§ 8-6C-03

A licensed direct–entry midwife may not assume or continue to take responsibility for a patient’s pregnancy and birth care and shall arrange for the orderly transfer of care to a health care practitioner for a patient who is already under the care of the licensed direct–entry midwife, if any of the following disorders or situations is found to be present at the initial interview or if any of the following disorders or situations occur as prenatal care proceeds:

(1) Diabetes mellitus, including uncontrolled gestational diabetes;

(2) Hyperthyroidism treated with medication;

(3) Uncontrolled hypothyroidism;

(4) Epilepsy with seizures or antiepileptic drug use during the previous 12 months;

(5) Coagulation disorders;

(6) Chronic pulmonary disease;

(7) Heart disease in which there are arrhythmias or murmurs except when, after evaluation, it is the opinion of a physician licensed under Title 14 of this article or a licensed nurse certified as a nurse–midwife or a nurse practitioner under this title that midwifery care may proceed;

(8) Hypertension, including pregnancy–induced hypertension (PIH);

(9) Renal disease;

(10) Previous uterine surgery, including a cesarean section or myomectomy;

(11) Indications that the fetus has died in utero;

(12) Premature labor (gestation less than 37 weeks);

(13) Multiple gestation;

(14) Noncephalic presentation at or after 38 weeks;

(15) Placenta previa or abruption;

(16) Preeclampsia;

(17) Severe anemia, defined as hemoglobin less than 10 g/dL:

(i) That has been measured after treatment; or

(ii) Based on blood tests performed at or after 36 weeks;

(18) Uncommon diseases and disorders, including Addison’s disease, Cushing’s disease, systemic lupus erythematosus, antiphospholipid syndrome, scleroderma, rheumatoid arthritis, periarteritis nodosa, and Marfan’s syndrome;

(19) AIDS/HIV;

(20) Hepatitis;

(21) Acute toxoplasmosis infection, if the patient is symptomatic;

(22) Acute Rubella infection during pregnancy;

(23) Acute cytomegalovirus infection, if the patient is symptomatic;

(24) Acute Parvovirus infection, if the patient is symptomatic;

(25) Alcohol abuse, substance abuse, or prescription abuse during pregnancy;

(26) Continued daily tobacco use into the second trimester;

(27) Thrombosis;

(28) Inflammatory bowel disease that is not in remission;

(29) Primary genital herpes simplex virus infection during the third trimester or active genital herpes lesions at the time of labor;

(30) Significant fetal congenital anomaly that directly impacts the birthing process or requires immediate emergency care, as determined by the Board in regulations;

(31) Ectopic pregnancy; or

(32) Post term maturity (gestational age 42 0/7 weeks and beyond).