Columbus County Health Department
Guidelines for Prenatal Clinic
Policy and Procedure
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Policy Title:
Guidelines for Prenatal Clinic
Program Area:
Maternal Health
Policy Identifier:
(optional)
Effective Date:
Approval Date:
Revision
Date(s):
3/1/04
March 1st, 2004
Approved by:
Kim Smith RN, BSN, MSHCA, Health Director
Approved by:
Hilda Memory RN, BS, MSHA, Director of Nursing
2/22/05, 5/20/09, 8/26/2010, 3/29/2010,
4/8/2014, 1/12/2015
Purpose:
To provide quality prenatal care and education for women of childbearing age,
counseling/education on the care of their newborn, provide nutritional needs, as well as follow up
with family planning and birth control.
Definitions:
Columbus County Health Department will provide prenatal care to women living in Columbus and
adjoining counties with priority given to the low income women.
Responsibilities:
Clerical Staff, Obstetrical Nurse Practitioner/Midwife, Physician, OB Case Manager, Laboratory, WIC.
Procedures:
1. Appointments are made by self-referral, family members, private physicians, Department of
Social Services, schools, etc. with documentation of pregnancy.
2. New patients are scheduled on Mondays.
 I there is a 3 week or greater waiting list, the women must be triaged to assess adverse
pregnancy risk factors for purposes of scheduling the first visit. The scheduling MH
PAIII will refer the patient(s) to the MH Nurse or Nurse Practitioner/Midwife to
complete a risk assessment. If done by nurse the NP/Midwife will review findings. First
visit will be scheduled according to risk assessment findings.
 Fees are assessed according to the Rules and Regulations described in the Purchase of
Care Eligibility Manual (Medicaid or Private Pay accepted) See Billing Fee Schedule
page
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Columbus County Health Department
Guidelines for Prenatal Clinic
Policy and Procedure
3. Return patients are scheduled all day on Wednesdays High risk patients’ charts are
marked/flagged. Both high risk and 2nd visit patients will be seen by M.D.
4. Patient flow:
 Registration
a) Clerical staff obtains patient information at time of new patient admittance
(DHHS 3963 A).
b) Name, age, marital status, education, occupation, address, telephone number,
directions to home, mode of transportation, emergency name/numbers and other
household information.
c) Clerical staff reviews consents and obtains signatures for Maternity Services and
HIPPA regulations.
d) Patient labels are made and put in record by clerical staff. A billing sheet, routing
slip, lab requisitions, and patient labels are put in lab folder and the patient is
accompanied to the lab by a staff member and the lab requisitions are given to a
lab technician.
e) Clerical staff updates patient information on subsequent visits.
 Lab:
 Clerical staff makes appropriate requisitions on initial and subsequent
visits per maternity guidelines as indicated on DHHD 4010.
f) Clinical flow:
 Nurse interview to include documentation of history (DHHS 3963 A&B,
3967, 4095, 3963 C1 & 2, 3963 D, and 3964) BP, Height, Weight,
gestational progress, lab results, etc.
 Nurse or Nurse Practitioner reviews Maternity consent form and witnesses
patient signing.
 Physical exam by physician or nurse practitioner.
 Nurse practitioner will give a Nutritional referral if patients BMI < 18 or >30
and as indicated (All new patients are interviewed by WIC staff for prenatal
diet and WIC instruments issued.) Educational materials include Health
Mom Healthy Baby.
 OB Case Manager (on first visit) and referred to DSS when indicated.
 OB Case Manager interviews new patients for enrollment in the case
management program. Counseling/education may include but not limited to
Bilateral Tubal Ligation (BLT), Human Immunodeficiency Virus (HIV), and
vaginal birth after caesarean Section (VBAC), smoking cessation,
contraception, STD prevention, care of infant, etc
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Columbus County Health Department
Guidelines for Prenatal Clinic
Policy and Procedure
1. The Prenatal clinic shall provide:
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.
m.
Follow-up of missed prenatal appointments.
Follow-up of pregnant women who express interest in permanent sterilization or
contraception. (Guidelines for Perinatal Care, 7th ed. p. 202-205) control click on
link Page 2 of Pregnancy Test Policy
Identification, follow-up and referral as indicated for pregnant women who have a past
current substance use issue (including alcohol, nicotine, and other drugs). Informed
consents shall be obtained before performing a drug screen test. (Guidelines for
Perinatal Care, 7h ed. p. 127-130) See page 2-3 Medical Records/Release Policy,
Interventions should be documented in the provider notes.
Follow-up and referral as indicated of patients with a positive HIV (Guidelines for
Perinatal Care, 7th ed. p.398-403) or hepatitis B (Guidelines for Perinatal Care, 7th ed.
p.386-391) for both women and infants. (10A NCAC 41A.0203 (d)(1))
Identification, follow-up and referral as indicated for pregnant and postpartum women
are experiencing domestic violence. The minimum standard for identification is the use
three recommended ACOG screening questions for all pregnant women, administered
first prenatal contact, each trimester and postpartum. (Guidelines for Perinatal Care,
p.131-132; ACOG Committee Opinion No. 518 Feb. 2012)
Collaboration with local Obstetricians and Emergency Physicians, local emergency
hospital staff and tertiary care center staff is required to formulate a community wide
accepted plan of care between the Local Health Department and the physicians who
will provide care for pregnant women exposed to varicella with no immunity.
(Periodic MH Liaison meetings with Physicians and Columbus Regional Healthcare
staff)
Use of interpreter services for all maternal health programs as indicated
Increased staff awareness of disparities in health status and service delivery,
especially disparities related to race, ethnicity, disability, education, and
socioeconomic status.(Guidelines for Perinatal Care, 7th ed. p. 3-4; ACOG
Committee Opinion No. 493 May 2011)
Promoting customer friendly services that meet the needs of populations that are
underserved. (Healthy People 2020)
Referral to a high-risk maternity clinic or obstetrician for identified high-risk
conditions. (Guidelines for Perinatal Care, 7th ed. p.6-8, 477-478)
Provision of Rubella vaccine and Varicella vaccine (Guidelines for Perinatal Care,
7th ed.p.118-119) post-delivery if patient is not immune.
Provision of 17 Alpha Hydroxyprogesterone Caproate (17P) for women at risk for
developing preterm labor, such as a history of previous spontaneous birth at less
than 37 weeks. (Guidelines for Perinatal Care, 7th ed. p. 257; ACOG Committee
Opinion No. 419 Oct. 2008)
Shall provide community and patient maternal health education services within the
jurisdiction of the Local Health Department. Education services shall promote
healthy lifestyles for good pregnancy outcome. (10A NCAC 46.0205(3)(b)
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Columbus County Health Department
Guidelines for Prenatal Clinic
Policy and Procedure
Laws and Rules:
HIPPA, Medicaid guidelines
Reference(s):
Maternal Health Agreement Addendum 2014-2015
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