Labor, Delivery, Recovery and Postpartum Care

Section 250 Section 250.1870  Labor, Delivery, Recovery and Postpartum Care a)         Hospitals may establish a labor, delivery, recovery and postpartum care program in compliance with this Section.  The labor, delivery, recovery and postpartum care program may include the hospital's entire obstetric service or a specific portion of the hospital's obstetric service. b)         General Description 1)         A labor, delivery, recovery and postpartum care program provides labor, delivery, recovery and postpartum care for a mother in one room.  The combination of functions in one room is designed to reduce the movement of the mother within the hospital. 2)         The labor, delivery, recovery and postpartum care program shall be coordinated with other obstetric services of the hospital.  Facilities for emergency caesarean deliveries shall be available.  Labor, delivery, recovery and postpartum rooms may be used in hospitals at all Level designations, except for caesarean deliveries, based on the hospital's program. 3)         Rooms used for labor, delivery, recovery and postpartum care shall include facilities for care of the infant during delivery and after birth. c)         Program Operation 1)         The labor, delivery, recovery and postpartum obstetric service program shall be part of the hospital's maternity and neonatal services plan and shall include all of the policies and procedures that are required by this Section. 2)         The hospital shall have policies and procedures for assessing the level of risk for each patient, for determining which patients may not qualify for labor, delivery, recovery and postpartum care, and for referring patients to another hospital. 3)         Any increases or decreases in the number of beds in the hospital's obstetric service that occur as a result of the establishment of a labor, delivery, recovery and postpartum care program may also require the approval of the Illinois Health Facilities and Services Review Board.  (See 77 Ill. Adm. Code 1100 and 1110.) d)         Designation of Rooms.  The labor, delivery, recovery and postpartum  care program shall designate the specific rooms that will be used for labor, delivery, recovery and postpartum care.  These rooms may be used as patient rooms for other obstetric patients in the obstetric department at times when they are not being used for labor, delivery, recovery and postpartum care. e)         Staffing Requirements 1)         The program shall include a staffing plan that meets the nursing needs of the patients. 2)         The program shall include provisions for specialized orientation and training for nurses and other health care personnel in the operation of the labor, delivery, recovery and postpartum care program, including the care of both mothers and infants. f)         Physical Plant Requirements 1)         Each room used for labor, delivery, recovery and postpartum care shall be considered a private room.  Occupancy by two patients, the mother and the infant, shall be permitted.  Rooms for multiple patients are not otherwise permitted for labor, delivery, recovery and postpartum care. 2)         Architectural plans for new construction or remodeling that are required for the establishment or continued operation of a labor, delivery, recovery and postpartum care program shall be submitted to the Department for review and approval pursuant to the requirements of this Section and Section 250.2420.  The hospital shall not implement the program prior to the Department's approval of the program and of the architectural plans. 3)         Each room used for labor, delivery, recovery and postpartum care shall include a minimum dimension of 12 feet and a minimum clear area of 250 square feet except as provided in subsection (f)(4) or (f)(6) of this Section. 4)         Rooms that were approved for use as "birthing rooms" by the Department prior to September 1, 1990 may continue to be used for labor, delivery, recovery and postpartum. The hospital shall continue to comply with the requirement of this Part. 5)         At least one delivery room with a minimum clear area of not less than 300 square feet shall be available for more complex deliveries and unanticipated risks. The delivery room shall be in the obstetric unit, on the same level as the rooms in which labor, delivery, recovery and postpartum care is provided, and accessible without passing through any areas used for functions other than labor, delivery, recovery and postpartum care, and without traversing any obstacles. In determining the accessibility of the delivery room, the Department will consider factors including, but not limited to, traffic patterns, corridor width, corridor width changes and the number of turns. 6)         The Department will approve rooms that contain a minimum dimension of 10 feet and a minimum clear area of 180 square feet  for labor, delivery, recovery and postpartum care, when the hospital demonstrates that all of the following conditions are met: A)        Policies and procedures for assessing the level of risk for each patient, for determining which patients may not  qualify for labor, delivery, recovery and postpartum care, and for referring patients to other hospitals have been established and are being followed. B)        The hospital participates in a Regional Perinatal Network and has been approved for Level I, Level II, or Level II extended neonatal care. The hospital does not provide Level III care as described in the Regionalized Perinatal Health Care Code. C)        The medical staff of the hospital has approved the use of the rooms for labor, delivery, recovery and postpartum care based on the medical staff's judgment that this care can be provided safely within the rooms. 7)         For the purposes of this subsection (f), clear area shall include only useable space within the patient room and shall not include entry or vestibule areas  or space for fixed, immovable furniture.  The bathroom shall not be included in calculating the clear area of the patient room. 8)         Staff hand-washing sink A)        Each room used for labor, delivery, recovery and postpartum care shall have direct access to a hand-washing sink for the exclusive purpose of staff hand washing prior to and during the delivery process.  The sink may be used for other purposes at other times. B)        The staff hand-washing sink shall be adequate in size and appropriately equipped to allow thorough hand washing. C)        The staff hand-washing sink may be located in the room, in the adjacent bathroom (if the bathroom is not shared with another patient room), or directly outside the room. 9)         Bathroom A)        Each room used for labor, delivery, recovery and postpartum care shall include a bathroom equipped with a toilet and a shower or bathtub.  The bathroom shall also include a sink, unless a sink is located in the patient room. B)        The bathroom shall be directly accessible from the patient room without going through the corridor. 10)       An area for gowning by staff and visitors prior to delivery shall be provided within or immediately adjacent to each room used for labor, delivery, recovery and postpartum care. 11)       Rooms used for postpartum care of the mother shall also comply with the patient room requirements of Section 250.2630(d)(1) or Section 250.2440(d)(1), as applicable. 12)       Adequate nursery facilities shall be provided for periods when infants are not with their mothers. 13)       Each room used for labor, delivery, recovery and postpartum care shall also comply with the following requirements: A)        The mechanical requirements for patient rooms in Section 250.2480(e)(8) or Section 250.2660. B)        The electrical requirements for patient rooms in Section 250.2500 or Section 250.2680. 14)       Wall, floor, and ceiling finishes shall be cleanable.  All finishes shall be able to withstand cleaning and treatment with chemicals and disinfectants. g)         Equipment Requirements 1)         All equipment necessary for delivery, for emergency care of the mother, for infant care, and for infant resuscitation shall be available to each room used for labor, delivery, recovery and postpartum care. 2)         A complete set of delivery and infant care equipment shall be provided for every four or fewer rooms used for labor, delivery, recovery and postpartum care. For example:  if four rooms are used, one complete set of equipment shall be provided;  if five to eight rooms are used, two sets of equipment shall be provided; if nine to twelve rooms are used, three sets of equipment shall be provided. 3)         Equipment may be stored in an equipment alcove or closet in the room, or in a separate equipment storage room.  The equipment shall be accessible for use without passing through another patient room.  Each equipment storage area shall be located on the same floor and not more than 75 feet from each of the rooms served by the equipment storage area.