• Saraswathi Vedam CNM MSN,

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    • Saraswathi Vedam received her nurse-midwifery education and an MSN from the Yale School of Nursing Nurse-Midwifery Program in 1985. Since then, she has practiced in a large-volume hospital-based health maintenance organization, a home and hospital private midwifery service, and currently, in a solo home birth practice. She has been a clinical instructor and lecturer for EPA, SFSU, and CNEP nursing and nurse-midwifery programs. Over the past 25 years, she has attended births in India, the Netherlands, and the United States. She is the mother of four daughters, all born at home.

  • Yelena Kolodji CNM

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    • Yelena Kolodji has been a certified nurse-midwife since 1988 when she graduated from the UCSF/SFGH Interdepartmental Nurse-Midwifery Educational Program. She received her BA from the University of Minnesota. She has had a home birth practice for 14 years in Northern California, the last 10 as a solo practitioner. Following an apprenticeship with a CNM, she worked first as a direct-entry midwife while completing a nursing program at Deanza College. Certification enabled her to become a full-scope provider. She is a member of the standing Home Birth Committee of the ACNM.

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Numerous studies have documented the safety of planned home birth; yet, few have identified specific criteria for selection of the home birth candidate. Home birth midwifery practice achieves successful outcomes by appropriate evaluation of medical and obstetric risk factors, as well as an ongoing evaluation and development of the client's psychosocial resources and the midwife-client relationship. Relevant medical and obstetric factors include significant medical illnesses, antenatal course, smoking history, commitment to breastfeeding, and the woman's nutritional profile. Social and environmental factors include the need for a stable birthing environment, practical means for hospital transfer, and the presence of loving support for the client during and after delivery. The client's psychological preparedness is a critical variable that may affect the ability to deliver in the home setting without analgesia or labor augmentation. Active participation in prenatal care, preparation of the home and family members, and a realistic attitude regarding the risks, benefits, and potential complications of planned home delivery are all components of this preparedness. Because midwifery practice promotes midwife-client rapport by careful attention to both medical and psychosocial issues during prenatal care, this relationship is itself an important predictor of the client's suitability for home birth. The quality of midwife-client interactions may influence not only the decision to plan a home birth but the indications for hospital transfer should problems arise. In this article, existing literature is reviewed and criteria are proposed for selecting home birth candidates within the American midwifery practice setting.