Who may be eligible for birth at a free-standing birth?

According to the Washington State Administrative code (WAC 246-329), birth center and home birth services should be available only to “low-risk maternity clients.” The official definition:

"WAC 246-329-010    Definitions.

(13) "Low-risk maternal client" means an individual who:

(a) Is in general good health with uncomplicated prenatal course and participating in ongoing prenatal care;

(b) Is participating in an appropriate childbirth and infant care education program;

(c) Has no major medical problems;

(d) Has no previous major uterine wall surgery, caesarean section, or obstetrical complications likely to recur;

(e) Has parity under six unless a justification for a variation is documented by clinical staff;

(f) Is not a nullipara of greater than thirty-eight years of age unless a justification for a variation is documented by clinical staff;

(g) Is not less than sixteen years of age unless a justification for variation for ages fourteen through fifteen only is documented by clinical staff;

(h) Has no significant signs or symptoms of pregnancy-induced hypertension, polyhydramnios or oligohydramnios, abruptio placenta, chorioamnionitis, multiple gestation, intrauterine growth retardation, meconium stained amniotic fluid, fetal complications, or substance abuse;

(i)  Demonstrates no significant signs or symptoms of anemia, active herpes genitalis, pregnancy-induced hypertension, placenta praevia, malpositioned fetus, or breech while in active labor;

(j)  Is in labor, progressing normally;

(k) Is without prolonged ruptured membranes;

(l)  Is not in preterm labor nor postterm gestation;

(m) Is appropriate for a setting where analgesia is limited; and

(n) Is appropriate for a setting where anesthesia is used in limited amounts and limited to local infiltration of the perineum or pudendal block.

 

Note that these criteria are only guidelines, and all women interested in out-of-hospital birth should meet with a caregiver who can address their particular health condition.

 

Birth centers are specifically prohibited from providing these services:

·     Vaginal birth after cesarean (VBAC)

·     Premature delivery before 37 weeks

·     Postdates delivery after 42 weeks

·     Breech presentation

·     Twins or higher multiples

 

Who may be eligible for home birth?

There is no official definition. It is left to the discretion of the attending midwife, who may consult with a physician for any significant deviation from normal.