Birth at Home

Indications for Referral or Transfer of Care to a Physician

  1. The following serious conditions that may exist prior to pregnancy would likely necessitate referral to a physician for prenatal care and delivery:
    • high blood pressure
    • cardiac disease
    • diabetes
    • renal disease
    • bronchial asthma or emphysema
    • epilepsy or other seizure disorder
    • drug addiction (including alcohol & marijuana)
    • tuberculosis
    • previous Rh sensitization
    • previous classical cesarean section incision
    • HIV/AIDS
  2. The following pre-existing conditions might necessitate consultation with a physician during your pregnancy:
    • sickle cell anemia
    • uterine fibroids
    • history of severe pre-eclampsia or eclampsia
    • history of repeated miscarriages (3+)
    • congenital abnormalities in mother or fetus that might affect childbirth
    • mental illness
  3. The following conditions that may develop during your current pregnancy might necessitate referral to a physician for the remainder of your pregnancy and for your birth:
    • a primary outbreak of genital herpes
    • the onset of labor prior to 36 weeks’ gestation
    • the absence of labor after 42.5 weeks’ gestation
    • fetal presentation other than vertex (head down) at 36 weeks
    • multiple gestation
    • unexplained bleeding in the third trimester
    • gestational diabetes not controlled by dietary changes
    • pre-eclampsia or uncorrected hypertension
    • severe anemia (hemoglobin less than 10.0) uncorrected by iron or other therapy
    • inappropriate uterine size for gestational age
    • unresolved mental health problems compromising mother’s ability to care for herself or her baby
    • inability of parents to responsibly prepare for homebirth
  4. The following conditions that may develop during labor would necessitate transfer to a hospital:
    • maternal fever of more than 100.5 degrees
    • signs or symptoms of pre-eclampsia
    • abnormal presentation of baby
    • umbilical cord prolapse
    • signs of fetal distress by abnormal heart rates that don’t improve with simple measures (e.g., maternal repositioning)
    • thick or fresh meconium staining of amniotic fluid when birth is not imminent
    • abnormal bleeding
    • extremely prolonged or arrested labor after natural means of labor stimulation have failed
    • severe maternal exhaustion
    • the desire of the mother for pain medication
    • the desire of the mother for hospital transfer for any reason
  5. The following conditions that may arise in the immediate postpartum period would necessitate transfer to the hospital:
    • severe hemorrhage
    • retained placenta
    • fourth-degree perineal laceration
    • an infant with persistent respiratory distress, cardiac irregularities, congenital anomalies, a fever, a five-minute Apgar score of less than 7, or any problem requiring immediate care or medical assessment