Protocols for Homebirth

What criteria do I have to meet for homebirth?

How does the midwife manage complications for me and baby? 

Qualifying for out-of-hospital births

During your initial consult, the midwife will ask for a brief history of your past births, any health problems, and your personal situation regarding choosing homebirth.

Although some midwives may choose to serve any women who makes a free choice to birth wherever she pleases, at Moonlight Midwifery we are practicing according to the global standards of criteria that keep mothers and babies safe- starting pregnancy healthy, and ending it without problems that have significant risks of complications. 


Healthy, low-risk homebirth candidates look like.... 

Start Healthy

  • Healthy body
  • Healthy mind
  • Healthy home (that isn't too far from hospital)

Stay Healthy 

  • Healthy growth
  • Healthy labwork 
  • Healthy vitals (blood pressure)

Baby's Healthy

  • Healthy anatomy scan
  • Healthy growth
  • Healthy fluid level
  • Healthy placenta flow & heart rate

You  may be risked out of homebirth

for these criteria
  • Prior or current medical problems
  • Heart issues- Pregnancy is a big load on the heart. You'd need cardiologist clearance. 
  • Thyroid disorder uncontrolled throughout pregnancy. Most hypothyroidism is fine as it can be controlled with meds and therefore does not affect fetal development. 
  • Uterine surgery- not just prior cesarean, but other uterine or abdominal surgery also.
  • Severe anemia
  • Rh isoimmunization
  • Obesity, BMI >40- Associated with increased risks, but midwife may evaluate clinical picture of health and lifestyle individually

  • Prior pregnancy problems
  • Hemorrhage with need for transfusion or related to blood clotting problem
  • Fetal growth problems, if reason for IUGR is suspected to be repeated
  • History of preterm labor or preterm birth
  • History of newborn complications, such as pathologic jaundice or GBS sepsis

  • Current pregnancy problems
  • Abnormal fetal growth pattern
  • Abnormal amniotic fluid amount
  • Abnormal fetal anatomy scan or genetic screening
  •  High blood pressure 
  • Pre-eclampsia
  • Intrahepatic Cholestasis of Pregnancy (ICP)
  • Low platelets, ITP
  • Severe anemia
  • Blood sugar dysregulation- gestational diabetes not controlled by diet
  • Baby is not head down- breech, transverse presentation

  • Labor problems
  • Abnormal fetal heart rate
  • Meconium in amniotic fluid
  • Prolonged gestation >42wks
  • High blood pressure
  • Poor coping, physically or emotionally, with labor
  • Problems progressing through stages of labor or pushing


Homebirth is for healthy women who start pregnancy without medical problems, maintain healthy nutrition and lifestyle, and have well-grown babies that tolerate contractions happily.

Testing


My professional responsibility and personal commitment to protecting women and babies is to adhere to the standard screening tests, which includes an infectious testing panel and anatomy ultrasound screen of baby. I choose to only attend homebirths with negative screenings. Additionally, I feel glucose management is very important, so gestational diabetes screening (using dye-free glucose or, in low-risk cases, grape juice) is required.

  • Initial labwork: Blood type, Antibody screen, CBC (anemia screen), infection panel
  • Genetic screening and early ultrasound- optional
  • Anatomy ultrasound of baby at 20 weeks
  • Third trimester labs: CBC, glucose testing, infection rescreening (optional), GBS test

Additional testing is done to monitor when there are abnormalities or risks.

This additional testing is necessary sometimes to ensure baby is doing well. It may be a part of your required contract of care with me, because my obligation is to protect your baby.


Antepartum Testing

“AP testing” usually involves several methods, typically after 32wks:

-NST (Non-stress test)- fetal heart rate monitoring x20min. This can be done in my office. 

-Growth scan ultrasound- monthly after 28wks to monitor changes in fetal growth percentile. Done at perinatal MD.

-BPP (Biophysical Profile) ultrasound- checks placenta, cord flow, amniotic fluid amount, fetal wellbeing. Done at perinatal MD.


Informed Consent


You reserve the right to decline testing and recommended care- choice is something midwives believe in respecting and honoring. 


However, based on what I read in natural momma facebook forums about women's complaints about even midwives' coercing them into care, please understand that we, midwives, are amongst all doctors and medical providers, practicing according to our training, our experience, and our liability risk... and therefore, I do try to convince clients of what we feel is best.... that's the informed part of "informed consent."  I'm not a free-for-all midwife. That's why I'm on the internet here... trying to explain to you how and why I practice... I want to keep my record of outcomes clean and not cross into crazy. Thanks for reading all this-Crystal

Interventions

I may use and frequency


  • Naturopathy- Herbs, homeopathy, nutraceuticals- common
  • Artificial rupture of membranes- rare
  • Mechanical ripening of cervix- foley bulb or laminaria- sometimes
  • IV-sometimes
  • Doppler- Electronic doppler is used for labor
  • Vaginal exams in labor- usually I rely on other signs of labor progress. I use them to know the dynamics of the pelvic floor and fetal presentation, and what tricks are needed to help the process. 
  • Manual rotation- rare, but sometimes a baby doesn’t come through unless the head changes rotation
  • Manual removal of placenta- rare, recommend to be in hospital setting
  • Pitocin after birth- sometimes
  • Suturing- I like to put things back together if they come apart; lidocaine used of course!

Newborn Care


After birth, baby stays on the mother, and all vital signs and exam are done there.
Babies that are very small or very large may have their blood sugar checked.
Babies born to mothers with Rh negative blood type will have blood typing. 
All babies will be observed for jaundice through my close postpartum care and bili levels checked as needed. 
Good latch, swallows, pees and poops are followed to ensure baby thrives in this new world he/she entered! 



GBS protocols

I recommend the 36 week perineal swab for Group Beta Strep testing, and offer standard treatment protocol with IV Ampicillin during labor. If you decline testing, or test positive, I monitor baby closely for signs of sepsis, and parents must complete their part in monitoring baby's vitals and reporting to me. Baby needs to be seen at 24hr and 48hr by myself and/or pediatrician. 


View Moonlight Midwifery's Risk Levels and Protocol Document

Learn about how birthing at home can be not only a Safe, but the safest option.