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 (I am not attending homebirth VBAC at this time)
• Severe anemia
• Rh isoimmunization
• Obesity, BMI >30 (with prior healthy pregnancy history, I may consider case-by-case)
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• 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, preterm birth or abruption
• History of newborn complications, such as pathologic jaundice or GBS sepsis
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• 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
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• 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

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.

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

You deserve to make choices and not be coercied. However, please understand that Nurse Midwives are healthcare professionals, practicing according to our training, our experience, and our liability risk.  Advice may not always be in alignment with your opinion.  As an integrative practitioner, I usually present multiple perspectives- naturopathic opinions and medical recommendations.  If your choice would put you outside my comfort for homebirth risks, we'd discuss thoroughly and respectfully dissolve our contract if needed. My efforts to be transparent in my care standards will hopefully prevent any mismatched midwife-client relationships. 

What may be used?

• 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 always 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- as necessary; lidocaine used of course!