(a) Using reasonable skill and knowledge, the midwife shall assess the mother during the immediate postpartum period by monitoring vital signs, uterine fundus, bleeding and subjective status for a minimum of two hours after mother's condition is stable as indicated.
(b) Using reasonable skill and knowledge, the midwife shall:
  (1) collect, assess and document maternal care data throughout the postpartum period including history, physical exam, laboratory testing;
  (2) develop and implement a plan of care;
  (3) evaluate the client's condition on an ongoing basis and modify the plan of care as necessary; and
  (4) provide health education/counseling.
(c) If on any postpartum assessment one of the following conditions exists, the midwife shall recommend referral to an appropriate health care professional and document that recommendation in the midwifery record:
  (1) infection requiring antimicrobial therapy;
  (2) bladder dysfunction;
  (3) major depression; or
  (4) any other condition or symptom which could threaten the health of the mother, as assessed by a midwife exercising reasonable skill and knowledge.
(d) If on any postpartum assessment one of the following conditions exists, the midwife shall initiate immediate emergency transfer, initiate emergency care as indicated by the situation, continue care as needed, and document that action in the midwifery record:
  (1) uncontrolled hemorrhage;
  (2) maternal shock;
  (3) any hypertensive disorder, including preeclampsia/eclampsia;
  (4) signs of thrombophlebitis or pulmonary embolism; or
  (5) any other condition or symptom which could threaten the life of the mother, as assessed by a midwife exercising reasonable skill and knowledge.

Source Note: The provisions of this §115.116 adopted to be effective October 1, 2016, 41 TexReg 4477