Mich. Admin. Code R. 338.17135 - Emergent transfer of care

Rule 135.

(1) In the following emergent circumstances, a licensed midwife shall immediately arrange for transport of the patient to a hospital and notify hospital staff of the transfer of care of the patient:

(a) Mother:

(i) Seizures.

(ii) Unconsciousness.

(iii) Respiratory distress or arrest.

(iv) Maternal shock unresponsive to treatment.

(v) Symptoms of maternal stroke.

(vi) Symptoms of suspected psychosis.

(vii) Symptomatic cardiac arrhythmias or chest pain.

(viii) Prolapsed umbilical cord.

(ix) Symptoms of uterine rupture.

(x) Symptoms of placental abruption.

(xi) Symptoms of preeclampsia or eclampsia.

(xii) Severe abdominal pain inconsistent with normal labor.

(xiii) Symptoms of pulmonary or amniotic fluid embolism.

(xiv) Symptoms of chorioamnionitis that include the presence of a fever greater than 100.4 degrees Fahrenheit or 38.0 degrees Celsius and 2 of the following 3 signs: uterine tenderness, maternal or fetal tachycardia, or foul/purulent amniotic fluid.

(xv) Unresolved fetal malpresentation not compatible with spontaneous vaginal delivery.

(xvi) Hemorrhage non-responsive to therapy.

(xvii) Uterine inversion.

(xviii) Persistent uterine atony.

(xix) Symptoms of anaphylaxis.

(xx) Failure to deliver placenta within 2 hours in the third stage.

(xxi) Persistent abnormal vital signs.

(xxii) Significant abnormal bleeding prior to delivery, with or without abdominal pain.

(xxiii) Fetal distress evidenced by abnormal fetal heart tones when birth is not imminent.

(xxiv) A single blood pressure reading of greater than or equal to 160/110.

(xxv) Genital herpes lesions at the time of delivery if the lesions cannot be covered by an occlusive dressing.

(b) Infant:

(i) Persistent cardiac irregularities.

(ii) Persistent central cyanosis, pallor, or abnormal perfusion.

(iii) Persistent lethargy or poor muscle tone.

(iv) Seizures.

(v) Apgar score of 6 or less at 5 minutes without significant improvement by 10 minutes.

(vi) Non-transient respiratory distress.

(vii) Significant signs or symptoms of infection.

(viii) Evidence of unresolved hypoglycemia.

(ix) Abnormal, bulging, or depressed fontanel.

(x) Significant evidence of prematurity.

(xi) Clinically significant abnormalities in vital signs, muscle tone, or behavior.

(xii) Failed critical congenital heart defect screening.

(xiii) Persistent inability to suck.

(xiv) Clinically significant abdominal distension.

(xv) Clinically significant projectile vomiting.

(xvi) Contact with genital herpes lesions at birth.

(2) As required under subrule (1) of this rule, a licensed midwife shall initiate immediate transport according to the licensed midwife's emergency care plan; provide necessary emergency stabilization until transfer to a hospital or emergency medical services personnel is completed; provide pertinent information to the provider assuming care of the patient or patients; and is encouraged to fill out a patient transfer form provided by the department.

(3) Transport via private vehicle is an acceptable method of transport if it is the most expedient method for accessing medical services.

(4) A licensed midwife if present, is allowed to provide care to a patient with any of the complications or conditions set forth in this rule under any of the following circumstances:

(a) If no emergency medical services personnel are available.

(b) If delivery occurs during transport.

(c) If the patient refuses to be transported to the hospital.

(d) If the transfer or transport entails futility, or extraordinary and unnecessary human suffering.

(5) The licensed midwife may remain in consultation with the appropriate health professional after a transfer is made.

(6) If authorized by the patient, a licensed midwife may be able to be present during the labor and childbirth, and care may return to the midwife upon discharge.

Notes

Mich. Admin. Code R. 338.17135

2019 MR 14, Eff. 8/1/2019