1. (a) Transport of a client by means of a private vehicle is an acceptable method of transport if it is the most expedient and safest method for accessing medical services. When transferring a client, the certified direct-entry midwife shall

   1. (1) initiate immediate transport according to the certified direct-entry midwife's emergency plan;
   2. (2) provide emergency stabilization until emergency medical services arrive or transfer is completed;
   3. (3) accompany the client or follow the client to a hospital in a timely fashion; and
   4. (4) provide pertinent information to the receiving facility.

2. (b) A certified direct-entry midwife shall immediately notify a physician and provide emergency transport to a hospital of a client exhibiting

   1. (1) seizures or unconsciousness;
   2. (2) respiratory distress or arrest;
   3. (3) evidence of shock;
   4. (4) psychosis;
   5. (5) symptomatic chest pain or cardiac arrhythmias;
   6. (6) prolapsed umbilical cord;
   7. (7) unresolved shoulder dystocia;
   8. (8) symptoms of uterine rupture;
   9. (9) preeclampsia or eclampsia;
   10. (10) severe abdominal pain inconsistent with normal labor;
   11. (11) chorioamnionitis;
   12. (12) clinically significant fetal heart rate patterns or other manifestation of fetal distress;
   13. (13) presentation not compatible with spontaneous vaginal delivery;
   14. (14) laceration greater than second degree perineal or any cervical;
   15. (15) hemorrhage non-responsive to therapy;
   16. (16) uterine prolapse or inversion;
   17. (17) persistent uterine atony;
   18. (18) anaphylaxis;
   19. (19) sustained instability or persistent abnormal vital signs; or
   20. (20) an other condition or symptom that could threaten the life of the mother, fetus, or neonate.

3. (c) A certified direct-entry midwife may deliver a client with any of the complications or conditions set out in (b) of this section if

   1. (1) no physician or other equivalent medical services are available and the situation presents immediate harm to the health and safety of the client;
   2. (2) the complication or condition entails extraordinary and unnecessary human suffering; or
   3. (3) delivery occurs during transport.

(Eff. 5/11/94, Register 130; am 3/2/2011, Register 197; am 2/22/2023, Register 245)

Authority: AS 08.65.030, AS 08.65.140, AS 08.65.190