She's trained and prepared for these "sometimes" things.  

• Complications of Pregnancy
  When issues arise in prenatal care, we will spend time discussing options of interventions that include nutrition, supplements, herbs, homeopathics, and other natural things to improve wellbeing. For anemia, for example, I will make these recommendations, then repeat labwork to ensure improvement. Severe anemia may involve a referral to a hematologist, and may risk you out of homebirth. For gestational diabetes, we follow testing and nutrition protocols. Depending on blood sugar levels, you may be referred to a perinatologist and ultrasound or other monitioring recommended. If medicaiton (insulin) is needed, then I don't recommend homebirth. We work with multiple Perinatologist to get you seen for risk factors and problems. Monitoring, using Non-stress test (fetal heart monitor- I can do this in my office) and ultrasounds (at perinatologist), can be used and still plan for a homebirth, or of course, if arise, risk you out of homebirth. If the condition is such that my protocols have risked you out of homebirth, then I will help you to find a practice that will allow you to transfer into their care, such as a hospital-based midwife /OB practice. 
• 
  
• Complications of Labor 
  Some of the issues that may complicate labor and therefore risk you out of homebirth in my practice include: high blood pressure, thick meconium (baby poop in amniotic fluid), prolonged premature rupture of membranes without active labor, protracted/obstructed labor, maternal exhaustion, fetal malpresentaion with failure to descend while pushing, and non-reassuring fetal heart rate. These are non-emergent, but urgent reasons to peacefully make our way to the hospital. Usually, that journey can be by car, and to the chosen backup hospital. More rarely, an EMS would be called the closed hospital used. The very rare, but emergent complications, include: abruption, cord prolapse, and embolism. In those rare instances, the life-saving interventions that are needed would be delayed due to transfer time, as opposed to if you were are the hospital. We choose together to be out-of-hospital because of the rarity of these events, and I practice conservatively, for example, rarely performing artificial rupture of membranes, in order to not increase risk of cord prolapse. VBACs do have an increase risk of complications, and I do not think homebirth is ideal because of that. Choosing homebirth is a balance of considering all risks, of considering benefits, and of considering the value of myself being your experienced midwife, vs you freebirthing solo at home (please don't do that!). 
  
• 
  
• Complications of Birth
  The midwife is to be prepared for complications, and that is largely why you hire us! When babies have big shoulders and "get stuck", we are there to maneuver you and the baby. Shoulder dystocias can be very dangerous and deadly to the baby, but can usually be resolved with our skills. These babies often need a little help breathing while they get over this "stunning" event, and midwives are no stranger to giving babies breaths with an ambu bag. We breathe for baby when baby can't breathe. I have done this sooo many times. What about when a baby needs more than initial breaths? We are trained in advanced neonatal resuscitation, and my birth bag is complete with laryngeal mask airway, intubation, volume expansion, epinephrine, oxygen and CPAP equipment. I have used all of these in the past... mostly because I didn't always get the easy-resusc babies when I worked in Africa!. After baby's out, the placenta has to come out. This can get complicated when it adheres, retains, or the uterus fails to contract afterwards. We carry hemorrhage medications. However, there are risks for  hemorrhage, and when we run into them, we consider the need to get to the hospital, because postpartum hemorrhage is the leading cause of maternal death, and a risk to take seriously. As far as perineal and labial lacerations, I am experienced and prepared to repair 1st, 2nd and 3rd degree lacerations at home, with lidocaine numbing.

She orders the same sterile, medical grade supplies and medications from companies like Medline that would be used in the hospital or accredited birth center. Nurse Midwives are licensed and have professional accounts. 

• Labor supplies: stethoscope, BP monitor, thermometer, doppler, catheter, amnihood, labor support supplies
• Birth supplies: sterile instruments, sterile cord clamps, perineal massage oil, emergency supplies
• Perineal repair: lidocaine, sterile instruments, Vicryl absorbable suture
• Newborn resuscitation supplies: Ambu bag, DeLee suction, oxygen, NeoTee resuscitator for CPAP, LMA airway, Epinephrine, Masimo pulse oximeter
• Hemorrhage supplies: Pitocin, Misoprostol, Herbal oxytotics, tamponade kit
• Other meds: IV fluids, Benedryl,  Zofran, Ampicillin (GBS+ prophylaxis), Sterile water papule supplies, Homeopathics, Bach Rescue Remedy
• Newborn supplies: scale, newborn stethoscope, vitamin K, blood sugar monitor