The Licensed Midwife will practice in accordance with the knowledge, clinical skills, and judgments described in the Midwives Alliance of North America (MANA) Core Competencies for Basic Midwifery Practice, within the bounds of the midwifery scope of practice as defined by Act 2017-383; the Alabama State Board of Midwifery Standards for the Practice of Licensed Midwifery in Alabama and; the practice guidelines of the individual midwifery practice.

1. (a) Newborn Transfer of Care. Conditions for which a licensed midwife must facilitate the immediate transfer of a newborn to a hospital for emergency care:

   1. 1. Respiratory distress, defined as tachypnea (more than 60 breaths per minute), retractions, grunting, and/or nasal flaring that does not resolve within the immediate postpartum period;
   2. 2. Apgar score of six (6) or less at ten (10) minutes of age;
   3. 3. Bleeding;
   4. 4. Any condition requiring continuous, immediate postpartum evaluation;
   5. 5. Any bright green emesis.
2. (b) A licensed midwife shall accompany a client during a transfer pursuant to this rule unless the circumstances make it impossible to do so.

3. (c) Newborn Consultation Required. A consultation refers to a situation in which the licensed midwife, using professional knowledge of the client and in accordance with this document, seeks the opinion of a physician competent to give advice in the relevant field: 1) it is the LM responsibility to provide all relevant records to the physician when requested; 2) Consultation should be fully documented by the LM in the medical record, and the LM should then discuss the consultant's advice with the client. Conditions for which a licensed midwife must consult a Pediatric Provider (Neonatologist, Pediatrician, Family Practice Physician, Emergency Room Physician, Advanced Practice Registered Nurse, or Physician Assistant):

   1. 1. Temperature instability, defined as a rectal temperature less than ninety-six point eight (96.8) degrees Fahrenheit or greater than one hundred point four (100.4) degrees Fahrenheit documented two (2) times more than thirty (30) minutes apart;
   2. 2. Murmur lasting more than twenty-four (24) hours immediately following birth;
   3. 3. Cardiac arrhythmia;
   4. 4. Congenital anomalies;
   5. 5. Birth injury;
   6. 6. Any jaundice in the first twenty-four (24) hours after birth or significant jaundice at any time;
   7. 7. No stool for more than twenty-four (24) hours immediately following birth;
   8. 8. No urine output for more than twenty-four (24) hours;
   9. 9. Development of persistent poor feeding effort at any time;
   10. 10. Signs or symptoms concerning for neonatal abstinence syndrome from opiate or other medications (persistent irritability, sneezing, jitteriness); or
   11. 11. Persistent asymptomatic hypoglycemia (<45mg/dL).

Author: Alabama State Board of Midwifery

Statutory Authority: Code of Ala. 1975, §§34-19-14, et seq.

History: New Rule: Filed September 24, 2018; effective November 9, 2018.