Comprehensive Midwifery Pregnancy Care - What to expect?
We want to get to know you and your family, your priorities and values, so we are better able to support you and provide highly individualized care during your pregnancy, labor, birth and postpartum.
During the first two trimesters of your pregnancy we like to see our clients in person either at their home or in our office every four (4) weeks. The initial appointment is ~ 90 minutes, and subsequent appointments last 30-60 minutes. Beginning at 32 weeks, we want to begin seeing you more frequently, ideally every other week. At your 36 week appointment we allot extra time and do a Birth Rehearsal. This takes place at your birth location (e.g., your home or designated birth center) and we invite all who will be present the day-of to attend. We set weekly appointments from 36 weeks on until your baby arrives, since week 37 you are considered “term” and your baby may safely come at any point. If you are still pregnant after 41 weeks, your appointments will be more frequent, likely every 2-3 days until you go into labor.
During early labor, we as your midwives want to remain in close contact with you to provide phone support, as well as to determine together when it is time for us to make our way to join you. If things go as hoped, you will be in active labor when we arrive, at least 5-6 cm dilated with strong minute-long contractions every 2-3 minutes. These numbers are a guideline and not a rule, but generally pretty decent indicators that it is time for your midwives to be with you. From the time you call to say you are ready for our support until the time your primary midwife arrives at your home (or the birth center, if that is where you are going) it can be an hour or more depending on your location, so it is critical that you communicate early and often with your midwives during early labor. Please never be shy about calling! We want to hear from you whatever the hour!
Our typical birth team consists of two licensed midwives and may include a birth assistant or midwifery student in lieu of a second midwife. When we first arrive, we may offer to check your cervical dilation with a manual vaginal exam to assess your progress and make sure it is not “too early” for us to be there. However, as with all things in this practice, it is always your choice, so if you prefer no cervical checks or vaginal exams, that is fine with us. Your labor and birth will progress as they will, we support you as you would like, and you can expect us to remain present with you for a minimum of 2 hours after the birth of your placenta.
We will connect with you at 12-24 hours to check on how you and your baby are faring, and will be at your home again at 48-72 hours, and again between day 5-7. We like to see you at 2 weeks, 4 weeks, 6 weeks and 12 weeks postpartum, as well. We remain on-call for you and your family 24/7 for the first two weeks postpartum, and we provide postpartum support to you for the first full year after your baby is born, in-person or virtual. During the first six weeks postpartum, we are able to provide all necessary newborn exams, assessments and care for your baby , with the exception of vaccination or circumcision, so you don’t have to go to the pediatrician’s office with your healthy newborn unless you want to. We also are here for you to assist with breastfeeding, your milk supply and a positive latch, jaundice and all of the physiologically NORMAL things that happen in those first tender weeks.
Prenatal schedule of care:
Initial visit (Week 6-12) - this is a 60-90 minute appointment and includes:
● Review of your full medical and family histories and prior pregnancies
● Review of medications, supplements
● Mini physical exam
● Discussion of your plans, hopes for this pregnancy
● Answering any initial questions about your care or trouble shoot 1st trimester symptoms
● Checking maternal wellbeing, vitals, etc.
● Discuss options for prenatal genetic testing
● We may offer to do a full panel of lab work at this initial visit, if it has not already been done this pregnancy, and if you are feeling well enough for a blood draw.
Prenatal visit (Week 13-16)
● Review lab results (if not already done over the phone), offer recommendations
● Evaluate baby’s wellbeing, listen to baby with doppler or fetoscope
● Checking maternal wellbeing, vitals, etc.
● Review resolution of 1st trimester symptoms, and discuss options to resolve
● We may offer to do a full panel of lab work at this visit, if it has not already been done this pregnancy
● Offer prenatal genetic screening
Prenatal visit (Week 17-20)
● Review lab results (if not already done over the phone), offer recommendations
● Evaluate baby’s wellbeing, listen to baby with doppler or fetoscope
● Checking maternal wellbeing, vitals, etc.
● Provide referral for (optional) 20-22 week anatomy scan (ultrasound)
● Review symptoms and discuss options to resolve
● Review diet, movement
● Discuss childbirth education, breastfeeding, etc
Prenatal visit (Week 22-24)
● Evaluate baby’s wellbeing, listen to baby with doppler or fetoscope
● Checking maternal wellbeing, vitals, etc.
● Review anatomy scan report (if not already done over the phone)
● Discuss options for screening for Gestational Diabetes (glucose tolerance test - GTT) at 24-28 weeks; food-based options
● Review plans for support during birth and postpartum
Prenatal visit (Week 27-28)
● Evaluate baby’s wellbeing, listen to baby with doppler or fetoscope
● Checking maternal wellbeing, vitals, etc.
● Review any symptoms and discuss options to resolve
● Offer to repeat blood work for CBC (Complete Blood count) and if wanting a water brith recheck STIs
● Offer Glucose tolerance testing (fasting) with whole food-based option to screen for gestational diabetes
● Review plans for support during labor, birth and postpartum
● Review birth kit and postpartum supplies
Prenatal visit (Week 31-32)
● Review lab results (if not already done over the phone), offer recommendations
● Evaluate baby’s wellbeing, listen to baby with doppler or fetoscope
● Checking maternal wellbeing, vitals, etc.
● Review symptoms and discuss options to resolve
● Discuss options for testing for Group Beta Streptococcus (GBS) at 35-37 weeks and prophylactic treatments in advance of performing the vaginal swab
● Discuss options and preferences/plans if transfer to hospital is indicated before, during or after labor/birth
● Discuss options for immediate postpartum procedures (e.g. cord cutting, placenta, medication/tinctures, Vitamin K for baby, erythromycin)
Prenatal visit (Week 33-34)
● Evaluate baby’s wellbeing, listen to baby with doppler or fetoscope
● Checking maternal wellbeing, vitals, etc.
● Review symptoms and discuss options to resolve
● Review plans for newborn care and assessments (e.g., pediatrician, hearing screening, CCHD, metabolic screening)
● Review preparations are complete for home or birth center birth
Birth Rehearsal (Week 35-36) @ Home or Birth Center: invite your entire birth team to participate
● Ensure all logistical arrangements for birth are complete and supplies in order/organized
● Review when and how to contact midwives for labor support
● Review birth scenarios and discuss client birth plans/preferences
● Review plans and logistics in case of transfer
● Evaluate baby’s wellbeing, listen to baby with doppler or fetoscope
● Checking maternal wellbeing, vitals, etc.
● Review any symptoms and discuss options to resolve
● Offer to have client self-collect Group Beta Streptococcus (GBS) vaginal swab
● Offer referral for ultrasound growth scan, if indicated
WEEKLY Prenatal visits until labor/birth (Weeks 37-42) FULL TERM
● Evaluate baby’s wellbeing, listen to baby with doppler or fetoscope
● Checking maternal wellbeing, vitals, etc.
● Review signs of labor, when and how to contact midwives for labor support
● Review any symptoms and discuss options to resolve
● Encourage rest, relaxation, nourishment, trust, body work (e.g. massage, acupuncture, etc.
Postpartum schedule of care for you and your baby:
Initial Assessment (0-4 hours after birth) - immediately postpartum
We must feel assured that both you and your baby are transitioning well and that you have adequate support at home before we leave your home or discharge you from a birth center. We do a complete and comprehensive Newborn Exam with you, and we make sure mom has eaten something warm and nourishing, has been able to get up and walk to the toilet and successfully voided, and is then tucked into a clean bed. We want to get out of your way so you can take a well deserved nap and bond with your baby, but we make sure your bleeding is under control, pain is managed, you and baby are stable and all is well before we depart.
First 24 hours (12-24 hours after birth) - Home visit or virtual
We remain in close contact with you by phone during the first 24 hours after your birth, and typically return to your home during that time to ensure you and baby are both doing well and experiencing a positive transition. Some prefer just a phone check-in, since we will be back around day 3, but we like to lay eyes on you and baby and help with any latch issues or postpartum discomfort sooner rather than later.
Day 2-3 - Home visit
We return to your home between 48 and 72 hours to check on the wellbeing of both you and baby and to perform all critical newborn assessments that happen during this window (e.g. hearing screening, CCHD, metabolic screening), so you don’t have to go see a pediatrician in these early days. We evaluate baby for jaundice, check maternal and newborn vital signs, offer breastfeeding andlactation support, comfort measures for any postpartum discomfort, bind your belly if desired, assess for postpartum blues and adequate nutrition, hydration, support and sleep.
Week 1 evaluation (Day 5-7)
We remain in close contact by phone over the first week, then return in person to your home between day 5-7 to check on the wellbeing of both you and baby, continuing to monitor for anything outside of the norm. At this visit we offer to weigh your baby and spend time whatever time is necessary troubleshooting any issues or concerns.
Week 2 evaluation (Day 14-18)
This visit can be done at home or in our office (perhaps your first trip outside!). If you have any concerns at all, we want to see you in person. We evaluate the wellbeing of mom and baby, including weighing your baby again if desired, and continue to monitor for anything moving out of the norm.
Week 4 (Day 28-32)
This visit can be done at home, in our office or virtually. We evaluate the wellbeing of mom and baby and continue to monitor for anything moving out of the norm. If you have any concerns at all, we want to see you in person. Sometimes this visit is spent talking about the labor and birth itself, and can be a special time to integrate. If you desire a postpartum bone-sealing ritual, which is a separate offering from the midwifery care package, often that longer ritual is scheduled to coincide with this appointment. Ask us if you want more information on that ritual.
Week 6 (Day 40-42)
This visit is typically done in our office. It is our final postpartum appointment caring for your baby, and we offer to do a full examination of your infant. We evaluate the overall wellbeing of mom and baby and continue to monitor for anything moving out of the norm. We discuss returning to sexual activity, your fertility, family planning, and offer to do a pelvic exam if that feels supportive. If a PAP smear is indicated, we are able to do them at this visit, though we generally recommend waiting until 12 weeks postpartum to perform this test.
Week 12 (Day 80-84) - optional
While we are often told the postpartum period ends at 6 weeks, in most other parts of the world postpartum is considered another full trimester, so 12 weeks. It is at this point that the fourth trimester of a pregnancy has ended. Some clients wish to defer discussions of returning to sexual activity, everyday activity or their fertility until after 12 weeks. If a PAP smear is indicated, we generally recommend waiting until this 12 weeks postpartum to perform this test. While we remain on call for you for another 9 months, this is often our last in-person meeting. Our hope is that you feel well supported to move forward in your sexual and reproductive health.