Section 630.30  Health Services for Women of Reproductive Age

 

The Division of Family Health, Department of Public Health, State of Illinois, through its Maternal and Child Health Program may allocate funds for programs providing health services for women of reproductive age. All such services must be delivered based upon the standards of the American Congress of Obstreticians and Gynecologists set forth in Section 630.80(a)(5), Family Planning Services Code (77 Ill. Adm. Code 635.90), Regionalized Perinatal Health Care Code (77 Ill. Adm. Code 640), and Hospital Licensing Requirements (77 Ill. Adm. Code 250.1810-1860) (See Section 630.80(a)(5)). One or more of the following MCH services may be included in application proposals for Title V and State MCH Project grant funds:

 

a)         Services for nonpregnant women that relate to the occurrence and course of future pregnancy.

 

1)         Comprehensive family planning services as described in the Department's Family Planning Services Code − 77 Ill. Adm. Code 635.90.

 

2)         Genetic evaluation counseling as indicated.

 

3)         Counseling and referral to licensed adoption services if indicated or desired.

 

b)         Services for pregnant woman.

 

1)         Early diagnosis of pregnancy.

 

2)         Counseling regarding plans for pregnancy continuation.

 

A)        For those electing to carry to term, referral for and provision of prenatal care.  Referral to childbirth preparation classes as desired or to adoption services at licensed agencies if indicated.

 

B)        For those electing abortion, referral to appropriate counseling and family planning facilities.

 

3)         Prenatal care services including:

 

A)        History (general medical-surgical, social and occupational, family and genetic background, health habits, previous pregnancies, and current pregnancy).

 

B)        Complete physical examination including blood pressure, height and weight, and fetal development as well as a complete systems review.

 

C)        Laboratory tests as appropriate, such as syphilis serology, Papanicolau smear, gonococcal culture, chlamydia smear, hepatitis B, diabetic screening, hemoglobin/hematocrit, urinalysis for glucose and protein, Rh determination and irregular antibody screening, blood group determination, and rubella test.

 

D)        Diagnosis and treatment or referral and follow-up of general health problems, both acute and chronic, preexisting or arising during the prenatal period, that can adversely affect pregnancy, fetal development, or maternal health.

 

E)        Referral and follow-up of mental health problems, both acute and chronic, preexisting or arising during the prenatal period, that can adversely affect pregnancy, fetal development, or maternal health.

 

F)         Nutritional assessment and services as needed.  Provision of vitamin, iron and other supplements as appropriate. The water supply for clients on nonpublic sources should be tested for nitrates by the Illinois Department of Public Health Laboratories.

 

G)        Dental services limited to oral pathology that can directly affect the outcome of pregnancy.

 

H)        Subsequent prenatal visits should include at the minimum:  blood pressure, weight, urinalysis for protein and glucose, ascertaining fetal development, update on pertinent medical history, height of fundus, rate and location of fetal heart tones, periodic hemoglobin and/or hematocrit as well as a vaginal examination and other special tests as indicated (e.g., Rh titer). Visits should occur at ACOG recommended frequency.

 

I)         Screening, diagnosis (including amniocentesis), and counseling with follow-up for selected fetal genetic defects.

 

J)         An assessment to identify high risk pregnancies and appropriately consult and/or refer within the Perinatal System.

 

K)        Home health and homemaker services.

 

L)        Counseling and anticipatory guidance with referral and followup as needed regarding:

 

i)          Physical activity and exercise.

 

ii)         Nutrition during pregnancy, including the importance of adequate but not excessive weight gain.

 

iii)        Avoidance during pregnancy of smoking, alcohol and other drugs; and of environmental hazards including radiation, hazardous chemicals, and various workplace hazards.

 

iv)        Signs of problems arising during pregnancy and at the onset of labor, including signs of preterm labor.

 

v)         Preparation of the woman (and her partner where appropriate) for labor and delivery, including plans for place of delivery and use of anesthesia.

 

vi)        Use of medication during pregnancy.

 

vii)       Infant nutritional needs and feeding practices, including breast feeding.

 

viii)      Child care arrangements.

 

ix)        Parenting skills, including meeting the physical, emotional and intellectual needs of the infant, with specific appraisal to detect parents at risk of child abuse or neglect.

 

x)         Planning for continuous and comprehensive pediatric care following delivery, including arrangements for a pediatric antenatal visit to link the family to pediatric care.

 

xi)        Emotional and social changes occasioned by the birth of a child, including changes in marital and family relationships, the special needs of the mother in the postpartum period, and preparing the home for the arrival of the newborn.

 

xii)       Referral to appropriate community health resources such as WIC, food stamps, welfare and social services that can benefit health status significantly.

 

xiii)      Discussions regarding postpartum family planning options.

 

xiv)      Housing (including alternative placement).

 

xv)       Other relevant topics in response to patient concern.

 

4)         Services in the intrapartum period.

 

A)        Assessing the progress of labor and the condition of the mother and fetus throughout labor.

 

B)        Medical services during labor and delivery for diagnosis and management of conditions threatening the mother and/or infant, including the availability of a Cesarean birth operation when indicated and consultation and/or referral for high risk perinatal problems within the Perinatal System.

 

C)        Delivery and/or referral of the baby to the appropriate level facility within the Perinatal System.

 

D)        RH workup and Rhogam administration as indicated.

 

5)         Services during the postpartum period.

 

A)        Diagnosis and treatment or referral and follow-up of general health problems, both acute and chronic, preexisting or arising during the postpartum period that can adversely affect the mother's health and/or child caring abilities.

 

B)        Diagnosis and treatment or referral and follow-up of mental health or behavioral problems, both acute and chronic, preexisting or arising during the perinatal and postpartum periods (including maternal depression) that can adversely affect the mother's health and/or child care abilities.

 

C)        Counseling and anticipatory guidance with referrals and follow-up as needed regarding:

 

i)          Postpartum changes, both normal and abnormal.

 

ii)         Family planning methods.

 

iii)        Infant development and behavior.

 

iv)        Infant nutritional needs and feeding practices, including breast feeding.

 

v)         Automobile restraints for infants and children, and general accident prevention concepts (especially home accidents and accidental poisoning).

 

vi)        Infant stimulation and parenting skills, with specific appraisal to identify parent as risk for child abuse or neglect.

 

vii)       Need for and importance of immunizations.

 

viii)      Effect on children of parental smoking, use of alcohol and other drugs, and other health-damaging behaviors.

 

ix)        The importance of a source of continuous and comprehensive care for both mother and child, including identification of available resources to help with such problems as illness in the newborn, breast feeding difficulties or problems with contraception.

 

x)         Recognition and management of illness in the newborn.

 

xi)        Infant care.

 

xii)       Child care arrangements.

 

xiii)      Using community health resources such as WIC, food stamps, welfare and social services that bear significantly on health status.

 

xiv)      Physical activity and exercise.

 

xv)       Nutrition assessment and services.

 

xvi)      General health practices.

 

xvii)     Genetic diagnostic services and counseling if indicated.

 

xviii)    Other relevant topics in response to parental concern.

 

xix)      Organic medical problems such as renal and heart disease, hypertension, diabetes, and endocrine problems.

 

D)        Diagnosis and treatment or referral and follow-up for general health problems (of project registrants) that can adversely affect future pregnancy, fetal development, and maternal health such as:

 

i)          Sexually transmitted diseases.

 

ii)         Immune status (such as rubella).

 

iii)        Gynecological anatomic and functional disorders.

 

iv)        Inadequate nutritional status, including both under and overweight.

 

v)         Occupational exposures.

 

vi)        Acute dental problems such as infection.

 

vii)       Family history of genetic disorder.

 

E)        Comprehensive family planning services, during intrapartum and postpartum period, including:

 

i)          Information, education, and counseling regarding family planning concepts and techniques, and other issues such as the importance of prenatal care, and risks to mother and child of childbearing at extremes of the reproductive age span.

 

ii)         History and physical examination, including heart, lungs, thyroid, breast and pelvic examination, as indicated, and tests such as a Papanicolau smear, gonococcal culture, chlamydia testing, hematocrit urinalysis, and serological examination for syphilis, as appropriate.

 

iii)        Provision of family planning methods and instruction regarding their use.

 

iv)        Sterilization counseling, information, and education.

 

v)         Sterilization treatment services for persons 21 years of age and over, and legally capable of consent.

 

vi)        Rubella immunization as indicated.

 

vii)       Genetic counseling services.

 

F)         Home health and homemaker services.

 

G)        Routine postpartum examination, four to six weeks following delivery with referrals and follow-up as needed, including:

 

i)          Physical examination and intrapartum history.

 

ii)         Laboratory services as appropriate.

 

iii)        Family planning services.

 

iv)        Rubella immunization as indicated.

 

c)         Access-related services:

 

1)         Outreach services.

 

2)         Translator and 24-hour emergency telephone services.

 

3)         Child care services to facilitate obtaining needed health services and other social services as needed.

 

4)         Availability of services directly or through referral regardless of handicapping conditions.

 

5)         Transportation.

 

(Source:  Amended at 14 Ill. Reg. 11219, effective July 1, 1990)