LAC 46:XLV.5339. Required Physician Consultation, Antepartum and Intrapartum Periods [Formerly §5363.A-B]

A. The midwife shall obtain medical consultation or refer for medical care any woman who during the antepartum period: 1. develops edema of the face and hands; 2. develops severe, persistent headaches, epigastric pain, or visual disturbances; 3. develops a blood pressure of 140/90 or greater; 4. does not gain 14 pounds by 30 weeks gestation or at least 4 pounds a month in the last trimester or gains more than 6 pounds in two weeks in any trimester; 5. develops greater than trace glucosuria or greater than trace proteinuria on two consecutive separate visits; 6. has abnormal vaginal discharge with no signs of improvement with medication; 7. has symptoms of urinary tract infection; 8. has vaginal bleeding before onset of labor; 9. has rupture of membranes prior to 37 weeks gestation; 10. has marked decrease in or cessation of fetal movement; 11. has inappropriate gestational size; 12. has demonstrated anemia by blood test (hematocrit less than 30 percent); 13. has a fever of equal or greater than 100.4F or 38C for 24 hours; 14. has polyhydramnios or oligohydramnios; 15. has excessive vomiting or continued vomiting after 24 weeks gestation; 16. has severe, protruding varicose veins of extremities or vulva; 17. has known structural abnormalities of the reproductive tract; 18. has a history of stillbirth from any cause; 19. has an abnormal Pap smear; 20. reaches a gestation of 41 weeks, 3 days by dates and examination. B. The midwife shall obtain medical consultation or refer for medical care any woman who during the intrapartum period: 1. develops a blood pressure of 140/90 or greater; 2. develops severe headache, epigastric pain, or visual disturbance; 3. develops proteinuria; 4. develops a fever over 100.4F or 38C; 5. develops respiratory distress; 6. has persistent or recurrent fetal heart tones below 100 or above 160 beats per minute between or during contractions, or a fetal heart rate that is irregular; 7. has ruptured membranes without onset of labor after 12 hours; 8. has bleeding prior to delivery (other than bloody show); 9. has meconium or blood stained amniotic fluid with abnormal fetal heart tones; 10. has an abnormal presentation other than vertex; 11. does not progress in effacement, dilation, or station in accordance with practice standards; 12. does not show continued progress to deliver in second stage labor in accordance with practice standards; 13. does not deliver the placenta within one hour if there is no bleeding and the fundus is firm; 14. has a partially separated placenta during the third stage of labor with bleeding; 15. has a blood pressure below 100 systolic if the pulse rate exceeds 100 beats per minute or who is weak and dizzy; 16. bleeds more than 500 cc with or after the delivery of the placenta; 17. has retained placental fragment or membranes; or 18. desires medical consultation or transfer.