Section 844 IAC 17-1-9 - ReferralsAuthority: IC 25-22.5-2-7; IC 25-23.4-2-6
Affected: IC 25-22.5; IC 25-23.4
Sec. 9.
(a) In addition to the requirements of this section and IC 25-23.4-6-1, a certified direct entry midwife shall refer for consultation or transfer care to a physician if there is a case, which in the judgment of the certified direct entry midwife or the collaborating physician, the client or the client's fetus is at risk of serious harm or injury, or any other case requiring care that exceeds the scope of the certified direct entry midwife's training or skill.(b) A certified direct entry midwife shall refer for consultation or transfer care to a physician if any of the following prenatal conditions exist in either the client or the client's fetus: (3) Severe renal disease.(4) Severe liver disease.(5) Human immunodeficiency virus (HIV) or acquired immune deficiency syndrome (AIDS).(6) Uncontrolled hyperthyroidism.(7) Chronic obstructive pulmonary disease (COPD).(8) Seizure disorder requiring prescriptive medication.(9) Severe psychiatric disorders requiring hospitalization or medication known to have adverse effects.(10) Current substance abuse known to cause adverse effects.(11) Chronic hypertension.(12) Insulin dependent diabetes or uncontrolled gestational diabetes.(13) Previous second trimester miscarriage.(14) Previous premature delivery.(15) Preterm rupture of membranes.(16) Prior intrauterine growth retardation.(17) Primary outbreak of genital herpes.(18) Inappropriate fetal size for gestation as documented by ultrasound.(19) Significant second or third trimester bleeding.(20) Incomplete spontaneous abortion.(21) Abnormal fetal cardiac rate or rhythm.(23) Suspected platelet disorder.(24) Prior caesarean section or uterine surgery with a fundal incision or myomectomy, or both.(25) Rh or other blood group isoimmunization.(26) History of hemoglobinopathies.(27) Acute or chronic deep vein thrombosis (DVT).(28) Anemia where hematocrit is less than thirty (30) or hemoglobin is less than ten (10) at term.(29) Blood coagulation defect.(30) Preeclampsia or eclampsia.(32) Placental abruption.(33) Placenta previa or complete, marginal, or low-lying placenta after eighteen (18) weeks of gestation.(34) Documented oligohydramnios or polyhydramnios.(35) Suspected chorioamnionitis.(37) Pregnancy lasting longer than forty-two (42) weeks with an abnormal nonstress test.(38) Abnormal fetal surveillance tests.(39) Suspected malpresentation incompatible with vaginal delivery.(40) Suspected multiple gestation.(41) Suspected serious perinatal mood disorder; or(c) A certified direct entry midwife shall refer for consultation or transfer care to a physician if any of the following intrapartum conditions exist in either the client or the client's fetus:(1) Current substance abuse.(2) Documented intrauterine growth retardation (IUGR) or fetus small for gestational age (SGA) at term.(3) Suspected uterine rupture.(4) Active herpes lesion in a location that cannot be covered during delivery.(5) Prolapsed cord or cord presentation.(6) Suspected complete or partial placental abruption.(7) Suspected placenta previa.(8) Suspected chorioamnionitis.(9) Preeclampsia or eclampsia.(10) Thick meconium stained amniotic fluid without reassuring fetal heart tones when birth is not imminent.(11) Suspected malpresentation incompatible with vaginal delivery unless birth is imminent.(12) Abnormal auscultated fetal heart rate pattern unresponsive to treatment or inability to auscultate fetal heart tones.(13) Excessive vomiting, dehydration, or exhaustion unresponsive to treatment.(14) Blood pressure greater than 140/90 that persists or rises and birth is not imminent.(15) Maternal fever equal to or greater than one hundred and four-tenths (100.4) degrees Fahrenheit.(16) Labor or premature rupture of membranes (PROM) less than thirty-seven (37) weeks of gestation, documented by ultrasound or clinically calculated due date in the absence of ultrasound.(d) A certified direct entry midwife shall refer for consultation or transfer care to a physician if any of the following maternal postpartum conditions exist: (1) Undelivered placenta.(2) Uncontrolled hemorrhage.(4) Signs of deep vein thrombosis (DVT).(5) Subinvolution of the uterus.(6) Repair of laceration beyond the skill of the certified direct entry midwife.(7) Failure of laceration or episiotomy to heal and with signs of infection or breakdown.(8) Infection requiring prescriptive therapy; or(9) Severe perinatal mood disorder or psychosis.(e) A certified direct entry midwife shall refer for consultation or transfer care to a physician if any of the following neonatal conditions exist:(1) Persistent respiratory distress.(2) Persistent pallor or central cyanosis.(3) Jaundice within the first twenty-four (24) hours after birth.(7) Major congenital anomaly not diagnosed prenatally.(8) Unstable vital signs.(9) Persistent hypotonia, lethargy, flaccidity, or irritability.(10) Birth weight under five (5) pounds.(11) Abnormal laboratory test results, including abnormal newborn screening results.(12) Two (2) vessel cord.Medical Licensing Board of Indiana; 844 IAC 17-1-9; filed 4/20/2017, 9:26 a.m.: 20170517-IR-844150448FRAReadopted filed 5/30/2023, 1:19 p.m.: 20230628-IR-844230101RFAReadopted filed 2/27/2024, 10:19 a.m.: 20240327-IR-844230772RFA