Indications Requiring Transfer of Care

Situations that a midwife must transfer care to a doctor or nurse midwife.


   Labor, birth risks, and postpartum factors:

           Significant fetal distress,  including prolonged elevated baby heart beat (more than 170) or prolonged low baby heart beat (less than 100);

          Unengaged baby head in mother’s pelvis, above -3 station in first time mother, in active labor;

           Fever of 102 degrees Fahrenheit or greater;

            Prolonged rupture of membranes (greater than 24 hours with no progress of labor);

          Thick meconium stained fluid, with birth not imminent;

           Severe bleeding prior to or during delivery;

          Maternal respiratory distress;

           Mother desires consult or transfer;

          Maternal bleeding after a birth uncontrolled by IM pitocin;

          Third or fourth degree tear in her bottom after birth (into the muscle);

          Signs of infection;

          Evidence of blood clots in the legs.


Newborn risk factors:

            Less than three vessels in umbilical cord;

            Apgar score less than seven at five minutes;

           Baby fails to urinate or move bowels within 24 hours;

           Obvious birth anomaly in baby;

            Respiratory distress;

           Cardiac irregularities;

            Pale cyanotic or gray color;

           Abnormal cry;

           Jaundice within 24 hours of birth;

            signs of prematurity, dysmaturity, or postmaturity;

           Baby is acting abnormally weak and sleepy, lethargic;

           Baby is swollen, has edema;

          Signs of hypoglycemia such as agitation, high pitched cry, sleepy, will not nurse

          Abnormal facial expression (possible seizures or nerve damage)

          Abnormal body temperature (outside the 97-100 degrees range, not resolved within one hour);

         Abnormal neurological signs, including jitteriness, decreased tones, seizures or poor sucking reflex; or inability to nurse after 12 hours.