Home birth criteria

A member's health plan may cover part or all home-birth services. We do not require a prior authorization for ancillary services associated with typical, low-risk prenatal care such as hematocrit and glucose screening. Please use a Kaiser Permanente-owned or contracted facility for these services.

If you have questions about a particular test or procedure, please confirm coverage with the Provider Assistance Unit at 1-888-767-4670. All other testing and diagnostic services require consultation, referral, or both.

If a patient does not meet the screening requirements for home birth, you must document your visit, detailing the disqualifying factors. Send this documentation to the woman's primary care provider.

Eligible Home Birth Candidates

Kaiser Permanente uses criteria based on the ACOG (American College of Obstetricians and Gynecologists Committee opinion and the American Academy of Pediatrics Policy Statement on Planned Home Births 2013 .

• Women inquiring about planned home birth should be informed of its risks and benefits based on recent evidence. Specifically, they should be informed that although planned home birth is associated with fewer maternal interventions than planned hospital birth, it also is associated with a more than twofold increased risk of perinatal death (1–2 in 1,000) and a threefold increased risk of neonatal seizures or serious neurologic dysfunction (0.4–0.6 in 1,000). The fewer maternal interventions may reflect fewer obstetric risk factors among women planning home birth compared with those planning hospital birth. Although the American College of Obstetricians and Gynecologists believes that hospitals and accredited birth centers are the safest settings for birth, each woman has the right to make a medically informed decision about delivery.
• Women should be informed that several factors are critical to reducing perinatal mortality rates and achieving favorable home birth outcomes. These factors include the appropriate selection of candidates for home birth; the availability of a certified nurse–midwife, certified midwife or midwife whose education and licensure meet International Confederation of Midwives’ Global Standards for Midwifery Education , or physician practicing obstetrics within an integrated and regulated health system; ready access to consultation; and access to safe and timely transport to nearby hospitals.
• The Committee on Obstetric Practice considers fetal malpresentation, multiple gestation, or prior cesarean delivery to be an absolute contraindication to planned home birth.

Candidates for home delivery

• Absence of preexisting maternal disease
• Absence of significant disease occurring during the pregnancy
• A singleton fetus estimated to be appropriate for gestational age
• A cephalic presentation
• A gestation of between 37 0/7 weeks and 41 6/7 weeks of pregnancy
• Labor that is spontaneous or induced as an outpatient
• A mother who has not been referred from another hospital Systems needed to support planned home birth
• The availability of a certified nurse-midwife, certified midwife, or physician practicing within an integrated and regulated health system who is licensed, credentialed, and contracted with Kaiser Permanente
• Attendance by at least 1 appropriately trained individual whose primary responsibility is the care of the newborn infant
• Ready access to consultation – The home birth provider must have 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 the home birth provider is unavailable. These policies and procedures must 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 Kaiser Permanente’s credentialing process and who is contracted with Kaiser Permanente to provide Licensed Midwifery services; and assure the availability of consultation and a referral relationship with an obstetric physician (whenever feasible the relationship should be with a Kaiser Permanente Obstetric Specialist).
• Assurance of safe and timely transport to a nearby hospital with a preexisting arrangement for such transfers

ACOG considers previous cesarean delivery to be an absolute contraindication to planned home birth. The ineligible patient can explore other care options with their primary care provider, one of the Women's Health Care Service centers (West of the Cascades), or Member Services (all areas).