Uterine inversion is a rare but potentially life-threatening obstetrical emergency.

Incarceration of the gravid uterus is a rare but serious complication of pregnancy. The diagnosis is clinical and confirmed with imaging, with magnetic resonance imaging being superior to delineate the distorted maternal anatomy. Reduction of the incarcerated uterus should be attempted to restore polarity and avoid unnecessary cesarean delivery.

Widening of the pubic symphysis greater than 10 mm is pathologic. The diagnosis is clinical and confirmed by imaging studies, with magnetic resonance imaging being the superior technique. Conservative treatment is the first line of therapy. Failure of conservative therapy is treated by surgical stabilization.

High transverse skin incisions may reduce the risk of wound complications in parturients with obesity. A study with more power should be considered.

Importance Birth plans are an important part of childbirth preparation for many women. Objective The aim of this review was to discuss some common requests, specifically home birth, water birth, placentophagy, lotus birth, vaccination refusal, and vaginal seeding, including evidence-based recommendations, perceived benefits, and potential maternal and neonatal consequences. Evidence Acquisition A literature search for each topic was undertaken using PubMed and Web of Science. For the home birth section, the MeSH terms home AND birth OR childbirth AND outcomes OR complications OR recommendations OR guidelines were used. For the vaccination section, birth OR childbirth OR maternal AND vaccination refusal were searched. For the remainder of the sections, umbilical cord AND nonseverance OR placentophagy OR vaginal seeding OR lotus birth were searched. A total of 523 articles were identified. The abstracts were reviewed by 2 authors (J.R.W. and J.A.R.); 60 of these articles were selected and used for this review. Results Home birth is currently not recommended in the United States. Immersion in water for labor is acceptable, but delivery should not occur in water. Placentophagy and lotus birth should be discouraged because of risk of neonatal infection. Vaccines should be administered in accordance with national guidelines. Vaginal seeding should be discouraged until more is known about the practice. Conclusion and Relevance These evidence-based recommendations provide clear guidance for physicians so that the birthing experience can be enhanced for both mother and neonate without compromising safety. Relevance Statement This is an evidence-based literature review of alternative birth plans and recommendations for directive counseling. Target Audience Obstetricians, midwives, family practitioners, pediatricians, and nurse practitioners who provide obstetric and/or pediatric care. Learning Objectives After completing this activity, the learner should be better able to counsel patients on the risks and benefits of alternative birth plans; distinguish which maternal requests are associated with increased risk of neonatal infections; and risk stratify patients for home birth and identify absolute contraindications to home birth.