Illinois Administrative Code › Title 77 - PUBLIC HEALTH › Part 265 - BIRTH CENTER DEMONSTRATION PROGRAM CODE › Subpart A - GENERAL REQUIREMENTS › Section 265.1550 - Admission Protocols for Acceptance for Birth Center Clients

Current through Register Vol. 48, No. 28, July 12, 2024
a) An admission
				protocol specifying the criteria for admitting a client to the birth center
				shall be included in the application as provided in Section
				265.1300.
b) Only clients whose births are planned to
				occur following anormal, uncomplicated, and low-risk pregnancy shall be allowed
				to receive services at the birth center. The medical director and the Director
				of Nursing and Midwifery Services shall jointly develop and approve policies
				defining the criteria to determine which pregnancies are accepted as normal,
				uncomplicated and low-risk, and the anesthesia services and other services
				available at the birth center. (Section 35(6) of the Act)
c) No general anesthesia, which includes
				spinal/epidural, or regional, may be administered at the birth center. (Section
				35(6) of the Act)
d) Any pregnant
				walk-in person who is beyond 32 weeks of gestation or is ready to deliver her
				baby, and who has not previously been approved for admission, shall be
				immediately transferred to a hospital.
e) An obstetrician, family
				practitioner/physician, or certified nurse midwife shall attend each woman in
				labor from the time of admission through birth and throughout the immediate
				postpartum period. (Section 35(6) of the Act)
f) Criteria for acceptance for admission
				shall be in writing.
g) No
				pharmacologic agents are permitted to induce or enhance labor.
h) The birth center shall have a contractual
				relationship/transfer agreement with a hospital capable of performing obstetric
				deliveries.
i) The birth center
				shall have a letter of agreement with a hospital designated under the Perinatal
				System. (Section 35(6) of the Act)
j) The birth center's governing body shall
				approve the acceptance for admission protocol and any subsequent
				revisions.
k) Each birth center
				shall establish written policies and procedures stating the medical and social
				risk factors that exclude women from the low-risk intrapartum group.
l) Each birth center shall establish a
				written risk assessment that shall be completed for each client and included in
				the client's clinical record. The assessment shall include a detailed medical
				history, a physical examination, family circumstances and other social and
				psychological factors.
m) Women who
				fail to register for acceptance with the birth center before 32 weeks gestation
				and who have not received prenatal care shall be excluded from admission unless
				a written, signed exception is made by the medical director on an individual
				basis. The woman shall otherwise meet the criteria for the risk assessment that
				are set forth in this Section, the birth center shall have documentation of
				prenatal care, and the birth center shall comply with the letter of agreement
				between the birth center and the hospital in the Perinatal System, pursuant to
				the requirement of subsection (i).
n) Criteria for antepartum acceptance and
				transfer to a hospital, and intrapartum and postpartum transfer to a hospital,
				and the certified nurse midwife-physician collaborative agreement shall be
				described in the birth center's established written protocols in accordance
				with the American Association of Birth Centers, Standards for Birth Centers.
				The criteria for acceptance and transfer to a hospital at any stage shall also
				comply with the letter of agreement between the birth center and the hospital
				in the Perinatal System, pursuant to the requirements of subsection
				(i).
o) A physician or a certified
				nurse midwife shall determine the general health and complete a risk assessment
				of the client, using the following criteria for exclusion as a birth center
				client. These criteria shall be applied to all clients prior to acceptance for
				birth center services and throughout the pregnancy for continuation of
				services. The medical director and Director of Nursing and Midwifery Services
				shall make the final determination of each client's risk.
1) Body mass index of less than 18 or greater
				than 40 (client will not be accepted).
2) Medical problems, including, but not
				limited to:
A) Heart disease, pulmonary
				embolus, or chronic hypertension not controlled by medication;
B) Congenital heart defects assessed as
				pathological by a cardiologist, placing mother and/or fetus at risk;
C) Severe renal disease;
D) Current drug or alcohol
				addiction;
E) Diabetes mellitus or
				gestational diabetes not controlled by diet;
F) Thyroid disease that is not maintained in
				a euthyroid state;
G) Bleeding
				disorder or hemolytic disease;
H)
				Adrenal disease;
I) Systemic
				collagen, connective tissue and autoimmune diseases (e.g., systemic lupus
				erythematosis, anti-phospholipid syndrome, progressive system sclerosis, and
				periarteritis nodosa);
J) Acute or
				chronic liver disease;
K)
				Neurological disorder or seizure disorder requiring use of anticonvulsant
				drugs;
L) Active HIV positive or
				confirmed active genital herpes at term;
M) Active subarachnoid hemorrhage,
				aneurysm;
N) Active hernia of the
				nucleus pulposus;
O) Active lung
				function disorder/COPD;
P) Active
				moderate to severe asthma;
Q)
				Tuberculosis, active; or
R) Active
				inflammatory bowel disease, including ulcerative colitis and Crohn's
				disease.
3) Previous
				history of obstetrical complications, including, but not limited to:
A) Previous gynecologic uterine wall surgery
				where uterine cavity was entered;
B) Two previous caesarean sections;
C) Previous caesarean section with documented
				conditions: vertical scar, placenta anterior and low lying;
D) Cervical insufficiency (and/or
				Shirodkar-procedure);
E) Placental
				abruption;
F) Postpartum hemorrhage
				as a result of cervical tear;
G)
				Postpartum hemorrhage, other causes;
H) Manual removal of a placenta.
4) Risk factors in prenatal course
				of current pregnancy, including, but not limited to:
A) Anemia (less than 9 gm hemoglobin
				concentration and not responding to therapy);
B) Complete placenta previa in third
				trimester;
C) Nonvertex
				presentation in labor;
D)
				Pre-eclampsia;
E) Known multiple
				gestation;
F) Hypertension -
				resting blood pressure 140/90 or an increase of 30 systolic or 15 diastolic
				over the client's baseline pressure;
G) Premature labor at less than 37 weeks; the
				client may return to the birth center if undelivered at 37 weeks;
H) Premature rupture of membrane at less than
				37 weeks;
I) Prolonged rupture of
				membranes requiring Pitocin induction/augmentation:
J) Prolonged pregnancy (at 42 completed weeks
				or more);
K) Significant
				isoimmunization against Rh or other antigen that may affect the fetus with
				rising titres;
L)
				Pyelonephritis;
M)
				Toxoplasmosis;
N)
				Rubella;
O)
				Cytomegalovirus;
P) Parvovirus
				infection;
Q) Tuberculosis,
				active;
R) Syphilis;
S) Ectopic pregnancy;
T) Deep venous thrombosis;
U) Placental abruption; or
V) Dead fetus.