WatterbergSlides0713

Report
Planned Home Birth:
American Academy of Pediatrics
Policy Statement
Kristi Watterberg
For the Committee on Fetus & Newborn
Background for AAP statement: the
revised ACOG statement

“Although the Committee on Obstetric Practice
believes that hospitals and birthing centers are the
safest setting for birth, it respects the right of a woman
to make a medically informed decision about delivery.”


OB/GYN 2011; 117:425
With ACOG recognition of women’s autonomy to
choose a home birth, AAP felt it necessary to outline
policy standards for care of infants born at home
Prenatal counseling

Advocate for best interest of the child: communicate
the apparent increase in neonatal mortality

Assess whether the specific situation qualifies as lowrisk for a planned home birth

Recognize that a substantial number of women will
need transfer (10 - 40%); transfer is not a failure of
home birth but a success of the system

Support provision of care by midwives certified by
American Midwifery Certification Board
Low-risk fetus for home delivery

Appropriate for gestational age

not small or large for gestational age (SGA, LGA)

Term gestation (37 – <41 completed weeks)

Singleton

Cephalic presentation
Care of the neonate at delivery

At least one person should be present whose
primary responsibility is care of the newborn

And who has the training, skills, and equipment
to resuscitate the infant, including positive
pressure and chest compressions

The telephone (or other communication system)
should be tested and the weather monitored
Care of the neonate: transition

Transition: (first 4 – 8 hours): physical exam, risk
assessment, vital signs q 30’ until stable for 2o

Infants who received extensive resuscitation should
be transferred to a hospital for close monitoring
and evaluation


If mother is  for Group B strep, treat with
antibiotics and observe baby closely
Infants who appear <37 weeks gestation, and those
with any signs of illness should also be transferred
Continuing care after delivery


Comprehensive standards are found in: “Guidelines
for Perinatal Care” available from AAP/ACOG
Specific Screening and Rx standards






Glucose screening (LGA, SGA, resuscitated infants)
Vitamin K injection
Eye prophylaxis
Hepatitis B vaccination
Evaluation for hyperbilirubinemia (24 – 48o)
Screening: hearing, ‘universal newborn screening’ per
state regulations
Follow up care

Comprehensive documentation and
communication with follow up provider is critical


Examination by an experienced pediatric provider
within 24o of birth and within 48o of first exam



Include written documentation of screenings and
treatments performed, medications given
Weight, physical exam
Feeding evaluation
Oxygen saturation screening
Continuing care of the newborn infant

Care should adhere to “Guidelines for Perinatal
Care” and the AAP statement regarding care of
the well newborn infant (Pediatrics 2010; 125:405).

Regardless of the circumstances of his or her
birth, including location, every newborn
deserves health care that adheres to these
standards.
In conclusion

The goal of providing high quality care to all
newborn infants can best be achieved through
continuing efforts by all participating providers
and institutions to develop and sustain
communications and understanding based on
professional interaction and mutual respect
throughout the health care system.

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