(a) Labor room and/or LDR, LDRP room.

1. (1)

   1. (A) Provisions shall be made for patients in labor in either a:

(i) Designated labor room; and/or

1. (ii) Birthing room.

   1. (B) Rooms used only for labor shall be in close proximity to the delivery room.
   2. (C) Furniture, washable wallpaper, pictures, radio, television, and other items may be used as long as the needs of the mother and baby are not compromised.
   3. (D) Items selected shall be made of durable materials with a smooth, impervious surface that can be easily cleaned and disinfected.
2. (2) All beds used for labor shall be equipped with side rails.

3. (3) There shall be equipment and supplies available for the examination and preparation of patients in labor, which shall consist of the following:

   1. (A) Precipitous delivery tray;
   2. (B) Stethoscope;
   3. (C) Suction equipment;
   4. (D) Sterile gloves;

   5. (E) Emergency medications as approved by the Pharmacy and Therapeutics Committee and supplies to include:

      1. (i) Laryngoscopes;
      2. (ii) Airways;
      3. (iii) Endotracheal tubes; and
      4. (iv) Infant Ambu bags; and
   6. (F) Fetal monitoring device.

4. (4)

   1. (A) A physician shall be immediately available when oxytocin is administered.

   2. (B) “Immediately available” shall be determined by the hospital’s:

      1. (i) Administrative staff;
      2. (ii) Medical staff; and
      3. (iii) Governing body.
5. (5) Father or support persons may be allowed with the patient during labor unless medically contraindicated.

(b) Delivery areas.

1. (1)

   1. (A) Hospitals offering delivery and maternity services shall comply with the requirements of this section.
   2. (B) See 20 CAR § 41-110, patient care service and 20 CAR § 41-113, Health Information Services.

2. (2)

   1. (A) General operating rooms may not be used for deliveries, except for major surgical deliveries.

   2. (B) Delivery rooms shall:

      1. (i) Be separate from operating rooms; and
      2. (ii) Not be used for any other purpose, with the exception of a tubal ligation immediately following a delivery.

   3. (C) Delivery rooms may be used for Caesarean sections provided:

      1. (i) The usual operating room equipment is used; and
      2. (ii) Surgical policies and procedures related to the delivery are made a part of the labor and delivery manual.

3. (3) The following equipment and supplies shall be provided:

   1. (A) Supply of medications as approved by the Pharmacy and Therapeutics Committee;

   2. (B)

      1. (i) Infant identification and supplies.
      2. (ii) Identification shall be done in the delivery room at the time of birth and shall remain in place during the entire period of hospitalization.
      3. (iii) Identification information shall be sufficient to identify the infant or infants with one (1) mother.
      4. (iv) Identification bands shall be waterproof plastic with tag inserts written in waterproof ink;
   3. (C) Heated bassinet, crib, or incubator;

   4. (D)

      1. (i) Supply of prophylaxis medication for the prevention of infant blindness.
      2. (ii) The medication shall be administered within one and one-half (1 1/2) hours of the time of birth per written order of the physician;
   5. (E) Commercially manufactured delivery table/birthing bed with a waterproof nonconductive table pad;
   6. (F) Side tables for instruments and other necessary equipment;
   7. (G) Approved surgical light;
   8. (H) Wall clock;
   9. (I) Equipment and supplies for timed scrub technique and an approved disinfectant soap;
   10. (J) Apgar score chart;
   11. (K) Suction equipment, infant and adult;
   12. (L) Sphygmomanometer; and

   13. (M) Fetal monitoring device.

       1. (c) Organization.

4. (1)

   1. (A) Delivery services shall be under the:

      1. (i) Direction of a qualified physician; and
      2. (ii) Supervision of a registered nurse.
   2. (B) A registered nurse shall be present during labor, delivery, and postdelivery of each patient.
   3. (C) The birth shall be attended by a physician or a certified nurse midwife with hospital privileges.

5. (2)

   1. (A) Patients shall be provided with direct care by a registered nurse during:

      1. (i) Labor;
      2. (ii) Delivery;
      3. (iii) Recovery; and
      4. (iv) Postpartum.
   2. (B) All patients in active labor shall be attended and/or monitored.
   3. (C) Qualified nurses in adequate numbers shall be provided to meet the needs of each patient.

6. (3)

   1. (A) An on-call schedule shall be provided to ensure that a physician with obstetrical privileges is readily available to perform obstetrical services at all times.

   2. (B) “Readily available” shall be determined by the hospital’s:

      1. (i) Administrative staff;
      2. (ii) Medical staff; and
      3. (iii) Governing body.

7. (4)

   1. (A) Qualified registered nurses shall always be available in-house for labor and delivery patients.
   2. (B) When there are no patients, on-call staff may be utilized if approved by the medical staff and governing body.
8. (5) Procedures for obtaining the mother’s Rh factor shall be provided by the facility or documented by the mother’s attending physician upon admission.
9. (6) When a patient presents to the hospital for evaluation, the physician shall be notified.

10. (7) Policies and procedures shall include:

    1. (A) Immediate delivery;
    2. (B) Obstetrical emergencies;

    3. (C) Setting up and cleaning the:

       1. (i) Delivery room;
       2. (ii) LDR or LDRP room; and
       3. (iii) C-section room;
    4. (D) Equipment requirements;
    5. (E) Visitation;
    6. (F) Climate control (physical);
    7. (G) Infection prevention and control measures;
    8. (H) Aseptic techniques;
    9. (I) Intermittent rooming in;
    10. (J) Anesthesia;
    11. (K) Deliveries occurring outside the delivery area;
    12. (L) Infectious patients; and
    13. (M) Infant security.

11. (8)

    1. (A) A permanent record of all deliveries shall be maintained.

    2. (B) There shall be a reasonable attempt to collect current information to include the following:

       1. (i) Mother’s:

(b) (b) Date of birth;

1. (c) (c) Maiden name;

   1. (d) (d) Father’s name if available;

(h) (h) Rh factor;

1. (i) (i) Hepatitis C status; and

(j) (j) Length of gestational period; and

1. (ii) Baby’s:

(b) (b) Race;

1. (c) (c) Date of birth;

   1. (d) (d) Time of birth;

(g) (g) Baby identification band number.

1. (C) The healthcare provider shall record in the medical record if the pregnant woman declines to be tested for Hepatitis C.

   1. (d) Anesthesia.

2. (1) Only a physician, anesthesiologist, or certified registered nurse anesthetist (CRNA) shall be permitted to:

   1. (A) Initiate and reinject continual epidural or caudal anesthesia; and
   2. (B) Initiate or continue general or regional anesthesia.

3. (2)

   1. (A) A physician shall be immediately available for consultation if CRNAs are administering anesthesia.

   2. (B) “Immediately available” shall be determined by the hospital’s:

      1. (i) Administrative staff;
      2. (ii) Medical staff; and
      3. (iii) Governing body.

4. (3) The permanent record shall contain the names of the:

   1. (A) Physician;
   2. (B) Anesthesiologist;
   3. (C) Anesthetist; or
   4. (D) CRNA.

(e) Postpartum care.

1. (1) Policies and procedures shall be developed specific to the care of maternity patients.
2. (2) Maternity patients shall not be routinely cared for in rooms with patients admitted for diagnosis other than maternity.
3. (3) After an observation period, the infant may stay in the room with the mother for the duration of the hospital stay.

4. (4) Mothers with infection, fever, or other condition that could adversely affect the safety and welfare of others shall be immediately:

   1. (A) Segregated; and
   2. (B) Isolated in a separate room.

(f) Maternal-child education.

1. (1) The hospital shall develop an educational program for the care of the obstetrical patient and infant.

2. (2) Policies and procedures shall include:

   1. (A) Personal hygiene;
   2. (B) Dietary instruction;
   3. (C) Care of episiotomy and perineum;
   4. (D) Care of incision;
   5. (E) Breast care;
   6. (F) Exercise program;
   7. (G) Car seat safety, the Child Passenger Protection Act, Arkansas Code § 27-34-101 et seq.;
   8. (H) Preventive health;
   9. (I) Referral services;
   10. (J) Infant care;
   11. (K) Distributing educational materials for shaken baby syndrome, Arkansas Code § 20-9-1401 et seq.; and
   12. (L) Hepatitis C counseling.