1. (a) only patients at low risk are admitted and cared for at the midwifery birth center;
2. (b) written policies, procedures and standard risk assessment criteria for determining low-risk pregnancies based upon generally accepted standards of practice are developed and implemented;
3. (c) written policies, procedures and protocols for the management of care are implemented pursuant to generally accepted standards of practice and in accordance with midwifery birth center philosophy;
4. (d) a record is made of all informed consent, including shared decision making, that indicates concurrence from both caregiver and patient parties;

5. (e) there is a transfer agreement with one or more perinatal centers for medical care of patients when complications arise antepartum, intrapartum, or postpartum and that meets the following requirements:

   1. (1) compliance with section 400.9 of this Title;
   2. (2) the surface travel time to reach a receiving perinatal hospital is less than two hours under usual weather and road conditions; and
   3. (3) the receiving hospital is accessible and convenient to the patient’s place of residence whenever possible;
6. (f) support services such as laboratory, radiology and imaging, and family planning services not provided by the midwifery birth center are available by referral;
7. (g) the midwifery birth center services are available 24 hours a day for the admission of patients, professional consultation and prompt response to inquiries;
8. (h) kitchen facilities are available to enable families to store and prepare food brought in for the laboring family;
9. (i) the midwifery birth center acts in accordance with the requirements of section 405.21(c)(14) of this Title with respect to a voluntary acknowledgement of paternity for a child born out of wedlock;
10. (j) the midwifery birth center refers patients for genetic screening, carrier testing, and genetic counseling as needed;
11. (k) the midwifery birth center refers patients requiring physical or occupational therapy to an appropriate therapist as needed; and
12. (l) the needs of infants demonstrating difficulty feeding and swallowing are addressed to ensure the infant is healthy and developing properly, including referral to a lactation consultant or licensed speech and language pathologist as needed.

The operator shall ensure that: