Birth American Academy of Pediatrics Policy Statement Kristi Watterberg For the Committee on Fetus amp 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 b ID: 136704
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Slide1
Planned Home Birth:American Academy of Pediatrics Policy Statement
Kristi Watterberg
For the Committee on Fetus & NewbornSlide2
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 homeSlide3
Prenatal counseling
Advocate for best interest of the child: communicate the apparent increase in neonatal mortality
Assess whether the specific situation qualifies as low-risk 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 BoardSlide4
Low-risk fetus for home deliveryAppropriate for gestational age
not small or large for gestational age (SGA, LGA)
Term gestation (37 – <41 completed weeks)
Singleton
Cephalic presentationSlide5
Care of the neonate at deliveryAt 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 Slide6
Care of the neonate: transitionTransition: (first 4 – 8 hours): physical exam, risk assessment, vital signs
q 30’ until
stable for
2
o
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 transferredSlide7
Continuing care after deliveryComprehensive 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 – 48
o
)
Screening: hearing, ‘universal newborn screening’ per state regulationsSlide8
Follow up careComprehensive documentation and communication with follow up provider is critical
Include written documentation of screenings and treatments performed, medications given
Examination by an experienced pediatric provider within 24
o
of birth and within 48
o
of first exam
Weight, physical exam
Feeding evaluation
Oxygen saturation screeningSlide9
Continuing care of the newborn infantCare 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.Slide10
In conclusionThe 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.