24.159.1477    CIRCUMSTANCES CONSTITUTING A LOW RISK OF ADVERSE HOMEBIRTH OUTCOMES

(1) A low risk of adverse birth outcomes indicates a clinical scenario for which there is not clear demonstratable benefit for a medical intervention or transfer to a physician's care. 

(2) Consultation with a physician does not preclude a low risk of adverse birth outcomes.

(3) Preexisting arrangements for emergency transportation to a nearby hospital if needed do not preclude a low risk of adverse birth outcomes.

(4)  The following conditions preclude a low risk of adverse birth outcomes.

(a)  Pre-existing conditions (not gynecological):

(i)  subarachnoid hemorrhage, aneurysm;

(ii)  recent or acute herniated nucleus pulposus;

(iii)  active tuberculosis or ongoing treatment;

(iv)  human immunodeficiency virus, acquired immunodeficiency syndrome, hepatitis B or hepatitis C;

(v)  heart defect with hemodynamic consequences;

(vi)  clotting disorders;

(vii)  kidney dysfunction;

(viii)  hypertension;

(ix)  diabetes mellitus;

(x)  unmedicated thyroid disorders with present TSH receptor antibodies;

(xi)  inflammatory bowel disease, including ulcerative colitis and Crohn's disease;

(xii)  systemic and rare disorders, including Addison's disease, Cushing's syndrome, systemic lupus erythematosus, antiphospholipid syndrome, scleroderma, rheumatoid arthritis, polyarteritis nodosa, Raynaud's disease, and Marfan syndrome;

(xiii)  illegal drug use; or

(xiv)  alcoholism.

(b)  Pre-existing gynecological conditions:

(i)  pelvic floor reconstruction;

(ii)  conization;

(iii)  myomectomy or other uterine surgery; or

(iv)  uterine distortion, including bicornuate, septate, unicornuate, or didelphic conditions.

(c)  Obstetric history:

(i)  blood group antagonism, including Rhesus, Kell, Duffy, and Kidd glycoproteins;

(ii)  previous pre-term (before 34 weeks) birth. If a normal pregnancy occurred after the premature birth, the current birth may be considered to be low risk;

(iii)  cervical insufficiency or cerclage;

(iv)  placental abruption;

(v)  caesarean section - must transfer current pregnancy at 37 weeks if no reason for transfer prior;

(vi)  dysmaturity;

(vii)  uncontrolled post-partum hemorrhage;

(viii)  manual placental removal;

(ix)  placenta accreta; and

(x)  total uterine rupture with no functional recovery; or

(xi)  history of intrauterine fetal demise.

(d)  Occurring or diagnosed during pregnancy:

(i)  rubella;

(ii)  cytomegalovirus;

(iii)  genital herpes (primo infection);

(iv)  parvovirus;

(v)  tuberculosis;

(vi)  human immunodeficiency virus or acquired immunodeficiency syndrome;

(vii)  syphilis;

(viii)  illegal drug use;

(ix)  alcoholism;

(x) maternal anemia;

(xi)  extrauterine pregnancy;

(xii)  amniotic fluid loss or preterm labor before 37 weeks;

(xiii)  uncontrolled diabetes mellitus;

(xiv)  gestational diabetes mellitus;

(xv)  gestational hypertension with diastolic blood pressure above 100 or systolic blood pressure above 160;

(xvi)  preeclampsia, superimposed preeclampsia, hemolysis, or elevated liver enzymes and low platelets (HELLP) syndrome;

(xvii)  blood group antagonism;

(xviii)  deep vein thrombosis;

(xix)  clotting disorders;

(xx) vasa previa;

(xxi) velamentous cord insertion;

(xxii)  placenta previa;

(xxiii)  placental abruption;

(xxiv)  serotonin syndrome;

(xxv)  cervical insufficiency prior to 37 weeks of gestation;

(xxvi)  multiple pregnancy;

(xxvii)  breech or abnormal position at term; or

(xxviii)  fetal mortality; or

(xxix)  prolonged gestation > 42 weeks.

History: 37-1-131, MCA; IMP, 37-8-202, MCA; NEW, 2023 MAR p. 1561, Eff. 11/4/23.