The midwife recognizes certain conditions as high risk and generally deemed inappropriate for home birth. These conditions are outlined in the Risk Factor Guidelines. The midwife shall make every effort to educate parents as to the risks and assist them in transfer to physician and/or hospital care when necessary.

The midwife will not perform any surgical procedure other than an episiotomy in an emergency when indicated, cutting the umbilical cord, and/or perineal vaginal repair.

Drugs

The midwife shall not administer any drug without prior instruction as to how it is administered and knowledge of side effects.

The midwife shall not administer oxytocin (Pitocin) prior to delivery of the infant.

A midwife who has a contagious infection shall not attend a birth.

The midwife shall not use mechanical means (forceps or vacuum extractor) to assist a birth.

The midwife shall consider using a signed consent form from the parents stating agreement to, and understanding of, any procedure and responsibility accepted for it.

Exceptions to the above limitations may be made only with the fully informed agreement of the woman and her health care providers, and may be subject to additional restrictions as outlined in the Risk Factor Guidelines.

Exceptions to the above limitations may be subject to evaluations by a Practice Review Board as established by the MMA Practice Committee.

Exceptions to the above may be appropriate in certain settings by protocol by trained and experienced midwives in emergency situations.