The qualified practitioner will conduct a careful screening to ensure that the woman?s condition is suitable for giving birth at home, that she has no fetal or maternal contraindications, and that she has the capacity to make informed consent.

6.1 The prerequisite for a home birth is that the woman should have an uncomplicated singleton pregnancy with a cephalic presentation between 37 and 42 weeks of gestation (259 to 294 days).

6.4 The following conditions preclude a woman giving birth at home.

Obstetric history?previous:

􀀂 caesarean section;
􀀂 postpartum haemorrhage in excess of one (1) litre;
􀀂 shoulder dystocia;
􀀂 baby requiring intensive or prolonged special care;
􀀂 perinatal death.

Medical history (as identified in the SA Pregnancy Record):

􀀂 any significant medical condition;
􀀂 alcohol or drug dependency;
􀀂 female genital mutilation.

Current pregnancy:

􀀂 body mass index >35 or maternal weight greater than 100 kg;
􀀂 antepartum haemorrhage;
􀀂 abnormal placentation (including placenta praevia);
􀀂 hypertension and/or pre-eclampsia;
􀀂 gestational diabetes;
􀀂 suspected intrauterine growth restriction or small for gestational age;
􀀂 suspected fetal abnormalities that require paediatric attention at birth;
􀀂 polyhydramnios or oligohydramnios;
􀀂 pre-labour rupture of membranes (see 6.4); and
􀀂 post-term pregnancy (􀀁 42 completed weeks; that is, 􀀁 294 days).

During labour:

􀀂 need for continuous fetal monitoring;
􀀂 evidence of infection or maternal temperature >37.6? C;
􀀂 lack of engagement of the fetal head;
􀀂 meconium-stained liquor;
􀀂 fetal heart rate abnormalities;
􀀂 intrapartum haemorrhage;
􀀂 absence of progress in established labour;
􀀂 active first stage labour in excess of 18 hours.

Home environment:

􀀂 more than 30 minutes travelling time from the support health unit;
􀀂 lack of easy access (in case transfer during labour is warranted);
􀀂 lack of clean running water and/or electricity;
􀀂 lack of cleanliness and hygiene;
􀀂 domestic violence;
􀀂 recreational drug use.

6.3 Situations may arise at or after birth that require referral to a health unit; these include:

􀀂 retained or incomplete placenta;
􀀂 postpartum haemorrhage;
􀀂 third or fourth degree tear;
􀀂 Apgar score < 7 at 5 minutes;
􀀂 neonatal respiratory problems;
􀀂 neonatal convulsions;
􀀂 congenital abnormalities;
􀀂 low birthweight (< 2,500 gms).

Care at home is acceptable with pre-labour rupture of the membranes, provided Group B Streptococcus (GBS) status is known, there is clear non-malodorous liquor, and the woman is and remains afebrile on four-hourly temperature recordings. Antibiotic treatment should be instituted for women who are GBS positive (refer to the South Australian Perinatal Practice Guidelines found at the website: http:home). Home birth is contraindicated for women with pre-labour rupture of the membranes for more than 12 hours if they are GBS positive, or if their GBS status is unknown.