La. Admin. Code tit. 46, § XLV-5345 - Postpartum Care [Formerly Section 5327 and Section 5357]
A. The licensed midwife practitioner shall
remain with the mother and infant for at least two hours postpartum, or until
the mother's condition is stable and the infant's condition is stable,
whichever is longer. Maternal stability is evidenced by normal blood pressure,
normal pulse, normal respirations, firm fundus, and normal lochia. Infant
stability is evidenced by established respirations, normal temperature, strong
sucking and normal heart rate.
B.
Immediately following delivery of the placenta, the midwife must determine that
the uterus is firmly contracted without excessive bleeding. The uterus should
be massaged firmly to stimulate contraction if relaxation is noted.
C. In case of an unsensitized Rh negative
mother, the midwife shall obtain a sample of cord blood from the placenta and
arrange for testing within 24 hours of the birth and ensure referral to a
physician so that the mother receives Rh immunoglobulin (Rhlg) as indicated
within 72 hours of delivery.
D. The
midwife shall provide the client with information concerning routine postpartum
care of the mother and infant, including information on breast-feeding, care of
the infants umbilical cord, and perinatal care.
E. The midwife shall recommend that the
parents immediately contact the pediatrician or primary care physician who will
be assuming care for the infant to arrange for a neonatal examination within 72
hours or sooner if it becomes apparent that the newborn requires medical
attention for problems associated with, but not limited, to congenital or other
anomalies. The midwife shall provide the doctor with her written summary of
labor, delivery, and assessment of the newborn and shall be available to
consult with the doctor concerning the infant's condition.
F. The midwife shall make a postpartum visit
within 36 hours of birth, with further visits as necessary. The purpose of
these contacts is to ascertain that the infant is alert, has good color, is
breathing well, and is establishing a healthy pattern of waking, feeding, and
sleeping and that the mother is not bleeding excessively, has a firm fundus,
does not have a fever or other signs of infection, is voiding properly, and is
establishing successful breastfeeding. In the event that any complications
arise, the midwife shall consult with a physician or other appropriate health
care provider or shall ensure that the client contacts her own
physician.
G. The midwife may
conduct a postpartum office visit not later than six weeks postpartum, to
include a recommendation for rubella vaccine if indicated, counseling
concerning contraception and answering any other questions that have arisen.
Alternatively, the client may be referred back to her primary care physician or
other health care provider for this care.
H. The midwife shall encourage the mother to
have a postpartum evaluation conducted by a physician within two to six weeks
after delivery.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
A. The licensed midwife practitioner shall remain with the mother and infant for at least two hours postpartum, or until the mother's condition is stable and the infant's condition is stable, whichever is longer. Maternal stability is evidenced by normal blood pressure, normal pulse, normal respirations, firm fundus, and normal lochia. Infant stability is evidenced by established respirations, normal temperature, strong sucking and normal heart rate.
B. Immediately following delivery of the placenta, the midwife must determine that the uterus is firmly contracted without excessive bleeding. The uterus should be massaged firmly to stimulate contraction if relaxation is noted.
C. In case of an unsensitized Rh negative mother, the midwife shall obtain a sample of cord blood from the placenta and arrange for testing within 24 hours of the birth and ensure referral to a physician so that the mother receives Rh immunoglobulin (Rhlg) as indicated within 72 hours of delivery.
D. The midwife shall provide the client with information concerning routine postpartum care of the mother and infant, including information on breast-feeding, care of the infants umbilical cord, and perinatal care.
E. The midwife shall recommend that the parents immediately contact the pediatrician or primary care physician who will be assuming care for the infant to arrange for a neonatal examination within 72 hours or sooner if it becomes apparent that the newborn requires medical attention for problems associated with, but not limited, to congenital or other anomalies. The midwife shall provide the doctor with her written summary of labor, delivery, and assessment of the newborn and shall be available to consult with the doctor concerning the infant's condition.
F. The midwife shall make a postpartum visit within 36 hours of birth, with further visits as necessary. The purpose of these contacts is to ascertain that the infant is alert, has good color, is breathing well, and is establishing a healthy pattern of waking, feeding, and sleeping and that the mother is not bleeding excessively, has a firm fundus, does not have a fever or other signs of infection, is voiding properly, and is establishing successful breastfeeding. In the event that any complications arise, the midwife shall consult with a physician or other appropriate health care provider or shall ensure that the client contacts her own physician.
G. The midwife may conduct a postpartum office visit not later than six weeks postpartum, to include a recommendation for rubella vaccine if indicated, counseling concerning contraception and answering any other questions that have arisen. Alternatively, the client may be referred back to her primary care physician or other health care provider for this care.
H. The midwife shall encourage the mother to have a postpartum evaluation conducted by a physician within two to six weeks after delivery.