North Dakota Administrative Code › Title 33 - State Department of Health › Article 33-07 - Licensing Medical Hospitals › Chapter 33-07-01.1 - Hospitals › Section 33-07-01.1-34.1 - Outpatient birth services in hospitals

Current through Supplement No. 393, July, 2024
1.
				General acute hospitals providing outpatient birth services in hospitals are
				subject to the outpatient birth services requirements for specialized hospitals
				in this section.
2. Primary care
				hospitals may not provide outpatient birth services.
3. Any facility that provides outpatient
				birth services shall comply with this section. A facility may not hold itself
				out to the public as providing outpatient birth services unless such outpatient
				birth service has been licensed by the department and meets the requirements
				for outpatient birth services in this section.
a. The facility provides peripartum care of
				low-risk patients for whom prenatal and intrapartum history, physical
				examination, and laboratory screening procedures have demonstrated normal,
				uncomplicated singleton term (thirty-seven to forty-one and six-sevenths
				weeks), multipara pregnancies with a spontaneous labor, and vertex presentation
				that are expected to have an uncomplicated birth. The policy and procedures
				must specify medical and social criterion to determine risk status at admission
				and during labor.
b. Patients who
				are not considered low risk, patients who experience no cervical dilation in
				over three hours who are considered in active labor according to the American
				college of obstetricians and gynecologists standards, and patients who develop
				a high-risk condition based on standards of practice shall be transferred as
				described in subsection 6.
c.
				Patients shall be fully informed on and provide written consent to the benefits
				and risks of the services available and alternatives if more advanced services
				are required.
d. Surgical
				procedures must be limited to those procedures normally encountered during
				uncomplicated childbirth, such as episiotomy and repair, and must not include
				operative obstetrics or cesarean section. Circumcisions of newborns are
				allowed.
e. Labor may not be
				inhibited, stimulated, or augmented with chemical agents during the first or
				second stage of labor nor may labor be induced by artificial rupture of
				membranes.
f. Vacuum extractors,
				forceps, and recorded electronic fetal monitors are not appropriate for use
				after admittance in active labor in outpatient birth services. Patients
				requiring these interventions shall be transferred as described in subsection
				6.
g. General and conduction
				anesthesia may not be administered. Local anesthesia and pudendal block may be
				administered if procedures are established and approved by medical
				staff.
h. Emergency medications,
				equipment, and supplies must be available, including tocolytics and uterotonic
				medications. Nothing in the foregoing should be construed to prohibit exercise
				of medical skills or the use of emergency medications to benefit the patient or
				the baby in case of emergency. Patients requiring these interventions shall be
				transferred as described in subsection 6.
i. Patients and infants must be discharged
				within twenty-six hours after birth in accordance with standards set by the
				medical staff and specified in the policies and procedures. A program for
				prompt followup care and postpartum evaluation after discharge must be ensured
				and outlined in the policies and procedures. This program must include
				assessment of infant health, including physical examination, laboratory and
				screening tests required by state law at the appropriate times, maternal
				postpartum status, instruction in child care including immunization, referral
				to sources of pediatric care, provision of family planning services, and
				assessment of bonding relationship, including breastfeeding.