Midwives keep homebirth safe by only accepting clients who are low-risk and are experiencing a healthy, normal pregnancy. Although the majority of pregnancies fall in this low-risk category, preexisting health conditions such as heart disease, renal disease, essential hypertension, diabetes, hepatitis, HIV, severe psychiatric illness, active cancer, alcoholism, or drug abuse may mean that some pregnant people are not good candidates for homebirth.
Although pregnancy and birth are natural physiologic processes, certain complications or conditions may develop during pregnancy, birth, and/or postpartum that require transfer of care to a medical provider and/or facility. Homebirth midwives do their best to provide adequate information in a timely manner in the event of a transfer of care. Most homebirth midwives consult with qualified medical providers and refer when evaluation is indicated. If any significant deviations from normal develop, the appropriate specialists are consulted. If transport to the hospital during labor, birth, or postpartum is required, homebirth midwives generally accompany the client to the hospital, though medical decisions are made solely by the client in conjunction with hospital care providers. A specific emergency transport plan is developed with each individual client.
The most common reasons for consultation and/or transfer of care are listed here (although these may differ slightly from midwife to midwife):
- Gestational diabetes uncontrolled by diet and/or exercise
- High blood pressure or preeclampsia
- Anemia not improved with diet and/or supplements
- Inadequate or excessive amniotic fluid or fetal growth
- Documented fetal abnormality
- Severe vaginal bleeding
- Labor before 37 weeks or after 42 weeks
- Persistent abnormal or breech presentation (anything other than head down after 34 weeks)
- Multiple pregnancy (twins, triplets, etc.)
- Abnormally long labor pattern
- Persistent fetal distress
- Thick meconium staining of amniotic fluid and birth not imminent
- Uncontrolled hemorrhage
- 3rd or 4th degree perineal or vaginal tears
- Retained placenta
- Respiratory distress
- Unstable or abnormal vital signs
- Birth defects or birth injuries
Homebirth midwives maintain personalized, family-centered care to the greatest degree possible, with the goal of having a successful homebirth, realizing that very occasionally plans for a homebirth will have to change during the course of a pregnancy. The emphasis of homebirth midwifery care is on excellent nutrition, daily physical activity and exercise, stress reduction, relaxation techniques, and holistic preparation for birth. These self-care activities optimize the chances for a healthy pregnancy, birth, and postpartum transition.
Wondering how to optimize your ability to have a safe pregnancy and birth in any setting? Take my online childbirth preparation course and find out! This course is suitable for people planning a home, birth center, or hospital birth and is 100% inclusive of all types of parents and families. Gender-neutral and relationship-neutral language is used throughout the course to refer to birthing parents and their birth partners. We celebrate the diversity and beauty of your unique family! If you are LGBTQIA, a single parent, or a person of color you will find yourself represented, included, and welcomed in this course.
Childbirth Preparation Course (web-based eight-module program)
Promotes birth as a normal, physiological process and acknowledges that people have a fundamental right to understand all of their choices in childbirth. The course is appropriate for people choosing to birth at home, in a birth center, or at a hospital and addresses the circumstances around each environment. It is the goal of the course to address not only the many factors of pregnancy and birth but to also provide a space in which there is a sensitivity to and celebration of gender, sexuality, race, ethnicity, relationship status, and family framework.