1. (1) Immediate postpartum care shall be provided to the mother at the birthing center by qualified members of the medical staff.
2. (2) The condition of the mother shall be monitored frequently to detect signs of hemorrhage or other complications requiring prompt transfer to a hospital.
3. (3) Adequate nutrition must be provided to the mother during her stay at the birthing center, as evidenced by written dietary requirements on file at the birthing center.

4. (4) Qualified members of the birthing center's staff shall perform a postpartum examination on the mother, as permitted within the staff member's legal scope of practice, prior to discharge and within 72 hours after delivery, and an additional examination of the mother shall be performed at approximately 4 to 6 weeks after delivery by the birthing center, a referral facility, or a qualified medical professional.

   1. (a) The patient examination prior to discharge and within 72 hours shall include, at a minimum:

      1. 1. Interval history.
      2. 2. Blood pressure measurement.
      3. 3. Observation of the breasts, perineum, and abdomen.

   2. (b) The patient examination at 4 t o6 weeks shall include all of the above and:

      1. 1. Weight.
      2. 2. Hemoglobin and hematocrit.
      3. 3. Bi-manual pelvic examination.

5. (5) Immediate postpartum care shall be provided to the newborn at the birthing center by qualified members of the medical staff as permitted within the staff member's legal scope of practice.

   1. (a) A prophylaxis shall be instilled into each eye of the newborn.
   2. (b) A cord blood sample shall be secured for laboratory testing for type, Rh determination, and direct Coombs test when the mother is Rh negative. The newborn shall also receive umbilical cord care.
   3. (c) Newborn screening monitoring as 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, testing for Group B Streptococcal infection, HIV, syphilis, and metabolic screening, to include newborn hearing screening and congenital cardiac screening, as required by state law.
   4. (d) The newborn shall be weighed, measured, and examined for abnormalities and complications, and an Apgar score shall be obtained and recorded at 1 and 5 minutes. An identification tape shall be placed on all newborns.
   5. (e) One-half milligram of Vitamin K shall be administered to the newborn within 24 hours after birth.

   6. (f) The newborn must be examined by a qualified medical staff member, pursuant to each one's scope of practice, prior to discharge and shall be immediately referred to a qualified physician or hospital care if any of the following conditions occur:

      1. 1. Low birth weight (under 2,500 grams).
      2. 2. Apgar score of 7 or less at 5 minutes.
      3. 3. Signs of pre- or post-maturity.
      4. 4. Jaundice.
      5. 5. Persistent hypothermia consisting of a body temperature of less than 97°F for more than 2 hours after birth.
      6. 6. Respiratory difficulties.
      7. 7. Major congenital anomalies.
      8. 8. Exaggerated tremors.
      9. 9. Any other condition requiring medical care.

6. (6) Discharge Criteria.

   1. (a) Prior to discharge of the newborn, recommendations and care consistent with the American Academy of Pediatrics and American College of Obstetricians and Gynecologists Guidelines for Perinatal Care and the rules and regulations of the Department must be followed, to include, but not be limited to, any required treatment for congenital syphilis, post-exposure prophylaxis for HIV, Hepatitis B immune globulin, and Hepatitis B vaccination. The newborn should also be evaluated for the risk for hyperbilirubinemia by either blood or transcutaneous measurement, with a written plan for medical follow up.

   2. (b) The mother and newborn shall be discharged from the birthing center within 24 hours after the birth occurs, except under the following conditions:

      1. 1. The mother is in a deep sleep when the 24-hour period is completed. In this case, the mother shall be discharged as soon after waking as is feasible; or
      2. 2. The 24-hour period is completed between the hours of 10 p.m. and 6 a.m.
7. (7) If the mother or newborn is retained at the birthing center longer than 24 hours after the birth, a report shall be filed with the Department's Division of Licensure and Certification within 48 hours after the birth, describing the circumstances and reasons for retention.
8. (8) The mother shall be counseled and receive written information regarding breastfeeding, perineal care, family planning, signs of common complications, activities and exercises, sex relations, care and feeding of the newborn, and changing family relationships prior to discharge from the birthing center.
9. (9) Prior to discharge, the parents shall be instructed by the birthing center in the importance of immunization and a 2-week screening for the newborn in accordance with the American Academy of Pediatrics schedule of visits. Parents shall also be instructed in the importance of repeat metabolic screening starting at several weeks of age. The parents shall be referred to providers of pediatric care if not provided on site.
10. (10) Observation of the Newborn at 72 Hours and 4 to 6 Weeks. A metabolic screening test shall be performed on the newborn by the birthing center, a referral facility, or a qualified medical professional between 24-72 hours and shall include, at a minimum, hypothyroidism and phenylketonuria. Sickle cell testing should be included if indicated. An examination of the newborn should also be made at 4 to 6 weeks by qualified members of the birthing center's medical staff, pursuant to each staff member's legal scope of practice, or a licensed pediatrician, family medicine practitioner, or pediatric nurse practitioner.
11. (11) If complications in the mother or newborn occur during the postpartum period, a consultation or referral shall be made to the appropriate source of secondary or tertiary care.
12. (12) If the mother refuses to permit eye prophylaxis, Vitamin K injections, or a metabolic screening test prophylaxis for the newborn due to religious beliefs, a waiver indicating this decision shall be signed by the mother, witnessed by a medical staff member, and filed with the clinical record.

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.