California College of Midwives
State chapter ~ American College of Community Midwives

Section Two D

~ to establish the following minimum practice requirement for emergency care parameters regarding FIRST RESPONDER EMERGENCY CARE & EMERGENCY TRANSFER

MEMERGENCY DEFINED ~ “emergency” refers to a situation that presents an immediate hazard to the health and safety of the client or her unborn or newborn baby or would cause extreme and unnecessary suffering.

e The following procedures may be performed by the midwife in an emergency situation, for which the health and safety of the mother or newborn are determined to be at risk.

1. Cardiopulmonary resuscitation of the mother or newborn with a bag and mask

2. Administration of oxygen

3. Episiotomy

4. Administration of oxytocin (Pitocin or Methergine) to control postpartum bleeding

5. Manual exploration of the uterus for placenta to control severe bleeding

6. Lactated Ringer or saline IV fluids

7. Epinephrine for life-threatening allergic reaction or anaphylactic shock

Transfer of Care in an Emergency Situation

e In an emergency situation, the midwife is the “first responder” whose immediate responsibility is to initiate emergency care as indicated by the situation. Concurrently with the first-responder role, the midwife shall initiate immediate transfer of care in accordance with practice guidelines and the specific arrangements identified in the client’s emergency transfer plan. The midwife shall make a reasonable effort to contact the health care professional and/or institution to whom the client will be transferred and to follow the health care professional's instructions; and continue emergency care as needed while:

1. transporting the client by private vehicle or
2. calling 911 and reporting the need for immediate transfer

e Emergency Exemptions Clause (Sec 2063) The California licensed midwife may deliver a woman with complications or other bona fide emergency conditions, if the delivery is a verifiable emergency and no physician or other equivalent medical services are available.