What makes for a poor candidate for HB?

[GoddessKristie]

I've been seeing a lot of midwife and home birth websites that say things like "If you're a good candidate for home birth" or that a midwife will attend a birth of twins or breech in "select clients."

What makes a person a poor candidate for home birth? What things would disqualify you if you were having twins or your baby were breech? 

I know some of this may vary between midwives, but I'm curious if there are standard reasons that a person wouldn't be a good candidate.

[LiLStar]

I'm guessing type of brech matters. And depending on the midwife, there could be rules such as not in first time moms, or not in babies who are estimated over a certain size. Twins, I expect extra monitoring would be prudent, and watching for things like TTTS. There's different types of twin pregnancies, like whether they share a placenta or sac. I'm not well informed on twin pregnancies but I imagine two babies in one sac (which I believe is uncommon) would make for a higher risk birth compared to separate sacs.

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[MidwifeErika]

Some things that could make a person a poor candidate for homebirth:

heart disease

lung disease

liver or kidney disease

HIV

Bleeding and clotting disorders

unresolved seizure disorders

essential hypertension

use of drugs and alcohol

untreated mental health issues (and sometimes even with treatment they may be too severe to be a good candidate)

super complicated obstetric history that seems likely to repeat

being in overall poor health

There are likely other conditions that may come into play based on location (and things that I am likely just not thinking of at the moment). In some states midwives are unable to attend VBACs, for instance.

Type of twins and type of breech matters. Other factors with those things that need to be considered: what number baby is it? What is the gestational age? Do the parents understand what the increased risks are? Exact positioning. Distance from hospital. Local political environment. Experience of attendant. Size of baby (or babies in the case of twins). So, a midwife may attend a breech for one woman and yet transport the next based on all those things and how they make up the overall picture.

[4 in 2005]

Yeah there are so many factors.  My midwife, accepted me despite my risk for a pre-term baby.   She agreed to deliver if I went a week earlier than what she normally allows because--

A.  My family has a long history of 35 weekers that have had 0 issues.  Including myself and my youngest son.  

B. If baby did have an issue the hospital is 3 minutes away, the hospital with the best NICU is under 10 minutes away and there is an ambulance base station a block away from my house.   She said those three things make her more comfortable delivering me a week earlier at home than if I lived where I am moving to next year which is 45 minutes up the road and while there is a hospital 10 minutes away it is not the same quality and the NICU is almost an hour away. 

The thing is I am 36 weeks 6 days, just ONE more day to go to "technically" viewed as full term. So much for the OBs telling me a preemie was a given.   The midwife told me I was higher risk of a preemie, but with the OBs I was told I would have a preemie no ifs, ands or buts about it.   Ironically with that fear I bet I would have had a higher risk of a preemie.