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Prenatal Care

 
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I usually begin prenatal care between nine and twelve weeks, or whenever the woman has contacted me.  Prenatal visits are scheduled every month until the seventh month, at which time they increase to every other week.  At thirty six weeks (roughly the ninth month), I visit clients in their home to make sure that everything is prepared for the birth and that I know how to get to their home. Visits are scheduled weekly thereafter until the woman begins labor.

Prenatal visits usually last from forty-five minutes to one hour.  At each visit I assess blood pressure and pulse, measure the uterus to check fetal growth, check urine and weight gain, palpate the position of the baby in the uterus and listen to fetal heart tones.  Mothers are also asked about their diets, exercise and any symptoms they may be experiencing.

I believe what a pregnant woman does every day for herself and her baby is the heart of prenatal care.  I suggest that women eat whole foods, building meals around protein and adding fruits, vegetable, and whole grains.  Women also need to drink lots of water and exercise three to four times per week.  And last, but not least, pregnant mothers need to have happy thoughts and enjoy their pregnancies.  How often in our lives do we get to make a baby?

The Details:  

  • Visits begin between 9 and 12 weeks

  • Monthly visits continue up to the 7th month

  • Visits shift to every 2 weeks from 7th month to 36 weeks.

  • A home visit occurs at the 36th week

  • After the home visit, weekly visits begin and continue until labor begins

 
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Labor & Birth

 
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Labor can begin with either contractions or spontaneous rupture of membranes (only 15% of the time).  Women usually call me whenever either of the two occurs.  If labor is early, we stay in telephone contact on a regular basis until contractions are stronger.  Sometimes, with a fast labor, I have to grab my bags and run!

I am usually at the birth when a woman is between two and five centimeters dilated.  I monitor maternal vital signs, as well as the heart tones of the fetus.  I encourage women to stay hydrated, to urinate on a regular basis, and to move and find positions that will make them as comfortable as possible, yet facilitate progression of the labor.  Fathers are encouraged to find the roles that best suits them.  Some men are actively involved in labor coaching and "catching" the babies; other men prefer to hire a doula to help their wives with labor.  Parents can also decide whether or not to have other children present.

When the babies are born, they are given APGAR scores at one and five minutes to assess their well-being.  The babies are given immediately to the mothers who are free to initiate breastfeeding if they so choose.  I attend to the expulsion of the placenta, all the while monitoring the mother's condition.  I perform an initial newborn exam after the first hour of the birth, checking the baby's vitals, gestational signposts, and measuring and weighing the baby.   After several hours when both the mother and the baby are stable, I leave.

The Details:

  • Call Diane at the onset of labor

  • Phone contact may suffice until contractions are stronger

  • Diane is at the birth between 2 cm and 5 cm dilation

  • Monitoring begins

  • After the birth, babies are assessed for well-being

  • After several hours and all are deemed healthy, Diane leaves

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Postpartum care

 
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Postpartum care begins the day after the birth when I journey to the client's home once again.  I check the mother for involution of the uterus, her blood pressure, pulse and temperature.  I want to know that she has eaten, replenished  fluids and is resting.  I like to talk to the moms about breast-feeding also.  I like to check the vitals of the baby and want to know that s/he is urinating, moving meconium through the system and nursing well.

The next visits are scheduled at five days, two or three weeks and six weeks after the birth.  I continue to monitor the vitals of both mom and baby, and I like to weigh the babies at each of these visits.  I also perform the metabolic screening and hearing test on the baby as well as submit a birth certificate.

The Details:

  • Day after visit at the home

  • Health assessment of mother and child

  • Breast feeding help/discussion

  • Future visits at 5 days, 2-3 weeks and 6 weeks

  • Baby's and mother's health is monitored at each visit

  • Birth certificate is submitted

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