Outpatient birth services in hospitals

1. General acute hospitals providing outpatient birth services in hospitals are subject to the outpatient birth services requirements for specialized hospitals in this section. 2. Primary care hospitals may not provide outpatient birth services. 3. Any facility that provides outpatient birth services shall comply with this section. A facility may not hold itself out to the public as providing outpatient birth services unless such outpatient birth service has been licensed by the department and meets the requirements for outpatient birth services in this section. a. The facility provides peripartum care of low-risk women for whom prenatal and intrapartum history, physical examination, and laboratory screening procedures have demonstrated normal, uncomplicated singleton term (thirty-seven to forty-one and six- sevenths weeks), multipara pregnancies with a spontaneous labor, and vertex presentation that are expected to have an uncomplicated birth. The policy and procedures must specify medical and social criterion to determine risk status at admission and during labor. b. Patients who are not considered low risk, patients who experience no cervical dilation in over three hours who are considered in active labor according to the American college of obstetricians and gynecologists standards, and patients who develop a high-risk condition based on standards of practice shall be transferred as described in subsection 6. c. Patients shall be fully informed on and provide written consent to the benefits and risks of the services available and alternatives if more advanced services are required. d. Surgical procedures must be limited to those procedures normally encountered during uncomplicated childbirth, such as episiotomy and repair, and must not include operative obstetrics or cesarean section. Circumcisions of newborns are allowed. e. Labor may not be inhibited, stimulated, or augmented with chemical agents during the first or second stage of labor nor may labor be induced by artificial rupture of membranes. f. Vacuum extractors, forceps, and recorded electronic fetal monitors are not appropriate for use after admittance in active labor in outpatient birth services. Patients requiring these interventions shall be transferred as described in subsection 6. g. General and conduction anesthesia may not be administered. Local anesthesia and pudendal block may be administered if procedures are established and approved by medical staff. h. Emergency medications, equipment, and supplies must be available, including tocolytics and uterotonic medications. Nothing in the foregoing should be construed to prohibit exercise of medical skills or the use of emergency medications to benefit the mother or the baby in case of emergency. Patients requiring these interventions shall be transferred as described in subsection 6. i. Mothers and infants must be discharged within twenty-six hours after birth in accordance with standards set by the medical staff and specified in the policies and procedures. A program for prompt followup care and postpartum evaluation after discharge must be ensured and outlined in the policies and procedures. This program must include assessment of infant health, including physical examination, laboratory and screening tests required by state law at the appropriate times, maternal postpartum status, instruction in child care including immunization, referral to sources of pediatric care, provision of family planning services, and assessment of mother-child relationship including breastfeeding. 4. The outpatient birth services shall ensure care is provided by licensed health care practitioners and nursing staff with access to and availability of consulting clinical specialists as follows: a. Every birth must be attended by at least two health care professionals, licensed or certified consistent with state laws, with relevant experience, training, and demonstrated competence and who have maintained competence in basic life support, including fluid resuscitation and a neonatal resuscitation program to respond to patient needs. b. The primary maternity care licensed health care practitioner who attends each birth shall be educated, licensed, and have approved clinical privileges to provide birthing services. c. A licensed health care practitioner with relevant experience, training, and demonstrated competence shall be on call and readily available within a reasonable time of birth for resuscitation if needed. d. A licensed health care practitioner with relevant experience, training, and demonstrated competence shall assess the neonate within twenty-four hours of delivery. e. There must be adequate numbers of nursing staff who have completed orientation and demonstrated competence in the care of uncomplicated pregnancies with the ability to detect, stabilize, and initiate management of unanticipated maternal-fetal or neonatal problems which occur during the antepartum, intrapartum, or postpartum period until the patient can be discharged or transferred to a facility at which specialty maternal care is available. 5. An appropriately staffed level I nursery must be available on the premises. 6. There must be criteria and a written agreement for transfer of patients to an acute care hospital capable of providing inpatient obstetrical and neonatal services with a level II or level Ill nursery. The outpatient birth services must be located within thirty minutes of this hospital. 7. There must be provisions in place either directly or by agreement for transport services, obstetric consultation services, pediatric consultation services, and childbirth and parent education support services. 8. The outpatient birth service shall develop and implement policies and procedures to ensure physical security of mothers and newborns.