Your Prenatal Visits
There is much more that goes on during a prenatal visit than what is described below. However, the following outline will give you a general idea of what to expect at your prenatal midwife visits.
Prenatal care really means wellness care and as such involves nutritional counseling, exercise recommendations, and non allopathic healing options such as homeopathy and herbology. This is also a time for you to get to know your midwife and grow in a trusting relationship that will make your birthing experience a memorable one! It is a time to ask questions, learn about your body and baby, and listen to your midwife’s expertise on pregnancy and childbirth. This aspect of midwifery care is called “continuity of care”. This is a very important feature of midwifery care that helps to make home birth safe. Rather than having to be examined by multiple providers from appointment to appointment, “continuity of care” assures you that your midwife will be the only one handling your care; there is less room for error because of this. Your first initial visit Usually after your consultation, an initial visit is set up. This appointment will consist of getting to know your midwife as well as your midwife getting to your medical past, rule out any health issues that may affect your pregnancy, assess your present well being (diet, exercise and nutritional supplements) and discuss your future goals; such as do you want a water birth, do you want your baby to receive vitamin K, etc. This is also the exciting time when the estimated due date of your baby is confirmed either by calculation on the gestational wheel or in some cases ultrasound! During this visit, a contract is signed and a back up plan is written out, in the event that your baby or you need medical care during pregnancy, labor or post partum. Your midwife will ask questions regarding your medical history such as: obstetrical history - previous pregnancies and birth experiences, gynecological history, contraceptive history, and family history. She will want to know if you have had any surgeries, accidents, or diseases; also if you have any allergies. By providing comprehensive, continuous prenatal care, your midwife will get to know you - well enough to have some sense of what to anticipate at your birth. She will also address common problems that you may be having such as nausea, insomnia, leg cramps, sciatica, hemorrhoids, indigestion, nightmares, swelling, headaches, varicose veins, etc. and if you are Rh negative, advise you on antibody screens (performed periodically during pregnancy) and RhoGam. Your midwife will then check your current state of health so she can chart a “baseline” for what is, and is not normal for your body during pregnancy and to rule out any conditions that would not make you a candidate for a home birth. Along with checking your urine with a test strip to rule out such conditions as urinary tract infections (UTI), toxemia, and diabetes; she will chart your weight, blood pressure and pulse, take the baby’s heart beat and measure your growing uterus. She will also send you to your local lab to obtain a blood test to determine your CBC (complete blood count - that includes your hemoglobin, hematocrit and platelet count, among other things), blood type and Rh factor, antibody screen, whether you have hepatitis B, and are immune to Rubella. She may also request a urine culture. This is rule out any infections, or abnormal results to make sure that your baby has a perfectly safe sanctuary to grow in for the next nine months! Your midwife will also talk to you about 1st and 2nd trimester AFP screenings (optional). http://www.cdph.ca.gov/programs/PNS/Pages/default.aspx She may refer you to a chiropractor, lactation consultant, nutritional consultant, perinatologist or ultrasound technician among other specialists depending on the need (optional). Many midwives do physical exams, vaginal exams, pap smears, and vaginal cultures at this time. (optional) Weeks 8-28, you will be seen every 4 weeks After your initial visit, a follow up prenatal visit during these weeks goes as follows: ~ Your weight gain since last visit is assessed. Normally it will be 1-2 lbs a week. ~ Your urine is tested via the urine test strip ~ Your blood pressure is checked. If it is low or high she will make nutritional suggestions. ~ Your fundal height measurement is taken, assessing the growth of your baby by using a measuring tape and counting how many centimeters your belly grows with each week. (Starting at around 20 weeks, growth is generally one centimeter per week) ~ Your baby’s heartbeat is listened to for rate & rhythm. ~ Your baby’s position in the womb (head down, breech, transverse, which way his/her back is facing) is palpated at 26 weeks, during which time the baby begins to go head down. ~ Your baby’s heartbeat is listened to for rate and rhythm, which generally can be heard with a Doppler after 10 weeks and with a fetoscope after 20) The amount of beats per minute should be anywhere between 120-160. The rhythm of the heart beat is also evaluated, to rule out arrhythmias. ~ Your midwife will talk to you about nutrition, exercise and complete well-being of both mother and baby; as well as answering all questions as to what to expect during these weeks and address any problems or concerns. She will inquire if you have any swelling, headaches, bruising, bleeding, difficulty sleeping, etc. During your 2nd trimester you may begin to feel ligament pain or pain in the symphysis pubis and your midwife can suggest remedies. She will ask you when you first felt the baby move. ~ 20 weeks some parents, and midwives prefer to do an ultrasound referred to as a Bio Physical Profile (optional) to rule out abnormalities in the baby. ~ 26-28 weeks is when (optional) glucose testing would be done, to rule out gestational diabetes and another antibody screen performed if you are Rh negative. http://www.babycenter.com/0_glucose-screening-and- glucose-tolerance tests_1483.bc?page=2) http://www.babycenter.com/0_blood-test-for-rh-status-and-antibody-screen_1480.bc?page=2 Weeks 28-36, you will be seen every 2 weeks. At this time of pregnancy your prenatal visits become more frequent, as more problems are likely to occur as gestation progresses. A routine prenatal visit during these weeks goes as follows: ~ Your weight gain since last visit is assessed. Normally it will be 1-2 lbs a week. ~ Your urine is tested via the urine test strip ~ Your blood pressure is checked ~ Your fundal height measurement is taken ~ Your baby’s heartbeat is listened to for rate and rhythm. ~ Your baby’s position in the womb (i.e. head down, breech, transverse, which way his/her back is facing) is palpated. Your midwife may ask you where you feel the most movement. If Baby is not vertex by 32 weeks your midwife may refer you to a chiropractor for the Webster technique as well as talk to you about other options in turning your baby such as external version, breech tilt, acupuncture, and homeopathy. Some midwives will deliver a breech baby at home. She will go over the risks and benefits of that decision. ~ Your midwife will ask you about nutrition, exercise, water intake, and ask if you have any swelling, headaches, bruising, bleeding, difficulty sleeping, leg cramps or any other issues. ~Your midwife will go over any test results, such as your Glucose Tolerance Test or antibody screen if you are RH negative. (~ At 28 weeks, some providers will re check your hemoglobin and hematocrit) Weeks 36-42, you will be seen weekly. A routine prenatal visit during these weeks goes as follows: ~ At 36 weeks a vaginal (optional) GBS culture is obtained. ~ Your weight gain since your last visit is assessed ~ Your urine is tested via the urine test strip ~ Your blood pressure is checked ~ Your fundal height measurement is taken, assessing the growth of your baby by using a measuring tape and counting how many centimeters your belly grows with each week. ~ Your baby’s heartbeat is listened to for rate and rhythm. ~ Your baby’s position in the womb (ex; head down, breech, transverse, which way his/her back is facing) is palpated. By this time your baby should be head down or vertex. ~ Your midwife will talk to you about nutrition, exercise and complete well-being of both mother and baby. She will address any problems or concerns that you have, ask if you have started preparing your home for the birth with things such as towels, a birth kit, and a mattress cover. ~ A home visit will be scheduled so that your midwife knows how to get to your home, to talk about birth plans and wishes, and give you information regarding setting up the birthing tub (if desired), ~If you are close or past your due date, or having labor like contractions, your midwife may ask you if you would like your cervical dilation checked (optional) ~At 41 to 41 ½ weeks a non stress test and an ultrasound may be advised. An ultrasound can measure the amniotic fluid amount, estimate the weight of the baby, give a grade on the placenta, check for birth defects. ~By 42 weeks your baby should have been born. Your midwife may suggest ideas for stimulating labor or advise you to go into the hospital to be induced. She may recalculate your due date, ask you if you have any emotional issues holding up labor. Be sure to ask your midwife how long she is comfortable with you going past your due date when you begin your care with her.
Copyright 2017 Anne Sommers