1. (a) The LLM must:

   1. (1) Consult a licensed physician or CNM whenever there are significant deviations from normal in either the mother or the newborn; and
   2. (2) Act in accordance with the instructions of the physician or CNM.

2. (b) In those situations requiring transport to a hospital, the LLM must:

   1. (1) Notify the emergency room or labor and delivery unit of the designated hospital of an imminent transport; and
   2. (2) Provide a copy of the complete medical record to the appropriate staff at the receiving facility.
3. (c) The LLM is expected to use their judgment regarding the need for referral or emergency transport when problems arise that are not specified in the protocol.
4. (d) No licensed lay midwife may assist labor by any forcible or mechanical means, attempt to remove adherent placenta, administer, prescribe, advise, or employ any prescription drug or device, or attempt the treatment of a precluded condition, except in an emergency when the attendance of a physician or CNM cannot be speedily secured.

5. (e)

   1. (1) Any authorized or unauthorized emergency measures must be reported to the Department of Health in an incident report (found in Appendix A or available on the department website).

   2. (2) In the case of actions/procedures authorized by a physician or CNM in the case of a specific emergency, the LLM will:

      1. (A) Document these orders with an order signed by the physician or CNM; and
      2. (B) Submit it to the department on the tenth of the following month.

Codification Notes: "CNM" means certified nurse midwife. "LLM" means licensed lay midwife.