Holistic Health CareLast modified: May 11, 2012
- All homebirth clients are responsible to find medical care if they desire shadow care at the same time as midwifery care.
- Prenatal care includes:
1. Complete history (medical, obstetrical, psychosocial)4. Nutritional assessment and counseling
5. Lab work; standard prenatal screen is recommended:
- Complete blood count (CBC) with differential
- ABO type & Rh factor
- Rapid plasma reagin (RPR) or veneral disease research laboratory (VDRL)
- Hepatitis B surface antigen
- Antibody screen
- Urinalysis (UA) culture & sensitivity
- Every 4 weeks, up to 28 weeks LMP;
- Every 2 weeks, from 28 weeks to 36 weeks;
- Weekly from 36 weeks until the birth.
2. Visits more frequent as needed.
3. Assessment of client’s general well-being:
- Weight gain assessment
- Fetal heart tones
- Fetal growth
- Urinalysis for protein/glucose
- Blood pressure
- Nutritional review & counseling
- Educational review & discussion
- Psychosocial review & counseling
4. 1 hour to 30 minute minimum visit
- 36-37 Week Visit
1. Home visit when possible
2. Check emergency transport phone # list
3. Check birth supplies
4. Instructions for early labor, including when to call and how to reach midwife
- The midwife will refer the mother for consultation and/or care with the mother’s health care provider if any client exhibits signs and/or symptoms of that go out of our scope of practice.
Labor & Birth
- Initial exam during labor includes checking Fetal Heart Rate (FHR), maternal blood pressure, pulse, temperature, fetal position by palpation, and noting status of membranes. When indicated, a vaginal exam to assess dilation, effacement and station may be done.
1. Fetal Heart Rate Screening includes:
- Minimum of every 15-30 minutes during early active labor
- Every 5-15 minutes during late active labor
- Every contraction to every other contraction during second stage, not to exceed 5 minute intervals.
B. In addition, it is beneficial to evaluate FHT’s
- Immediately after contractions
- Intermittently through contractions
- Upon rupture of membrances
- With increasing frequency if any signs of risk factors develop
2. Temperature, pulse, blood pressure repeated every 4 hours or as indicated.
3. Monitor progress of labor through observation and/or examination.
4. Anticipate transport if risk factors develop.
5. The midwife or qualified assistant must be present in home from beginning of active phase onward.
6. Maintain maternal hydration / nutrition / elimination.
7. Maintain sterile technique as procedure dictates.
1. Prepare for birth: check/set up supplies, set appropriate room temperature.
2. Assist client with birth according to her wishes and present circumstances.
3. Use midwifery techniques to preserve perineal integrity.
- Third Stage: Newborn
1. Assess neonatal status, record 1 and 5 minute Apgar.
2. Suction or resusitate, as needed.
3. Maintain newborn temperature through immediate maternal contact and appropriate room temperature.
4. Use sterile instruments for cord cutting.
- Third Stage: Mother
1. Expectant management unless otherwise indicated.
2. Assess uterine height, tone, and estimate blood loss.
3. Facilitate birth of placenta.
4. Take cord blood if necessary.
5. Examine placenta and cord.
6. Examine perineum for lacerations.
7. Suture if necessary using sterile technique and local anesthetic as needed.
- Fourth Stage
Minimum 2 hour postpartum maternal and newborn monitoring including:
- Facilitating breastfeeding
- Perform a basic newborn exam
- Give postpartum instructions for first 24 hours
- Encourage appropriate home environment
- Ensure stable condition of mother and baby
- Post Partum
- Minimum 2 visits
1. First visit within 24-36 hours.
2. Second visit within 5 days.
3. Perform or refer to pediatrician for Newborn Screening Program.
4. Observe and monitor parameters of maternal and newborn well-being including involution, lochia, breastfeeding, jaundice, and cord condition.
- Midwife recommends clients make arrangements for pediatric exam with their health care provider according to the provider’s preferred time frame.
- 6 Week Office Visit(if requested
1. Complete pelvic exam. (bimanual and speculum)
2. Pap test if not done during pregnancy.
3. Breast exam and instructions on self exam as needed.
4. Abdominal exam.
5. Assessment of family adjustment and parenting.
6. Birth control counseling and information.
7. Follow up on pediatric care.
- Birth Certificate: Assist parents with filing Birth Certificate within the required time frame.