64B24-7.009. Responsibilities of the Midwife During Postpartum

(1) Care of the newborn shall include:

(a) Clearing the airway of mucus.

(b) Clamping and cutting the umbilical cord.

(c) Obtaining a cord blood sample for laboratory testing for type, Rh Factor, and direct Coombs test when the mother is Rh negative.

(d) Assessing the newborn’s condition according to Apgar scoring at one (1) minute and five (5) minutes and record the results of each assessment.

(e) Weighing the infant.

(f) Instilling prophylaxis into each eye or retain the written objection pursuant to Section 383.04 and 383.06, F.S.

(g) Administering vitamin K prophylaxis.

(h) Examining the newborn and reporting any abnormalities or problems to the physician including low Apgar score.

(i) Providing for infant bonding with parent.

(2) The midwife shall consult, refer or transfer the infant to a physician if any of the following conditions occur:

(a) Apgar score less than 7 at 5 minutes.

(b) Signs of pre- or post-maturity.

(c) Weight: if less than 2500 grams.

(d) Jaundice.

(e) Persistent hypothermia, meaning a body temperature of less than 97º F rectal after 2 hours of life.

(f) Respiratory problem.

(g) Exaggerated tremors.

(h) Major congenital anomaly.

(i) Any condition requiring more than 4 hours of postdelivery observation.

(3) Care of the mother shall include:

(a) Observation for signs of hemorrhage.

(b) Inspection of the expelled placenta to insure that it is intact and free from defects or abnormalities.

(c) Palpation of the fundus to insure that it is firm.

(d) The midwife shall instruct the mother in self care and care of the infant including feeding and cord care.

(4) The midwife must remain with the mother and infant for at least 2 hours postpartum, or until both the mother’s and infant’s conditions are stable, whichever is longer. Maternal stability is evidenced by normal blood pressure, pulse, respirations, bladder functioning, fundus firm and lochia normal. Infant stability is evidenced by established respirations, normal temperature, and strong sucking.

(5) If any complications arise, such as a retained placenta or postpartum hemorrhage, the midwife shall consult with a physician, or transport the patient for emergency medical care dependent upon the urgency of the situation.

(6) A follow-up visit shall be made between 24 and 48 hours following delivery, unless conditions warrant an earlier visit. The midwife may arrange for such a visit to be made by a physician, certified nurse midwife, registered nurse, or another licensed midwife. The patient shall be instructed to have a postpartum examination within 6 to 8 weeks after delivery or sooner if any abnormalities exist or problems arise.

(7) If the mother is Rh negative, the midwife shall obtain the laboratory tests results of the cord blood studies, and if the infant is Rh positive, assure and document that the mother receives Rho immune globulin within 72 hours of the delivery.

(8) The midwife shall instruct the parents regarding the requirement for the infant screening blood test for metabolic disorders. If arrangements for this screening have not been made, the midwife shall notify the county health unit or retain the written objection pursuant to Section 383.14, F.S.

(9) The midwife shall conduct the Healthy Start Postnatal Screening for the infant or assure that it will be done.

(10) Within 5 days following each birth, form DH 511, Certificate of Live Birth, available from the local county health department, must be completed and submitted to the local registrar of vital statistics.

(a) For births occurring in a hospital, birth center or other health care facility, or en route thereto, the person in charge of the facility is responsible for the preparation and filing of the certificate, and for certifying the facts of the birth therein. Within 48 hours of the birth, the midwife shall provide the facility with the medical information required for the birth certificate.

(b) For births occurring outside a facility wherein a licensed midwife is in attendance during or immediately after the delivery, the midwife shall prepare and file the certificate.

Specific Authority 467.005 FS. Law Implemented 382.013, 467.015 FS. History–New 7-14-94, Formerly 61E8-7.009, Amended 3-20-96, Formerly 59DD-7.009, Amended 9-11-02.