OAR 333-077-0100: Client Care Services

(1) Clients registering for care at a birthing center shall receive an orientation and written information regarding the services provided at the birthing center including a statement of client rights in accordance with section (3) of this rule. (2) Each client shall sign, and receive a copy of, a client disclosure form which includes, but is not limited to, the following information: (a) Services provided to the client and newborn; (b) Risks, benefits, and eligibility requirements; (c) Responsibilities of the client and family members or legal representatives; (d) Fees for services including financial arrangements; (e) Malpractice coverage or professional liability coverage; (f) Risk assessment, consultation, and transfer requirements; (g) Emergency care and transport plan in the event of complications to the client or newborn; and (h) Identity and qualifications of clinical staff. (3) The statement of client rights shall include, but is not limited to, the following: (a) Clients shall be treated with courtesy, dignity, respect, privacy, and freedom from abuse; (b) Clients shall be offered services without discrimination as to race, ethnicity, color, religion, gender identification, sexual orientation, national origin, or source of payment; (c) Privacy of personal information and confidentiality of health care records; (d) Clients shall be informed of all laboratory and diagnostic tests, reports, recommendations, and treatments in a timely fashion; (e) Participation in a plan of care and any changes to the plan of care; (f) Clients may refuse treatment; (g) Clients shall be offered nourishment; (h) Clients shall be informed of screening requirements and referrals to services determined necessary; and (i) Information on how and where to file a complaint. (4) A birthing center shall: (a) Provide intrapartum and postpartum care described in sections (6) and (7) of this rule. (b) Assess the client's risk status throughout pregnancy, labor, and delivery in accordance with OAR 333-077-0125 to determine if care and services in a birthing center, including delivery, is appropriate. (c) Consult with a provider of perinatal care or other specialty provider in accordance with OAR 333-077-0125. (d) Provide dietary services in accordance with OAR 333-077-0160. (5) A birthing center that provides prenatal care shall perform regular, periodic prenatal exams and assessments of client and fetus risk status. A prenatal exam shall include at a minimum: (a) Physical exam; (b) Urinalysis and other laboratory screenings as determined necessary by the clinical provider; (c) Discussions about the client's health and newborn's health including good nutrition and how to reduce pregnancy complications and newborn's risk for complications; (d) Fetal health assessment; and (e) In third trimester, discussions about preparing for childbirth and classes available; (6) Intrapartum care provided by a birthing center shall include, but is not limited to: (a) Periodic assessment of the client's physical health and emotional and psychological needs including but not limited to: (A) Monitoring of vital signs; (B) Urinalysis if indicated; (C) Pain assessment; and (D) Frequency of contractions. (b) Periodic assessment of the fetus's health including but not limited to: (A) Monitoring fetal heart rate and fetal movement; and (B) Abdomen palpation to determine fetal lie and presentation. (c) Comfort measures including but not limited to: (A) Physical assistance; (B) Emotional support; and (C) Pain relief methods. (d) Companionship during labor and childbirth with a client's companion of choice. (7) Postpartum care shall consist of periodic assessment of the client's health and newborn's health. (a) The client health assessment includes but is not limited to: (A) Physical exam; (B) Laboratory screening tests, if applicable; (C) Education in child care including breast or chest feeding, immunization, and referral to sources of pediatric care; (D) Provision of, or referral to, family planning services; and (E) Referral to newborn screenings as required in OAR 333-077-0170 if screenings are not provided by the birthing center. (b) The newborn health assessment includes but is not limited to: (A) Physical exam; (B) Laboratory screening tests, if applicable; and (C) Screenings for newborns in accordance with OAR 333-077-0170. (8) A clinical provider may use telemedicine to provide prenatal and postpartum care to clients after completion of an initial, in-person assessment if no risk factors or complications were identified. (a) Telemedicine may be conducted through electronic and telecommunication technologies such as video communication, teleconference, landline or wireless communications. Real-time communication between the clinical provider and the client is required. (b) A clinical provider must ensure that an in-person assessment is completed with the client at least two times between 28 to 36 weeks, and two times between 36 weeks to 39 weeks, 6 days. (c) Telemedicine may not be conducted after 39 weeks, 6 days. (9) A clinical provider may use a birthing center for both primary care clients and birthing center clients. Client files must be distinct and maintained separately.