2011 Florida Regulations 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, or advanced registered nurse practitioner 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. An exception to this rule is permissible for all centers which are participating in the Vaginal Birth after a Caesarean (VBAC) Section study sponsored by the National Association of Childbearing Centers. Centers planning to participate in this study should notify the State Health Office. Every VBAC candidate shall be evaluated and approved for a birth center delivery by an obstetrician or physician with hospital obstetrical privileges. This evaluation and approval shall be documented in the client’s record;
3. Seven or more term pregnancies;
4. Previous placenta abruptio.
(d) Significant signs or symptoms of:
1. Hypertension;
2. Toxemia;
3. Poly or oligo hydramnios;
4. Abruptio placenta;
5. Chorioamnionitis;
6. Malformed fetus;
7. Multiple gestation;
8. Intrauterine growth retardation;
9. Fetal distress;
10. Alcoholism or drug addiction;
11. Thrombophlebitis; or
12. Pyelonephritis.
(5) With the exception of those facilities exempted under Section 383.335, F.S., 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.