I have a health condition. Does this risk me out of midwifery care?

Below is a list of some conditions that do risk women out of care with midwives, either because they need higher level care during pregnancy, or they or baby may require higher level care at the time of birth. This list isn't all-inclusive. If you have questions about your specific situation, email us at hello@rootedbirthmw.com and we'll discuss it with you.

Conditions that generally risk out of care:

• Type I or Type II diabetes

• Gestational diabetes not controlled by diet and exercise

• Heart disease, including hypertension

• Severe psychiatric illness

• Rh-negative blood type with antibodies

• Pre-eclampsia, eclampsia, or HELLP

• Preterm labor (labor prior to 37 weeks)

• Postdates pregnancy (past 42 weeks)

• Fetal position incompatible with vaginal birth

• Fetal distress

• Maternal fever in labor

• Membranes ruptured over 96 hours, in the absence of GBS

• Active labor signs without progress

• Lacerations beyond midwife’s ability to repair

• Retained placenta

• Persistent uterine prolapse or inversion

• Placenta previa at term

• Placental abruption

• Cord prolapse, unless birth is imminent

• Uncontrollable postpartum hemorrhage

• Newborn with Apgar under 6 at 10 minutes

• Persistent central cyanosis

Will I know who will be at my birth?

Yes! Mostly. At present, Rooted Birth has one staff midwife, who plans to be at all births for all clients. In an unexpected situation such as two simultaneous births, the midwife being sick or injured, or a planned situation like traveling, the midwife will call in another area midwife to cover and provide care for all clients. She will always give as much heads-up in this situation as is possible, but extenuating circumstances do occur that may make that difficult.

In addition to the midwife, our student midwife will be at all births to which she is invited, barring extenuating circumstances such as illness or multiple simultaneous births. Each client will have the opportunity to get to know the student midwife during prenatal visits.

Finally, our birth assistants are on-call on a rotating basis, so we cannot guarantee which of them will be on for a specific birth. Most clients will not meet them ahead of their birth.

What happens if I need to transfer to the hospital?

Hospital transfers can happen for a variety of reasons; how they are handled depends on the exact situation. We remain in touch with the clients via phone for questions and concerns. Regardless of reason or timing of transfer, we encourage clients to see us for postpartum care after the birth, so they can continue to benefit from the Midwifery Model of Care. These are some general guidelines, but your specific situation may vary.

• Transfer prior to labor: A client may be transferred to the care of a doctor or hospital if a condition develops during the course of prenatal care or in early labor that risks her out of care for a midwifery-led birth. In this case, we call the provider or hospital of your choice, arrange for them to see you, and send over your records.

• Transfer in labor that is not an emergency: Sometimes a client decides to transfer care, or a midwife recommends it, based on how labor is going or what the client is feeling. This is sometimes the case in long labors, particularly when a mother is getting exhausted and needs the benefit of an epidural to get some rest. In these cases, we call the provider or hospital of choice, send over records, and may accompany you to the hospital to help you settle in, if circumstances allow.

• Transfer in an emergency: Rarely, emergencies happen in labor or the immediate postpartum that require us to transport a mother or baby to the hospital via ambulance. In these cases, a team member calls 911 to activate EMS, while the rest of the team continues to care for the client. The midwife will typically transfer with the client, sometimes in the ambulance and sometimes driving separately, depending on the situation. She will stay with the client and/or family as long as it is helpful.