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Re: OB:Home Births in AustraliaFrom: MS GAIL M HART (YTDP43A@prodigy.com)Fri Aug 28 01:39:14 1998
I didn't want to wade into the subject, but looks like I might need to just get one or two toe wet..
RE<Kathi Wilson<<where I practice, it is completely against standard
to manage breeches, multiples and
>documented post-term pregnancies at home. Non-reassuring fetal In Oregon, state licensed midwives follow under the same (legaly binding) protocols. Certified midwives have similar standards. RE>>> We also have practice standards about transport time from the home setting.<<< most midwives require <6 minute 911 response time. Every licensed midwife carries oxygen and neonatal resusc equipment. ALL must maintain current neonatal resuscitation training (NARLS) and many have been trained in intensive resusc - intubation as well. RE John> Robertson>>>This is good to "hear" Kathi, as I have personally been told by a college regestered midwife here in B.C. that she sees no problems with delivering breeches or VBACs at home. >>> well, one can play the statistics with VBAC and conclude that catastrophic rupture after low transverse section is similar to rate of primip rupture (re Flamm). Many midwives will attend a VBAC who has an excellent prognosis (deeply engaged head etc). Some wont. Almost all midwives refuse to do breeches at home. Sometimes parents feel coerced into delivering breech at home if their only option is a mandatory ceserean. (This is a rotten situation. If a vaginal breech is going to be attempted, it SHOULD be done in hospital). Most midwife certifying-bodies forbid thier members to attend breech out- of-hospital. I think the conclusions of the australia study are clear. Home birth is riskier than hospital birth for high risk situations. I sure agree with that! But the other conclusion should be clear as well -- that home birth is safe for LOW RISK women and for women who do not develop risk factors in labor (s/s of fetal distress). THe key to safe home birth is good risk screening in pregnancy, careful monitoring in labor, and conservative protocols for transfer to a medical facility. RE; How to monitor without an Electronic Fetal Monitor? Isn't the data quite clear that intermittent auscultation by fetoscope/doptone is equaly predictive to EFM for low risk labor? Isn't EFM actualy recomended for high risk labors? The GEPC concludes so (pg214 second edition). We follow the ACOG protocols for auscultation intervals in labor. Gail Hart, midwife for twenty plus years, Oregon, USA
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