We don't and won't know exactly how "high risk" this last pregnancy was considered. There is an increased risk with Lupus but not necessarily to the level of high-risk. Colorado has clear standards for midwives (who are highly trained professionals that, again, often work in conjunction with you own OB.) Here's a snippet of what consitutes "high risk" in CO:
G. The registered direct-entry midwife shall refer mothers for evaluation by a qualified licensed health
care provider and shall not continue as the primary care provider without the mother's
consultation with a health care provider when the following conditions are noted until the mother
has been assessed by the licensed health care provider and that provider has determined, based
upon generally accepted medical standards, the pregnant woman is not exhibiting signs or
symptoms of increased risk of medical or obstetrical or neonatal complications or problems during
the completion of her pregnancy, labor, delivery or the post partum period, and is not exhibiting
signs and symptoms of increased risk that her child may develop complications or problems
during the first 6 weeks of life:
1. urine glucose of 2+ or greater on two sequential visits or if other signs or symptoms of
gestational diabetes occur with the urine glucose;
2. hyperemesis beyond the 24th week of gestation;
3. hypertension - blood pressure greater than 140/90 or an increase from the baseline of greater
than 30 mm Hg in the systolic or 15 mm Hg in the diastolic pressure;
4. signs and symptoms of preeclampsia including but not limited to persistent edema, increased
blood pressure or proteinuria, increased reflexes, persistent headaches, epigastric pain
or, visual disturbances;
5. seizures;
6. vaginal bleeding after 20 weeks;
7. signs and symptoms of urinary infections or sexually transmitted disease;
8. oral temperature in excess of 101° F for more than 24 hours accompanied by other signs or
symptoms of clinically significant infection, or, which does not resolve within 72 hours;
9. laboratory results indicating need for medical treatment, for example, a positive culture;
10. anemia not responding to over the counter iron therapy as measured by Hemoglobin below
11 grams or Hematocrit below 34% at term;
11. signs and symptoms of polyhydramnios or oligohydramnios;
12. suspected fetal demise - lack of fetal movement, inability to auscultate fetal heart tones;
13. decreased fetal movements;
14. gestation longer than 42 weeks;
15. rupture of membranes for longer than 12 hours without labor;
16. premature labor - less than 37 weeks gestation;
17. active herpes;
18. intrauterine growth retardation; or
19. suspected abnormality of pelvis
https://www.sos.state.co.us/CCR/GenerateRulePdf.do?ruleVersionId=1650
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