Obstetrical services

1. All general acute hospitals providing obstetrical services shall provide for the admission, medical care, transfer, or discharge of obstetric and neonatal patients. Obstetrical services must include the following: a. The obstetrical services must have an organized obstetric staff with a chief of obstetrical services who is either certified or qualified in obstetrics or a physician who regularly practices obstetrics as head of the obstetrical service. The level of qualification and expertise of the chief of the obstetrical services must be appropriate to the level of care rendered in the hospital. Responsibilities of the chief of the obstetrical service include: (1) The general supervision of the care of obstetrical patients. (2) The arrangement of conferences held at regular intervals to review surgical procedures and operations, complications, and mortality. (3) The provision for exchange of information between medical, administrative, and nursing staffs. b. Only members of the medical staff with appropriate privileges may admit and care for patients in the obstetrical services areas. A roster of licensed health care practitioners, specifying the obstetrical privileges of each, must be maintained and available to staff in the obstetrical services area and in the files of the hospital administration. c. Obstetrical patients under the effect of an analgesic or an anesthetic, in active labor or delivery, must be monitored and attended in accordance with the current standards of practice for obstetric-gynecologic services as identified by the association of women's health, obstetric and neonatal nursing and defined by hospital policies and procedures. d. Fetal maturity must be established and documented prior to elective inductions and Caesarean sections. e. There must be a written policy and procedure established in accordance with the current standards of practice as identified by the association of women's health, obstetric, and neonatal nursing concerning the administration and documentation of oxytocic drugs and their effects. Oxytocin may be used for medical induction or stimulation of labor only when qualified personnel, determined by the medical staff, can attend the patient closely. If electronic fetal monitoring is not available, the patient must be monitored on a one-to-one basis during the administration of the oxytocic drugs. The following areas must be included in the written policy and procedure for administration and documentation of oxytocic medications: (1) The licensed health care practitioner shall evaluate the patient for induction or stimulation, especially with regard to indications for use of oxytocic medications. (2) The licensed health care practitioner or other individuals starting the oxytocin shall be familiar with its effects and complications and be qualified to identify both maternal and fetal complications. (3) A qualified licensed health care practitioner shall be immediately available as necessary to manage complications effectively. f. Birthing and delivery rooms must be equipped and staffed to provide emergency resuscitation for infants in accordance with the current association of women's health, obstetric, and neonatal nursing standards of practice. Only personnel qualified and trained to do so may use infant emergency resuscitation equipment. g. Equipment and personnel trained to use the equipment to maintain a neutral thermal environment for the neonate must be available and utilized as needed. h. Nursing staff for obstetrical services must include: (1) Nursing supervision by a registered nurse must be provided for the entire twenty-four-hour period the obstetrical services is occupied. (2) At least one nurse trained in obstetrical and nursery care must be assigned to the care of mothers and infants at all times. Infants must be visually or electronically monitored at all times. (3) A registered nurse must be in attendance at all deliveries, and must be available to monitor the mother's general condition and that of the fetus during labor. i. A clean nursery must be provided near the mothers' rooms with adequate lighting and ventilation and must include the following: (1) Bassinets equipped to provide for the medical examination of the newborn and for the storage of necessary supplies and equipment. (2) A glass observation window through which infants may be viewed. (3) Each nursery must have immediately on hand equipment necessary to stabilize the sick infant in accordance with current standards of practice established by the association of women's health, obstetric, and neonatal nursing and defined in hospital policies. j. The hospital shall identify specific rooms and beds to be used exclusively for obstetrical patients, obstetrical and gynecological patients, and nursery patients as provided in a plan specifically approved by the department. (1) Obstetrical services must be located and arranged to provide maximum protection for obstetrical and neonatal patients from infection and cross-infection from patients in other services of the hospital. (2) Obstetrical services must be located in the hospital so as to prevent through traffic to any other part of the hospital. 2. If the primary care hospital provides obstetrical services, the hospital shall comply with obstetrical services requirements for general acute hospitals in this section. 3. If a specialized hospital provides obstetrical services, the specialized hospital is subject to the obstetrical services requirements for general acute hospitals.