17.1 General
1. If healthcare organization provides obstetric services these services shall be integrated within the scope of the services offered by the healthcare organization. The clinical processes shall meet recognized standards of care, regulatory, and national requirements.
2. The obstetrical services shall have policies and procedures in place which shall include but are not limited to:
a) antenatal policies and procedures to reduce risk to mother and child including a combined multidisciplinary maternal fetal evaluation based on history, current physical status, environment of care, and psycho-social needs identified;
b) intrapartum policies and procedures in keeping with the standard of care as described above to include but not limited to:
i. care of women in labor;
ii. fetal monitoring;
iii. decisions relating to caesarean section;
iv. diagnosis and treatment of eclampsia;
v. diagnosis and treatment of shoulder dystocia;
vi. appropriate options related to operative vaginal delivery;
vii. prevention and treatment of post-partum hemorrhage including multidisciplinary consultation as required;
viii. provision of anesthesia services as described below;
ix. care and management of severely ill women including potential transfer to a higher level of care if determined to be in the best interest of mother and child;
x. provision of opportunities for family or other support and participation in the delivery process;
c) postnatal policies and procedures in keeping with the standard of care as described above to include but not limited to:
i. immediate care of the mother and newborn;
ii. admission or transfer of the newborn to a neonatal unit or intensive care facility as required;
iii. newborn nutrition including consultation and support breast feeding and other potential dietary needs;
iv. discharge control to include appropriate counseling and instructions. This shall include education required to ensure ongoing maternal and fetal health. Of special note are medication and reappointment requirements.
3. The obstetrics services shall provide appropriately trained medical and other staff to include but not limited to nurses, nursing assistants, midwives, obstetricians, anesthesiologists, CRNAs, and pediatricians.
4. Training shall occur at regular intervals as determined by the healthcare organization, medical staff, and nursing service. The results of this training shall be monitored, measured, and analyzed to determine the necessary improvements, corrections, and corrective actions required to ensure intended outcomes and promote patient satisfaction.
5. Records as determined by Top management to be necessary shall be maintained and/or retained as documented information.
17.2 Obstetric Anesthesia Services
1. If anesthesia services are provided for labor and delivery, the same standard of care as described in STANDARD 15 shall be provided in the obstetrical service. This shall comply with regulatory requirements and any national legislation or recommendations as applicable.
2. If a patient has received epidural analgesia, there shall be a credentialed practitioner immediately available to manage any complication for the analgesia or the specific obstetrical condition.
NOTE 1 An credentialed physician/LIP is considered "immediately available for assistance" only when he or she is physically located within the same area as the CRNA, e.g., in the same operative suite, or in the same labor and delivery unit, or in the same procedure room, and not otherwise occupied in a way that prevents him/her from immediately conducting hands-on intervention, when required.
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