1. (1) The birthing center shall establish and maintain a safe environment for healthy women anticipating an uncomplicated labor and birth, with adequate space for furnishings, equipment, and supplies necessary to ensure comfortable and private accommodations for the mother and family, and adequate space for personnel, including but not limited to:

   1. (a) Admissions Office. There shall be a room designated as the admissions office, where patients may discuss personal matters in private. The admissions office may be combined with the business office and medical record room if privacy can be maintained when confidential matters are being discussed. This space shall be separated from the treatment area by walls.
   2. (b) Business Office. This space shall be adequate for the number of birthing center personnel.
   3. (c) Reception and Waiting Area. A waiting room shall be provided with sufficient seating for the maximum number of persons that may be waiting at any time. Public toilets, telephones, and drinking fountains, accessible to the handicapped, shall be available.
   4. (d) Staff/Employee Locker Rooms and Toilets. The birthing center shall provide male and female toilet and locker rooms, which are centrally located.
   5. (e) Family Room and Play Area for Children. The size and number of family rooms shall be adequate for the patient caseload. A couch, chairs, end table, reading lights, and toy storage area shall be included. Sufficient precautions for child safety shall be observed. Depending on the size of the caseload, the family area may double as a conference room and/or classroom. Toilet facilities shall be available.
   6. (f) Conference/Educational Facilities/Library Area. These areas may be one room or separate rooms; however, each area shall be of sufficient size for the number of personnel in the birthing center and the patient caseload. The conference area may be used for childbirth classes, staff inservice education, meetings, etc.
   7. (g) Clean Utility. A clean workroom for storage and assembly of supplies shall contain storage cabinets or storage carts, a work counter, and a sink.
   8. (h) Soiled Utility. The soiled utility room shall contain a deep sink, work counter, waste receptacle, and soiled linen receptacle.
   9. (i) Medicine Room. The medicine room shall include a sink, small refrigerator, locked storage, narcotic locker, and work counter. The medicine area may be combined with the clean utility room.
   10. (j) Clean Linen Storage. The clean linen storage shall contain a closet large enough to hold an adequate supply of clean linen. This can be combined with the clean utility room.
   11. (k) Kitchen Facilities. The kitchen/nourishment centers shall have sufficient storage for patients' prepared food and beverages. A centralized kitchen/nourishment center may be shared or individual nourishment centers may be present in each birthing room.
   12. (l) Janitor's closet.
   13. (m) Laundry. A laundry room with a residential washer and dryer shall be provided if an outside laundry contract is not used.
   14. (n) Laboratory.  The laboratory area shall contain a counter, sink, and storage area for supplies.
   15. (o) Emergency cart storage.
   16. (p) Examination Rooms. The number of examination rooms shall be adequate for the patient caseload. When used for prenatal care, the examination rooms shall be situated away from the birthing rooms. Each examination room shall contain at least I 00 square feet. At least one examination room shall be provided for admission evaluation, containing an examining table with stirrups, stool, goose neck light, equipment table, sink, and supply storage area.

   17. (q) Central Sterile Supply. Written policies and procedures shall be maintained for the sterilization of supplies and water and reprocessing of sterile supplies at specific time periods. The following areas shall be separated:

       1. 1. The receiving and clean-up area shall include a two-compartment sink with two drainboards.
       2. 2. The area for instrument pack assembly shall have a sterilizer or approved alternate source of sterilization, work counter, and a lavatory or sink. A sterile storage area shall also be provided.
       3. 3. When sterilization services are provided via contract outside of the birthing center, there shall be a separately designated area in the facility for dirty, clean, and sterile supplies.

   18. (r) Birthing Rooms.

       1. 1. Birthing rooms shall have sufficient space for a double bed, cradle, nightstand, rocking chair, cabinet for supplies, and a sink, with a minimum of 120 square feet. A counter area for infant resuscitation should be lighted in such a manner as to provide at least l00 foot candles at the infant's body surface, and should include an overhead source of radiant heat, a heating pad overlying a thin mattress on which the neonate is placed, and a large wall clock with a clearly visible second hand.
       2. 2. Ceiling height of the birthing rooms shall be a minimum of 8 feet.
       3. 3. Each birthing room will have immediate access to a bathroom.  Tubs are recommended.
       4. 4. Birthing rooms shall be designed to provide privacy for the mother and family.
       5. 5. All walls and floors shall be suitable for washing.
       6. 6. A nurse call outlet or emergency call system shall exist with control switches in all birthing rooms that can be activated during an emergency.
       7. 7. Portable oxygen and suction shall be available.  All outlets shall be grounded.

   19. (2) Equipment.

       1. (a) The birthing center shall have properly maintained equipment for routine care of women and neonates, including, but not limited to:

          1. 1. A readiant heat source for newborn examination.
          2. 2. Transfer incubator or isolete.
          3. 3. Sterilizer or an approved alternate source of sterilization.
          4. 4. Blood pressure equipment, thermometers, fetoscope/doptone.
          5. 5. Intravenous equipment.
          6. 6. Oxygen equipment for mother and newborn.
          7. 7. Instruments for delivery, episiotomy, and repair.

       2. (b) Testing and Diagnostic Equipment. All testing and diagnostic equipment, including equipment that is readily available to perform ongoing assessments of the mother and fetus/infant, shall be maintained in good working order at all times and tested on a routine basis.

          1. 1. If equipment is obsolete or permanently unusable because of irreparable damage, malfunction, or any other condition that renders its use detrimental to patient care, it shall be immediately separated from the equipment currently in use, clearly tagged as permanently unusable, and properly disposed of as soon as possible.
          2. 2. If equipment is temporarily unusable, it shall be immediately separated from equipment currently in use and clearly tagged as being temporarily unusable until it is repaired or otherwise made fit for use. Equipment is temporarily unusable if in need of repair or if not maintained in accordance with manufacturer standards, regardless of whether there is an apparent defect. Tagged equipment shall not be returned to use until repaired and tested to ensure proper operation.

       3. (c) Preventive Maintenance. There shall be a schedule of preventive maintenance developed for all equipment in the birthing center integral to patient care to assure satisfactory operation thereof. This schedule shall cover at least the following equipment and shall be retained by the birthing center for a minimum of 2 years:

          1. 1. Ultrasound. All ultrasound machines must be tested and calibrated by a trained, qualified technician in accordance with the manufacturer's recommendations. In no event shall testing and calibration be done less than annually.
          2. 2. Autoclave. All autoclaves must be tested and maintained at least annually by a trained, qualified technician in accordance with the manufacturer's recommendations, except that necessary routine weekly cleaning, maintenance, and inspection may be performed by properly trained clinic staff or a trained, qualified technician in accordance with the manufacturer's recommendations. Dated chemical indicators shall be used with every load to ensure sterilization. Biological indicator testing must be performed every 40 service-hours, and the results of the biological indicator testing must be logged.
          3. 3. A readily accessible emergency cart or tray for the mother shall be equipped to carry out the birthing center's written emergency procedures. A written log of routine equipment maintenance shall be maintained for the emergency cart. The emergency cart or tray for the mother shall contain mechanical ventilating assistance equipment, airways, manual breathing bag, laryngoscope and endotracheal tubes, suction equipment, emergency drugs and supplies, intravenous equipment, an automatic external defibrillator (AED), blood expanders, and postpartum hemorrhagic equipment.
          4. 4. A readily accessible emergency cart or tray for the newborn shall be equipped to carry out the birthing center's written emergency procedures and shall be securely placed with a written log of routine maintenance. The emergency cart or tray for the newborn shall contain mechanical ventilating assistance equipment, airways, manual breathing bag, laryngoscope and endotracheal tubes, suction equipment, emergency drugs and supplies, and intravenous equipment and shall be available in each birthing room.

       4. (d) The birthing center must maintain a record for all equipment containing the following information:

          1. 1. Manufacturer, make, and model of the equipment.
          2. 2. Date of purchase.
          3. 3. Any dates on which the equipment was removed from service for repair or maintenance and, if applicable, date equipment was returned to service.
          4. 4. Date and description of all tests, maintenance, or repairs performed on the equipment, including all routine inspection and maintenance performed by medical staff.
          5. 5. Names and qualifications of the company and technician performing the tests, maintenance, or repairs.
          6. 6. Results of any tests, maintenance, or repairs.
          7. 7. All manufacturer literature and information. Any missing information shall be noted in the equipment record, and if there is no record of proper maintenance in the last year, the equipment must be immediately tested and, if necessary, calibrated or repaired.

       5. (e) The birthing center shall have properly maintained accessory equipment, which incudes, but is not limited to:

          1. 1. A conveniently placed telephone and emergency call system.
          2. 2. Portable lighting, including an emergency light source.
          3. 3. Kitchen equipment usually found in home for light refreshment.
          4. 4. Laundry area for residential washer and dryer if an outside laundry contract ids not used.

   20. (3) Supplies.

       1. (a) The inventory of supplies shall be sufficient to care for the number of childbearing women and families registered for care.
       2. (b) Shelf life of all medications and intravenous fluids shall be monitored. Medications and supplies which have deteriorated or reached their expiration dates shall not be used for any reason. All expired or deteriorated items shall be disposed of promptly and properly. The birthing center shall examine all stored medications and supplies no less frequently than once each month and shall remove from its inventory all deteriorated items and all items for which the expiration date has been reached. The birthing center shall maintain a log recording each such examination with its date, time, the person conducting the examination, and a description of each item or group of items removed from inventory and the reason for removal.

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.