59A-11.016. Postpartum Care

(1) A cord blood sample shall be secured for laboratory testing for type, Rh determination, and direct Coombs test when the mother is Rh negative.

(2) The newborn shall be weighed, measured, inspected for abnormalities and examined for complications. An identification tape shall be placed on the newborn if more than one newborn is at the center at the same time.

(3) One half milligram of Vitamin K shall be administered to the newborn within 24 hours after birth. If no one on the birth center staff is licensed to administer this medication, the parents shall be instructed to take the infant to a private physician or clinic for the injection.

(4) The newborn shall be referred to physician or hospital care if the following conditions occur:

(a) Low birthweight (under 2500 grams);

(b) Apgar score of six or less at five minutes;

(c) Signs of pre or post maturity;

(d) Jaundice;

(e) Persistent hypothermia consisting of a body temperature of less than 97 degrees Fahrenheit for more than two hours after birth;

(f) Respiratory difficulties;

(g) Major congenital anomalies;

(h) Exaggerated tremors; and,

(i) Any other condition requiring medical care.

(5) The condition of the mother shall be monitored frequently to detect signs of hemorrhage, or other complications, requiring prompt transfer to a physician or hospital.

(6) The mother and infant shall be discharged from the birth center within 24 hours after the birth occurs except under the following conditions:

(a) The mother is in a deep sleep when the 24 hour period is completed. In this case the mother shall be discharged as soon after waking as feasible; or

(b) The 24 hour period is completed during the middle of the night.

(7) If the mother, or infant, is retained at the birth center longer than 24 hours after birth, except as identified in paragraphs 59A-11.016(6)(a) and (b), F.A.C., a report shall be filed with the local county public health unit within 48 hours after the birth describing the circumstances and reasons for the decision.

(8) A postpartum examination shall be performed within 72 hours after delivery and at approximately four to six weeks after delivery.

(a) The examination within 72 hours shall include at a minimum:

1. Interval history;

2. Mental health screening;

3. Blood pressure measurement; and,

4. Observation of the breasts, perineum and abdomen.

(b) The examination at four to six weeks shall include all of the above and also:

1. Weight;

2. Hemoglobin or hematocrit; and,

3. Bi-manual pelvic examination.

(9) The mother shall be counseled regarding breast feeding, perineal care, family planning, signs of common complications, postpartum depression including the provision of the telephone number of the Family Health Line operated pursuant to section 383.011, F.S., activities and exercises, sex relations, care and feeding of the newborn, and changing family relationships.

(10) The metabolic screening test shall be performed on the newborn in accordance with section 383.14, F.S.

(11) The parents shall be referred to providers of pediatric care and instructed about immunization.

(12) If complications in the mother or newborn occur during the postpartum period, a consultation or referral shall be made to the appropriate source of secondary or tertiary care.

(13) If the mother refuses to permit eye prophylaxis on account of religious beliefs contrary to the use of drugs, Vitamin K injection, or metabolic screening test, a waiver indicating this decision shall be signed by the mother, witnessed by a clinical staff member, and filed with the clinical record.

(14) Infant (postnatal) screening shall be offered and documented in accordance with the following statute and rule administered by the Department of Health: section 383.14, F.S. and chapter 64C-7, F.A.C.

Rulemaking Authority 383.309 FS. Law Implemented 383.318 FS. History–New 3-4-85, Formerly 10D-90.16, 10D-90.016, Amended 9-27-94, 2-12-96, 1-16-19.