1. (1) Risk factors shall be assessed throughout labor to determine the need for emergency transport. The autonomous nurse practitioner shall transfer the patient to a hospital with obstetrical privileges if one or more of the following occur during labor, delivery or immediately thereafter:

   1. (a) Premature labor, meaning labor occurring at less than 37 weeks of gestation.
   2. (b) Premature rupture of membranes, meaning rupture occurring more than 12 hours before onset of regular active labor.
   3. (c) Non-vertex presentation.
   4. (d) Evidence of fetal distress.
   5. (e) Abnormal heart tones.
   6. (f) Moderate or severe meconium staining.
   7. (g) Estimated fetal weight less than 2,500 grams or greater than 4,000 grams.
   8. (h) Pregnancy induced hypertension, which is defined as 140/90, or an increase of 30 mm hg systolic or 15 mm hg diastolic above baseline.

   9. (i) Failure to progress in active labor:

      1. First stage: lack of steady progress in dilation and descent after 24 hours in primipara and 18 hours in multipara.

      2. Second stage: more than 2 hours without progress in descent.

      3. Third stage: more than 1 hour.

   10. (j) Severe vulvar varicosities.
   11. (k) Marked edema of cervix.
   12. (l) Active bleeding.
   13. (m) Prolapse of the cord.
   14. (n) Active infectious process.
   15. (o) Other medical or surgical problems.
2. (2) Every certified nurse midwife engaged in the autonomous practice of nurse midwifery must maintain a written policy for patient transfer and include the use of form DH5109-MQA, 09/2024, Autonomous Certified Nurse Midwife Emergency Plan-of-Care for Delivery, which is incorporated by reference and available at HYPERLINK "https://www.flrules.org/Gateway/reference.asp?No=Ref-17527"https://www.flrules.org/Gateway/reference.asp?No=Ref-17527.
3. (3) An Autonomous Certified Nurse Midwife shall report an emergency transfer to the Board of Nursing and submit a copy of the EPC with the report.
4. (4) Any adverse incident must be reported to the Department of Health using the Autonomous Certified Nurse Midwife Adverse Medical Incident Report form DH5105-MQA, 8/2024, which is hereby incorporated by reference and available at: HYPERLINK "https://www.flrules.org/Gateway/reference.asp?No=Ref-17528"https://www.flrules.org/Gateway/reference.asp?No=Ref-17528.

Rulemaking Authority 464.0123(3)(b) FS. Law Implemented 464.0123(3)(b) FS. History–New 2-4-25.