (15) significant clinical evidence of glycemic instability; (16) abnormal, bulging, or depressed fontanel; (17) significant clinical evidence of prematurity; (18) medically significant congenital anomalies; (19) significant or suspected birth injury; (20) persistent inability to suck; (21) diminished consciousness; (22) clinically significant abnormalities in vital signs, muscle tone, or behavior; (23) clinically significant color abnormality, cyanotic, or pale or abnormal perfusion; (24) abdominal distension or projectile vomiting; or (25) signs of clinically significant dehydration or failure to thrive. (d) Consultation with a health care professional does not establish a formal relationship with the client. Consultation does not establish a formal relationship between a licensed certified professional midwife and another health care professional. by a blood pressure of 140/90 on 2 occasions greater than 6 hours apart; pain, or visual disturbances; infection; of labor not associated with uncomplicated spontaneous abortion; gestation; fetal movement; Celsius or greater for more than 24 hours; gestation; positive titers, or any other positive antibody titer, which may have a detrimental effect on the childbearing individual or fetus; dietary management; protracted weight loss or failure to gain weight; childbearing individual with history of previous cesarean delivery; the site of birth; biophysical profile; oligohydramnios; confirmed dates; than 30/15 points or greater than 140/90; or visual disturbances; degrees Celsius in absence of environmental factors; established labor after 18 hours; abnormal bleeding, with or without abdominal pain or evidence of placental abruption; delivery or unstable fetal lie; labor or following 2 hours of active second stage labor; patterns; not imminent; or midwife desires physician consultation or transfer; Celsius and unresponsive to therapy for 12 hours; uterine sepsis; significant improvement by 10 minutes; normal range; birth; instability; signs, muscle tone, or behavior; cyanotic, or pale or abnormal perfusion; failure to thrive.
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