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Subject 290-2-20 CARE AND PROGRAM

Rule 290-2-20-.01 Health Program

(1) Medical Services. Medical services for mothers and babies should be provided according to the best standards for maternal and child health which the local community affords and shall conform to standards established by the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics. If considered by the Department of Human Resources as a hospital they shall meet standards of the Department of Human Resources for this service. Responsibility for the health supervision of the Maternity Home shall be placed in one licensed physician appointed by the governing board. The Maternity Home shall have an isolation facility available. There shall be an arrangement with the hospitals accepting unmarried mothers for confinement which insures that the unmarried mothers are protected from interviews with persons seeking to effect or facilitate an independent placement.
(a) Prenatal Care. The program of prenatal care shall include:
1. A complete medical and obstetrical history before admission to the Home. Preadmission physical should include blood test, vaginal smear and T. B. test;
2. Periodic examinations during pregnancy. Monthly during the first seven months, every two weeks during the eighth month and every week during the ninth month;
3. Medical care at time of delivery, including hospitalization, and nursing care where indicated. Confinement should take place in an accredited hospital meeting recognized standards, with facilities for dealing with complicated cases or emergencies. Confidentiality shall be respected for the unmarried mother entering a hospital. Maternity Homes operating own hospitals shall have an organized medical staff, medical service shall be approved by the proper accrediting agencies in the field of medicine and hospital care;
4. Dental examination and treatment;
5. Paramedical services, including nursing, nutrition, and health education.
(b) Postpartum Care of Mother. Provision shall be made for all mothers to receive a postpartum examination within six (6) weeks after confinement. Provision should be made to insure the mother's return to a clinic or private physician for necessary checkups and medical instruction on diet, exercises and/or any immediate postpartum care that may be indicated. A mother shall not be required to remain after she has been medically discharged.
(c) Medical Records. A complete medical record shall be maintained on each unmarried mother. This record should include:
1. Report of the medical and obstetrical history obtained prior to admission;
2. Reports of all examinations while mother is in Maternity Home;
3. Delivery information on the infant;
4. Physician's discharge report.
(d) Pediatric Care of the Infant.
1. Care for the infant shall be supervised by a registered nurse experienced in the care of infants.
2. Provision shall be made for a complete physical examination within the first twenty-four (24) hours, or sooner if indicated. A repeat examination should be done within the first ten (10) days.
3. All newborn infants, particularly during the first forty-eight (48) hours shall be closely observed by the nurse or attendants.
4. Babies shall be held by nurse, attendant, or mother while being fed.
5. A separate room or space shall be provided for preparation of milk mixtures, other foods and water. Provision shall be made for sterilizing utensils, bottles, and nipples, and adequate refrigeration for storing of milk and food.
6. All formulas and changes in feeding shall be approved by the physician.
7. A mother who wishes to give personal attention to her baby, such as bathing and feeding, shall be permitted to do so. A mother who does not wish to see her child shall not be required to do so.
8. No visitor shall be permitted to see the baby except with the consent of both the mother and the director of the Home.
9. The Home shall not keep a baby longer than is necessary to make proper and sound plans for his care elsewhere.
10. A baby shall be discharged only to the following:
(i) His parent or legal guardian;
(ii) A licensed child-placing agency.
(2) Food Service.
(a) Menus shall provide for varied, balanced and adequate diet. The diet shall be planned in consultation with the physician in charge. Necessary changes in diet prescribed in individual cases by the physician shall be followed.
(b) All Maternity Homes should be aware of and should avail themselves of the services provided by nutritional consultants from the Department of Human Resources.
(c) Planned menus should be written out week-by-week and should be kept on file for at least six (6) months.
(d) The same food shall be served to the staff and unmarried mothers when they dine together, except when special diets must be prepared for any of the unmarried mothers.
(e) The milk supply shall meet local and State ordinances and codes.
(f) Kitchens and Kitchen equipment shall meet standards prescribed for eating establishments by the Local Health Department and the Department of Human Resources.
(g) The food needs of the pregnant woman and her baby will be met if each expectant mother receives every day:

Milk:

One Quart

Vegetables and Fruits:

A green leafy or deep yellow vegetable A raw vegetable or fruit A fruit or vegetable rich in Vitamin C

Bread or Cereal:

Whole-grain bread and cereals or enriched bread or cereal

Eggs:

One egg

Meat:

One serving. Liver should be served once a week.

A good source of Vitamin D:

Cod-Liver Oil or some other source directed by the doctor.

Rule 290-2-20-.02 Program

Activities within the Home should be developed in such a way as to assure the unmarried mother as much freedom as possible.

(a) Regulations.
1. The Maternity Home should define for the girls in residence the requirements which are essential in a group living situation and for orderly maintenance of a Home.
2. Regulations shall not infringe on the unmarried mother's privilege of writing and receiving uncensored mail and visits from her family. Visits from her family may be limited, if it seems to be wise from a casework basis.
(b) Recreation.
1. A recreational program shall be provided which will meet the need for individual activities, as well as for group participation. It is desirable to encourage unmarried mothers interested in community activities to participate in them.
2. Ample yard space which provides privacy and which is equipped with comfortable outdoor furniture shall be available.
3. It is desirable for the recreation program in the Home to be planned and developed by workers trained and experienced in the field of group work and recreation. Carefully selected volunteer workers supervised by professional leadership can be used quite effectively in providing recreational activities.
(c) Education.
1. Educational activities should be planned in accordance with the treatment plan for the individual unmarried mother.
2. Formal academic instruction shall be available for those whose education has been interrupted. Arrangements should be made with the local board of education to insure that credit will be given for work completed under a qualified teacher. Safeguards are necessary to assure that information about the girls will be kept confidential when credits are transferred.
3. Vocational training should be available for those who wish to participate on a voluntary basis.
4. Informal educational activities should include instruction in arts and crafts, discussion groups on subjects of current interest to the residents, and health education. Health education instruction should be under the supervision of qualified nursing or medical staff.
(d) Work Program.
1. Residents should not be considered as substitutes for employed staff.
2. Work assignments shall be planned as part of the treatment program and should be geared to the physical health and emotional well-being of the prospective mother.
3. Assignments which could augment emotional problems shall be avoided. An unmarried mother shall not be permitted to work in the nursery except on a planned casework basis.
(e) Religious Services.
1. The Maternity Home program should offer opportunities for religious activities and for development of ethical standards and spiritual values.
2. Residents should be encouraged but not forced to participate in religious services. Unmarried mothers should not be denied the privilege of attending the church of their choice, however, religious services should be available in the Maternity Home for those who wish to attend there.
3. An unmarried mother wishing consultation with her pastor shall be provided the opportunity.
4. A religious counselor assigned to the Maternity Home is desirable, however, clergymen of all the major faiths should be available.