1. (1) General.

   1. (a) Location. The birthing center shall be in a location that is free from undue noise, smoke, dust, or foul odors and shall have sufficient parking spaces to accommodate patients and their families.
   2. (b) Local Requirements. The birthing center shall comply with all local zoning, building, and fire ordinances. A birthing center may not be operated in a private residence.
   3. (c) Accessibility. The birthing center shall be located on streets or roads which can be kept passable at all times.
   4. (d) Communication. The birthing center shall have telephones to summon help in case of fire or other emergency.
   5. (e) Occupancy. No part of the birthing center may be rented, leased, or used for any commercial purpose or for any purpose not necessary or in conjunction with the operation of the birthing center. Food and drink machines may be maintained or a diet kitchen provided for prepared foods.

2. (2) Submission of Plans and Specifications.

   1. (a) Scope. A facility constructed or renovated after the effective date of these rules shall be classified as Business Occupancy and shall comply with the codes and standards adopted by the State Board of Health and in effect at the time of plan submission, including, but not limited to, the specific requirements for freestanding birth centers set forth in the Guidelines for Design and Construction of Hospitals and Outpatient Facilities, applicable Life Safety Codes, and the National Fire Protection Association (NFPA) International Building Code (IBC).
   2. (b) New Construction, Additions, and Major Alterations. When construction is contemplated for new buildings, conversions, or additions to existing buildings coming within the scope of these rules, plans and specifications shall be submitted for review by the Department in accordance with Alabama Administrative Code Rule 420-5-22, "Submission of Plans and Specifications for Health Care Facilities)".
   3. (c) Minor Alterations and Remodeling. Minor alterations and remodeling which do not affect the structural integrity of the building, change functional operation, affect fire safety, and add services to those for which the birthing center is licensed need not be submitted for review.
   4. (d) Water Supply, Plumbing, and Drainage. No system of water supply, plumbing, sewage, garbage, or refuse disposal shall be installed, nor shall any such existing system be materially altered or extended until complete plans and specifications for the installation, alteration, or extension have been submitted to the Department for review.
   5. (e) Inspections. The State Board of Health and its authorized representatives shall have access to the work for inspection wherever it is in preparation or progress.

3. (3) Building Requirements.

   1. (a) Structural Soundness. The building shall be structurally sound, free from leaks and excessive moisture, in good repair, and painted at intervals to be reasonably attractive inside and out.
   2. (b) Temperature to be Maintained. The mechanical system shall be capable of maintaining a temperature of 70° F to 75° F throughout the birthing center.
   3. (c) Lighting. There shall be general lighting and provision for adequate examination lights in the birthing room.
   4. (d) Screens. All screen doors and non-stationary windows (except in air-conditioned areas) shall be equipped with tight fitting, full length 16 mesh screens. Screen doors shall swing out and shall be equipped with self-closing devices.
   5. (e) Emergency Lighting System. Emergency lighting systems shall be provided to adequately light corridors, exit signs, stairways, and lights at the exterior of each exit in case of electrical power failure.
   6. (f) Emergency Power. An emergency generator shall be provided to operate the emergency lighting system and make life sustaining equipment operable in case of power failure. Emergency outlets shall be provided in all patient care areas.
   7. (g) Floors. All floors in birthing rooms shall be smooth resilient tile, free from cracks, and finished for easy cleaning. All other floors shall be covered with hard tile, resilient tile, carpet, or the equivalent. Carpeting is prohibited as a floor covering in birthing rooms.

   8. (h) Interior Finish and Decorative Materials. All combustible decorative and acoustical material, to include wall paneling, shall be as follows:

      1. 1. Materials on wall and ceiling in corridors and rooms occupied by four or more persons shall carry a flame spread rating of 25 or less and a smoke density rating of 450 or less in accordance with ASIM E-84.
      2. 2. Rooms occupied by less than four persons shal1 have a flame spread rating of 75 or less and a smoke density rating of 450 or less in accordance with ASIM E-84.
   9. (i) Ramps. Ramps shall not be steeper than 1 foot of rise in 12 feet of run, shall be finished with a nonslip surface, and shall be provided with handrails on both sides. Exterior ramps, where installed, shall be provided with handrails on open sides.

   10. (j) Doors.

       1. 1. The minimum width of doors to all rooms needing access for stretchers shall be 3 feet 8 inches.
       2. 2. Hardware on all toilet and bathroom doors shall be operable from outside the room.
       3. 3. Birthing doors shall not be equipped with hardware that will permit a patient to lock herself within the room.
   11. (k) Floor Levels. All differences in floor levels or step-downs within the building shall be accomplished by stairs of not less than three 6-inch risers or ramps and shall be equipped with handrails on both sides.
   12. (l) Ventilation. The building shall be well ventilated at all times. Birthing rooms shall be ventilated in such a manner as to supply fresh air and to prevent accumulation of objectionable odors. Kitchens, laundries, service rooms, toilets, bathrooms, and all inside rooms shall be ventilated by louvers, wall vents, or undercut in doors and by windows, gravity vents, or mechanical means so as to prevent offensive odors from entering other parts of the building.
   13. (m) Fire Extinguisher. An all purpose fire extinguisher shall be provided at each exit and special hazard area and located so a person would not have to travel more than 75 feet to reach an extinguisher. Fire extinguishers shall be of a type approved by the local fire department or State Fire Marshal and shall be inspected at least annually. An attached tag shall bear the initials or name of the inspector and the date inspected.
   14. (n) Elevators. Multi-story facilities shall be equipped with at least one automatic elevator of a size sufficient to carry a patient on a stretcher.
   15. (o) Multi-Story Buildings. All multi-story buildings shall be of fire resistive construction in accordance with NFPA 220, Standard Types of Building Construction.
   16. (p) Exits. Each floor of a facility shall have two or more exit ways remote from each other, leading directly to the outside or to a 2-hour fire resistive passage to the outside. Exits shall be so located that the maximum distance from any point in a floor area, room, or space to an exit doorway shall not exceed 100 feet, except that when a sprinkler system is installed, the distance of travel shall not exceed 150 feet.

   17. (q) Exit Door. Exit doors shall meet the following criteria:

       1. 1. Shall be no less than 44 inches wide.
       2. 2. Shall swing in the direction of the exit and shall not obstruct the travel along any required fire exit route.
       3. 3. One exit door shall be easily accessible to ambulances in the event of an emergency transport.
   18. (r) Exit Signs. Exits shall be equipped with approved illuminated signs bearing the word "Exit" in letters at least 4 1/2 inches high. Exit signs shall be placed in corridors and passageways to indicate the direction of exit.
   19. (s) Carpet. All carpet or pad shall carry a flame spread rating of 75 or less or a radiant flux greater than 0.45 watts per square centimeter and a smoke density rating of 450 or less.
   20. (t) Curtains. All draperies shall be rendered and maintained flame retardant.
   21. (u) Handicapped Facilities. The facility shall be accessible to the physically handicapped and shall comply with ANSI 117.1, "Making Buildings and Facilities Accessible and Useable by the Physically Handicapped."
   22. (v) Garbage Disposal. Space and facilities shall be provided for the sanitary storage and disposal of waste by incineration, containerization, removal, or by a combination of these techniques. Infectious waste materials shall be rendered noninfectious on the premises by appropriate measures.

   23. (w) Corridors.  Corridors shall comply with the following:

       1. 1. All rooms shall open onto a corridor leading to an exit.
       2. 2. Corridors used by patients shall be a minimum of 6 feet wide.
       3. 3. Service corridors may be a minimum of 4 feet wide.

   24. (x) Water Temperature.  Water temperature shall be as follows:

       1. 1. Hot water at handwashing facilities shall not exceed 120° F.
       2. 2. Hot water at bathing facilities shall not exceed 110° F.

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. Amended: Filed February 20, 1997; effective March 27, 1997. Amended: Filed June 18, 2002; effective July 23, 2002. Repealed: Filed April 16, 2010; effective May 21, 2010. New Rule: Published August 31, 2023; effective October 15, 2023.