Health Challenges

These are the challenges that we want to, if possible, help you to avoid or minimize. 

Should they develop, based on the rule of the Arizona Department of Health, we will need to either terminate, transfer or receive a medical consultation. 

Some of these are not actually that concerning. For example; having had more than five babies. Thats really not that big of a deal in terms of challenges. Others, like placenta previa after 30 weeks, simply cannot be prevented and absolutely should be managed by physicians in a hospital setting.

Consult- This means that we need to speak with a CNM or a physician about the condition. 

Termination of Care- This means that your care with us has ended.

Transfer of Care- This means that your care must be transferred to a different provider. In some cases, the transfer will need to happen immediately via ambulance, in some cases it means we can transport to the hospital by private vehicle and in some cases the transfer of care may be accomplished in the office via paperwork. 

If your care must be terminated or transferred we may still be able to provide supportive care if you would like.

REASONS TO OBTAIN A CONSULTATION DURING PREGNANCY

  • Mother's decline of certain lab tests
  • To obtain a prescription for medications
  • History of seizure disorder or organ disease
  • History of stillbirth & Premature Birth
  • Mom has had more than 5 babies
  • Low fetal movement or slow growth
  • No fetal heart tones by 22 weeks
  • Mom has not gained 12 pounds by the 30th week of pregnancy.
  • Mom gained more than 8 pounds in a 2 week period
  • Abnormal urine dip on 2 consecutive visits
  • Excessive vomiting after 20 wks 
  • First time mom under the age of 16
  • First time mom over the age of 40
  • Fever of 100.4° for 24 hrs
  • Top of uterus is tender
  • Sexually transmitted infections
  • GBS infection
  • Signs of labor before 36 wks
  • Persistent shortness of breath or painful breath 

RESONS FOR TERMINATION/TRANSFER OF CARE DURING PREGNANCY

  • Unsafe home
  • Unsafe Pelvis
  • hypertension/preeclampsia
  • Placenta previa or accreta; 
  • History of PP Hemorrhage w/ transfusion
  • T.B or STI’s, some until treated
  • DVT  or pulmonary embolism;
  • Mental illness or substance abuse
  • Labor outside 36-42 week
  • Rh disease with positive titers; 
  • Uncontrolled diabetes
  • Multiples
  • Anemia- hgb <10, Hct <30
  • Abnormal presentation
  • Certain breeches & VBAC’s

REASONS TO OBTAIN A CONSULT DURING LABOR & AFTER BIRTH

  • Significant vaginal tear
  • Pre or Post term by exam
  • Excessively pink coloring of body
  • Unengaged head at 7cm & active
  • Yellowish skin w/in 48 hours
  • Failure to void/BM in first 24hrs
  • Baby less than 5 1/2 pounds
  • Abnormal crying
  • Hip dysplasia
  • Minor congenital anomalies
  • Meconium staining of skin
  • Uncommon skin rash
  • APGAR <7 at 5 minutes
  • Lethargy
  • Temp persistently <97.6 or >99.0
  • Persistent Resps >60/min
  • Irritability
  • Other concerning health signs
  • Persistent poor muscle tone
  • Poor feeding
  • Failure of uterus to return to normal size in the postpartum period.

REASONS and POSSIBLE REASONS TO TRANSFER CARE DURING & AFTER BIRTH 

  • Patient wants to go to the hospital
  • Abnormal labor pattern
  • Retained placenta
  • Home is unsafe for mom or baby
  • Ruptured membranes w/out labor
  • Baby less than 4.4 pounds
  • Signs of infection
  • Abnormal baby heart rate
  • Pale, blue or gray baby @ 10min
  • Hypertension/abnormal Vitals
  • Medication to control bleeding
  • Baby has edema or anomalies
  • Multiple babies
  • Thick meconium or blood fluids
  • Respiratory distress
  • Abnormal baby position
  • Heavy postpartum bleeding
  • Complicated vaginal tearing