State Board of Charities and Corrections Rules and RegulationsGoverning Maternity Hospitals and Homes Compiled and published by the California State Board of Charities and Corrections 995 Market Street, San Francisco1018 Pacific Finance Building, Los Angeles September, 1922 California State Printing OfficeSacramento, California LAW GOVERNING LICENSE AND SUPERVISION OF MATERNITY HOSPITALS AND HOMESBY THE CALIFORNIA STATE BOARD OF CHARITIES AND CORRECTIONS. CHAPTER 69, STATUTES 1913. _An act to provide for the licensing, inspecting and regulating ofmaternity hospitals or lying-in asylums, and institutions, boardinghouses and homes for the reception and care of children, by the stateboard of charities and corrections, and providing a penalty for theviolation of the provisions of this act. _ [Approved April 23, 1913. In effect August 10, 1913. ] _The people of the State of California do enact as follows:_ SECTION 1. No person, association, or corporation shall hereaftermaintain or conduct in this state any maternity hospital or lying-inasylum where females may be received, cared for or treated duringpregnancy, or during or after delivery; or any institution, boardinghouse, home or other place conducted as a place for the reception andcare of children, without first obtaining a license or permittherefor, in writing, from the state board of charities andcorrections, such permit or license once issued to continue untilrevoked for cause after a hearing. SEC. 2. The state board of charities and corrections is herebyauthorized to issue licenses or permits to persons or associations toconduct maternity hospitals, lying-in asylums, or homes for children, as provided in section one of this act, and to prescribe theconditions upon which such licenses or permits shall be granted, andsuch rules and regulations as it may deem best for the government andregulation of maternity hospitals, lying-in asylums and institutions, boarding houses, or homes for the reception and care of children, andsaid board is further authorized, by one or more of its members, secretary, or duly authorized representative, to inspect and reportupon the conditions prevailing in all such institutions. SEC. 3. Any person who maintains or conducts, or assists inmaintaining or conducting as manager or officer any maternityhospital, lying in asylum, or any institution, boarding house, home orother place conducted as a place for the reception and care ofchildren, or who keeps at any such place any child under the age oftwelve years, not his relative, apprentice or ward, without firsthaving obtained a license or permit therefor in writing, as providedin section one of this act, shall be punished upon conviction byimprisonment in the county jail for not more than one year, or by afine not to exceed five hundred dollars, or both a fine andimprisonment may be imposed at the discretion of the court. RULES AND REGULATIONS FOR THE GOVERNMENT OF MATERNITY HOSPITALS ANDHOMES. In accordance with Chapter 69, Statutes 1913. Definitions. Any place into which women are received to be cared for before, duringor after parturition shall be considered as a maternity hospital orhome. Institutions caring for maternity patients are classified as follows, according to equipment: _Class A. _ Separate class A building with complete equipment caringfor maternity patients only. _Class B. _ Hospital with maternity department with fully equippeddelivery room and nursery. _Class C. _ General hospital with either delivery room or nursery andgeneral hospital using the operating room for delivery. For rules and regulations for Class A, B and C maternity hospitals, see page 6. _Class D. _ Private homes. For rules and regulations for Class D private maternity homes, seepage 13. RULES AND REGULATIONS GOVERNING MATERNITY HOSPITALS. (Classes A, B and C. ) Granting and revoking license. 1. All maternity hospitals and homes are required, in accordance withSection 3, Chapter 69, Statutes 1913, to secure the license of theState Board of Charities and Corrections, and to conform to thestandards set by that board. 2. Application for license must be made on blanks furnished by theState Board of Charities and Corrections. 3. Every applicant must have the approval of the local board of healthor health officer. 4. Every licensee shall post his license in a conspicuous place. 5. Any change of ownership, management, location or name shall bepromptly reported to the State Board of Charities and Corrections. When any such change is contemplated an application for a new licenseshall be made. In such instance the new license may be granted onsurrender of the license held. 6. No greater number of women and infants shall be cared for at onetime on such premises than is authorized by the license and no womenor infants shall be kept in a building or place not designated in thelicense. Physical equipment. 1. All rooms and wards occupied by patients shall be outside rooms andthe window space shall not be less than one-fifth of the floor space. 2. The rooms and wards shall be of sufficient size to allow not lessthan 800 cu. Ft. Of air space and 100 sq. Ft. Of floor space for eachadult patient and 250 cu. Ft. Of air space for each infant therein. Ventilation shall conform with state housing laws. 3. All plumbing, drainage and other arrangements for the disposal ofexcreta and household waste shall be in accordance with the rules andregulations of the State Board of Health and local health ordinances. 4. Toilets and hoppers shall be properly and adequately ventilated tothe external air. 5. In order that the heating of all rooms shall be safe and adequateno gas stove shall be used which is not directly connected with anoutside flue and all gas connections should be of metal piping. 6. Fire protection shall be according to the rules and regulations ofthe local fire commission or city ordinance and the rules andregulations of the State Board of Charities and Corrections. Thesestandards will be furnished with the application. 7. Provision for isolation of contagious diseases shall be made. 8. There shall be sanitary equipment for thorough bathing of patientsand infants. 9. An adequate supply of clean bedding, body linen and towels shall bekept on hand at all times. Bed pan sterilizers are recommended for hospitals. A separate bed panmarked for use of individual patients is strongly advocated. Delivery room. 1. A delivery room shall be provided; it must be ready at all timesand used for no other purpose. 2. The floors, walls and ceiling shall be of such material as willpermit of being easily washed. Provision must be made forsterilization of water, basins, instruments and dressings. There shallbe running water with a properly trapped and vented basin. 3. The delivery room shall be furnished with a delivery table or bed, instrument table, irrigating apparatus, basins and pitchers. Thereshall be an ample supply of sterile linen and dressings. Drugsordinarily needed for use shall be kept in the room at all times. 4. Two infants' tubs shall be provided for resuscitation in deliveryroom. 5. Every infant shall be marked for identification before it is takenfrom delivery room. Nursery. 1. A separate room for a nursery shall be provided. 2. Infants' cribs or baskets shall have firm, clean mattresses, covered with rubber sheeting and washable pads. Clean woolen blanketsshall be used. There shall be a separate bed for each infant. 3. It is recommended that the nursery be provided with stationarybathing facilities, a properly protected dressing table and correctscales. 4. The nursery shall be heated and ventilated. A wall thermometer mustbe provided in order to be sure that an even temperature ismaintained. 5. A covered container for soiled linen shall be provided. 6. A dressing tray shall be set up at all times. The followingarticles are recommended in dressing and caring for infants: Sterilegauze, absorbent cotton, medium and small safety pins, bottle ofalcohol, a bar of pure mild soap, a proper lubricant (albolene orolive oil), boric acid solution, pure powder, abdominal binder forinfant. 7. Bottles and nipples shall be properly sterilized after each use. 8. A minimum of one dozen diapers per child shall be provided for each24 hours. Freshly laundered diapers only shall be used. 9. If hot water bags are ordered by physician, they must be coveredwith a flannel bag before being placed in the crib, and must not comein direct contact with the baby's body. Care of patients. 1. Immediately upon the beginning of labor, a legally qualifiedphysician shall be notified and shall be present and in attendance atthe time of birth. 2. The eyes of all new born infants shall be treated immediately afterbirth with a one per cent solution of nitrate of silver, two drops ineach eye, or with other approved solution and during the first fewdays cleansed daily with saturated boric acid solution. Ampoules ofnitrate of silver solution may be obtained free of charge bycharitable institutions upon application to State Board of Health, 713Wells Fargo Building, San Francisco, or 821 Pacific Finance Building, Los Angeles. 3. Attention is called to Chapter 724, Statutes 1915, which requiresthe reporting of reddened or inflamed eyes of an infant, within twoweeks after birth, to the local health officer of the county ormunicipality within which the mother of such infant resides. 4. If the child is kept in the hospital and is not breast fed by themother, the feeding and selection of food, shall be under thedirection of a registered physician. If a wet-nurse is provided, sheshall meet the approval of the physician. Whenever advisable themother shall be urged to nurse her child. 5. Each maternity hospital shall employ at least one graduate nurse. 6. Any patients afflicted with a venereal or other communicabledisease shall be properly isolated in a separate room and allnecessary precautions taken to prevent the spread of such disease toother persons. Disposal of child. 1. Attention is called to section 224 of the Civil Code in accordancewith which a child not retained by the mother must be legallyrelinquished before it can be adopted. This relinquishment must beexpressed in writing, signed and acknowledged before an officerauthorized to take acknowledgments, or before the secretary of one ofthe organizations mentioned below. Before adoption can take place acopy of the relinquishment must be filed with the State Board ofCharities and Corrections. 2. Attention is called to Chapter 569, Statutes 1911, providing forthe supervision and control by the State Board of Charities andCorrections of the placing of dependent children into homes, whichmakes it a misdemeanor for any person, association or society toengage in the work of placing children into homes without a licensefrom the State Board of Charities and Corrections. The followingagencies have been licensed to place dependent children into homes andto arrange for adoption: Berkeley Welfare Society, 2120 Grove street, Berkeley. Children's Home Society, 919 E. Twenty-fifth street, Los Angeles. Children's Home Society (Branch), 3491 Sixty-sixth street, Oakland. Catholic Ladies' Aid Society, City Hall, Oakland. Oakland Associated Charities, City Hall, Oakland. Little Children's Aid, 995 Market street, San Francisco. Children's Agency of the Associated Charities, 1500 Jackson street, San Francisco. Eureka Benevolent Society, 436 O'Farrell street, San Francisco. Native Sons' and Daughters' Central Committee on Homeless Children, 955 Phelan Building San Francisco, 322 N. Van Ness avenue, LosAngeles. 3. Each licensee shall use due diligence to prevent the abandonment ofchildren, which is, according to section 270-271 and 271a of the PenalCode, a penal offense. 4. A licensee shall not be permitted to advertise that he will procurethe adoption of children or to hold out inducements to mothers topart with their offspring. 5. Maternity hospitals shall report on the usual report forms to theState Board of Charities and Corrections within twenty-four hours thename and address of any person other than a parent or relative, byblood or marriage, or the name and address of the organization orinstitution into whose custody a child is given on discharge from thelicensed premises. Records. 1. Every licensee must have a register wherein he shall enter the nameand address of every maternity patient, the date of admission anddischarge of every patient, the name and sex of every child born orboarded on the premises, the date of every birth, the legitimacy orillegitimacy of every child, the name and residence of the father, thedate of removal of the child, the name and address of the persontaking it away, and, if relinquished by the mother, the date ofrelinquishment, the name and address of the person to whom the childis relinquished, and the reasons therefor; and if adopted, the date ofadoption, the name of the person signing the consent to adoption, andthe name and address of the person adopting the child. Everyadmission, discharge, birth, death, relinquishment or adoption must berecorded in the register within twenty-four hours after itsoccurrence. [1] [Footnote 1: The State Board of Charities and Corrections does not furnish the maternity hospital register, it merely prescribes the form. A book may be obtained from A. Carlisle and Co. , 251 Bush street, Schwabacher, Frey and Company, 611 Market street, or H. S. Crocker, 565 Market street, San Francisco, and from Morris and Le Leviere, 218 New High street, Los Angeles. These forms are kept in duplicate, the perforated sheets to be removed and sent to the office of the State Board of Charities and Corrections, as the semi-annual report. The carbon copy remains permanently bound for the hospital record. ] 2. A semi-annual report, which shall be an exact transcript of thisregister, shall be made to the State Board of Charities andCorrections, 995 Market street, San Francisco, January 1 and July 1 ofeach year. 3. A detailed medical record of mothers' and infants' physicalcondition shall be maintained. (Sample forms provided by State Boardof Charities and Corrections, upon request. ) 4. It is recommended that all orders from physicians regarding mothersand infants be written in ink on charts or in order book. 5. It is recommended that attending physician examine mother andinfant on day of discharge and attach signature to statement offindings. 6. All births and deaths must be reported promptly to the localauthorities by the attending physician. (See Political Code, Section3077, Chapter 378, Statutes 1915. ) Inspections. The proprietor or person in charge of a maternity hospital shall givethe inspectors of the State Board of Charities and Corrections allinformation required and shall afford them every facility forexamining the records, inspecting the premises, and seeing theinmates, and inquire into all matters concerning such hospital orhouse and the inmates thereof. RULES AND REGULATIONS GOVERNING MATERNITY HOMES. (Class D. ) No private maternity home shall receive at any one time more thanthree patients. No other type of patient shall be cared for in thishome. Delivery shall take place in a room with washable walls, ceilings and doors. Granting and revoking license. 1. All maternity homes are required, in accordance with Section 3, Chapter 69, Statutes 1913, to secure the license of the State Board ofCharities and Corrections, and to conform to the standards set by theboard. 2. Application for license must be made on blanks furnished by theState Board of Charities and Corrections. 3. Every applicant must have the approval of the local board of healthor health officer. 4. Every licensee shall post his license in a conspicuous place. 5. Any change of ownership, management, location or name shall bepromptly reported to the State Board of Charities and Corrections. When any such change is contemplated an application for a new licenseshall be made. In such instance the new license may be granted onsurrender of the license held. 6. No greater number of women and infants shall be cared for at onetime on such premises than is authorized by the license and no womenor infants shall be kept in a building or place not designated in thelicense. Physical equipment. 1. All rooms occupied by patients shall be outside rooms and thewindow space shall not be less than one-fifth of the floor space. 2. The rooms shall be of sufficient size to allow not less than 800cu. Ft. Of air space and 100 sq. Ft. Of floor space for each adultpatient and 250 cu. Ft. Of air space for each infant therein. Ventilation shall conform with state housing laws. 3. All plumbing, drainage and other arrangements for the disposal ofexcreta and household waste shall be in accordance with the rules andregulations of the State Board of Health and local health ordinances. 4. Toilets and hoppers shall be properly and adequately ventilated tothe external air. 5. In order that the heating of all rooms shall be safe and adequateno gas stove shall be used which is not directly connected with anoutside flue and all gas connections should be of metal piping. 6. Fire protection shall be according to the rules and regulations ofthe local fire commission or city ordinance and the rules andregulations of the State Board of Charities and Corrections. Thesestandards will be furnished with the application. 7. There shall be sanitary equipment for thorough bathing of patientsand infants. 8. An adequate supply of clean bedding, body linen and towels shall bekept on hand at all times. A separate bed pan marked for use of individual patients is stronglyadvocated. The following equipment shall be provided: For delivery. 1. Suitable table or hospital bed for delivery. 2. At least three pitchers. 3. Two basins. 4. Two tubs or large basins for resuscitation. 5. One pail for waste material. 6. Ample supply of sterile dressings, towels, leggings, sheets. 7. Two nail brushes for doctor's use only; should be boiled before andafter using and kept in a weak solution of bichloride of mercury, orlysol, in a glass jar. 8. All linen should be marked and kept separate for patients. 9. Wooden blocks 4 and 6 inches high shall be provided for use in caseof hemorrhage, where surgical bed is not in use. 10. At the time of delivery plenty of hot and cold sterile water(boiled for 20 minutes). 11. Facilities for sterilizing instruments shall be provided. 12. The following supplies are recommended to be kept on hand: Fl. Extract of ergot, lysol, bichloride tablets (blue), sterile cord tapeand blunt scissors, nitrate of silver (1%), or argyrol, two pieces oflinen tape. For Infant. 1. Separate cribs or baskets for babies--clean mattresses covered withrubber sheeting and clean flannel blankets are to be used. 2. Correct scales for weighing infants. 3. Nitrate of silver one per cent solution. 4. A tray or basket equipped with necessary articles to be used indressing and caring for infants; to contain sterile gauze, absorbentcotton, medium and small safety pins, cotton applicators, bottle ofalcohol, a bar of pure mild soap, a proper lubricant (albolene orolive oil), boric acid solution, pure powder, abdominal binder forinfant. 5. If hot water bags are ordered by physician they must be coveredwith a flannel bag before being placed in the crib, and must not comein direct contact with the baby's body. 6. All nursing bottles and nipples must be boiled at least once a day, and individual nipples must be provided for each child. For mother. 1. Clean piece of rubber sheeting for each patient's bed. 2. Individual bed pans marked with name of patient. 3. Metal douche cans instead of rubber irrigating bags. 4. Glass rips and nozzles--to be boiled before and after using andkept in lysol solution. 5. Clinical thermometers; to be washed in alcohol before and afterusing. Care of patients. 1. This board urges the attendance of a legally qualified physician atall confinements. The law permits midwifes to assist women only incases of normal child birth. (See Statutes 1917, Sec. 8, page 96. ) Inany but a normal case the midwife must immediately call a legallyqualified physician. 2. The eyes of all new born infants shall be treated immediately afterbirth with a one per cent solution of nitrate of silver, two drops ineach eye, or with other approved solution and during the first fewdays cleansed daily with saturated boric acid solution. Ampoules ofnitrate of silver solution may be obtained free of charge bycharitable institutions upon application to State Board of Health, 713Wells Fargo Building, San Francisco, or 821 Pacific Finance Building, Los Angeles. 3. Attention is called to Chapter 724, Statutes 1915, which requiresthe reporting of reddened or inflamed eyes of an infant, within twoweeks after birth, to the local health officer of the county ormunicipality within which the mother of such infant resides. 4. If the child is kept in the home and is not breast fed by themother, the feeding and selection of food, shall be under thedirection of a registered physician. If a wet-nurse is provided, sheshall meet the approval of the physician. Whenever advisable themother shall be urged to nurse her child. 5. Any patients afflicted with a venereal or other communicabledisease shall be properly isolated in a separate room and allnecessary precautions taken to prevent the spread of such disease toother persons. Disposal of child. 1. Attention is called to section 224 of the Civil Code in accordancewith which a child not retained by the mother must be legallyrelinquished before it can be adopted. This relinquishment must beexpressed in writing, signed and acknowledged before an officerauthorized to take acknowledgments, or before the secretary of one ofthe organizations mentioned below. Before adoption can take place acopy of the relinquishment must be filed with the State Board ofCharities and Corrections. 2. Attention is called to Chapter 569, Statutes 1911, providing forthe supervision and control of the State Board of Charities andCorrections of the placing of dependent children into homes, whichmakes it a misdemeanor for any person, association or society toengage in the work of placing children into homes without a licensefrom the State Board of Charities and Corrections. The followingagencies have been licensed to place dependent children into homes andto arrange for adoption: Berkeley Welfare Society, 2120 Grove street, Berkeley. Children's Home Society, 919 E. Twenty-fifth street, Los Angeles. Children's Home Society (Branch), 3491 Sixty-sixth street, Oakland. Catholic Ladies' Aid Society, City Hall, Oakland. Oakland Associated Charities, City Hall, Oakland. Little Children's Aid, 995 Market street, San Francisco. Children's Agency of the Associated Charities, 1500 Jackson street, San Francisco. Eureka Benevolent Society, 436 O'Farrell street, San Francisco. Native Sons' and Daughters' Central Committee on Homeless Children, 955 Phelan Building, San Francisco, 322 N. Van Ness avenue, LosAngeles. 3. Each licensee shall use due diligence to prevent the abandonment ofthe children, which is, according to sections 270-271 and 271a of thePenal Code, a penal offense. 4. A licensee shall not be permitted to advertise that he will procurethe adoption of children or to hold out inducements to mothers to partwith their offspring. 5. Maternity hospitals and homes shall report on the usual reportforms to the State Board of Charities and Corrections withintwenty-four hours the name and address of any person other than aparent or relative by blood or marriage, or the name and address ofthe organization or institution into whose custody a child is given ondischarge from the licensed premises. Records. 1. Every licensee must have a register wherein he shall enter the nameand address of every maternity patient, the date of admission anddischarge of every patient, the name and sex of every child born orboarded on the premises, the date of every birth, the legitimacy orillegitimacy of every child, the name and residence of the father, thedate of removal of the child, the name and address of the persontaking it away, and, if relinquished by the mother, the date ofrelinquishment, the name and address of the person to whom the childis relinquished, and the reasons therefor; and if adopted, the date ofadoption, the name of the person signing the consent of adoption, andthe name and address of the person adopting the child. Everyadmission, discharge, birth, death, relinquishment or adoption must berecorded in the register within twenty-four hours after itsoccurrence. [2] [Footnote 2: The State Board of Charities and Corrections does not furnish the maternity hospital register, it merely prescribes the form. A book may be obtained from A. Carlisle and Co. , 251 Bush street, Schwabacher, Frey and Company, 611 Market street, or H. S. Crocker, 565 Market street, San Francisco, and from Morris and Le Leviere, 218 New High street, Los Angeles. These forms are kept in duplicate, the perforated sheets to be removed and sent to the office of the State Board of Charities and Corrections, as the semi-annual report. The carbon copy remains permanently bound for the hospital record. ] 2. A semi-annual report, which shall be an exact transcript of thisregister, shall be made to the State Board of Charities andCorrections, 995 Market street, San Francisco, January 1 and July 1 ofeach year. 3. A detailed medical record of mothers' and infants' physicalcondition shall be maintained. (Sample forms provided by State Boardof Charities and Corrections, upon request. ) 4. It is recommended that all orders from physicians regarding mothersand infants be written in ink on charts or in order book. 5. It is recommended that attending physician examine mother andinfant on day of discharge and attach signature to statement offindings. 6. All births and deaths must be reported promptly to the localauthorities by the attending physician. (See Political Code, Section3077, Chapter 378, Statutes 1915. ) Inspection. The proprietor or person in charge of the maternity home shall givethe inspectors of the State Board of Charities and Corrections allinformation required and shall afford them every facility forexamining the records, inspecting the premises, and seeing theinmates, and inquiring into all matters concerning such home or houseand the inmates thereof.