"Risk Score" for out-of-hospital birth in Florida

[3inclothdiapers]

Hi all! I am pregnant with my 6th baby. Babies #1-4 were born in hospitals. Baby #5 was born in a Birth Center with a midwife. I've been chatting with a midwife who does homebirths, and she said that because this is #6, I have a risk score of 3 and will have to consult with an OB in order to have a homebirth. Does anyone have more information on how they figure out this risk score? Apparently it is based solely on the fact that I have had 5 previous babies (and I'm lumped in the same category as those who have had a previous c-section, which doesn't make sense to me). I haven't talked with the Birth Center yet, but I'm assuming if I opt to go there again, I'll have to consult with an OB to be allowed to deliver there too. A homebirth at our home is out of the question because we live way too far from a hospital with OB care. But we could have a "homebirth" if we can find someone who will let us use their house. I'm only 7 weeks so we have time to figure this out; I'm just wanting more information on this risk score thing! It wasn't an issue with #5, so #6 seems to be the magic number.

Thanks!

[bcrn]

At our birthing center[freestanding] grandmultips are not necessarily looked upon as low risk because there is a risk of post partum hemorrhage after having so many babies. We request that the clt agree to IVaccess use in case of heavy bleeding,etc,not for any other reason,most of the accept because they are not tied to an iv pole,they can get into the pool ,tub shower without interference. Hope this helps

[elus0814]

I'm in the panhandle and planning a homebirth for #5, all others were natural hospital births but I'm not comfortable with the local hospital or the obs/midwives who practice there. At the first (and only) appointment I had with a hospital midwife I was told that because I've had a previous premature birth that I'm now high risk and would need all kinds of extra ultrasounds and interventions. No thanks. I went to a homebirth midwife and she says I'm not high risk for any reason (previous premature birth OR previous number of births) and that a homebirth would be a good option for me. She didn't mention anything about me having had four previous births other than she would be sure to keep an injection nearby when I deliver in case the bleeding gets to be too much, no big deal.

I agree with you, it doesn't make any sense that going from #5 to #6 magically puts you at a higher risk.

[cathicog]

I would find a midwife, (certified professional, preferably) who has more experience working with larger families...midwives here have moms who are having their 14-16th babies, (moms with more than 5 are routine) and they don't risk out of hb because of thier parity...We just keep an eye out for pph, Pre-e, and make sure their diets are very good. Hb is about the only way to have a truly uninterfered with birth in many places....

[AlexisT]

The FL risk score is written into law and is binding on all licensed midwives.

Here you go:
https://www.flrules.org/Gateway/View...asp?id=6944441

(word format download)

All midwifery laws and regulations:
https://www.flrules.org/gateway/Orga...sp?OrgNo=64b24

[3inclothdiapers]

Thanks for the info everyone. We haven't actually talked to the Birth Center where I had #5 yet to see how they'll handle this. We do know that the only way the homebirth midwife can attend our birth is if we find a home/apartment to rent/borrow for the birth, because the nearest hospital with OB services is over an hour from our house. She said we'd need to get much closer for her to do a homebirth for us. The Birth Center we used before is 90 minutes away, so it is a pain having to drive so far for all my appointments, but they are less than 10 minutes from a hospital in the event of an emergency. The Birth Center does have an OB come in with a portable ultrasound machine once a week to do the 20-week ultrasounds; maybe they consult with him for the patients that need approval. I'm just hoping that this required consult doesn't end up costing me more money (the entire birth will be out-of-pocket for us).

Anyway, thanks again for the information!

[elus0814]

Originally Posted by AlexisT

The FL risk score is written into law and is binding on all licensed midwives.

Here you go:
https://www.flrules.org/Gateway/View...asp?id=6944441

(word format download)

All midwifery laws and regulations:
https://www.flrules.org/gateway/Orga...sp?OrgNo=64b24

I'm almost laughing at some of those! Because I live 40 minutes from emergency services and not 30 or under I automatically reach their magic 3 points and become risky but if I smoke 10 cigarettes per day I would only accumulate 1 point towards that total. What were they thinking when they came up with that? How is 5+ parity so much more dangerous than 4+ parity that 4 previous births carries no points but 5 carries 3 points?

I suppose they had to draw lines for risk somewhere but with many of those items have such an exact cutoff that it's laughable. I would hope most doctors and midwives would use their common sense and not use a list but think about overall risk. I mean, really, is a woman who weighs 151 pounds suddenly more at risk for complications than a woman weighing 150 pounds?

I find it very interesting that the list makes no mention of previous birth interventions. I would think that in the eyes of a mainstream doctor a woman who "needed" an episiotomy or who pushed for longer than a specific number of minutes must be at higher risk for problems in subsequent deliveries. It would be totally untrue but I am very surprised to see that nothing like that made the list.