Current through Register No. 40, October 3, 2024
(a) At the time of
admission, personnel of the birthing center shall:
(1) Provide, both verbally and in writing, to
the client or the client's legal representative, the birthing center's policy
on client rights and responsibilities, complaint procedure, and rules and
obtain written confirmation acknowledging receipt of the policies;
(2) Collect and record the following
information:
a. Client's name, home address,
and home telephone number;
b.
Client's date of birth;
c. Name,
address, and telephone number of an emergency contact;
d. Name of client's primary care provider
with the address and telephone number; and
e. Client's insurance information, if
applicable;
(3) Provide
an orientation to the scope of services provided at the birthing
center;
(4) Provide instruction and
education relevant to the following:
a.
Conception;
b. Health and
nutrition;
c. Pregnancy;
d. Lactation and lactation
assistance;
e. Family
planning
f. The postpartum
period;
g. Holistic care;
h. Early recognition and prevention of
potential health problems;
i.
Detection of any abnormal conditions in the mother, fetus, and
newborn;
j. Procurement of medical
assistance, if necessary; and
k.
Execution of emergency measures in the absence of medical help, if
necessary;
(5) Complete
a health examination and a social, family, medical, reproductive, nutritional,
and behavioral history;
(6) Obtain
from the client documentation of informed consent; and
(7) Obtain from the client a written consent
for release of information, if the client so authorizes.
(b) Only clients who meet the eligibility
criteria and have registered at least 4 weeks prior to the anticipated date of
birth shall be admitted to the birthing center.
(c) In order to be eligible:
(1) The client's licensed or certified
practitioner shall determine that the client was medically, psychologically,
surgically, and obstetrically uncomplicated during her prenatal care;
(2) A client shall not present any of the
following contraindications:
a. Placenta
previa;
b. Multiple
fetuses;
c. Insulin dependent
diabetes;
d. Previous cesarean
section, unless authorized in accordance with Mid 503; or
e. Rh factor sensitivity with positive
antibody titre;
(3) A
client shall have written approval from a medical doctor (MD), doctor of
osteopathic medicine (DO) with certification in natural childbirth, or APRN-CNM
to deliver in the birthing center if she presents with any of the following
potential medical risk factors:
a. Maintenance
on anti-epileptic medications without convulsive activity within the last
year;
b. Blood
dyscrasias;
c. Current
hepatitis;
d. A positive HIV test
result or AIDS;
e. Current
alcoholism;
f. Current drug
addiction, including use of hallucinogens;
g. Chronic pulmonary disease that interferes
with oxygen saturation;
h. Chronic
hypertension;
i. Past history of
significant heart disease; or
j.
Maintenance on psychotropic medication which, as a result of a consultation
with the client's physician, has been determined to have a sedating effect on
the newborn.
(d) All clients who present with, or develop
during prenatal care, any one or more of the following shall be evaluated by a
physician or a certified nurse midwife to determine appropriateness for
delivery in a birthing center:
(1) Younger
than 16 or older than 45 years of age;
(2) High blood pressure, which is defined as
140/90 or elevation of 30 systolic or 15 diastolic on at least 2 occasions, at
least 6 hours apart;
(3) Anemia,
which is defined as hemoglobin of less than 10 grams, unresolved at
term;
(4) History of genetic
problems or previous intrauterine death at greater than 20 weeks or unexplained
stillbirth;
(5) Possibility of
multiple fetuses, malpresentation, or fetus too small or large for gestational
age;
(6) Past history of
significant hemorrhaging during delivery, which is defined as the loss of 500
cubic centimeters (cc) of blood or greater;
(7) Abnormal Pap smear;
(8) Active primary herpes at term;
(9) Positive cervical herpes
cultures;
(10) Indications that the
fetus has died in utero;
(11)
Suspected postmaturity greater than 42 weeks;
(12) Heart murmur or arrhythmia other than
functional;
(13) Prior obstetrical
problems, including, but not limited to:
a.
Past prematurity;
b. Uterine
abnormalities;
c. Placental
abruption; and
d. Incompetent
cervix;
(14) Development
of other conditions potentially detrimental to the pregnancy, such as recurrent
urinary tract or kidney infection or active gonorrhea;
(15) Polyhydramnios or
oligohydramnios;
(16) Suspected
intrauterine growth retardation;
(17) Condyloma acuminata, significant or
intravaginal;
(18) Suspected
premature labor less than 37 weeks;
(19) Present with or develop a significant
overweight or underweight state; or
(20) Non-insulin dependent gestational
diabetes or abnormal glucose challenge test.
(e) If the client's risk factors, as outlined
in (d) above, have been evaluated by an MD, DO with certification in natural
childbirth, or APRN-CNM and deemed appropriate for delivery in the birthing
center, the MD, DO with certification in natural childbirth, or APRN-CNM shall:
(1) Provide written documentation of their
approval; and
(2) Include this
documentation as part of the client's record.
(f) Any client who develops the following
conditions during prenatal care shall be prohibited from delivery at the
birthing center and transferred to the care of a physician or a certified nurse
midwife for a hospital delivery:
(1) Multiple
fetuses;
(2) Malpresentation,
including breech position, that is not resolved before the onset of
labor;
(3) Confirmation that the
fetus is small for gestational age;
(4) Placenta previa or abruptio
placenta;
(5) Onset of labor prior
to the 37th week of pregnancy; or
(6) Insulin dependent diabetes.
(g) A care plan shall be developed
and revised based on needs identified by the client's licensed or certified
practitioner.
(h) If a certified
midwife is the primary practitioner, the midwife shall consult with a physician
or licensed APRN who is certified as a midwife and develop a plan of care for
all clients who present with the following conditions:
(1) Maternal distress as indicated by:
a. Hypertension; which is a systolic reading
of 30 mm of mercury and a diastolic reading of 15 mm of mercury over
baseline;
b. Blood loss greater
than 500 cc; or
c. Temperature
greater than 100 degrees Fahrenheit or less than 97 degrees
Fahrenheit;
(2)
Prolonged rupture of the membranes prior to the onset of labor for more than 18
hours;
(3) Fetal distress as
indicated by:
a. Persistent
bradycardia;
b. Persistent
tachycardia; or
c. Particulate
meconium;
(4) Failure to
progress in spite of active labor that is defined as:
a. A lack of steady dilation and descent
after 24 hours for primigravida or 18 hours for multigravida during the first
stage of labor;
b. A lack of fetal
descent after 2 hours during the second stage of labor; or
c. Failure to deliver the placenta after one
hour during the third stage of labor;
(5) Neonatal distress as indicated by:
a. Obvious congenital anomalies;
b. Apical pulse rate greater than 160 per
minute;
c. Respiratory rate greater
than 80 per minute;
d. Temperature
outside the parameters of 97.7 to 99.4 degrees Fahrenheit or 36.5 to 37.5
degrees Celsius;
e. Persistent
signs of respiratory difficulty without signs of improvement within one hour
after birth;
f. Persistent central
cyanosis or pallor;
g. Signs of
hypoglycemia, such as jitteriness, lethargy or hypothermia;
h. Jaundice appearing before 24 hours after
birth;
i. Small for gestational
age; or
j. A 5 minute Apgar score
that is 6 or 7.
(i) All clients who present the following
conditions during labor or delivery shall be immediately transferred to a
hospital:
(1) Malpresentation;
(2) Multiple fetuses;
(3) Prolapsed cord;
(4) Neonatal distress as indicated by:
a. Apnea with persistent central cyanosis or
pallor;
b. Persistent grunting and
retractions;
c. A 5 minute Apgar
score of 5 or less, or failure to achieve an Apgar score of 7 within 30
minutes; or
d. Jaundice before 24
hours; or
(5)
Uncontrolled maternal bleeding.
(j) Prenatal care shall be provided at the
home of the client, at the office of the licensed practitioner, or at the
birthing center.
(k) Prenatal care
shall include, but is not limited to:
(1) A
health examination including pelvic and speculum exam, as applicable;
(2) A social, family, medical, reproductive,
nutritional, and behavioral history;
(3) Assessing vital signs including blood
pressure;
(4) Arranging for the
following blood tests if not previously completed during the present pregnancy:
a. Complete blood count (CBC);
b. Blood type and Rh antibody
screen;
c. Rubella titre;
d. Syphilis serology;
e. Hepatitis B surface antigen; and
f. HIV testing, if requested by the
client;
(5) An initial
nutritional assessment and counseling;
(6) Pap smear, if not done in the last 2
years;
(7) Chlamydia and gonorrhea
screening tests, as applicable;
(8)
Establishment of gestational age; and
(9) Advising of available prenatal
testing.
(l) Following
the initial visit, the licensed or certified practitioner shall see the client:
(1) Once a month through the 28th week of
pregnancy;
(2) Once every 2 weeks
from the 28th week until the 36th week of pregnancy; and
(3) Once a week from the 36th week of
pregnancy until the onset of labor.
(m) Each prenatal visit shall include, but is
not limited to, the following care:
(1)
Determining weight;
(2) Assessing
blood pressure;
(3) Urine dip for
protein and glucose, which may be performed by the client;
(4) Assessment of general health;
(5) Monitoring of uterine measurements, fetal
heart rate, and fetal activity; and
(6) Arranging for birthing center tests or
procedures as indicated.
(n) Intrapartum care shall include, but is
not limited to:
(1) Monitoring the condition
of mother and fetus;
(2) Providing
emotional and physical support;
(3)
Assisting with the delivery;
(4)
Repairing minor tears or episiotomies as necessary;
(5) Examination and assessment of the
newborn;
(6) Inspection of the
placenta, membranes, and cord vessels; and
(7) Management of any maternal or neonatal
complications.
(o)
Postpartum care shall include, but is not limited to:
(1) Remaining with the client and newborn for
a minimum of 2 hours after birth or until:
a.
The infant:
1. Is alert;
2. Has good color;
3. Has a good sucking reflex;
4. Is breathing normally; and
5. Has a stable temperature within the range
of 97 to 100 degrees F; and
b. The mother:
1. Has a firm fundus;
2. Does not have excessive vaginal
bleeding;
3. Is afebrile;
4. Has voided; and
5. Has established successful breastfeeding,
if applicable;
(2) Obtaining or arranging for a blood sample
from the newborn for metabolic disorders as required by
RSA
132:10-a;
(3) Providing the client with information on
routine postpartum and newborn care, including follow up care with a
pediatrician or family practitioner for the newborn;
(4) Providing the client's obstetrician,
primary care physician, pediatrician, or certified nurse midwife with a written
summary of labor and delivery and an assessment of the newborn;
(5) Contacting the client by telephone within
24 hours of discharge to establish well-being and health of mother and
newborn;
(6) Providing 2 postpartum
visits within 6 weeks of delivery; and
(7) Managing any complications that may arise
and, based on the complication:
a. Consulting
with a physician under the arrangements required by
Mid
502.06 or a certified nurse midwife; or
b. Transferring the client with notification
to the consulting physician or certified nurse midwife.
(p) The certified nurse midwife or
certified midwife, or other person authorized by law, shall administer the
following medications as clinically indicated:
(1) Rhogam (immune globulin) for Rh blood
incompatibility;
(2) Eye
prophylaxis for prevention of gonococcal infection in the newborn;
(3) Oxygen for fetal distress and infant
resuscitation;
(4) Lidocaine
hydrochloride by infiltration only for the purpose of postpartum repair of
tears, lacerations, or episiotomies;
(5) Vitamin K, orally or intramuscular, for
prevention of hemorrhagic disease in the newborn;
(6) Oxytocins, orally or intramuscular, for
control of postpartum maternal hemorrhage; and
(7) Intravenous fluids as an emergency
measure for maternal complications.
(q) Birthing center personnel shall follow
the orders of the licensed or certified practitioner.
(r) The client's record shall contain written
notes for:
(1) All care and services provided
at the birthing center, including:
a. Date
and time that the care or services were provided;
b. Description of the care or services
provided;
c. Client's response to
the care or services provided; and
d. Signature and title of the person
providing the care or service; and
(2) Any reportable incidents involving the
client, which shall include, but not be limited to:
a. Date and time of the reportable
incident;
b. Description of the
reportable incident, including identification of injuries, if
applicable;
c. Actions taken by
personnel, including follow-up;
d.
Date and time the emergency contact person, guardian, or agent acting pursuant
to a DPOA and the licensed or certified practitioner were notified if medical
intervention was required;
e.
Signature and title of the person reporting the unusual incident; and
f. Signature and title of the person
completing the report.
(s) The use of chemical or physical
restraints shall be prohibited except as allowed by
RSA
151:21, IX.
(t) In addition to (s) above, the use of
mechanical restraints shall be prohibited.
(u) Clients shall be transferred or
discharged from the birthing center:
(1) In
accordance with:
a.
RSA
151:21,V and
RSA
151:26; and
b. The birthing center's policies;
and
(2) When there is:
a. A written order from a licensed
practitioner;
b. A medical
emergency and the client is in need of care and services not available at the
birthing center; or
c. The client
has developed one of the conditions listed in (f) above.
(v) A summary shall be written for
any client discharged or transferred from the birthing center which includes:
(1) The date and time the client left the
birthing center;
(2) The place to
which the client was transferred or discharged;
(3) The condition of the client at the time
of discharge or transfer; and
(4)
The discharge plan and instructions for home and follow up care.
(w) After receiving permission
from the client or legal representative, copies of the clinical progress notes
and medication records shall accompany the transferred client.
(x) For each client accepted for care and
services at the birthing center, a current and accurate record shall be
maintained and include, at a minimum:
(1) The
written confirmation required by (a) (1) above;
(2) The identification data required by (a)
(2) above;
(3) The record of the
health examination required by (a) (5) above;
(4) Consent forms and release forms required
by (a) (7) above;
(5) All orders
from a licensed practitioner, including the date and signature of the licensed
practitioner;
(6) Results of any
birthing center tests or ultrasounds;
(7) All consultation reports;
(8) All assessments;
(9) All written notes required by (r) above;
and
(10) A discharge or transfer
summary as required by (v) above.
(y) Client records shall be safeguarded
against loss, damage, or unauthorized use by being stored in locked containers,
cabinets, rooms, or closets except when being used by the birthing center's
personnel.
(z) Client records shall
be retained for a minimum of 4 years after discharge or, in the case of a
minor, until one year after reaching age 18, but no less than 4 years after
discharge.
(aa) Prior to the
birthing center ceasing operation, it shall arrange for the storage of and
access to client records for 4 years after the date of closure, which shall be
made available to the department and past clients upon
request.
#8957, eff
7-27-07
