1. (a)

   1. (1) The freestanding birthing center shall have written criteria for:

      1. (A) Evaluation of risk status;
      2. (B) Admission;
      3. (C) Transfer;
      4. (D) Discharge; and
      5. (E) Complications requiring medical or surgical intervention.

   2. (2) The criteria shall be:

      1. (A) Developed by the clinical staff; and
      2. (B) Approved by the governing body.

   3. (3) Criteria for admission for labor, birth, and postpartum care shall include but are not limited to:

      1. (A) Low-risk pregnancy with the expectation of a singleton, vertex, spontaneous vaginal birth at term without complications;
      2. (B) Evidence of adequate prenatal care that:

2. (i) Begins no later than twenty-eight (28) weeks’ gestation; and

   1. (ii) Provides continuous prenatal screening; and

      1. (C) Evidence of preparation for out-of-hospital birth and early discharge.
   2. (4) Criteria shall be developed for conditions of the mother or neonate requiring transfer to an acute care facility.
   3. (5) Criteria for discharge of the mother and newborn in not more than twenty-four (24) hours from admission shall be developed and approved by the governing body.

3. (b) In no event shall a patient meeting any of the following criteria be accepted as a candidate for delivery at a freestanding birthing center:

   1. (1) Females below fourteen (14) years of age;

   2. (2) Documented problems in the maternal medical history, including:

      1. (A) Heart disease;
      2. (B) Pulmonary embolus;
      3. (C) Symptomatic congenital defects;
      4. (D) Moderate to severe renal disease, including nephritis;
      5. (E) Severe mental health problems and/or current use of drugs related to their management;
      6. (F) Epilepsy or seizures after ten (10) years of age that required use of anticonvulsive medications;
      7. (G) Breech presentation;
      8. (H) Preterm labor;
      9. (I) Insulin-dependent gestational diabetes;
      10. (J) Thyroid disease that is not maintained in euthyroid state;
      11. (K) Bleeding disorder or hemolytic disease;
      12. (L) Other serious medical problems;
      13. (M) Multiple births;
      14. (N) Vaginal birth following C-section;
      15. (O) Preeclampsia;
      16. (P) Moderate or severe asthma;
      17. (Q) Severe obstructive pulmonary disease;
      18. (R) Severe systemic disease (e.g., SLE, hyperthyroidism, Marfan’s syndrome);
      19. (S) Hypercoagulable state (i.e., protein S or C deficiency, AT III deficiency); or
      20. (T) History of intracranial injury; and

   3. (3) Patients with the following physical findings:

      1. (A) Previous Rh sensitization;
      2. (B) Positive HIV antibody;
      3. (C) Gestation of more than twenty-eight (28) weeks with no prenatal care;
      4. (D) Hematocrit below twenty-eight percent (28%);
      5. (E) S/S (sickling) hemoglobin or abnormal protein electrophoresis;
      6. (F) Evidence of active tuberculosis;
      7. (G) Chronic hypertension;
      8. (H) Known severe fetal abnormality;
      9. (I) Severe polyhydramnios;
      10. (J) Severe oligohydramnios; or

      11. (K) Placenta previa.

          1. (c) Admission to the program.

   4. (1) Childbearing women prior to twenty-eight (28) weeks’ gestation seeking care in the center shall be initially screened by either the:

      1. (A) Physician;
      2. (B) Certified nurse midwife;
      3. (C) Registered nurse practitioner; or
      4. (D) Advanced practice nurse.

   5. (2) The initial screening shall include at a minimum:

      1. (A) Complete social, family, medical, reproductive, nutritional, and behavioral history;
      2. (B) Evidence of results of complete physical examination to include Papanicolaou smear and assessment for sexually transmitted diseases; and

      3. (C)

         1. (i) Prenatal laboratory profile to include:
4. (a) (a) A complete blood count;

5. (b) (b) A blood type and Rh antibody screen if necessary;

   1. (c) (c) Urinalysis or urine culture;

      1. (d) (d) Tests for sexually transmitted diseases;
6. (e) (e) Mother’s Hepatitis C status; and

7. (f) (f) Other tests as medically indicated.

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

      1. (d) Continuing prenatal care shall include a repeat evaluation of the hemoglobin or hematocrit at twenty-eight (28) to thirty-six (36) weeks’ gestation.

8. (e) Freestanding birthing centers shall comply with Arkansas (Acts 1967, No. 192, as amended by Acts 1981, No. 481, the same being Arkansas Code §§ 20-15-302 – 20-15-304), that require newborn infants to be tested for:

   1. (1) Phenylketonuria;
   2. (2) Congenital hypothyroidism; and
   3. (3) Galactosemia.

9. (f)

   1. (1) Newborn testing for critical congenital heart defects shall include the performance of pulse oximetry testing on all newborns before discharge.
   2. (2) Arkansas Code § 20-9-103.
   3. (3) Performance of a pulse oximetry test on a newborn is not required if the parent or legal guardian of the newborn objects to the testing on medical, religious, or philosophical grounds.

10. (g) Newborn testing for genetic illnesses shall be in accordance with:

    1. (1) Rules Pertaining to Testing of Newborn Infants, 20 CAR pt. 107; and
    2. (2) Arkansas Code § 20-15-302.

11. (h) Newborn testing for early detection of hearing loss shall be in accordance with:

    1. (1) Rules for Universal Newborn Hearing Screening, Tracking, and Intervention Program and Advisory Board, 20 CAR pt. 11; and

    2. (2) Arkansas Code § 20-15-1504.

       1. (i) Educational plan for antepartum care.

    3. (1) There shall be a written plan that shall include but not be limited to:

       1. (A) Anticipated physiologic and psychologic changes during pregnancy;
       2. (B) Fetal development;
       3. (C) Normal nutrition;
       4. (D) Warning signs of complications of pregnancy;

       5. (E) Self-care to include information of the:

          1. (i) Dangers of smoking, alcohol, and substance abuse; and
          2. (ii) Need for dental care;
       6. (F) Stages of labor;
       7. (G) Nonpharmacologic techniques to promote comfort and relaxation during labor;
       8. (H) Delivery process;
       9. (I) Immediate care of the newborn;
       10. (J) Criteria for and process of transfer to an acute care facility;
       11. (K) Normal postpartum;
       12. (L) Criteria for discharge from the center;
       13. (M) Breastfeeding;
       14. (N) Importance of immunization;
       15. (O) Child safety to include use of car seats;
       16. (P) Directions for obtaining laboratory tests for newborns required by the Department of Health;
       17. (Q) Instruction as to clothing/supplies needed at the time of discharge from the center;
       18. (R) Instruction shall be appropriate to the assessed educational level and within the cultural framework of the childbearing family;
       19. (S) The educational plan shall include provisions for material and teaching in languages other than the dominant language where possible; and
       20. (T) Informing, counseling, and instructing the pregnant woman, by a physician or healthcare provider, regarding Hepatitis C.
    4. (2) The facility shall develop instructional programs to orient family members desiring to be present at the birth.
    5. (3) There shall be written documentation in the patient record of patient/family receipt of instructions.
    6. (4) There shall be documentation of annual review and revision of the educational plan.

12. (j) Family participating in the birth process.

    1. (1) The number of individuals/family members present at the time of birth shall be determined by center policy that takes into account:

       1. (A) Room size; and
       2. (B) Need for infection control.
    2. (2) Individuals/family members shall abide by the center's infection control policies in regard to handwashing, apparel, etc.
    3. (3) An adult not involved in the birthing process shall be in charge of the children.

    4. (4)

       1. (A) Children shall be screened for infectious disease by either the physician or CNM or RN prior to admission to the birthing room.
       2. (B) Children with evidence of infectious disease will not be allowed in the birthing room.
    5. (5) Only children who have completed sibling evaluation or preparation will be allowed in the birthing room.
    6. (6) Animals, except for seeing-eye dogs, shall be prohibited in the freestanding birthing center at any time.

13. (k) Emergency procedures. The freestanding birthing center shall have written procedures for emergency transfer of mother and/or newborn to an acute care facility.

    1. (l) Minimum equipment for birthing rooms.

    2. (1)

       1. (A) The birthing room shall be attractively furnished and decorated.
       2. (B) Furniture, vinyl wall covering, pictures, radios, television, and other amenities may be utilized so long as the potential medical needs of the mother and newborn are not compromised.
       3. (C) The furniture shall be easily cleanable.
    3. (2) Sterile equipment shall be used for the delivery.
    4. (3) Professionals directly involved in the delivery shall wear clean attire and sterile gloves.

    5. (4) Minimum equipment for the birthing room shall include:

       1. (A) Bed with waterproof pad;
       2. (B) Heated newborn crib, bassinet, or newborn examination unit;
       3. (C) Sphygmomanometer and stethoscopes, adult and newborn sizes;
       4. (D) Fetoscope;

       5. (E) Oxygen and oxygen equipment including:

          1. (i) Tubing;
          2. (ii) Nasal prongs;
          3. (iii) Ambu bags; and
          4. (iv) Masks;
       6. (F) Suction and suction equipment including DeLee traps for newborn suction;
       7. (G) Mobile or mounted spotlight or lamp;
       8. (H) Maternal and newborn airways;
       9. (I) Storage for clothing, linens, and supplies;
       10. (J) Wall clock;
       11. (K) Newborn scales;
       12. (L) Tape measure;
       13. (M) Identification supplies, maternal and newborn;
       14. (N) Prophylactic medications for newborns as required by the department;
       15. (O) Emergency call system;
       16. (P) Apgar chart;
       17. (Q) Amniotic hook;
       18. (R) Bulb syringe;
       19. (S) Nitrazine paper; and
       20. (T) Emergency drugs as identified by the facility.

Codification Notes: “AT” means antithrombin. "HIV" means human immunodeficiency virus. "SLE" means systemic lupus erythematosus. "S/S" means sickle-cell disease.