1. (a) Immediate care. The LLM must remain in attendance for at least two (2) hours after the delivery and shall assess and record the following:

   1. (1) Immediately following the delivery of the placenta, the LLM shall:

      1. (A) Determine that the uterus is firmly contracted without excessive bleeding;
      2. (B) Ascertain that the placenta has been delivered completely; and
      3. (C) Determine the number of cord vessels;

   2. (2)

      1. (A) LLMs may repair first and second degree perineal lacerations.
      2. (B) LLMs may apply topical benzocaine fourteen percent (14%) (available in gel form, solution, or spray) for repair of lacerations.
      3. (C) Benzocaine requires a prescription from a physician, CNM, or Department of Health clinician for the client and the prescription must be written in the client’s name;

   3. (3)

      1. (A) During the two-hour postpartum period, the LLM shall assess, as needed:

2. (i) Uterine firmness;

   1. (ii) Vaginal bleeding;

      1. (iii) Vaginal swelling or tearing;

         1. (iv) Maternal blood pressure; and
         2. (v) Pulse.

      2. (B) The LLM shall remain in attendance until:

         1. (i) These signs are well within normal limits; or
         2. (ii) A physician or CNM is in attendance if they are found to be abnormal; and

   2. (4) The LLM shall leave instructions for follow-up care that include signs and symptoms of conditions that require medical evaluation such as:

      1. (A) Excessive bleeding;
      2. (B) Increasing pain;
      3. (C) Severe headaches or dizziness; and
      4. (D) Inability to void.

3. (b) Follow-up postpartum care.

   1. (1) A follow-up home visit shall be performed between twelve (12) to thirty-six (36) hours postpartum to evaluate for:

      1. (A) Excessive bleeding;
      2. (B) Infection; or
      3. (C) Other complications.
   2. (2) For all mothers with Rh negative blood and a newborn who is Rh positive, the LLM must counsel the mother to obtain postpartum Rh immunoglobulin within seventy-two (72) hours of delivery.

   3. (3)

      1. (A) The LLM is required to follow the mother for a minimum of thirty (30) days from delivery.
      2. (B) Care shall include family planning counseling and education on the need for updated immunizations, including the rubella vaccine if susceptible.
      3. (C) The final postpartum evaluation shall be performed between four (4) to six (6) weeks after delivery.

Codification Notes: "CNM" means certified nurse midwife. "LLM" means licensed lay midwife.