Rule 24.111.611 - CONDITIONS WHICH REQUIRE PHYSICIAN CONSULTATION OR TRANSFER OF CARE(1) If the following conditions are present in a client, the direct-entry midwife shall attempt to consult a physician and/or transfer care to a physician. A certified nurse midwife or licensed direct-entry midwife shall also be consulted if appropriate attempts to consult a physician have been unsuccessful. Documentation of the condition, recommendation (including continuation of care by the licensed direct-entry midwife, if appropriate) and treatment must be maintained in the client records. Conditions include, but are not limited to the following: (a) prenatal factors: (ii) rubella contracted in the first or second trimester;(iii) maternal anemia (hemoglobin less than ten, hematocrit less than 30) unresponsive within one month of treatment;(iv) oligohydramnios (suspected);(v) polyhydramnios (suspected);(vi) premature rupture of membranes at less than 36 1/2 weeks;(vii) post term at 42 weeks by dates and physical exam;(viii) large for gestational age (LGA) or small for gestational age (SGA) (suspected);(ix) Rh sensitization in present pregnancy (not resulting from recent Rhogam);(x) history of severe postpartum hemorrhage requiring transfusion;(xi) known serious maternal viral/bacterial infection at term;(xii) blood pressure greater than 140/90 or increase of 30 mm Hg systolic or 15 mm Hg diastolic over baseline, that is unresolved within seven days;(xiii) develops signs and symptoms of preeclampsia;(xiv) develops signs and symptoms of gestational diabetes;(xv) has unresolved vaginitis that requires antibiotic treatment;(xvi) has unresolved urinary tract infection;(xvii) continued vaginal bleeding before onset of labor;(xviii) signs of fetal distress including prolonged fetal tachycardia (more than 170) or prolonged fetal bradycardia (less than 100), or fetal demise;(xx) history of preterm delivery (less than 36 1/2 weeks);(xxi) positive maternal diagnosis of HIV;(xxii) abnormal Pap smear (showing atypia or CIN);(xxiv) grand multiparity;(xxv) maternal age less than 16 or greater than 40;(xxvi) history of previous stillbirth;(xxvii) history of incompetent cervix;(xxviii) history of previous birth with Erb's Palsy or fractured clavicle or humerus;(xxix) history of neonatal anomaly; or(xxx) history of previous cesarean birth.(b) labor, birth risks, and postpartum factors:(i) significant fetal distress including prolonged fetal tachycardia (more than 170) or prolonged fetal bradycardia (less than 100);(ii) unengaged vertex above -3 station in primipara in active labor;(iii) fever of 102 degrees Fahrenheit or greater;(iv) prolonged rupture of membranes (greater than 24 hours with no progress of labor);(v) meconium stained fluid with delivery not imminent;(vi) severe bleeding prior to or during delivery;(vii) maternal respiratory distress;(viii) mother desires consult or transfer;(ix) uncontrolled maternal hemorrhage;(x) third or fourth degree perineal laceration;(xii) evidence of thrombophlebitis.(c) newborn risk factors: (i) less than three vessels in umbilical cord;(ii) Apgar score less than seven at five minutes;(iii) fails to urinate or move bowels within 24 hours;(v) respiratory distress;(vi) cardiac irregularities;(vii) pale cyanotic or gray color;(ix) jaundice within 24 hours of birth;(x) signs of prematurity, dysmaturity, or postmaturity;(xiii) signs of hypoglycemia;(xiv) abnormal facial expression;(xv) abnormal body temperature (outside the 97-100 degrees Fahrenheit range, not resolved within one hour);(xvi) abnormal neurological signs, including jitteriness, decreased tones, seizures or poor sucking reflex; or(xvii) inability to nurse after 12 hours.Mont. Admin. r. 24.111.611
NEW, 1993 MAR p. 1639, Eff. 7/30/93; AMD, 1994 MAR p. 386, Eff. 2/25/94; AMD, 1995 MAR p. 2684, Eff. 12/8/95; TRANS, from Commerce, 2001 MAR p. 1642; AMD,2018 MAR p. 976, Eff.5/12/2018; AMD, 2023 MAR p. 886, Eff. 8/26/2023AUTH: 37-27-105, MCA; IMP: 37-27-105, MCA