California College of Midwives
State chapter ~ American College of Community Midwives

Section Two

CRITERIA FOR CLIENT SELECTION ~ to define and clarify minimum practice requirements of safe care for women and infants regarding selection for community-based midwifery care

e Criteria for initial selection of clients for domiciliary birth services assumes a:

· Healthy mother without serious pre-existing medical or mental conditions affecting major body organs or biological systems

· History, physical assessment and laboratory results should be within limits commonly accepted as normal with no clinically significant evidence of the following:

1. Cardiac disease

2. Pulmonary disease, tuberculosis or severe asthma uncontrolled by medication

3. Renal disease

4. Hepatic disease

5. Endocrine disease

6. Significant hematological disorders /coagulopathies

7. Neurological disease

8. Essential hypertension (BP >>140/90 on two or more occasions six hours apart)

9. Active cancer

10. Insulin-dependent diabetes mellitus

11. History of a cesarean section with classical incision, 3 or more previous cesareans, cesarean less than18 months from current EDC

12. Serious congenital abnormalities affecting childbirth

13. Significant pelvic/uterine abnormalities (tumors, malformations, etc.)

14. Alcoholism or abuse

15. Drug addiction or abuse

16. Isoimmunization

17. HIV positive or AIDS

18. Current serious psychiatric illness

19. Social or familiar conditions unsatisfactory to OOH birth

20. Other significant abnormality or social/mental functioning affecting pregnancy, parturition and/or the ability to safely care for a newborn

21. Other as defined by the Midwife

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Obstetrical Consultation or Referral ~
Medical or mental conditions that need to be evaluated by a physician before a client is accepted for domiciliary services

1. Morbid Obesity

2. Medical condition of significance for which ongoing treatment is required or Rx medication is routinely being taken

3. Family history of genetic disorders, hereditary disease or significant congenital or genetic anomalies

4. History of repeated spontaneous abortions and/or two or more late miscarriages

5. History of preterm birth of VLBW infant, unexplained stillbirth or neonatal mortality associated with maternal disease, GBS infected newborn, congenital or genetic anomaly

6. History of fibroids or uterine surgery

7. Previous unexplained antepartum / postpartum hemorrhage requiring transfusion

8. Grand multipara (more than 5 previous births)

9. Less than 12 months from last delivery to present due date

10. Previous uncomplicated low-transverse cesarean surgery with non-repeating etiology and approximately 18 months or more before EDC for subsequent birth

11. Other medical or mental conditions that need to be medically evaluated before a client is accepted for domiciliary services