CRITERIA FOR MIDWIVES ATTENDING 
UNUSUAL CIRCUMSTANCES LABOR & BIRTH
  i.e., Moderate Risk Labor

     1.  Must have attended at least 75 births as the primary midwife following licensure

     2.  Must have advanced training, so that her “experience, training and comfort level” 
represent an elevated level of ability well beyond "entry -level"

     3.  Must have taken the ALSO (Advanced Life Support in Obstetrics) or an equivalent education

4.  Advanced experience via attendance of  moderate risk labors at home, hospital or a 
birth center  with documented, hands-on, supervised experience in unusual circumstances.

5. Must obtain "Special Circumstance" Informed Consent in writing
(see Generally Accepted Practices' ~ 10b. Parental Waiver for VBAC Informed Consent  

ADVANCED SKILLS For Special Circumstances

CRITERIA FOR HOME BREECH BIRTH

1.    Gestational age >36 ½ weeks, <41 ½ weeks

2.     Baby in frank breech position.

3.     Pelvis adequate for fetal size

4.     Head flexed

5.     Sono to r/o anomalies associated with breech presentation

6.     Distance to hospital <30 minutes

7.     Psycho-social aspects conducive to cooperation during labor, and delivery

8.     Signed informed consent/topic-specific special circumstances decline of medicalization

9.      Once labor begins, progress must be straightforward

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CRITERIA FOR HOME TWIN BIRTH

1.         Gestational age >36 ½ weeks

2.         First baby’s head in the pelvis.

3.         Distance to hospital <30 minutes

4.         Signed informed consent/topic-specific special circumstances decline of medicalization

5.         Once labor begins, progress must be straightforward.

6.         After birth of twin 1, # 2 should deliver promptly -- ideally within 30 minutes, outside limit 2 hours.

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CRITERIA FOR HOME POST-TERM BIRTH

1.       Adequate amniotic fluid by palpation q 3-4 days starting at 41 ½  weeks

2.       NST by fhts X 10 minutes indicating good variability

3.       Normal fetal movement & responsiveness

4.       Begin at 41 weeks to explain risks associated with >42 weeks, ie 25 % problems with babies due to placental insufficiency, sutures becoming hard, size of baby, etc.

5.       Discuss castor oil/ herbal induction at 42 weeks if birth hasn't occurred, or referral for hospital birth???

6.        Biophysical profile at 42 weeks

7.        Signed informed consent / topic-specific special circumstances decline of medicalization if home birth is planned.

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 CRITERIA FOR POST-CESAREAN LABOR/BIRTH @ HOME VBAC

1.         Documentation of one low transverse incision, greater than 18 months between births 

2.         Adequate pelvis for size of baby, appropriate progress, reassuring FHT pattern

3 .        Signed informed consent / topic-specific special circumstances decline of medicalization 
(see special circumstances VBAC informed consent for other VBAC-specific criteria) 

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  Last Updated ~ 1/23/2004  faith ^O^