The purpose of this section is to ensure the birth center is able to provide safe and appropriate care to the patients of the birth center.

1. (1) An applicant or licensee must establish and implement policies and procedures which include, but are not limited to:

   1. (a) Definition of a low-risk client who is eligible for birth services offered by the birth center. An applicant or licensee wanting to use a more recent version of the CABC indicators for compliance for the purpose of defining a low-risk client may submit an alternative method request following the process in WAC 246-329-025.
   2. (b) Identification and transfer of clients and newborns who, during the course of labor or recovery, are determined to be ineligible for continued care in the birth center.
   3. (c) Consultation, referral and transfer of care for client and newborn, including emergency transfer and transport of a newborn to a newborn nursery or neonatal intensive care nursery, and emergency transfer and transport of a client to an appropriate obstetrical department, patient care area, or hospital when additional care is necessary.
   4. (d) Transfer and discharge of clients and newborns.
   5. (e) Protocol for intermittent auscultation to monitor fetal status during labor.
   6. (f) Actions to be taken upon death of a patient.

   7. (g) Protocol for use of inhaled nitrous gas as an analgesic. Protocol must include, at minimum, the following:

      1. (i) A process for establishing staff competency in nitrous oxide use prior to client self-administration;
      2. (ii) Nitrous oxide being administered with oxygen by a member of the clinical staff. The maximum concentration of nitrous oxide is limited to 50 percent;
      3. (iii) The client must always self-administer the nitrous oxide (the laboring person holds the mask or mouthpiece without any assistance from staff);
      4. (iv) A clinical staff member is responsible for the counseling and education of the patient on nitrous oxide therapy and the setup and preparation of the nitrous oxide delivery system. These responsibilities cannot be delegated to other birth center personnel;
      5. (v) Birth centers that offer nitrous oxide for labor analgesia must meet the equipment requirements in WAC 246-329-130 (1)(c).
   8. (h) Birth centers that do not offer inhaled nitrous gas are not required to establish the policies, procedures, and protocols in (g) of this subsection.

2. (2) Clients must receive and sign written informed consent which must be obtained prior to admission and must include, but is not limited to:

   1. (a) Explanation of the birth services offered and potential risks;
   2. (b) Eligibility requirements for the admission to the birth center;
   3. (c) Client bill of rights according to WAC 246-329-085;
   4. (d) Explanation of transfer of care and emergency transfer and transport;

   5. (e) Notification and recommendation to acquire peripartum services and whether those services are available at the birth center, including:

      1. (i) Newborn metabolic and heart disease screening recommendations per chapters 70.83 RCW and 246-650 WAC.
      2. (ii) Newborn hearing screening.
      3. (iii) Prophylactic treatment of the eyes of the newborn in accordance with WAC 246-100-202.
      4. (iv) Vitamin K injection for the newborn.
      5. (v) Bilirubin screening for the newborn.
      6. (vi) Medications for GBS prophylaxis.
      7. (vii) Prophylactic administration of RhIG (immune globulin) within 72 hours of delivery for an Rh negative mother whose newborn(s) are Rh positive.
      8. (viii) MMR vaccination for nonimmune newly postpartum clients.

3. (3) The birth center must provide or ensure:

   1. (a) Reporting of patient/client abuse and neglect according to chapter 74.34 RCW.
   2. (b) Plans for service delivery when natural or man-made emergencies occur that prevent normal clinical operation.
   3. (c) Waived laboratory tests, if applicable, including the procurement of a medical test site waiver under chapter 246-338 WAC.

   4. (d) Privileged clinical staff, employed or contracted, who agree to execute the following responsibilities:

      1. (i) Education of clients, family and support persons in childbirth and newborn care.
      2. (ii) Plans for immediate and long-term follow-up of clients and newborns after discharge from the birth center.
      3. (iii) Registration of birth and reporting of complications and anomalies, including sentinel birth defect reporting under chapter 70.58 RCW.
      4. (iv) Prophylactic treatment of the eyes of the newborn in accordance with WAC 246-100-202 (1)(e).
      5. (v) Collection of a newborn screening blood specimen, or signed refusal, and submission to the department's newborn screening program under the requirements of WAC 246-650-020.
      6. (vi) For HIV positive patients, appropriate testing, treatment, and risk assessment.
      7. (vii) Intrapartum intravenous antibiotics for Group B Strep positive clients per the CDC protocol.
      8. (viii) For Hepatitis B positive clients, HBIG and Hepatitis B immunization for the newborn.
      9. (ix) Authorization and administration of medications, legend drugs and devices per appropriate health profession rules.
      10. (x) Actions to address patient communication needs.
      11. (xi) Emergency medical care of patient.
      12. (xii) Reporting of patient/client abuse and neglect according to chapter 74.34 RCW.
      13. (xiii) When a patient is transferred or discharged to another provider or facility, the clinical staff must provide a summary of care to the provider or facility to whom the patient is transferred or discharged.

[Statutory Authority: RCW 18.46.060 and 43.70.250. WSR 25-15-078, s 246-329-120, filed 7/15/25, effective 8/15/25. Statutory Authority: RCW 18.46.060. WSR 10-05-033, § 246-329-120, filed 2/9/10, effective 3/12/10. Statutory Authority: Chapter 18.46 RCW and RCW 43.70.040. WSR 07-07-075, § 246-329-120, filed 3/16/07, effective 4/16/07.]