1. (1) The birthing center's medical practitioners shall follow the guidelines set forth by the American College of Obstetricians and Gynecologists for testing pregnant women for sexually transmitted diseases.

2. (2) Initial Visit.

   1. (a) The birthing center shall at a minimum conduct one prenatal visit in which a comprehensive health history of the patient shall be completed, which includes medical, emotional, dietary, and obstetrical data, including a preterm delivery risk assessment.
   2. (b) A physical examination of the patient shall be completed by qualified staff, within their scope of practice, including height and weight measurements; vital signs, including blood pressure; and examination of the skin, head and neck, heart and lungs, breasts, abdomen, pelvis, and neurologic reactions.

   3. (c) The following tests are also required to be performed by a staff member or by other of the birthing center's qualified personnel:

      1. 1. Hemoglobin and hematocrit.
      2. 2. Urinalysis by dipstick for protein, sugar, and ketones.
      3. 3. Cervical cytology. Recommendation by The American Society of Colposcopy and Cervical Pathology (ASCCP) is for pap smears every 3 years (age 21-30) and every 5 years with co-testing (age 31-64).
      4. 4. Rh determination and blood type.
      5. 5. Prenatal screening recommended by the American Academy of Pediatrics and American College of Obstetricians and Gynecologists Guidelines for Perinatal Care and the rules and regulations of the Department, to include, but not be limited to, HIV, syphilis, and Hepatitis B surface antigen screening.

3. (2) At a minimum, return visits to the birthing center shall include the following measurements and testing:

   1. (a) Weight, blood pressure, fundal height, and fetal heart rate, as applicable.
   2. (b) Urinalysis by dipstick for protein and sugar.
   3. (c) Hemoglobin and hematocrit should be repeated at least twice and more often if indicated during the course of the pregnancy.
   4. (d) Review of signs and symptoms of complications of pregnancy and risk status.
   5. (e) Examination to determine the estimated weeks of gestation, fetal position, and presentation.
4. (3) If prenatal visits subsequent to an initial visit are offered at the birthing center, they should be scheduled at least every 4 weeks until the 28th week, every 2 weeks until the 36th week, and then every week until delivery, unless more frequent monitoring is required. Patients must be evaluated by qualified medical staff at the birthing center at their initial prenatal visit and regularly throughout their pregnancy, with a copy of each performed risk assessment retained in their file, to assure that they remain at low risk for an adverse pregnancy outcome. If prenatal visits subsequent to the initial visit are conducted at a location other than the birthing center, visit summaries must be obtained by the birthing center and reviewed as part of the continuing risk assessment for that patient. Prenatal visits conducted by a provider other than the birthing center must be scheduled and conducted with the same frequency as the visits conducted by the birthing center under these rules and must meet the same evaluation and risk assessment requirements for each visit in order for the patient to remain eligible for delivery in the birthing center.
5. (4) All patients shall receive specific instruction regarding preterm labor, including the potential hazards, preventive measures, symptoms, detection and timing of contractions, and the need for prompt notification of the health provider.
6. (5) At least one prenatal visit in the second trimester of pregnancy shall be overseen by the staff physician or consultant physician, to certify that the patient remains eligible for delivery in the birthing center. All patients found to be at obstetrical risk pursuant to the criteria set forth in these rules shall be referred to a qualified local physician, certified by the American Board of Obstetrics and Gynecology or the American Board of Osteopathic Obstetricians and Gynecologists, for continued care.

Author: Dana Billingsley, Diane Milledge

Statutory Authority: Code of Ala. 1975, §22-2-2(6), et seq.; §22-21-20, et seq.

History: Filed November 19, 1987. Repealed: Filed April 16, 2010; effective May 21, 2010. New Rule: Published August 31, 2023; effective October 15, 2023.