A midwife shall consult immediately with a physician with experience in the active practice of obstetrics or with a CNM about whether the care of the client should be transferred to the hospital setting if any of the following conditions should occur intrapartum:

1. (a) Unforeseen malpresentations;
2. (b) Unforeseen multiple fetuses;
3. (c) Fetal distress as indicated by heart rate monitoring;
4. (d) The presence of particulate meconium;

5. (e) Failure to progress such that:

   1. (1) In the first stage of labor, there is a lack of progress in dilation and descent for a period of up to 24 hours in the case of a primigravida or 18 hours in the case of a multigravida;
   2. (2) In the second stage, there are more than 2 hours without progress in descent or more than 3 hours with slow descent; or
   3. (3) In the third stage, there is more than one hour without delivery of the placenta;
6. (f) More than 18 hours elapse following the rupture of the membranes without the onset of labor;

7. (g) Maternal distress including:

   1. (1) Extreme physical or mental exhaustion;
   2. (2) Abnormal vital signs; and
   3. (3) Uncontrolled maternal bleeding.

Source. #7759, eff 9-7-02, EXPIRED: 9-7-10 New. #11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16 New. #12040, eff 11-10-16