1. (a)

   1. (1) The LLM shall be responsible for newborn care immediately following the delivery and care of the healthy newborn for the first fourteen (14) days of life unless care is transferred to a physician or APRN specializing in the care of infants and children before that.
   2. (2) After fourteen (14) days the LLM is no longer responsible and the mother should seek further care from a physician or an APRN specializing in the care of infants and children.
   3. (3) If any abnormality is suspected, including, but not limited to, a report of an abnormal genetic/metabolic screen or positive antibody screen, the newborn must be sent for medical evaluation as soon as possible but no later than seventy-two (72) hours.
   4. (4) This does not preclude the LLM from providing counseling regarding routine newborn care and breastfeeding.

2. (b) Immediate care. The following services must be provided by the LLM as part of immediate newborn care:

   1. (1) Suction nose and mouth prior to delivery of shoulders if needed;
   2. (2) Assess presence of meconium;
   3. (3) Assess baby’s status at birth as vigorous or non-vigorous;
   4. (4) Immediately after delivering entire body, suction mouth, then nose again, if needed;
   5. (5) Clamp and cut the cord;

   6. (6)

      1. (A) Directly place baby skin-to-skin with mother, covering baby with a blanket.
      2. (B) The baby should ideally remain in direct skin-to-skin contact with their mother immediately after birth until the first feeding is accomplished;
   7. (7) Determine Apgar scores at one (1) and five (5) minutes after delivery while baby is with mother;

   8. (8)

      1. (A) Routine care can be done with the baby and mother in skin-to-skin contact to insure warmth.
      2. (B) Observe and record:

3. (i) Skin color and tone;

   1. (ii) Heart rate;

      1. (iii) Respiration rate and character;

         1. (iv)
4. (a) (a) Estimated gestational age.

5. (b) (b) Indicate average, small, or large for gestational age;

   1. (v) Axillary temperature; and

      1. (vi) Weight, length, head circumference; and

   2. (9) Obtain cord blood for Rh and antibody screen if mother is Rh negative.

      1. (c) Feeding.
   3. (1) Newborn should be placed at the breast as soon as stable after delivery.
   4. (2) The bottle-fed newborn should be offered formula of choice within the first two (2) to three (3) hours after birth.

   5. (3) Instruct the mother in normal and abnormal feeding patterns.

      1. (d)
   6. (1) If indicated, the LLM must advise parents that the newborn must receive either Erthromycin one-half of one percent (0.5%) Opthalmic or Tetracycline one percent (1.0%) Opthalmic within one (1) hour of birth.
   7. (2) The LLM must document in the client’s medical record whether or not medication was administered to the newborn and by whom.

6. (e)

   1. (1) The LLM must advise parents that the newborn must receive vitamin K within two (2) hours of birth.
   2. (2) The LLM must document in the client’s medical record whether or not medication was administered to the newborn and by whom.

7. (f) Newborn screening.

   1. (1) Genetic/metabolic screening.

      1. (A) All newborns must have a capillary blood sample within the required time frame for the newborn screening as mandated by law and as specified on the Department of Health collection form.
      2. (B) Information can be obtained by contacting the department Newborn Screening Program.

   2. (2) Infant hearing screening.

      1. (A) The LLM must instruct the mother in available resources to obtain the infant hearing screen.
      2. (B) Assistance in completing and submitting the required form can be obtained by contacting the department Infant Hearing Program.
8. (g) Cord care. The LLM must instruct the mother in routine cord care.

Codification Notes: "APRN" means advanced practice registered nurse. "LLM" means licensed lay midwife.