Today, I finished a whopping four-page health history form. I think one of the major misconceptions about home birth is that we midwives just sign up to help anyone who plans to give birth at home. How it actually works, is that we first take an extensive health history to make sure each woman is healthy enough to give birth outside of a hospital.
Our "midwifery standards of care" as determined by the Medical Board's Division of Licensing, specify which conditions are considered inappropriate for home birth, and each midwife can add her own specifications to the list.
The wording from the standards of care goes like this:
Criteria for initial selection of clients for community-based midwifery care assumes:
- Healthy mother without serious pre-existing medical or mental conditions
- History, physical assessment and laboratory results within limits commonly accepted as normal and with no clinically significant evidence of the following:
Cardiac disease
Pulmonary disease
Renal disease
Hepatic disease
Endocrine disease
Neurological disease
Malignant disease in an active phase
Significant hematological disorders or coagulopathies
Essential hypertension (BP > 140/90 on two or more occasions, six hours apart)
Insulin-dependent diabetes mellitus
Serious congenital abnormalities affecting childbirth
Family history of serious genetic disorders or hereditary diseases that may impact on the current pregnancy
Adverse obstetrical history that may impact on the current pregnancy
Significant pelvic or uterine abnormalities, including tumors, malformations, or invasive uterine surgery that may impact on the current pregnancy
Isoimmunization
Alcoholism or abuse
Drug addiction or abuse
Positive HIV status or AIDS
Current serious psychiatric illness
Social or familiar conditions unsatisfactory for domiciliary birth services
Other significant physical abnormality, social or mental functioning that affects pregnancy, parturition, and/or the ability to safely care for a newborn
Other as defined by the licensed midwife
Quite a list, no? Oh, and notice that breeches, twins, and VBACs are not on the list, meaning we ARE specifically able to attend them at home. Obviously, there's some wiggle room with the interpretations of a couple of these, but anyone caught assisting a woman who is clearly not a candidate for a home birth could get in some serious trouble.
To make sure we are providing care to healthy women having normal pregnancies, we do a thorough health history. Hence, my four-page form. When a woman signs up for care, I will email the health history form to her so she can fill it out on her own. She'll send it back to me and I'll have a chance to review it before her first visit. The form includes questions and check lists (in perfectly formatted boxes!) covering information about the present pregnancy, previous pregnancies, gynecologic history, medical history, family history, and genetic screening.
At the first prenatal visit, which lasts at least 90 minutes, there is plenty of time to discuss any questions or concerns that either of us have about whether the woman is eligible for a home birth (with me) and how we can help ensure she stays healthy throughout the pregnancy and birth. The last line of the list, "other as defined by the licensed midwife," is something I'm still working on. I need to figure out who I will absolutely risk out for home birth, who (or what situations) I would have reservations about, and who gets the green light. I know a lot of this comes with experience, and my approach is to be extra-conservative at first. I'm actually looking forward to coming up with my own standards of practice.
I'm getting close to opening my practice!
No comments:
Post a Comment