Home birth consultation and prior authorization

You are required to consult with a Kaiser Permanente obstetric or pediatric specialist whenever there are significant deviations from the normal course of pregnancy, delivery, and post-partum or newborn care. See Pregnancy services for information on how to obtain consultation in your area, as well as a list of Kaiser Permanente-owned and contracted hospitals in Western Washington.

Refer members requiring hospitalization or care for services unrelated to the obstetrical event to the member’s primary care provider.

You must use legend drugs and devices that are deemed integral to safe care and within the your scope of practice as specified in state law and regulation. Refer all conditions unrelated to obstetrical care that require a prescription to the member’s primary care provider, obstetric specialist or pediatric specialist as appropriate.

Contractor shall develop written policies and procedures for physician consultation and referral relationships and the provision of backup Licensed Midwifery and Home Birth services in the event that Contractor is unavailable. These policies and procedures shall:

1. Ensure twenty-four (24) hours a day, seven (7) days a week availability (both in person and by telephone) of a Licensed Midwife who has completed KFHPWA’s credentialing process and who is contracted with KFHPWA to provide Licensed Midwifery services; and

2. Assure the availability of consultation and referral relationship with an obstetric physician; provided, that whenever feasible the relationship shall be with a KFHPWA Obstetric Specialist.

Antenatal conditions

Pre-birth conditions include, but are not limited to:

• Onset of labor or spontaneous rupture of membranes before the completion of the 37th menstrual week of pregnancy (corrected EDD) or after the 42nd week with clear dating information
• Non-cephalic presentation at 37th week
• Multiple gestation
• Maternal obesity, prepregnancy BMI greater than 30
• Evidence of placental abruption or previa
• Abnormal three-hour glucose tolerance test
• Gestational diabetes
• Fetal demise in the second or third trimester
• Incomplete or missed abortion
• Pregnancy induced hypertension (PIH) or any evidence of pre-eclampsia
• Severe anemia (Hgb less than 10) uncorrected by diet or iron therapy
• Documented Intrauterine Growth Restriction (IUGR)
• Documented evidence of significant fetal anomaly
• Positive antibody titre to Rh or any other blood known to cause hemolytic disease of the newborn
• Parents ill-prepared for home birth as assessed by midwife practitioner
• Patient request for physician consultation or referral

Intrapartum conditions

Conditions may develop during the course of labor that necessitate obstetric consultation, transfer to a hospital if time allows, or both. Notify the 24-hour Emergency Notification Line at 1-888-457-9516 of any intrapartum transfer or other urgent or emergent maternal or newborn hospital admission as soon as reasonably practical.

For some conditions, it may be appropriate to transfer the patient to our midwifery service after obstetric consultation. Conditions include but are not limited to:

• Active genital herpes simplex virus (HSV) at the onset of labor or rupture of membranes
• Maternal fever with temperature greater than or equal to 100.4 F
• Signs and symptoms of pre-eclampsia
• Presentation other than cephalic
• Signs of fetal distress
• Signs of maternal distress
• Thick, meconium-stained amniotic fluid
• Abnormal labor pattern without progressive change over reasonable time in active labor
• Abnormal bleeding
• Patient's request for pain medication or hospital transfer for any reason

Post-partum conditions

Conditions may develop during the first hours after delivery that will necessitate obstetric consultation, transfer to a hospital, or both. Conditions include but are not limited to:

• Significant post-partum hemorrhage
• Maternal vital signs unstable for any reason
• Retained placenta
• Fourth degree laceration, cervical laceration requiring repair, or any laceration where consultation is desired

Newborn conditions

Conditions may develop in the newborn's first hours of life that will necessitate pediatric consultation, transfer to a hospital, or both. Conditions include but are not limited to:

• Apgar score less than 7 at five minutes and not immediately improving
• Persistent tachypnea
• Respiratory distress
• Cardiac irregularity
• Congenital anomalies
• Prematurity, dysmaturity
• Weight less than 2500 grams (5.5 pounds)
• Significant increase or decrease in temperature
• Persistent hypoglycemia as evidenced by blood glucose level