(a) Prior to delivery, the midwife shall establish a plan with the client for continuing care of the newborn. This plan shall:
  (1) include referral or transfer to a health care professional who has current pediatric knowledge;
  (2) include a recommendation that the client pre-arrange the timing of the first newborn visit with the health care professional; and
  (3) be documented in the midwifery record.
(b) Using reasonable skill and knowledge, the midwife shall:
  (1) collect, assess and document newborn care data by monitoring the vital signs, performing a physical exam, and obtaining the laboratory tests necessary for the infant during the postpartum period;
  (2) provide appropriate education and counseling to the mother; and
  (3) observe the newborn for a minimum of two hours after he or she is stable with no signs of distress.
(c) If on any newborn assessment in the immediate postpartum period (first six hours of life), one of the following conditions exists, the midwife shall recommend referral and document that recommendation in the midwifery record:
  (1) birth injury;
  (2) gestational age assessment less than 36 weeks;
  (3) small for gestational age;
  (4) larger than 97th percentile for gestational age; or
  (5) any other abnormal newborn behavior or appearance which could adversely affect the newborn, as assessed by a midwife exercising reasonable skill and knowledge.
(d) If on any newborn assessment in the immediate postpartum period (first six hours of life), one of the following conditions exists, the midwife shall initiate immediate transfer to an appropriate health care professional, initiate emergency care as indicated by the situation, continue care as needed, and document that action in the midwifery record:
  (1) non-transient respiratory distress;
  (2) non-transient pallor or central cyanosis;
  (3) jaundice;
  (4) apgar at 5 minutes less than or equal to 6;
  (5) prolonged apnea;
  (6) hemorrhage;
  (7) signs of infection;
  (8) seizure;
  (9) major congenital anomaly not diagnosed prenatally;
  (10) unstable vital signs;
  (11) prolonged:
    (A) lethargy;
    (B) flaccidity; or
    (C) irritability;
  (12) inability to suck;
  (13) persistent jitteriness;
  (14) hyperthermia;
  (15) hypothermia; or
  (16) other abnormal newborn behavior or appearance which could threaten the life of the newborn, as assessed by a midwife exercising reasonable skill and knowledge.
(e) If on any newborn assessment after the immediate postpartum period, 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) abnormal laboratory test results;
  (2) minor congenital anomaly;
  (3) failure to thrive; or
  (4) any other abnormal newborn behavior or appearance which could adversely affect the infant, as assessed by a midwife exercising reasonable skill and knowledge.
(f) If on any newborn assessment after the immediate postpartum period, one of the following conditions exists, the midwife shall initiate immediate transfer to an appropriate health care professional and document that action in the midwifery record:
  (1) respiratory distress;
  (2) pallor or central cyanosis;
  (3) pathological jaundice;
  (4) hemorrhage;
  (5) seizure;
  (6) inability to urinate or pass meconium within 24 hours of birth;
  (7) unstable vital signs;
  (8) lethargy;
  (9) flaccidity;
  (10) irritability;
  (11) inability to feed;
  (12) persistent jitteriness; or
  (13) any other abnormal newborn behavior or appearance which could threaten the life of the newborn, as assessed by a midwife exercising reasonable skill and knowledge.

Source Note: The provisions of this §115.117 adopted to be effective October 1, 2016, 41 TexReg 4477; amended to be effective May 1, 2019, 44 TexReg 1849