La. Admin. Code tit. 48 § V-1903

Current through Register Vol. 50, No. 11, November 20, 2024

Section V-1903 - Description of Services

A. Maternity services consist of prenatal services as well as postpartal WIC nutritional services to eligible women. The WIC Program is governed by departmental regulations appearing elsewhere. Maternity clinics are scheduled in the parish health units on a regular basis utilizing an appointment system. The maternity services offered by OPPHS generally follow the recommendations of the American College of Obstetricians and Gynecologists as described in the sixth edition of Standards for Obstetric-Gynecologic Services 1985. Continuous risk assessments are made, utilizing referrals to state supported hospitals for more specialized care of high risk pregnant women. Maternity patients are referred to the regional high risk facility, because of the obvious risk that they represent for a poor pregnancy outcome under the following conditions:

1. taking antihypertensive medications;

2. Rhisoimmunized;

3. use of hard drugs (cocaine, heroin, and methadone);

4. forty years of age or older;

5. last baby weighed between one and four pounds at birth;

6. diabetes mellitus present;

7. sickle cell disease present;

8. current multiple pregnancy; and 9. previous caesarian section.

B. Patients referred to the high risk maternity clinic are contacted by telephone by parish health unit staff to insure that they have kept that clinic appointment.

C. The following services may be provided during the initial OPPHS maternity clinic visit:

1. laboratory tests including VDRL, Rubella titer, hemoglobin electrophoresis on black patients, hemoglobin/hematocrit, Rh factor, antibody screening, Pap smear, culture for gonorrhea, urine dipstick for sugar and protein, and pregnancy test (if indicated);

2. tetanus immunizations and tuberculin skin testing;

3. assessment for prenatal vitamins and iron;

4. patient's health history obtained by the nurse;

5. abdominal assessment by the nurse;

6. assessment of other symptomatology or problems by history and observation by the nurse;

7. nutritional assessment including review of diet intake with patient, nutrition counseling and referral to nutritionist if indicated;

8. social assessment including the patient's attitude toward pregnancy, family needs and referral to a medical social worker if appropriate;

9. counseling about the choice of choosing breast feeding or bottle feeding;

10. provision of other prenatal counseling, such as the recognition of the onset of labor, hospital and delivery procedures; and

11. continuing risk assessment for referral to the high-risk facility.

D. The patient is referred to the clinician in the parish health unit or to the regional state supported hospital prenatal clinic (if a physician is not available) for the initial complete physical examination in the health unit. The initial examination by the physician includes a complete physical examination with Pap smear and culture for gonococcus.

E. Patients following a normal prenatal course are scheduled to be seen by the public health nurse in maternity clinics every four weeks up to 28 weeks gestational age, every two weeks from 28 to 36 weeks, and every week thereafter. Other patients with problems that do not require referral to the high risk maternity clinic are seen according to the nurse's or physician's professional judgment.

F. Services generally provided to patients during return visits to the Maternity Clinic in the health unit include:

1. laboratory work consisting of VDRL, culture for gonorrhea, and repeat hemoglobin or hematocrit if indicated;

2. antibody screening referral to the regional state supported hospital where the patient plans to delivery (if the patient is Rh negative);

3. blood pressure determined;

4. height and weight plotted;

5. urine dipstick for glucose and protein and proper follow-up for a positive test;

6. nursing interview to obtain and evaluate interval history of symptomatology and for problems;

7. completed abdominal, leg and edema assessment;

8. counseling by the nurse regarding evaluation of the laboratory work and blood pressure, urine and weight findings, and referral as appropriate;

9. nutritional and social assessment by the nurse and referral to the nutritionist or medical social services if indicated; and

10. appropriate counseling by the nurse according to gestational age.

G. The patient is referred to the clinician in the parish health unit for a 32-36 weeks abdominal-pelvic physical examination. Patients having problems requiring medical attention are also referred to the clinician. Referrals are made to the state supported hospital if there is no physician present in the health unit.

H. Follow-up contacts by telephone, mail, or home visit are initiated by the parish health unit staff on missed maternity clinic appointments to offer the patient another appointment. The patient's record is generally closed if three consecutive appointments are failed by the patient or the parish health unit is unsuccessful in contacting the patient after three attempts.

I. Maternity services are primarily provided in nursing clinics. The maternity clinics are staffed by health care professionals including nurses, physicians, social workers, and nutritionists. Paraprofessional health care staff (aides and technicians) also provide services under professional supervision.

J. Home visits are made on a limited basis by nurses or medical social workers. These visits provide necessary follow-up according to agency protocol and professional judgment. Home visits are made by the nurse when:

1. patients consistently fail to keep appointments;

2. patients are in need of additional professional support services and counseling;

3. patients receive no prenatal care; and

4. patients are exhibiting prenatal indicators of child abuse or neglect.

La. Admin. Code tit. 48, § V-1903

Promulgated by the Department of Health and Human Resources, Office of Preventive and Public Health Services, LR 13:246 (April 1987).

AUTHORITY NOTE: Promulgated in accordance with the Social Security Act of 1935, Title V, Sections 501-516; P.L. 97-35, Title V, 42 U.S.C. 703; R.S. 971-972.