1. (a) The following conditions preclude Midwifery care and the Client must be transferred to a physician, CNM, or Clinician upon diagnosis:

   1. (1) Severe asthma;
   2. (2) Cyanotic heart disease or presence of a prosthetic valve;
   3. (3) New York Heart Association class two heart failure;
   4. (4) History of cardiac surgery with an abnormal echocardiogram;
   5. (5) Pulmonary Hypertension;
   6. (6) Hemoglobinopathies; sickle cell disease, thalassemia;
   7. (7) Chronic hypertension on medication or with renal or heart disease;
   8. (8) Severe obstructive pulmonary disease;
   9. (9) Chronic renal disease with a creatinine of greater than 1.5;
   10. (10) Lupus;
   11. (11) Marfan syndrome;
   12. (12) History of intracranial injury (stroke, AV malformation, or aneurisms);
   13. (13) Prolonged anti-coagulation;
   14. (14) Type 1 diabetes;
   15. (15) Severe Polyhydramnios less than 34 weeks;
   16. (16) Triplets or greater;
   17. (17) Monoamniotic twins;
   18. (18) Conjoined twins;
   19. (19) Placenta accrete;
   20. (20) Documented placenta previa in the third trimester; the placenta shall not be previa. To determine this, in the case of documented placenta previa or marginal placenta previa in the second trimester, a third trimester ultrasound must show resolution by 36 weeks or the Client must be referred. The Client must obtain an official ultrasound report with images performed by a Registered Diagnostic Medical Sonographer (RDMS) to determine that the location of the placenta is not previa or marginal placenta previa no later 34 weeks.
   21. (21) Uncontrolled seizure disorder;
   22. (22) Evidence of placenta abruption;
   23. (23) Evidence of preeclampsia/eclampsia;
   24. (24) Active tuberculosis or other serious pulmonary pathology;
   25. (25) Inadequately treated syphilis;
   26. (26) Hepatic disorders (cholestasis);
   27. (27) Uncontrolled endocrine disorders;
   28. (28) Significant hematological disorders;
   29. (29) Active cancer;
   30. (30) Active alcoholism or abuse;
   31. (31) Active drug addiction or abuse; and
   32. (32) Positive for HIV antibody.

2. (b) The following conditions preclude Midwifery care and the Client must be transferred to a physician, CNM, or Clinician upon diagnosis unless the Client obtains a signed consult note from a medically relevant physician and all recommended treatments can be completed in an out of hospital setting.

   1. (1) History of seizure disorder;
   2. (2) History of preterm labor or cervical insufficiency;
   3. (3) Evidence of shortened cervix;
   4. (4) Positive for Hepatitis B;
   5. (5) History of chronic hypertension;
   6. (6) Isoimmunization;
   7. (7) History of post-partum hemorrhage with concurrent anemia;
   8. (8) History of unexplained, recurrent stillbirths or neonatal death;
   9. (9) Severe psychiatric illness within the last six (6) months as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM);
   10. (10) Pregnancy that extends beyond 42 weeks 0/7 days gestational age;
   11. (11) Two or more previous cesarean deliveries unless the Client has also had a successful vaginal delivery since the last cesarean delivery;
   12. (12) BMI over 50 at onset of pregnancy;
   13. (13) Type 2 diabetes; and
   14. (14) History of cardiac surgery with a normal echocardiogram within the last 12 months.

Added at 38 Ok Reg 2005, eff 9-11-21