Planned Home - PowerPoint Presentation

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.