Midwifery Services

Initial Visit and Schedule of Subsequent Visits

We generally see new clients for the first time at +/- 12 weeks. At this initial visit, in addition to a standard prenatal check, we will go over your history (nutritional, physical, emotional, mental, etc.), collect blood for your OB panel workup (see the informational document on this in your client portal), and begin getting to know each other (and your support people).

After this initial appointment, we will schedule you for a prenatal visit every four weeks until you’re 28 weeks, and then every two weeks until you’re 36 weeks, at which time, you’ll be seen every week until you give birth. At around 36 weeks, we will have a home visit with you (unless you're giving birth at the birth center) where we will assess your home space, get an idea of where things are and otherwise assess safety, warmth, preparedness, etc.

We take into consideration that occasionally, there is a problem or concern that requires an extra visit or more, and those unexpected visits are also included in your care.

Prenatal Visits

A typical prenatal visit consists of using our hands to palpate your uterus through your abdomen, listening to baby’s heart rate, measuring your uterine growth, taking your vitals, and otherwise talking with you to get an idea of how you’re feeling, both emotionally and physically.

At some visits, you’ll also have additional procedures and lab work, depending on what week you are in. These visits (with the exception of the homebirth home visit) occur at the birth center.

Additional Procedures and Lab Work

Additional procedures and lab work follow this schedule:

• At between 20 and 22 weeks, 20 weeks being ideal, you’ll have a routine OB scan ultrasound. An OB scan can give us much valuable information, such as where the placenta is attached. We work closely with a wonderful ultrasound tech to do all of our necessary sonograms. We can often make it to this visit with you, at your request.

• At between 28 and 32 weeks, we do a gestational diabetes screen to make sure you are metabolizing glucose well. If the glucose screen number is outside of normal limits, we will do further glucose testing. We do this to make sure that you aren’t developing gestational diabetes, which can lead to unwanted complications. At the same time, we will also do a basic CBC (complete blood count). We do this to make sure that your hematocrit, hemoglobin, platelets and other things are at safe levels for birth.

• At 36 or 37 weeks, we will test for GBS (group B strep). This is done by taking a swab of the inside of the vagina. We let our clients do this themselves, as we feel you are quite capable. For more information on all of these tests, please see your client portal.

If complications arise, which fall under our scope of practice to treat, we may additionally complete other testing such as a urine sample, liver panel, vaginal culture, etc. Anything we do will be discussed in depth with you and we will never complete a procedure (unless in an emergency) without your consent.

Birth

At your birth, you can expect the following:

• Fetal heart tones will be taken every half-hour in active labor, and every other contraction in the pushing phase. We take fetal heart tones with a doppler that has a small plastic probe on it that we hold to your belly. We will listen for up to two-minutes each time. This helps us ensure that your baby is tolerating labor well, helps us to confirm position of baby, and can also give us an idea of when your baby has moved deep into your birth canal.

• We will take your vitals when we arrive and then every one to four hours throughout labor.

• A cervical exam may be performed at your consent at the beginning or periodically throughout labor. It may be useful in determining baby’s position or how labor is progressing. Sometimes we don’t do any at all, depending on the situation. 

• Labor support and encouragement go hand in hand with midwifery, but keep in mind that our first responsibility is to the health of you and your baby. Sometimes charting, conferring with another professional, assessing vitals, setting up birth supplies, etc. need to be attended to in order to keep you and your baby healthy. We strongly recommend inviting additional support people, such as a doula, to your birth for this reason.

• We will watch over you while you birth your baby and answer any questions that arise. We may also, with your consent, use herbs, homeopathic remedies or medications in the event of additional needed support.