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


Section 3 I

Minimum Practice Requirements POSTPARTUM CARE

 

~ to define and clarify minimum practice requirements for the safe POSTPARTUM CARE of women after the birth of the baby

 

e After the birth of the baby, the Midwife shall assess, monitor, and support the mother during the immediate postpartum period and shall remain with the mother and infant for a minimum of two hours after the birth or until the mother and infant are in stable condition, whichever is longer.

 

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

2.      Neonatal stability is evidenced by established respirations, normal temperature, normal heart rate and appropriate sucking reflex in the infant

 

A. Immediate postpartum care will assess:

 

1. overall maternal well-being

2. bleeding

3. vital signs

4. fundal height and firmness

5. bowel/bladder function

6. perineal exam and assessment

7. suture 1st or 2nd degree laceration(s)/episiotomy, as indicated

8. facilitation of maternal-infant bonding and family adjustment

9. concerns of the mother

 

B. The midwife shall instruct the mother and family in normal newborn behavior, breastfeeding or formula feeding as applicable, postpartum self care, emergency measures and shall schedule or make arrangements for the follow up visit before leaving the familys home.

 

C. The midwife shall provide or refer all Rh negative mothers for Rhogam within 72 hours of the birth.

 

D. On-going / follow-up postpartal care

The midwife shall make a follow up visit within 72 hours to assess the progress of the mother and infant. Such visit shall include an assessment of, at a minimum:

 

1.      overall maternal well-being including VS as indicated

2.      lochia, fundal height and firmness

3.      perineum, exam and assessment as indicated

4.      breasts, nipples, presence of colostrum or milk

5.      nutrition & hydration and ability or willingness of family to assist new mother

6.      elimination including ability to void and status of hemorrhoids

7.      emotional adjustment, maternal-infant bonding and family adjustment

8.      concerns of the mother