California College of Midwives
State chapter ~ American College of Community Midwives


Section 3 J

Minimum Practice Requirements – POSTPARTUM REFFERAL


~ to define and clarify minimum practice requirement for the safe care of women and infants in regard to POSTPARTUM PHYSICIAN CONSULTATION, REFERRAL, ELECTIVE TRANSFER OF CARE & EMERGENCY TRANSPORT


h The Midwife shall consult with a physician and/or another professional whenever there are significant deviations (including abnormal laboratory results), during the postpartum period. If a referral to a physician is needed, the Midwife will remain in consultation with the physician until resolution of the concern. It is appropriate for the Midwife to maintain care of her client to the greatest degree possible, in accordance with the client’s wishes.


A.     The following maternal conditions require physician consultation and may require physician referral and/or transfer of care.  


Immediate Postpartum Conditions ~ The Midwife shall arrange for immediate consultation and transport according to the emergency plan if the following conditions exist.


It should be noted that because of time urgency during certain situations, it may be necessary to institute emergency interventions while waiting physician consultation or emergency transport.


These maternal conditions include but are not limited to:


a.       Seizure or unconsciousness  (beyond transient fainting when getting up after birth)

b.      significant hemorrhage, not responsive to treatment;

c.       total maternal blood loss of more than 1,000 cc

d.      sustained maternal vital sign instability;

e.       adherent or retained placenta;

f.        uterine prolapse

g.       uterine inversion

h.       repair of laceration(s)/episiotomy beyond Midwife’s level of expertise

i.         anaphylaxis

j.        infection

k.      normally hydrated mother unable to void spontaneously within 6 hours after birth (if unable to catheterize), 12 hours postpartum if catheterized and still unable to void

l.         other serious medical or mental conditions

m.     mother’s request



B.     Extended Postpartum Condition ~ The midwife shall arrange for consultation and/or transport when/if:


1.      maternal fever of greater than 101oF on any of the second through 10th days postpartum

2.      lochia is excessive, foul smelling, or otherwise abnormal

3.      signs of clinically significant depression (not the "baby blues")

4.      signs of infection in perineal laceration or episiotomy repair

5.      Social, emotional or other physical conditions as defined by the Midwife