A midwife attending a woman who has had a previous birth by cesarean section shall:

1. (a) Provide all services required by this chapter;
2. (b) Monitor the fetal heart rate at least every 15 minutes during active labor;
3. (c) Monitor the fetal heart rate at least every 5 minutes during the second stage of labor;
4. (d) Monitor the client during labor for excessive vaginal bleeding;
5. (e) Monitor the client during labor for abnormal abdominal pain;

6. (f) Monitor the labor for failure to progress as indicated by the following:

   1. (1) During active labor, the passage of at least 2 hours without cervical change;
   2. (2) In the second stage of labor, the passage of at least one hour without progress in descent of the head or the passage of at least 2 hours with slow progress in descent of the head; or
   3. (3) In the third stage, the passage of at least one hour without delivery of the placenta;
7. (g) Consult immediately with an obstetrician if any of the circumstances listed in (f) above occur;

8. (h) Transfer the client to the hospital identified pursuant to Mid 503.02(f) when any of the following occur:

   1. (1) Repeated fetal heart rate abnormalities;
   2. (2) Unstable vital signs;
   3. (3) Significant bleeding; or
   4. (4) Abdominal pain experienced by the client which is inconsistent with the normal pain of labor; and
9. (i) In the event of an emergency transfer to a hospital, immediately notify the hospital to which the client is to be transferred of the nature of the emergency and the estimated time of arrival of the client.

Source. #7931, eff 8-6-03, EXPIRED: 8-6-11 New. #11095, INTERIM, eff 5-12-16, EXPIRED: 11-8-16 New. #12040, eff 11-10-16