Current through February 27, 2024
(a) A birth center
may provide midwifery services only to a woman who is a low-risk maternal
client under
7
AAC 12.446.
(b) If the midwife providing midwifery
services in a birth center is a
(1)
direct-entry midwife, the birth center shall ensure that the direct-entry
midwife provides midwifery services in accordance with the requirements of AS
08.65 and 12 AAC 14, and within the scope of practice set out under AS 08.65
and 12 AAC 14; and
(2) certified
nurse midwife, the birth center shall ensure that the certified nurse midwife
provides midwifery services in accordance with the requirements of AS 08.68 and
12 AAC 44, and within the scope of practice set out under AS 08.68 and 12 AAC
44.
(c) The birth center
shall ensure that its policies and procedures clearly describe the rights and
responsibilities of a client and her family or support person. The birth center
shall explain those rights and responsibilities to the client and the client's
family or support person before or upon admission for care.
(d) In addition to implementing the client
rights set out in
7
AAC 12.890, the birth center shall
(1) inform each client of the right to
request transfer to a hospital for care, and advise the client that the birth
center will make arrangements for any transfer;
(2) inform each client of the right to refuse
transfer if recommended by the midwife, and advise the client that the risks of
refusing transfer include maternal or fetal death; the birth center shall
document in writing any refusal described in this paragraph; and
(3) provide each client with a written
statement, including a glossary of terms, regarding
(A) fees for services and responsibilities
for payment;
(B) the established
criteria for admission to, and continuation in, the birth center program of
care;
(C) the benefits, risks, and
eligibility requirements for an out-of-hospital labor and birth;
(D) the services that are provided by the
birth center and those that are provided by contract, consultation, or
referral;
(E) the identity and
qualifications of care providers, consultants, and related services and
institutions, including the type of current license or certification held by
the midwife providing care;
(F) all
diagnostic procedures, reports, recommendations, and treatments;
(G) the birth center's plan for providing
emergency and nonemergency care to the client or newborn if a complication
occurs during pregnancy or labor;
(H) the approximate amount of time required
to reach the nearest hospital if emergency transfer is necessary;
(I) information regarding health care
options, and the state of the science regarding each option, to assist the
client in making informed decisions;
(J) the client's rights regarding
participation in
(i) decisions relating to
the plan for management of her care and any changes in that plan, including
referral and transfer to other practitioners or other levels of care if
requested by the client or if the care required is not within the midwife's
scope of practice; and
(ii)
research or student education programs;
(K) the birth center's plan for hearing
grievances;
(L) the client's right
to submit a complaint to the department regarding the care provided by the
birth center, including information about how to contact the department;
and
(M) whether the birth center
and clinical staff have malpractice liability insurance, if the client requests
that information.
(e) The birth center shall provide, or
demonstrate the availability at another appropriate entity of, a range of
services necessary to meet the physical, emotional, socioeconomic,
informational, and medical needs of clients and newborns, as those needs relate
to care at the birth center, including
(1) an
orientation to the fees and services of the birth center as described in (d) of
this section;
(2) prenatal care;
prenatal care may be provided by a practitioner at another site, regardless of
whether that practitioner is associated with the birth center;
(3) an educational program for pregnancy,
labor, breastfeeding, newborn care, parenting, self-care, self-help, and
sibling preparation;
(4) laboratory
service;
(5) 24-hour telephone
consultation;
(6) library
resources;
(7) intrapartum
care;
(8) light nourishment during
labor and postpartum care;
(9)
immediate postpartum care;
(10)
home or office follow-up for the client and newborn;
(11) exercise programs;
(12) parent support groups;
(13) postpartum classes;
(14) family planning;
(15) well baby care;
(16) information regarding the availability
of circumcision procedures at another appropriate entity;
(17) a nursing mother support
program;
(18) well woman
gynecological care; and
(19) public
education.
(f) The birth
center shall develop and implement a risk assessment tool to be completed for
each client at admission and at regular intervals after admission, and a method
or plan for consultation if necessary, to determine whether a client is a
low-risk maternal client under
7
AAC 12.446. The risk assessment tool must include
standards that, at a minimum, address
(1)
whether the physical examination conducted at admission or a physical
examination conducted after admission detected any abnormalities;
(2) the client's menstrual history;
(3) any past pregnancies, including, for each
pregnancy,
(A) the length of the pregnancy at
birth;
(B) any complications during
pregnancy or labor;
(C) the length
of labor;
(D) the type of delivery;
and
(E) the place of
delivery;
(4) the
client's medical history, including any history of
(A) diabetes;
(B) hypertension;
(C) heart disease;
(D) autoimmune disorders;
(E) kidney disease;
(F) neurological disorders;
(G) epilepsy;
(H) depression;
(I) postpartum depression;
(J) psychiatric problems;
(K) hepatitis;
(L) liver disease;
(M) asthma;
(N) tuberculosis or other pulmonary
disorders;
(O)
varicosities;
(P)
phlebitis;
(Q) thyroid
dysfunction;
(R) blood
transfusions;
(S) bleeding
disorders;
(T) trauma;
(U) domestic violence;
(V) allergies;
(W) abnormal Papanicolaou (PAP)
tests;
(X) uterine
anomalies;
(Y) surgery;
(Z) anesthetic complications;
(AA) Rh sensitivity;
(BB) infertility;
(CC) use of prescription or nonprescription
medications;
(DD) alcohol
use;
(EE) tobacco use;
(FF) substance abuse; and
(GG) use of vitamins, herbs, or other
nutritional, dietary, or health supplements;
(5) any pertinent family history related to
diabetes, hypertension, heart disease, bleeding disorders, kidney disease,
stroke, or other genetic disorders or family conditions that may be
significant; and
(6) infection
history, including
(A) exposure to
tuberculosis;
(B) whether the
client or the baby's father has a history of acquired immune deficiency
syndrome (AIDS), the human immunodeficiency virus (HIV), genital herpes, or any
sexually transmitted disease;
(C)
whether the client has a history of gram positive Group B
Streptococcus; and
(D) whether the client has experienced any
rash or viral illness since her last menstrual period.
(g) The birth center shall have a
written plan for evaluating the services provided, for assessing outcomes, and
for making necessary changes based on each evaluation.
(h) Before admitting a client, the birth
center shall ensure that the client has received ongoing prenatal care. If a
client requests the services of the birth center late in pregnancy and has no
evidence of ongoing prenatal care, the birth center shall ensure that
(1) the risk assessment conducted in
accordance with the standards developed under (f) of this section includes
necessary laboratory testing;
(2)
the client establishes regular and ongoing prenatal care; and
(3) the period of time before admission for
labor and delivery is adequate to establish the client's appropriateness for
birth center services.
(i) The birth center shall develop and
implement a policy approved by the governing body that provides the protocols,
procedures, and parameters for acceptance of a client who requests services
late in pregnancy and who has not had regular ongoing prenatal care.
(j) The birth center shall develop and
implement policies and procedures that
(1)
include screening for domestic violence or other relationship safety issues at
least once during each trimester; and
(2) describe how the birth center will
address a domestic violence or relationship safety issue if encountered,
including
(A) informing the client about
available resources for assistance; and
(B) reporting to authorities, if
appropriate.
(k) The birth center shall develop and
implement a policy and procedures manual that includes all aspects of birth
center practice and care, and shall ensure that the manual is available to the
clinical and support staff at all times.
(l) The birth center shall develop written
practice protocols that reflect how the birth center will implement applicable
standards of practice. The birth center shall ensure that the governing body
approves the practice protocols. The practice protocols must
(1) include a comprehensive, step-by-step
guide to care that addresses specific conditions that are expected or that may
arise during prenatal care, delivery, or postpartum care; and
(2) be designed to ensure and enhance safe,
high-quality care.
(m)
Surgical procedures provided in a birth center must be limited to those
normally performed during and after uncomplicated childbirth, and must be
performed in accordance with the practice protocols developed under
(l) of this section. A surgical procedure that includes
operative obstetrics or a cesarean section may not be performed in a birth
center.
(n) General or conduction
anesthesia may not be administered in a birth center. Local anesthesia may be
administered, and an episiotomy and episiotomy or laceration repair may be
provided, if performed by a midwife in accordance with that midwife's
applicable scope of practice as required under (b) of this section. The birth
center shall establish and implement policies and procedures that address the
administration of local anesthesia, the provision of episiotomies, and
episiotomy or laceration repair.
(o) Labor may not be induced, stimulated, or
augmented with oxytocin or any other pharmacological agent. If there is fetal
distress or a prolapsed cord, the birth center may use a pharmacological agent
to inhibit labor while making arrangements to transport the client to a
hospital.
(p) A birth center may
not use vacuum extractors, forceps, or ultrasound imaging in the birth center.
Except as provided in
7
AAC 12.430(a) (3)(G), a birth center
may not use recorded electronic fetal monitors in the birth center.
(q) Each client and newborn must be
discharged, or transferred if necessary, within 24 hours after the newborn's
birth. If a longer stay becomes necessary for a client or newborn, the birth
center must
(1) document in the medical record
that the client and newborn were expected, at the time of admission, to be
discharged within 24 hours after the newborn's birth; and
(2) describe in the report required under
7
AAC 12.405(j) (10) the reason for any
stay beyond 24 hours after the newborn's birth.
Authority:AS
47.32.010
AS
47.32.030
