Prenatal Care

Preparing family

 

If you think that you would like to attend this birth and are not sure you will be comfortable, please meet with the midwife first during the prenatal period so that I may help prepare you or discuss your concerns. Maybe even come to childbirth classes with the parents to learn more about normal, natural childbirth so that you can be more prepared to show healthy support to the birthing mom during her labor! Family members who are not comfortable with childbirth should wait at home so that they are not “transferring” their anxiety to the birthing parents by constantly asking if we should go to the hospital or if something is wrong. This causes the mom and dad stress and can hinder their birth progress tremendously.
 
Other Family Members

 

Ultimately, it is the mother and father’s decision to whom they invite to the birth. As the midwife, I am there to guide the woman and her family through this special event. Everyone is welcome. But it is important for everyone to understand the process of birth. If there is a time when the laboring mom needs rest, it is my duty as the midwife to ensure this happens. There should be no hard feeling toward anyone. Sometimes situations and circumstances change as labor progresses.
 
Safety Concerns/Transfers

 

Complications during a labor or delivery for low-risk healthy women are rare, especially for women having a drug-free birth experience. If a complication develops, it is important to remain calm and let the midwife do her work. The majority of the time, the situation will not be an emergency and everyone will be well informed of the process. If an emergency does occur, please step out of the room and allow us to do what we have been trained to do.

28 Weeks Gestation

You’re more than half way through your pregnancy!!! Between 24 and 28 weeks gestation, in addition to the routine prenatal visit procedures, we will also review fetal kick counts and belly mapping. A few lab tests will be performed during this visit and after this appointment I will start seeing you for prenatal visits every two weeks until you reach 36 weeks.

In addition to your standard visit, you will have eaten the breakfast listed below about 45 minutes before your scheduled appointment. We will perform a blood draw and obtain a blood sample to measure two different lab results.

One is the glucose tolerance test (blood sugar) testing for gestational diabetes. The results of this test should be no higher than 139. If your test results are higher than expected, a different test is performed that is a little more in depth.

The other is to test your hemoglobin (iron level). We measure your hemoglobin to make sure that you are not anemic. At this point of pregnancy, your blood volume has increased by as much as 50 percent, as it assists carrying oxygen throughout your body, as well as preparing for birth. This is called hemodilution. At this stage, although your blood volume has increased, it is just as described–diluted, and not as rich and thick as it will be toward the end of pregnancy. If your hemoglobin is below 10 gm/dl, we will review some dietary changes to increase your hemoglobin. It will then be rechecked in two weeks. The range we like to see hemoglobin (also called hgb) is at around 12 gm/dl.

For our Rh negative mommies, you get an added test and it is a regular blood draw and it is to check for antibodies. You will be offered a rhogam injection at this point in your pregnancy. We will discuss this more at your visit.

50 Gram Carb Breakfast

This diet has been adapted from the College Heights OB/Gyn Professional Corp and is done between 24 and 28 weeks gestation. This two-hour post-meal blood test is used to find out precisely how your body handles sugar.

In order for the test to be accurate and meaningful, you will need to eat the following foods listed. A blood test needs to be taken one hour after you have eaten this meal.

Please eat all the foods in the amounts listed:

4 ounces unsweetened juice (orange, grapefruit or apple)
2 eggs (scrambled, poached or boiled)
2 slices of whole wheat toast with butter
8 ounces low-fat milk (1-2%)

Are you vegetarian or vegan? No worries, we have a diet plan for you, too.

Fetal Kick Counts

You have probably noticed that your baby moves around a lot after 22 or 23 weeks. Fetal movement is a good indicator of the baby’s health. It is a great idea to do daily kick counts beginning around 28 weeks. Kick counts are done as follows:

Pick out a time in the evening after supper when you can lay down and pay attention to your baby. Note the time. Begin counting the baby’s movements. At the tenth movement, note the time. Do this each night and you will notice it takes about the same amount of time for the baby to make its ten movements. Usually this is about 15-30 minutes. If you notice that it seems to take long each night, or if it takes longer than 12 hours to feel the baby move, please call us. We will arrange to have an NST done immediately.

Labwork

Prenatal lab-work is scheduled at your first official appointment (the first appointment after your free consult). One blood draw is required and the blood is sent to either LabCorp or Quest Diagnostics for evaluation.

Tests routinely performed in the first trimester:
Complete Blood Count (CBC)
Blood Type and Rh Factor
Hemoglobin and Hematacrit
Sexually Transmitted Disease Screen (RPR)
Hepatitis B Surface Antigen Test (HBSag)
Rubella Status
Urinalysis/Urine Culture

Optional Lab Tests Offered:
Cystic Fibrosis Carrier Screening
Maternal Serum Alpha Fetal Protein Test (MSAFP)
Chorionic Villus Sampling / Amniocentesis
Ultrasound or Sonography
HIV Screening
Gonorrhea & Chlamydia Cultures

At 18-21 weeks we schedule your sonogram. This is the best time to have the test because all of the organs are formed and it is the best time (for you) to see the sex of the baby. Although that is the biggest reason moms and dads want to have a sonogram, your midwife is looking at different things. As an out-of-hospital healthcare provider, we want to make sure the baby is well formed, that the placenta looks good and know where it is located, and take a look at the heart and lungs.

At 28 weeks of pregnancy, we perform routine testing of your blood sugar (see the 28 week visit section for more details) and hemoglobin (checking for anemia), and offer the HbsAg test again. If you are an Rh negative mommie, we also test your Rh status at this point. Rh negative moms have to have this additional blood draw.

At 36 weeks, this is one last time to check your hemoglobin, test for Group B Strep, Gonorrhea, Chlamydia and offer the HbsAg test again, as well as the antibody screen again if mom is Rh negative.

Non-Stress Test

If you have reached 41 weeks or have special health problems, we might have you do a special test called a “non-stress test” (NST). This involves being placed on the fetal monitor for approximately 20-30 minutes. The baby’s heart rate will be monitored. Just as your heart speeds up when you exercise, so should your baby’s. A normal NST reassures us that the baby will probably remain healthy for the next three to four days.

After the Birth

Mom and baby are monitored for a minimum of two hours after the birth. They will both be tired, so letting them rest the first day is advisable. The most important place for the baby is with momma. It is very important for both of them to get good rest in the first 24 hours after the birth. If you come to visit, offering to help around the house or preparing a meal would be the biggest gift you could give them. Giving a gift of ourselves can be more valuable than bringing baby clothes!

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