motherhood is a journey…
well woman and pre-pregnancy care
Pregnant women are not our only clients! We encourage women to visit us before pregnancy, as this provides another opportunity to get to know us. We offer health assessments, education, gynecological care, blood work, nutritional counseling, vitamin or herbal/holistic supplements and the establishment of a healthier pre-pregnancy lifestyle.
We have many connections in the community and will gladly make referrals to other healthcare providers if necessary, including referrals for any medical or emotional issues which may be a factor during pregnancy or parenting.
Pre-pregnancy visits provide opportunities for partners to discuss concerns about parenting and pregnancy. We also can begin keeping records of menstrual, contraceptive and sexual history, which help us establish a more complete understanding of each individual woman.
Prenatal checkups are vital to your care, so we schedule full hour-long appointments for each visit. Most visits are done in a half an hour, but sometimes the conversation continues through the whole hour. We are here to answer your questions and gain insight into your life and pregnancy, to provide you with the best possible care.
The first prenatal visit, after the initial interview, is the longest. Your midwifery team will take a complete medical history and do a risk assessment for homebirth, including a brief physical exam evaluating your general well-being. We do not do a vaginal exam at this time because unless there is a concern, there is really no medical benefit. We may draw some blood for a complete prenatal lab work.
In the middle of your pregnancy, another blood sample is done by a finger prick to check your iron count. Occasionally blood sugar workup will be completed at this time as well. Ultrasounds and other testing are only recommended for special reasons or if desired.
At each visit we will check your urine with test strips. We always discuss anything found that is not normal so we can help you correct a small problem before it escalates. We also ask that you weigh yourself at each visit. We want to make sure you are gaining as you should, but you will not be lectured about “gaining too much weight.” We are much more interested in how you are eating rather than only in how much you are gaining. Some women will have perfectly healthy pregnancies and gain a lot of weight, while others can be unhealthy but have seemingly “ideal” weight gain. For this reason, at your first visit you are asked to keep a food diary for one week. Nutrition counseling will be done throughout your pregnancy as needed.
We will take your blood pressure at each visit and measure the growth of your uterus to help us evaluate the growth of your baby. It also helps confirm your estimated due date (EDD). Monitoring this measurement can also be the first clue to possible twins, should you be carrying them.
During your prenatal visits we will listen to your baby’s heart with our Doppler or fetoscope. Your partner and the baby’s siblings can hear it, too! Heart tones are reassuring to us all and help us to know what your baby’s usual heart rate is, important information to know when you go into labor. Listening to the baby’s heart is usually everyone’s favorite part of the prenatal visit. After the halfway point of your pregnancy we will palpate your uterus, meaning we will feel for the baby through your stomach and tell you the placement of his/her head, back and feet. You can learn to do this at home as well. We always take plenty of time getting to know your baby and his/her position. If the position is not ideal near the end of pregnancy you can do certain exercises that will help your baby move into a better position, vital to promoting easier labor and delivery. Occasionally it can even mean the difference between having a normal vaginal birth or a Cesarean section. Possibly the most important part of your prenatal visit is when we discuss how you are feeling. We will answer any questions you have and give you more information to take home and read as it is needed. We have a full library of books, DVDs and videos related to pregnancy, childbirth and babies. They are available for you to check out as you desire.
the home visit
When our clients reach the 36th week of pregnancy, the birth team will visit the home to do a prenatal appointment. This marks the point in pregnancy after which you can safely deliver at home. Visiting the home allows us to know exactly how to get there – information that is extremely important if labor starts at 2am! During the home visit we will go through the contents of your birth kit together. We also will discuss the desired laboring and birth location in the home and how to set up for birth. If possible, we would like to meet everyone who will be present at the birth, because we would like to answer their questions as well. After the home visit, the remaining weekly prenatal appointments will be done in the office.
You are encouraged to call the midwifery team as soon as you believe labor has begun. Through this conversation, we will determine if you are in active labor. Once active labor is established, the birth team will stay at your home through the labor and birth.
We will follow your lead on our level of involvement in your labor. It is our job to check on you and your baby, but if you prefer to labor quietly alone with your partner, we will respect that. We will quietly come in to check heart tones and vital signs, but leave you alone between checks. If you prefer, however, one or more members of our team will remain next to you to provide encouragement and comfort through your contractions.
We believe in encouraging laboring mothers to move as they feel most comfortable. We will offer suggestions for different positions, including laboring on a birth stool, but, ultimately, the laboring mother is in control of her body. You will be supported to eat and drink as you desire or need. Showering or soaking in a warm tub of water is suggested, as water is a wonderful comfort to a laboring woman. You will be able to walk around, go outside or do what feels right to you.
When it is time to deliver, you are free to choose your position. We may suggest a birthing position if you need help, but as long as you and your baby are doing well you will be encouraged to listen to your body and push as it tells you.
We rarely, if ever, do episiotomies (cutting the opening of the birth canal). Instead, we gently support and help the perineum stretch. Our clients usually don’t tear, but if they do, we are prepared to repair it. A tear heals much faster and easier than an episiotomy, and most natural tears are smaller than the standard episiotomy.
As your baby is being born, you will be supported to watch the process and even touch his/her head. Your partner will be shown how to deliver if desired. At delivery, your baby immediately will be placed upon your stomach. We always encourage beginning to breastfeed in the first several minutes. Under normal circumstances, delayed cord clamping is practiced. If the baby needs any special attention, most of the time we can tend to his/her needs right beside you. We carry emergency equipment such as oxygen and we are trained in resuscitation techniques, though they rarely are needed.
We carefully watch but never rush the delivery of the placenta (afterbirth). Once the placenta is delivered, we will try to give you time alone for your new family to bond, though we will have to come in from time to time to check on you and your baby. At this time we will stimulate your uterus to prevent bleeding, take your pulse and blood pressure, listen to your baby’s heart and lungs and check his/her temperature.
When you are ready we ask that you try to urinate and, if you desire, to shower or bathe. It is amazing how much energy a woman can get after natural birth! While you are in the bathroom the birth team will clean your room and remake the bed with fresh sheets. When you return to your room, we will do the newborn exam as you watch. This is when you will find out how much the baby weighs and other important measurements. We stay at your home for at least two hours after birth or as long as we are needed. We will then leave until the next day, but we’re always just a phone call away.
Your postpartum care actually begins the moment you give birth. We keep a close eye on everything for the first few hours, and one of us will return the next day and again on the third day. At the one-week visit in our office we will do the newborn screen, if you choose, to test for several treatable conditions with which babies are occasionally born. During these first few days we also complete and submit the birth certificate to the Arizona Office of Vital Records.
You may also choose to have your baby seen by your pediatrician or family practitioner in the early weeks.
The three- and six-week postpartum visits are done in our office. At the last visit we will do a final check, discuss family planning and offer a gynecological exam in the future, if you desire.