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 or the newborn should be transferred to the hospital setting if any of the following conditions should occur immediately postpartum:

1. (a) Significantly bleeding cervical lacerations;
2. (b) Third or fourth degree perineal lacerations;
3. (c) Uncontrolled maternal bleeding when the condition of the woman is becoming unstable;
4. (d) Maternal fever or unstable vital signs;
5. (e) An Apgar score of 6 or less at 5 minutes after birth, or an Apgar score that is dropping;
6. (f) Jaundice in the newborn appearing before 24 hours after birth;
7. (g) Obvious congenital anomalies;
8. (h) A newborn who is SGA;
9. (i) A newborn who shows signs of hypoglycemia, such as jitteriness, lethargy, or hypothermia;
10. (j) A newborn with persistent central cyanosis or pallor;
11. (k) A newborn with persistent signs of respiratory difficulty without signs of improvement within one hour after birth;
12. (l) A newborn with a pulse rate greater than 160 at rest persisting for longer than 2 hours;
13. (m) A newborn with respirations greater than 80 at rest persisting for longer than 2 hours;
14. (n) A newborn with temperature outside the parameters of 97.7-99.4 degrees Fahrenheit or 36.5 to 37.5 degrees Celsius persisting for longer than 2 hours; or
15. (o) Other conditions which the midwife assesses as outside normal limits.

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