Anyone familiar with Florida's risk score for out-of-hospital birth?

[lotsofpumpkins]

I have been emailing a midwife who does homebirths, as this is an option my dh and I are considering for our baby due in November. As it ends up, since we live in the middle of nowhere, our home would not be an acceptable location (we are WAY too far from a hospital with OB services). But, she is willing to attend our birth if we can have the baby somewhere else (someone else's house, rented apartment, etc). Besides our location, she also mentioned my "risk score". She said that because this is my 6th baby, I have a score of 3, meaning I have to consult with an OB to have a homebirth. I did some googling trying to find more information on how they determine this risk score, but haven't been able to find much. I have been able to figure out that this seems to be a risk score for out-of-hospital birth, meaning if I go back to the birth center where I had my 5th child, I'll have to consult with an OB for that too.

 

Just wondering if anyone has more detailed information on this risk score in Florida, and why having 5 perfectly healthy previous pregnancies has put me in the same catergory as those who have had a c-section... :001_huh:

 

(I did ask some questions of the midwife but she hasn't had a chance to respond yet, so I figured I'd ask here too in case anyone has any info for me!)

[Heather in OK]

Not from FL so you may get a better response from someone here who is. If not, try Mothering.com. You can ask in the Tribal Area for Florida and/or in the Homebirth forum. There will for sure be ladies there who know the specific details.

[lotsofpumpkins]

Thanks for the tip!

[lotsofpumpkins]

So far I'm not getting any answers over at MDC. I'll bump this one more time to see if anyone here knows anything!

[cjbeach]

I had a homebirth here in FL with my 3rd child, but I gave away my binder to a pg friend. My understanding is the risk score is just that...how risky a homebirth/center birth is for that individual as related to complications in past, genetic hx, pre-natal care, how far you are from the hospital "just in case."

Or possibly it's a medical insurance thing as well... if the patient's score is over "x" than considering too great a risk and will not be covered (well,the birth would not be covered). We paid OOP so I don't remember this being an issue.

[Barb_]

here is the statute in question plus a link to the entire law regarding homebirth:

 

 

 

64B24-7.004 Risk Assessment.

 

(1) For each patient, the licensed midwife shall assess risk status criteria for acceptance and continuation of care. The general

 

health status and risk assessment shall be determined by the licensed midwife by obtaining a detailed medical history, performing a

 

physical examination, and taking into account family circumstances along with social and psychological factors. The licensed

 

midwife shall risk screen potential patients using the criteria in this section. If the risk factor score reaches 3 points the midwife

 

shall consult with a physician who has obstetrical hospital privileges and if there is a joint determination that the patient can be

 

expected to have a normal pregnancy, labor and delivery the midwife may provide services to the patient.

 

(2) The licensed midwife shall continue to evaluate a patient during the antepartum, intrapartum and postpartum. If the

 

cumulative risk score reaches three points or higher and the patient is not expected to have a normal pregnancy, labor and delivery,

 

the midwife shall transfer such patient out of his or her care. The midwife may provide collaborative care to the patient pursuant to

 

Rule 64B24-7.010, F.A.C.

 

(3) The risk factors shall be scored as follows: Score

 

(a) Socio-Demographic Factors.

 

1. Chronological age under 16, or older than 40. 1

 

2. Residence of anticipated birth more than 30 minutes from emergency care. 3

 

(b) Documented Problems in Maternal Medical History.

 

1. Cardiovascular System

 

a. Chronic hypertension. 3

 

b. Heart disease. 3

 

(i) Heart disease assessed by a cardiologist which places the mother or fetus at no risk. 1

 

c. Pulmonary embolus. 3

 

- 395

 

d. Congenital heart defects. 3

 

(i) Congenital heart defects assessed by a cardiologist which places the mother or fetus at no risk. 1

 

2. Urinary System

 

a. Renal disease. 3

 

b. History of pyelonephritis. 1

 

3. Psycho-Neurological

 

a. History of psychotic episode adjudged by psychiatric evaluation and which required use of drugs related to its

 

management, but not currently on medication.

 

1

 

b. Current mental health problems

 

requiring drug therapy. 3

 

c. Epilepsy or seizures in the last two years. 3

 

d. Required use of anticonvulsant drugs. 3

 

e. During the current pregnancy, drug or alcohol addiction, use of addicting drugs.

 

f. Severe undiagnosed headache. 3

 

4. Endocrine System

 

a. Diabetes mellitus. 3

 

b. History of gestational diabetes. 1

 

c. Current thyroid disease.

 

(i) Euthyroid. 1

 

(ii) Non-Euthyroid 3

 

5. Respiratory System

 

a. Chronic bronchitis. 1

 

(i) Current or chronic or with medication. 3

 

(ii) Without medication or current problems. 1

 

c. Smoking.

 

(i) 10 or less cigarettes per day. 1

 

(ii) More than 10 cigarettes per day. 3

 

6. Other Systems

 

a. Bleeding disorder or hemolytic disease. 3

 

b. Cancer of the breast in the past five years. 3

 

7. Documented Problems in Obstetrical History

 

a. Expected Date of Delivery (EDD) less than 12 months from date of previous delivery. 1

 

b. Previous Rh sensitization. 3

 

c. 5 or more term pregnancies. 3

 

d. Previous abortions.

 

(i) 3 or more consecutive spontaneous abortions. 3

 

(ii) Two consecutive spontaneous abortions or more than three spontaneous abortions. 1

 

(iii) 1 septic abortion. 3

 

e. Uterus.

 

(i) Incompetent cervix, with related medical treatment. 3

 

(ii) Prior uterine surgery 3

 

f. Previous placenta abruptio. 3

 

g. Previous placenta previa. 1

 

h. Severe pregnancy induced hypertension during last pregnancy. 2

 

i. Postpartum hemorrhage apparently unrelated to management. 3

 

8. Physical Findings of Previous Births

 

a. Stillbirth occurring at more than 20 weeks gestation or neonatal loss (other than cord accident). 3

 

b. Birthweight.

 

(i) Less than 2500 grams or two or more previous premature labors without a subsequent low risk pregnancy and

 

full term appropriate for gestational age (AGA) infant.

 

3

 

(ii) Less than 2500 grams or two or more previous premature labors with one or more full term AGA infant(s)

 

subsequently delivered, after a low risk pregnancy.

 

1

 

(iii) More than 4000 grams.

 

c. Major congenital malformations, genetic, or metabolic disorder. 3

 

- 396

 

Specific Authority 456.004(5), 467.005 FS. Law Implemented 467.015 FS. History–New 7-14-94, Formerly 61E8-7.004, 59DD-7.004, Amended

 

9-11-02.

 

9. Maternal Physical Findings

 

a. Gestation.

 

(i) Of more than 22 weeks in the patient’s first pregnancy (nullipara), unless the patient provides a copy of a

 

medical record documenting a prenatal physical examination and prenatal care by a licensed physician, advanced

 

registered nurse practitioner, or licensed midwife trained in obstetrics and gynecology who regularly provides maternity

 

care.

 

3

 

(ii) Of more than 28 weeks if the patient has had at least one previous viable birth (multipara), unless the patient

 

provides a copy of a medical record documenting a prenatal physical examination and prenatal care by a licensed

 

physician, advanced registered nurse practitioner, or licensed midwife trained in obstetrics and gynecology who

 

regularly provides maternity care.

 

3

 

b. Prepregnant weight is not within the range of the following weights by height: 2

 

Height in Inches Prepregnant Minimum Prepregnant Maximum

 

Without Shoes Weight in Pounds Weight in Pounds

 

56 83 143

 

57 85 146

 

58 86 150

 

59 89 153

 

60 92 157

 

61 95 161

 

62 97 166

 

63 100 170

 

64 103 175

 

65 106 180

 

66 110 185

 

67 113 190

 

68 117 196

 

69 121 202

 

70 124 208

 

71 128 212

 

72 131 217

 

73 135 222

 

c. Evidence of clinically diagnosed pathological uterine myoma or malformations, abdominal or adnexal masses. 3

 

d. Polyhydramnios or oligohydramnios.

 

(i) Prior pregnancy. 2

 

(ii) Current pregnancy. 3

 

e. Cardiac diastolic murmur, systolic murmur grade III or above, or cardiac enlargement. 3

 

10. Current Laboratory Findings

 

a. Hematocrit/Hemoglobin.

 

(i) Less than 31% or 10.3 gm/100 ml. 1

 

(ii) Less than 28% or 9.3 gm/100 ml. 3

 

b. Sickle cell anemia. 3

 

c. Pap smear suggestive of dysplasia. 3

 

d. Evidence of active tuberculosis. 3

 

e. Positive serologic test for syphilis confirmed active. 3

 

f. HIV positive. 3

[lotsofpumpkins]

Thank you so much for all the info!

[fairfarmhand]

the risk could be higher for you because of all the previous pregnancies. Your labor is going to be much shorter than many others, giving the dr. less time to prepare for emergencies. And I see that Rh stuff gets a 3 also.

[lotsofpumpkins]

the risk could be higher for you because of all the previous pregnancies. Your labor is going to be much shorter than many others, giving the dr. less time to prepare for emergencies. And I see that Rh stuff gets a 3 also.

 

Yeah, my labors have gotten shorter in general. But with #5 I was so stressed about not making it to the birth center in time (90 minutes from our house!) that I ended up having contractions on and off for 6 days before she was born. I was sent home twice in "prodromal labor". I'm hoping this time I can be more relaxed about everything and not have to deal with that again. With #4 I had 3 hours of labor total and it was so nice and fast and relatively easy. With the long drive though, that's almost too fast! My Rh is + so at least that's not a problem for me on top of the # of pregnancies.