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Closing the Theory–Practice Gap: Intrapartum Midwifery Management of Planned Homebirths

Authors

  • Saraswathi Vedam CNM, MSN,

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    • Saraswathi Vedam, CNM, MSN, is the Director of the Division of Midwifery at University of British Columbia and serves as chair of the ACNM Division of Standards and Practice Homebirth Section.

  • Meredith Goff CNM, MS,

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    • Saraswathi Vedam, CNM, MSN, is the Director of the Division of Midwifery at University of British Columbia and serves as chair of the ACNM Division of Standards and Practice Homebirth Section.

    • Meredith Goff, CNM, MS, is on the midwifery faculty at Yale School of Nursing and provides intrapartum midwifery care in the Yale Midwifery Faculty Practice.

  • Vicki Nolan Marnin CNM, MSN

    Search for more papers by this author
    • Saraswathi Vedam, CNM, MSN, is the Director of the Division of Midwifery at University of British Columbia and serves as chair of the ACNM Division of Standards and Practice Homebirth Section.

    • Vicki Nolan Marnin, CNM, MSN, is clinical preceptor for Yale School of Nursing and practices in a homebirth midwifery private practice as well as a tertiary care intrapartum setting.


Saraswathi Vedam, CNM, MSN, Division of Midwifery, University of British Columbia, B54–2194 Health Sciences Mall, Vancouver, BC V6T 1Z3. E-mail: saraswathi.vedam@midwifery.ubc.ca

Abstract

In the United States, access to qualified homebirth providers varies by state, city, and community, and consistent, evidence-based guidelines for intrapartum management at home are not available. This article examines the similarities and differences in midwifery management of the intrapartum, postpartum, and neonatal course between planned homebirths and planned hospital births. Characteristics of qualified attendants, essential medical supplies and equipment, methods for maternal and fetal surveillance, and common intrapartum indications for transfer are discussed. Unique features of management of the healthy woman and baby in the home are described, as well as the process of consultation and/or referral for collaborative or medical management. Current evidence for the management of fetal intolerance of labor, meconium stained amniotic fluid, prolonged labor, postpartum hemorrhage, and the unstable newborn is discussed in the context of homebirth practice. Aspects of homebirth care that require cultural competency and affect the informed consent process are included. Homebirth practice may provide opportunities to increase the congruence between espoused midwifery philosophy and actual practice.

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