Current through Reg. 49, No. 12; March 22, 2024
(a) Prior to delivery, the midwife shall
establish a plan with the client for continuing care of the newborn. This plan
shall:
(1) include referral or transfer to a
health care professional who has current pediatric knowledge;
(2) include a recommendation that the client
pre-arrange the timing of the first newborn visit with the health care
professional; and
(3) be documented
in the midwifery record.
(b) Using reasonable skill and knowledge, the
midwife shall:
(1) collect, assess and
document newborn care data by monitoring the vital signs, performing a physical
exam, and obtaining the laboratory tests necessary for the infant during the
postpartum period;
(2) provide
appropriate education and counseling to the mother; and
(3) observe the newborn for a minimum of two
hours after he or she is stable with no signs of distress.
(c) If on any newborn assessment in the
immediate postpartum period (first six hours of life), one of the following
conditions exists, the midwife shall recommend referral and document that
recommendation in the midwifery record:
(1)
birth injury;
(2) gestational age
assessment less than 36 weeks;
(3)
small for gestational age;
(4)
larger than 97th percentile for gestational age; or
(5) any other abnormal newborn behavior or
appearance which could adversely affect the newborn, as assessed by a midwife
exercising reasonable skill and knowledge.
(d) If on any newborn assessment in the
immediate postpartum period (first six hours of life), one of the following
conditions exists, the midwife shall initiate immediate transfer to an
appropriate health care professional, initiate emergency care as indicated by
the situation, continue care as needed, and document that action in the
midwifery record:
(1) non-transient
respiratory distress;
(2)
non-transient pallor or central cyanosis;
(3) jaundice;
(4) apgar at 5 minutes less than or equal to
6;
(5) prolonged apnea;
(6) hemorrhage;
(7) signs of infection;
(8) seizure;
(9) major congenital anomaly not diagnosed
prenatally;
(10) unstable vital
signs;
(11) prolonged:
(A) lethargy;
(B) flaccidity; or
(C) irritability;
(12) inability to suck;
(13) persistent jitteriness;
(14) hyperthermia;
(15) hypothermia; or
(16) other abnormal newborn behavior or
appearance which could threaten the life of the newborn, as assessed by a
midwife exercising reasonable skill and knowledge.
(e) If on any newborn assessment after the
immediate postpartum period, one of the following conditions exists, the
midwife shall recommend referral to an appropriate health care professional and
document that recommendation in the midwifery record:
(1) abnormal laboratory test
results;
(2) minor congenital
anomaly;
(3) failure to thrive;
or
(4) any other abnormal newborn
behavior or appearance which could adversely affect the infant, as assessed by
a midwife exercising reasonable skill and knowledge.
(f) If on any newborn assessment after the
immediate postpartum period, one of the following conditions exists, the
midwife shall initiate immediate transfer to an appropriate health care
professional and document that action in the midwifery record:
(1) respiratory distress;
(2) pallor or central cyanosis;
(3) pathological jaundice;
(4) hemorrhage;
(5) seizure;
(6) inability to urinate or pass meconium
within 24 hours of birth;
(7)
unstable vital signs;
(8)
lethargy;
(9) flaccidity;
(10) irritability;
(11) inability to feed;
(12) persistent jitteriness; or
(13) any other abnormal newborn behavior or
appearance which could threaten the life of the newborn, as assessed by a
midwife exercising reasonable skill and knowledge.