1. A. A midwife shall obtain a consultation at the time a client is determined to have any of the following during the current pregnancy:

   1. 1. A positive culture for Group B Streptococcus;
   2. 2. History of seizure disorder;
   3. 3. History of stillbirth, premature labor, or having delivered more than five newborns;
   4. 4. Age younger than 16 years;
   5. 5. A first pregnancy in a client older than 40 years of age;
   6. 6. Failure to auscultate fetal heart tones by the beginning of 22 weeks gestation;
   7. 7. Failure to gain 12 pounds by the beginning of 30 weeks gestation or gaining more than eight pounds in any two-week period during pregnancy;
   8. 8. Greater than 1+ sugar, ketones, or protein in the urine on two consecutive visits;
   9. 9. Excessive vomiting or continued vomiting after the end of 20 weeks gestation;
   10. 10. Symptoms of decreased fetal movement;
   11. 11. A fever of 100.4° F or 38° C or greater measured twice at 24 hours apart;
   12. 12. Tender uterine fundus;
   13. 13. Effacement or dilation of the cervix, greater than a fingertip, accompanied by contractions, prior to the beginning of 36 weeks gestation;
   14. 14. Measurements for fetal growth that are not within 2 centimeters of the gestational age;
   15. 15. Second degree or greater lacerations of the birth canal;
   16. 16. Except as provided in R9-16-111(C)(4), a progression of labor that does not follow the guidelines in R9-16-108(J)(4)(c);
   17. 17. An unengaged head at seven centimeters dilation in active labor;
   18. 18. Failure of the uterus to return to normal size in the current postpartum period;
   19. 19. Persistent shortness of breath requiring more than 24 breaths per minute, or breathing which is difficult or painful;
   20. 20. Gonorrhea;
   21. 21. Chlamydia;
   22. 22. Syphilis;
   23. 23. Heart disease;
   24. 24. Kidney disease;
   25. 25. Blood disease; or

   26. 26. A positive test result for:

       1. a. HIV,
       2. b. Hepatitis B, or
       3. c. Hepatitis C.

2. B. A midwife shall obtain a consultation at the time a newborn demonstrates any of the following conditions:

   1. 1. Weight less than 2500 grams or five pounds, eight ounces;
   2. 2. Congenital anomalies;
   3. 3. An Apgar score less than 7 at five minutes;
   4. 4. Persistent breathing at a rate of more than 60 breaths per minute;
   5. 5. An irregular heartbeat;
   6. 6. Persistent poor muscle tone;
   7. 7. Less than 36 weeks gestation or greater than 42 weeks gestation by gestational exam;
   8. 8. Yellowish-colored skin within 48 hours;
   9. 9. Abnormal crying;
   10. 10. Meconium staining of the skin;
   11. 11. Lethargy;
   12. 12. Irritability;
   13. 13. Poor feeding;
   14. 14. Excessively pink coloring over the entire body;
   15. 15. Failure to urinate or pass meconium in the first 24 hours of life;
   16. 16. A hip examination which results in a clicking or incorrect angle;
   17. 17. Skin rashes not commonly seen in the newborn; or
   18. 18. Temperature persistently above 99.0° or below 97.6° F.
3. C. The midwife shall inform the client of the consultation required in subsections (A) or (B) and recommendations of the physician or certified nurse midwife.
4. D. The midwife shall document the consultation required in subsections (A) or (B) and recommendations received in the client record or newborn record, as specified in R9-16-115(B)(14) or (C)(7) as applicable.

Historical Note

Adopted effective March 14, 1994 (Supp. 94-1). Section expired under A.R.S. § 41-1056(E) at 7 A.A.R. 5029, effective September 30, 2001 (Supp. 01-4). New Section R9-16-112 renumbered from R9-16-109 and amended by exempt rulemaking at 19 A.A.R. 1805, effective July 1, 2013 (Supp. 13-2). Section amended by final expedited rulemaking at 28 A.A.R. 1119 (May 27, 2022), with an immediate effective date of May 4, 2022 (Supp. 22-2).