Part 754 - Birth Center Services

Effective Date: 
Wednesday, May 1, 1996
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Statutory Authority: 
Public Health Law, Section 2803

Section 754.1 - Definitions

Section 754.1 Definitions. (a) A birth center is a diagnostic and treatment center organized to provide care to low-risk patients during pregnancy, labor and delivery who require a stay of less than 24 hours after birth. Services are provided by a physician or licensed midwife to women during a normal and an uncomplicated pregnancy, labor, birth and puerperium. Birth center services are based on a philosophy that promotes a family-centered approach to care and views pregnancy and delivery as a normal physiological process requiring limited technological and pharmacological support. The center services are designed to meet the specific needs of the population being served and promote optimum pregnancy outcomes. The licensed midwife or physician provides care for the low-risk woman during pregnancy and stays with her during labor from the time of admission to the birth center through the immediate postpartum period providing continuous physical and emotional support, evaluating progress, facilitating family interaction and assisting the woman in labor and delivery. Nurse practitioners may provide prenatal and post partum care to birthing center patients. They may also provide supportive care during labor and delivery, but the attending provider for birth must be a physician or licensed midwife.

(b) A patient at low risk means a patient with a normal medical, surgical and obstetrical history and a normal, uncomplicated prenatal course as determined by adequate prenatal care, and prospects. for a normal uncomplicated birth. A pregnant woman, parturient or newborn shall be determined as low risk during the prenatal period, intrapartum and postpartum by the use of standardized criteria based on generally accepted standards of professional practice such as those approved by the department's Prenatal/Perinatal Advisory Council Subcommittee on Birth Centers in Guidelines for Birth Centers in New York State.

Effective Date: 
Wednesday, January 23, 2002
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Section 754.2 - Administrative requirements

754.2 Administrative requirements. When birthing center services are provided the operator shall ensure that:

(a) only those women for whom a prenatal and intrapartum history, physical examination and laboratory screening procedures have demonstrated the expectation of a normal, uncomplicated course of pregnancy and labor are admitted and cared for at the birth center;

(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;

(c) written policies, procedures and protocols for the management of care are implemented in accordance with birth center philosophy;

(d) a physician or licensed midwife reviews the content of the informed consent form with each woman, and a copy is given to the woman before signing;

(e) there is a transfer agreement with a hospital(s) located within 20 minutes' transport time from the birth center to the transfer hospital for medical care of a woman or an infant when complications arise during the antepartum, intrapartum, postpartum or newborn period, written in accordance with section 400.9 of this Title;

(f) support services such as laboratory, radiology and family planning services not provided by the birth center are available by referral;

(g) the birth center services are available 24 hours a day for the admission of women, professional consultation and prompt response to inquiries;

(h) kitchen facilities are available to enable families to store and prepare food brought in for the laboring family; and

(i) the birth center takes action in accordance with the requirements of paragraph 405.21(c)(13) of this Title with respect to a voluntary acknowledgement of paternity for a child born out of wedlock.

Effective Date: 
Wednesday, January 23, 2002
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Section 754.3 - Service restrictions

754.3 Service restrictions. The operator shall ensure that:

(a) only women assessed as being low-risk by application of risk assessment criteria during pregnancy, labor, birth and puerperium are admitted and cared for at the birth center;

(b) surgical procedures are limited to those which may be performed during and after uncomplicated childbirth such as episiotomy and repair. Other surgical procedures, including forceps and vacuum extraction will not be permitted;

(c) general and regional anesthesia are not administered at the center; and (d) labor is not induced, inhibited, stimulated or augmented with pharmacological agents acting directly on the uterus during the first or second stages of labor.

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Section 754.4 - Hospital transfer procedures

754.4 Hospital transfer procedures. (a) There are written plans and procedures for the transfer of a woman or an infant to the obstetrical or pediatric services of the transfer hospital(s) when complications arise of an emergency nature. Such plans and procedures shall include arrangements for an ambulance service and, when appropriate, the escort of the patient to the admitting facility by a clinical staff member of the birth center.

(b) The operator, in collaboration with the transfer hospital(s) , shall develop a list of indicators necessitating transfer and a written procedure for automatic acceptance of such transfers by the transfer hospital.

(c) There shall be a system to ensure that a copy of the medical record accompanies the patient upon transfer to the hospital.

(d) There shall be an established mechanism for jointly reviewing all transfer cases by the transfer hospital(s) and the center as part of the quality assurance program specified in section 754.9 of this Part.

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Section 754.5 - Medical director and medical consultants

754.5 Medical director and medical consultants. The operator shall:

(a) appoint a medical director who:

(1) is a qualified specialist, as defined in section 700.2 of this Title, in obstetrics/gynecology or family practice;

(2) has obstetrical privileges that include admission and care of maternity patients at the hospital(s) used for transfer. In the absence of obstetrical privileges at the transfer hospital(s), there must be formal arrangements for the provision of obstetrical care at the transfer hospital(s);

(3) approves all policies, procedures and protocols for the medical management of care;

(4) approves standardized criteria for admission screening and monitoring the risk status of each mother during pregnancy, labor, birth and postpartum; and (5) is available for consultation and referral or has made arrangements with a qualified physician for these services;

(b) appoint a consultant physician who:

(1) is a qualified specialist, as defined in section 700.2 of this Title, in pediatrics or family practice and who has pediatric privileges that include admission and care of newborns at the transfer hospital(s). In the absence of pediatric privileges, there must be formal arrangements for the provision of pediatric care at the transfer hospital(s); and

(2) is available for consultation and referral.

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Section 754.6 - Clinical staff

754.6 Clinical staff. The operator shall ensure that:

(a) a licensed midwife or an obstetrician or a family practitioner attends each woman in labor from the time of admission, during labor, during the birth and through the immediate postpartum period. Such attendance may be delegated only to another licensed midwife or physician;

(b) a second staff person is also present at each birth who:

(1) is under the supervision of the licensed midwife or physician in attendance;

(2) has specialized training in labor and delivery techniques and care of the new born; and

(3) receives planned and ongoing training as needed to perform assigned duties effectively;

(c) if the center employs licensed midwives, a licensed midwife is appointed as director of midwifery services who is responsible for the development of policies and procedures for such services.

Effective Date: 
Wednesday, January 23, 2002
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Section 754.7 - Services for the care of mothers and newborns

754.7 Services for the care of mothers and newborns. The operator shall ensure that the birth center provides at least the following:

(a) admission screenings to assure that only low risk women are admitted to the birth center;

(b) active participation by women and families in their own health care plan to include but not be limited to:

(1) orientation to the birth center services and its philosophy and goals preceding registration; and

(2) attendance at prenatal education classes approved by the clinical staff which address, as a minimum, labor and delivery, infant care and feeding, parenting, nutrition, the effects of smoking, alcohol and other drugs on the fetus, what to expect if transferred, and the newborn screening program with the distribution of newborn screening educational literature;

(c) prenatal and intrapartum care including:

(1) a plan of care developed according to accepted professional standards;

(2) selection of pediatric services by the woman for follow-up care of the infant;

(3) providing HIV counseling and recommending voluntary testing to pregnant women during a prenatal visit. Counseling and/or testing, if accepted, shall be provided pursuant to Public Health Law Article 27-F. Information regarding the woman's HIV counseling and HIV status must be transferred as part of her medical history to the labor and delivery site. Women with positive test results shall be referred to the necessary health and social services within a clinically appropriate time;

(4) continuous risk assessment of the woman and fetus; and

(5) labor support and professional attendance at birth for the mother and her family;

(d) postpartum care including:

(1) care in the birth center to be provided for a minimum of four hours and a maximum of 24 hours after the third stage of labor is complete;

(2) a physical assessment of the newborn with the required eye prophylaxis in accordance with section 12.2 of this Title and newborn screening tests in accordance with Part 69 of this Title;

(3) birth registration in accordance with section 4130 of the Public Health Law;

(4) a physical assessment of the mother in accordance with established protocols including the evaluation of Rh status, need for Rh prophylaxis and the mother's ability to feed the infant prior to discharge from the center; and

(5) the transfer to the newborn's medical record of a mother's HIV test result, if one exists.

(e) discharge and follow-up including:

(1) maternal and newborn home visits the following day after discharge and upon the third day after discharge unless arrangements have been made for the infant to be seen by his/her physician. The home visits may be performed by professional nursing staff from the birth center, if the facility is approved under article 36 of the Public Health Law, or through an arrangement with a certified or licensed home health agency, to include an assessment of the mother-child relationship, an evaluation of the nutritional status of the infant and the physical and psychological status of the mother, performance of a hematocrit, rubella vaccination and Rh prophylaxis, if indicated, and newborn screening blood collection in accordance with Part 69 of this Title;

(2) assurance of immediate and ongoing pediatric care;

(3) provision of family planning counseling or arrangements for family planning services, if desired by the patient; and

(4) arrangements for follow-up visits at the birth center within a six-week period following the birth.

Effective Date: 
Saturday, February 1, 1997
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Section 754.8 - Medical records

754.8 Medical records. The operator shall ensure that, in addition to meeting the requirements in section 751.7 of this Title:

(a) The medical record for each woman admitted to the birth center shall contain the following information:

(1) results of physical and risk assessments;

(2) maternal history, to include medical, surgical, gynecological and psychosocial history;

(3) informed consent for birth center services;

(4) ongoing assessments of fetal growth and development;

(5) periodic evaluations of maternal health;

(6) results of laboratory tests;

(7) labor and birth information;

(8) newborn physical assessment, including APGAR scores, maternal-newborn interaction, ability to feed, eye prophylaxis, vital signs and accommodation to extrauterine life;

(9) postpartum assessment;

(10) discharge and follow-up plans;

(11) home visit reports;

(12) birth center follow-up visit report; and

(13) documentation of family planning counseling and the arrangements made for family planning services, if any.

(b) The medical record for each newborn shall be cross-referenced with the mother's medical record and contain the following information:

(1) copy of the newborn physical assessment;

(2) results from newborn screening tests;

(3) discharge summary with follow-up plans; and

(4) home visit report.

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Section 754.9 - Quality assurance

754.9 Quality assurance. In addition to meeting the requirements set forth in section 751.8 of this Title, the operator shall ensure that there is a review of all mother and/or newborn hospital transfers, with reasons for such transfers documented. Findings from these reviews shall be used in the development and revision of policies and in the consideration of renewing or granting staff privileges.

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Section 754.10 - Emergency care

754.10 Emergency care. The operator shall ensure that:

(a) emergency equipment and supplies approved by the medical director are available for use and include at least the following:

(1) intravenous therapy equipment;

(2) infant warmer;

(3) infant transport equipment;

(4) oxygen and oxygen administration equipment for mother and infant;

(5) airways and manual breathing bags for mother and infant;

(6) suction machine and equipment for mother and infant;

(7) infant laryngoscope and endotracheal tubes; and

(8) medications and intravenous fluids with supplies and equipment for administration;

(b) center staff are trained in resuscitation and other emergency procedures; and

(c) a physician or registered professional nurse and another staff member, both trained in emergency procedures, are on duty in the center when a mother is in the birth center.

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Section 754.11 - Validity

754.11 Validity. If any clause, sentence, paragraph or section of this Part shall be adjudged by any court of competent jurisdiction to be invalid, such judgment shall not affect, impair or invalidate the remainder thereof, but shall be confined in its operation to the clause, sentence, paragraph or section thereof directly involved in the controversy in which such judgment shall have been rendered.

Effective Date: 
Wednesday, May 1, 1996
Doc Status: