59A-11.009. Risk Status Criteria for the Acceptance of Clients and Continuation of Care

(1) Birth center clients are limited to those women who are initially determined to be at low maternity risk and who are evaluated regularly throughout pregnancy to assure that they remain at low risk for a poor pregnancy outcome.

(2) Each birth center shall establish a written risk assessment system which shall be a part of the policy and procedure manual. The individual risk assessment shall be included in the client’s clinical record.

(3) The general health status and risk assessment shall be determined by a physician, certified nurse midwife, licensed midwife, licensed physician assistant or advanced practice registered nurse after obtaining a detailed medical history, performing a physical examination, and taking into account family circumstances and other social and psychological factors.

(4) The following criteria shall be used as a minimum baseline upon which the risk status of clients shall be determined. These criteria shall be applied to all clients prior to acceptance for birth center services and throughout the pregnancy for continuation of services. Clients with any of the following risk factors shall be referred to a physician for continuing maternity care and hospital delivery:

(a) Age limits to be determined on an individual basis.

(b) Major medical problems including but not limited to:

1. Chronic hypertension, heart disease, or pulmonary embolus;

2. Congenital heart defects assessed as pathological by a cardiologist, placing mother and/or fetus at risk;

3. Severe renal disease;

4. Drug addiction or required use of anticonvulsant drugs;

5. Diabetes mellitus or thyroid disease which is not maintained in a euthyroid state, or

6. Bleeding disorder or hemolytic disease.

(c) Previous history of significant obstetrical complications, including, but not limited to:

1. Rh sensitization;

2. Previous uterine wall surgery including Caesarean section;

3. Seven or more term pregnancies;

4. Previous placenta abruptio.

(d) Significant signs or symptoms of:

1. Hypertension;

2. Preeclampsia;

3. Poly or oligo hydramnios;

4. Abruptio placenta;

5. Chorioamnionitis;

6. Severe fetal anomalies;

7. Multiple gestation;

8. Intrauterine growth restriction;

9. Non-reassuring fetal status;

10. Alcoholism or drug addiction;

11. Thrombophlebitis, or

12. Pyelonephritis.

(5) Acceptance for and continuation of care throughout pregnancy and labor is limited to those women for whom it is appropriate to give birth in a setting where anesthesia is limited to local infiltration of the perineum or a pudendal block and where analgesia is limited.

Rulemaking Authority 383.309 FS. Law Implemented 383.309, 383.31 FS. History–New 3-4-85, Formerly 10D-90.09, Amended 7-20-92, Formerly 10D-90.009, Amended 2-21-17, 12-10-18.