Appropriate Patient for Midwife?

Are you asking for advice, or just wondering about the situation?

From what you posted, I am not sure entirely what you are asking. Most women who deliver with a certified nurse midwife deliver in a hospital. Only a small fraction of CNM births occur out of the hospital setting. Her advanced dilatation at 34 weeks probably does not risk her out of a CNM birth, unless the hospital has a specific policy that says so.

Anyway... as always, we can't give any sort of advice on this board, but I am unsure of why she would no longer be a good midwifery candidate based only on the fact that she is 4 cm at 34 weeks.

Hello, I've been reading this site for some time but this is the first time I have posted. I am a recent PN graduate, scheduled for NCLEX on June 6. I am also pregnant and regularly visit a website with boards just for pregnant women.

Recently I saw a post from a woman who is 4 cm dilated at 34 weeks gestation. She is on bedrest. They have not done an amnio to check for lung maturity but she was given steroids a month ago. I am thinking this is not a low risk pregnancy at this point. If she goes into pre-term labor, she needs to deliver in a hospital just in case the baby needs help. But I'm not a midwife...in fact the lowest test scores I received in school were in Maternal/OB. Am I wrong? Is this not high risk?

How many of you would continue to care for this patient?

Our facility never does an amnio check for lung maturity...ever.

We give Mom steriod injections x2 if she even remotely shows a sign that she may deliver early. In fact, an amnio at this point could push her over the edge.

Unless she is actively contracting, there is no reason she cannot complete her bedrest at home. However, if she goes into labor at 34 weeks, the baby does need to be delivered in the hospital in order to be able to monitor oxygen and to administer surfactant if necessary.

However, I would not consider that true high-risk...just needs to be monitored closely.

Thank you for your responses. The person I posted about is seeing a "midwife" (she didn't specify CNM or CPM)...and plans to deliver outside a hospital.

Any CNM that values her license will not deliver a 34 weeker outside the hospital.

Thanks for the clarification. I am not yet a midwife (in my last year of school), but I would not feel comfortable attending a home birth for a woman who was only 34 weeks.

However, many women walk around several cm dilated for weeks before delivering. Hopefully she will either make it a few more weeks, or choose to go to a hospital if she does kick in to active labor soon.