LAC 46:XLV.5353. Required Physician Consultation, Postpartum Period [Formerly §5363.C-D]

A. The midwife shall obtain medical consultation or refer for medical care any woman who, during the postpartum period: 1. has a third or fourth degree laceration; 2. has uterine atony; 3. bleeds in an amount greater than normal lochial flow; 4. does not void within 2 hours of birth; 5. develops a fever greater than 100.4F or 38C on any two of the first 10 days postpartum excluding the first 24 hours; 6. develops foul smelling lochia; 7. develops blood pressure below 100/50 if pulse exceeds 100, pallor, cold clammy skin, and/or weak pulse. B. The midwife shall obtain medical consultation or refer for medical care any infant who: 1. has an Apgar score of 7 or less at 5 minutes; 2. has any obvious anomaly; 3. develops grunting respirations, retractions, or cyanosis; 4. has cardiac irregularities; 5. has a pale, cyanotic, or grey color; 6. develops jaundice within 48 hours of birth; 7. has an abnormal cry; 8. weighs less than 5 pounds or weighs more than 10 pounds; 9. shows signs of prematurity, dysmaturity, or postmaturity; 10. has meconium staining of the placenta, cord, and/or infant with signs or symptoms of aspiration pneumonia; 11. does not urinate or pass meconium in the first 24 hours after birth; 12. is lethargic or does not feed well; 13. has edema; 14. appears weak or flaccid, has abnormal feces, or appears not to be normal in any other respect; 15. has persistent temperature below 97F; 16. has jitteriness not resolved after feeding; or 17. has a blood glucose level of less than 30mg/dL.