Care of the at-risk neonate born at home. A model for nurse-midwife/physician collaboration.

ABSTRACT

Because certified nurse-midwives (CNMs) who practice in the home lack the structure and boundaries provided in an institution, they must provide the elements of a safe environment for their practice, both physical and intangible. The relationship between the CNM who practices in the home and the physician(s) with whom s/he collaborates when women or neonates experience complications beyond the scope of nurse-midwifery practice is a critical element of this structure. This paper describes models for collaborative care for home birth, outlines the process of developing a collaborative practice agreement, and discusses specific factors to consider when forming a relationship. The care of the compromised home-birth neonate is developed as a model for collaborative practice. The paper discusses identification of the home-birth neonate requiring collaborative care, the preparation for potential newborn complications, and the initiation of emergency measures to be taken by the CNM when such a complication occurs.