Current through Register Vol. 50, No. 9, September 20, 2024
A. An
ABU shall have policies/procedures and written criteria for the evaluation of
risk status, admission, transfer, discharge, and complications requiring
medical or surgical intervention. The policies/procedures and written criteria
shall be developed, implemented, enforced, monitored, and reviewed annually by
the clinical staff and approved by the governing body.
1. In order for a pregnant woman to be
admitted to an ABU, the following admission requirements must be met.
a. The pregnancy shall be deemed low-risk by
the licensed practitioner with the expectation of a singleton, vertex, and
spontaneous vaginal birth at term without complication.
b. The pregnant woman shall have had
consistent prenatal care which began no later than 28 weeks gestation with
consistent prenatal screening.
c. A
maternal/fetal assessment performed by the CNM shall be completed and
documented within one hour of admission to the ABU.
2. The facility shall have policies and
procedures readily available in the event the condition of the mother and/or
newborn require transfer to an acute care unit within the hospital or emergent
transfer to another hospital.
3.
The facility shall have policies and procedures for discharge planning of the
mother and newborn.
B. A
patient who meets any of the following criteria/conditions shall not be
admitted for delivery in an ABU:
1. females
below 18 years of age;
2. a patient
with any of the below documented condition(s) in the maternal medical history,
based on an assessment by a licensed practitioner:
a. cardiovascular disease;
b. pulmonary disease and/or history of
pulmonary embolus;
c. renal
disease;
d. insulin-dependent
diabetes;
e. bleeding disorder or
hemolytic disease;
f. fetal
malpresentation;
g. placenta
previa;
h. preeclampsia;
i. oligohydramnios;
j. polyhydramnios;
k. ruptured membranes greater than 18 hours
prior to onset of labor;
l.
previous Rh sensitization;
m.
vaginal birth following C-section (VBAC);
n. multiple births;
o. preterm labor;
p. post-maturity; or
q. fetal abnormality; or
3. a patient with a high risk pregnancy as
determined by a licensed practitioner.
C. The following services shall be prohibited
in the ABU:
1. general, intravenous, and/or
conductive analgesia/anesthesia to include spinal and epidural
analgesia/anesthesia;
2. conscious
sedation;
3. caesarean sections and
operative obstetrics to include tubal ligations;
4. stimulation or augmentation with chemical
agents, e.g., oxytocin during the first and second stages of labor;
and
5. vacuum extractors and/or
forceps.
D. Prenatal
Screening Requirements
1. Pregnant women
shall be screened by either/or an OB/GYN, a certified nurse midwife (CNM), or
an advanced practice registered nurse (APRN). Documentation of the screening
shall include, but not be limited to:
a.
social, family, medical, reproductive, nutritional, drug and alcohol
use;
b. violence screen, depression
screen and mental health history;
c. physical examination to include
Papanicolaou smear and assessment for sexually transmitted diseases as
determined by a licensed practitioner;
d. a prenatal laboratory profile to include
a:
i. complete blood count, blood type and Rh
antibody screen;
ii. glucose
tolerance test;
iii. urinalysis;
and
iv. other diagnostic testing as
medically indicated; and
e. a repeat evaluation of the hemoglobin or
hematocrit between 28 and 36 weeks gestation.
E. Newborn Requirements. The ABU shall be in
compliance with current state laws, rules and regulations for screening of
newborn health conditions.
F.
Patient and/or Patient's Family Educational Requirements. The following
educational programs are required to be completed by the patient and/or
patient's family as determined by the policy and procedures of the ABU prior to
discharge:
1. anticipated physiological and
psychological changes during pregnancy;
2. fetal development;
3. normal nutrition;
4. warning signs of pregnancy
complications;
5. self-care to
include:
a. information on the dangers of
smoking, alcohol and substance abuse; and
b. the need for dental care;
6. stages of labor;
7. non-pharmacologic techniques to promote
comfort and relaxation during labor;
8. delivery process;
9. newborn care;
10. normal postpartum;
11. bonding;
12. breast-feeding;
13. importance of immunization;
14. criteria for discharge from the
center;
15. child safety to include
the use of car seats and safe sleeping practices;
16. directions for obtaining laboratory tests
for newborns as required by the Department of Health and Hospitals;
17. instruction as to the clothing/supplies
needed at the time of discharge from the center; and
18. a family instructional program.
G. In order for the family to
participate in the birth process in the ABU, the following requirements shall
be met.
1. The number of individuals/family
members present at the time of birth shall be determined by the ABU's policy
which takes into account room size and the need for infection
control.
2. Individuals/family
members shall abide by the facility's infection control policies.
3. An adult not involved in the birthing
process shall be in charge of all minor children.
4. Only service animals shall be allowed in
the ABU.
AUTHORITY NOTE:
Promulgated in accordance with
R.S.
40:2100-2115.
