Basic Birthing Center Functions

(1) Quality Assurance. The birthing center governing body must ensure that there is an established program for evaluating the quality of direct care services to childbearing families, and the environment in which the services are provided. with an organizational plan to identify and resolve problems. (2) Staff. (a) The governing body must ensure that there are adequate numbers of qualified and, where required, licensed personnel to provide services needed by mothers and families and to provide for safe maintenance of the birthing center. (b) The governing body must appoint a medical director who: 1. Is a qualified specialist in obstetrics/gynecology or family practice; 2. Approves all policies, procedures and practice guidelines for the medical management of care; 3. Approves standardized criteria for admission screening and monitoring the risk status of each mother during pregnancy, labor, birth and postpartum; and STANDARDS FOR BIRTHING CENTERS CHAPTER 0720-25 4. Is available for consultation and referral in obstetrics or pediatrics or has made arrangements with a qualified physician for these services. (3) Equipment. (a) A readily accessible emergency cart or tray for the mother, equipped to carry out the written emergency procedures of the center and securely placed with a written log of routine maintenance for readiness. (b) A readily accessible emergency cart or tray for the newborn, equipped to carry out the written emergency procedures of the center and securely placed with a written log of routine maintenance for readiness. (c) Properly maintained equipment for routine care of women and neonates including but not limited to: 1. A heat source for infant examination or resuscitation; 2. Transfer incubator or isolette or demonstrated capability of ready access to transfer incubator; 3. Sterilizer or demonstration of sterilizing capability; 4. Blood pressure equipment, thermometers, fetoscope/doptone; 5. Intravenous equipment; 6. Oxygen equipment for mother and newborn; and, 7. Instruments for episiotomy and repair. (4) Prenatal Care. The physician, certified professional midwife and nurse-midwife shall ensure that patients have adequate education and prenatal care by generally accepted definitions. Records of this care should be available in the center at the time of admission. When, in the course of prenatal care. risk factors are identified which preclude childbirth at the center, the woman shall be referred for care in a hospital setting and her prenatal records made available to the attending clinicians. (5) Surgical Services. Surgical procedures shall be limited to those normally accomplished during uncomplicated childbirth, such as episiotomy and repair, and must not include operative obstetrics or cesarean section. (6) If intervention beyond what is allowed in the practice guidelines is required at any time during the course of pregnancy and/or labor, the woman and her newborn must be managed at a more intensive level of care. (7) Laboratory Services. The birthing center shall have the capacity to perform on site routinely necessary tests such as hematocrit and urinalysis for glucose, protein, bacteria, and specific gravity. (8) Intrapartum Care. Labor shall not be inhibited, stimulated. or augmented with chemical agents during the first or second stage of labor. Drugs for induction or augmentation of labor, vacuum extractors, forceps, continuous electronic fetal monitoring and ultrasound imaging are not appropriate during normal labor. A nurse midwife. certified professional midwife or physician must be in attendance or available to attend during all stages of the delivery. STANDARDS FOR BIRTHING CENTERS CHAPTER 0720-25 (9) Analgesia and Anesthesia. General and conduction anesthesia shall not be administered at birthing centers. Local anesthesia for pudendal block may be performed. Systemic analgesia may be administered, but pain control should depend primarily on close emotional support and adequate preparation for the birth experience. (10) Postpartum Care. Mothers and infants must be discharged in accordance with standards set by the clinical staff and specified in the policy and procedures manual, including laboratory tests required by state laws. A program for prompt follow-up care and postpartum evaluation after discharge shall be ensured and outlined in the manual of policies and procedures. This program should include assessment of infant health including physical examination, laboratory screening tests 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 breast feeding. (11) Food Services. The birthing center must provide mothers and families with nutritious liquids and snacks as required. Food may be prepared by the family, catered, or prepared in the birthing center’s kitchen. Meals that are prepared and served by the birthing center will be subject to local regulations for food preparation and service. (12) The physical environment of the facility shall be maintained in a safe, clean and sanitary manner. (a) Any condition on the birthing center site conducive to the harboring or breeding of insects, rodents or other vermin shall be prohibited. Chemical substances of a poisonous nature used to control or eliminate vermin shall be properly identified. Such substances shall not be stored with or near food or medications. (b) Cats, dogs or other animals shall not be allowed in any part of the facility except for specially trained animals for the handicapped. The facility shall designate in its policies and procedures those areas where animals will be excluded. The areas designated shall be determined based upon an assessment of the facility performed by medically trained personnel. (13) Infection Control. A birthing center shall have an annual influenza vaccination program which shall include at least: (a) The offer of influenza vaccination to all staff and independent practitioners at no cost to the person or acceptance of documented evidence of vaccination from another vaccine source or facility. The birthing center will encourage all staff and independent practitioners to obtain an influenza vaccination; (b) A signed declination statement on record from all who refuse the influenza vaccination for reasons other than medical contraindications (a sample form is available at http://tennessee.gov/health/topic/hcf-provider); (c) Education of all employees about the following: 1. Flu vaccination, 2. Non-vaccine control measures, and 3. The diagnosis, transmission, and potential impact of influenza; (d) An annual evaluation of the influenza vaccination program and reasons for non- participation; and STANDARDS FOR BIRTHING CENTERS CHAPTER 0720-25 (e) A statement that the requirements to complete vaccinations or declination statements shall be suspended by the administrator in the event of a vaccine shortage as declared by the Commissioner or the Commissioner’s designee.