12 AAC 14.520. Postpartum care

(a) Postpartum care is management of the client through the six-week postpartum period.

(b) After normal delivery, a certified direct-entry midwife shall remain with the client and infant for at least three hours postpartum or until both the client's and infant's conditions are stable. If the client or infant is not stable within five hours, the certified direct-entry midwife shall transfer the client to an appropriate medical facility.

(c) Maternal stability is evidenced by normal blood pressure, pulse, and respiration; firmness of fundus; normal lochia; and the ability to empty the bladder.

(d) Neonatal stability is evidenced by established respirations, normal temperature, normal heart rate, and strong sucking of the infant.

(e) A certified direct-entry midwife shall maintain close contact with the client during the first 72 hours postpartum, making at least one postpartum visit to evaluate the condition of the mother and infant within 36 hours of birth. A certified direct-entry midwife shall determine whether the mother is bleeding excessively, has a firm fundus, has a normal temperature, and is establishing successful breast-feeding or bottle-feeding.

(f) In the case of a mother with Rh negative type blood, a certified direct-entry midwife shall

(1) obtain a sample of cord blood from the placenta and arrange for testing; and

(2) administer or arrange for and be certain that the mother receives RH immune globulin as indicated within 72 hours of delivery.

(g) A certified direct-entry midwife shall obtain medical consultation or refer for medical care any client who, during the postpartum period,

(1) does not void within six hours after birth;

(2) has a third or fourth degree perineal or cervical laceration;

(3) develops a fever greater than 100.4УИ F. or 38УИ C. on any two of the first 10 postpartum days;

(4) develops foul smelling lochia;

(5) develops hematoma;

(6) does not deliver the placenta within one hour of delivery of the infant;

(7) bleeds more than 1,000 cc (four cups) immediately after the delivery of the placenta and the bleeding is not readily controlled;

(8) has a partially separated placenta with

(A) heavy bleeding;

(B) a blood pressure below 90 systolic;

(D) weakness and dizziness; or

(9) has retained placental fragments or membranes.

History: Eff. 5/11/94, Register 130

Authority: AS 08.65.030

AS 08.65.140

AS 08.65.190

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