Outlines of Midwifery Care for Home, Birth Center and Hospital
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GUIDANCE & COUNSELING
FIRST TRIMESTER
Nutrition/appropriate weight gain
Supplements
Toxoplasmosis
Work Hazards
Substance Use and abuse
Stress
Initial Labwork
HIV/STD screening
Genetic counseling and/or Triple-screen
Ultrasounds
VBAC
Danger signs, How to Contact
Adaptations and Discomforts
Breast or Bottle Feeding
WIC, MSS, MCM
The essence of midwifery care
How our practice works
Financial considerations
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_____________________________________
SECOND TRIMESTER
Preterm labor
Fetal Movement, Kick counts
Importance of protein, fluids, calcium
Newborn care provider: Pedi vs FP
Classes: childbirth, refresher, and sibling
Mental/emotional preparation for labor
Labs: anemia, gestational diabetes, RhoGam
Family Planning
Circumcision Decisions: yes/no
Family planning
Postpartum help
Doulas
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THIRD TRIMESTER
Braxton-Hicks, preparation labor
Danger Signs
Signs/Symptoms of labor, Review when to call
Breech Tilt
Emotional approaches to pain relief
Tubal consult/consent appointment
GBS
Perineal Massage
Birth Preferences
Labs: anemia
PostDates management: NST, AFI @ 41 weeks
Postpartum follow-up
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_____________________________________
Explain legal status of dems in GA
Explain protocol
Explain booklet
Explain birth supplies
Give and discuss diet sheet
Returned diet sheet
Met father
Explain contracts
Returned contracts
Explained birth certificate info
Digital Pager instructions
La Leche Info - 681-0142
Obtain copy of labwork
Circumcision
Eye prophylaxis
Vitamin K
Genetic screening
1 hour challenge for gestational. diabetes
Transport info
Pediatrician info
Siblings-Children at Birth video
Siblings- support person
Explain midwife backup
Discuss RhoGAM & titers
Childbirth classes
Emergency numbers posted
Postpartum care- Doulas
Initial Discussion
_____Client Info and Consent Form discussed
_____Fees determined
_____Insurance form sent in
_____Diet Discussion/supplements
_____PNV rx?
_____Labs ordered
_____ Referrals (WIC, genetics, DSHS, etc.)
First Prenatal to 19 weeks
_____ STD screening desired?
_____AFP discussion
_____AFP ordered?
_____Diet review
_____Supplement review
_____ Exercise/Fitness
24-26 weeks
_____Discussion of 28 week labs
_____ Begin discussion of childbirth classes
_____Need library books?
28-30 weeks
_____Labs done
_____RhoGAM given, if needed
_____Review Preterm Labor sheet
_____Signed up for classes?
_____Diet review/ Ca+/Iron
32-34 weeks
_____Order birth kit
_____Start working on birth plan
_____Discussion of GBS
_____Discussion of prep tea
_____See videos?
36-37 weeks
_____Meet Debbie (my birth assistant)
_____Birth Supplies ready
_____Perineal Massage
_____Prep tea provided
_____Baby treatments/tests discussed
_____Need circ info?
_____Begin birth control discussion
Method selected ___________
38+ weeks
_____Discuss/provide pp tea or sitz
_____Finalize contingency plans
OB Group __________
OB Hospital ________
Peds Provider ________
Peds Hospital _________
_____Finalize plans for PP care
_____Fetal movement counts
_____Arrangements for peds care
Newborn Care Provider. Pediatrician vs. FP___________________
Childbirth Classes: options: one day, series, refresher, sibling
Doulas, labor support, labor attitudes
Labs: anemia, gestational diabetes
Family planning: Options: __________________________
Circumcision:
Fetal Movement/Kick Counts
___________________________
___________________________
THIRD TRIMESTER
Braxton Hicks
Danger Signs, When to call
Breech Tilt
Tubal Consent
Signs & Symptoms Labor/When to Call
GBS/vaginal culture @ 36 weeks, anemia labs
Perineal Massage
Birth Preferences/birth attitudes, visualizations
Postdates Management, NST, AFI & 41 weeks
Postpartum follow-up, support
Preparations for parenting
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Hospital-Based Protocol
Routine prenatal appointment:
A prenatal in my practice entails the "clinical stuff" which usually doesn't
take very long...pulse, Bp, urinalysis. I ask them if they've gained weight.
I ask them how the baby is doing, how it is moving, how active, when, etc.
I ask them if they have headaches, bleeding, unusual discharge, edema,
nausea or vomiting. I have them to lie on the sofa, feel the baby, teach
them the position, listen to the heartbeat, measure the fundus. We talk
a lot about nutrition, especially if something is amiss, BP, sugar, low
iron, etc, or if they haven't had a very good weight gain, or if I suspect
that they don't have access to good food. We talk about natural alternatives
for yeast infections and exercises and nutritional solutions for common
problems. We talk about the family, children, husband. Sometimes problems
in relationships come up. We discuss concerns about friends and relatives
hostile to homebirth. At the first visit they have filled out an info sheet,
and if it has unusual things on it, abuse, rape, stds, etc, we talk about
that. With first time moms, i usually order blood work and find out blood
types, etc. We get other lab work done as necessary throughout the pregnancy.
I do one vaginal exam before labor, at 37 weeks, mostly to familiarize
myself with the client, and to get her use to my touch. I often don't do
one for repeat clients at all. That exam is in her own home on her bed,
because we do our home visit at that time. Everyone attending the birth
comes to that meeting, can ask questions of us, etc, and we can make sure
birth supplies are in order. Throughout prenatal care we talk about her
wishes and desires for the birth, how she envisions herself giving birth,
why she wants a home birth, what she expects of her midwives, etc. We discuss
and instruct perineal massage, breastfeeding, and any other questions or
concerns the couple may have.
I see my clients once a month until the 28th week, then every other
week until the 37th week, then every week until the birth, more often if
there are any problems. I'm sure I'm leaving out critical stuff. Prenatals
last about an hour. I do many or most in the client's home. Many of the
midwives I work with have the couples come to their home or office.
Here is the AP checklist I use, which I got from NACC. I like it because
it's pretty inclusive of most everything.
Continuous Quality Improvement Program for Birth Centers
Client Health Record Checklist
Name:
Orientation:
INITIAL VISIT
Draw Labs
AFP
Genetic Counseling, if indicated
Give diet history
Students
Appointments, phone contact
Consent forms discussed
Financial contract signed
Insurance forms signed
New OB pack
Self-care
Danger signs: UTI, bleeding, abdominal pain, cramping, headache
Habits: smoking, ETOH, drugs
Exercise; sexuality
Discomforts
Early pregnancy classes
Met partner
Registration Log/Bulletin Board
SECOND VISIT
Review lab results
Review diet history
Fetal development
AFP drawn
Consent forms signed
20-28 WEEKS
Give pediatrician letter
GTT scheduled/drawn
RhoGam scheduled/drawn
PTL signs
CB class Sibling class
Discomforts
Breastfeeding
OB visit scheduled
30-32 WEEKS
Hct
GBS
Danger signs: cramping, ROM, headache, visual changes
Circumcision
Labor support
Supply list
Fetal movement counts
Braxton-Hicks contractions
OB visit completed
Nipples/breast cups
Peds letter returned
34-36 WEEKS
OB chart review
Review call system
Directions to home
Records to hospital
Emergency childbirth
37-38 WEEKS
Signs of labor
When to call
Newborn prophylaxis
Complications classes
Early Home Care class
Circumcision choice
Birth plan
40-42 WEEKS
PP support
Breastfeeding
Ready for baby
Post-dates routine
NST
PRENATAL DISCUSSION CHECKLIST
Before 20 weeks
1 - 2 week diet history
Library access
Referrals to childbirth classes
Back-up plan
Dispense birth supplies list
Labwork
Dispense pager number
Herbal aids for pregnancy (e.g. Raspberry Leaf Tea)
Records Requested: _____________________________________
Records Received: _____________________________________
Mission
Community Nurse Midwife (CNM) exists to provide the full scope of nurse-midwifery
care and to offer women a choice of birth settings in Pacific, Grays Harbor,
and parts of Mason County.
Philosophy of Care
Midwife means with woman. It is a way of being as well as a way
of providing care.
Midwifery is an art and a science. The art of midwifery consists of
sensitivity to the needs of women and families, and being able to meet
these needs in the most appropriate way. The art of midwifery involves
knowing when and how to intervene to promote safety if it becomes necessary,
and is grounded in scientific knowledge. The science of midwifery overlaps
with that of other disciplines such as medicine and nursing. The crux of
the midwifery art and science lies in the knowledge and devotion to keeping
birth, and other related processes normal. The emphasis of our care is
on building partnership with women and families in providing care and in
maintaining health. We see our clients as whole, capable people for whom
these processes offer the opportunity for significant personal growth.
This midwifery practice is shaped and informed by the following beliefs:
Childbearing is a normal process and it is not usually necessary to interfere
medically.
Women should have as much control as possible in determining their care,
and should be encouraged to be active participants in decision-making and
self-care.
The role of the midwife is act as a guide and a lifeguard. In the guide
role, the midwife provides the education, anticipatory guidance, and information
needed for parents to make informed choices. Emotional support is also
provided. The lifeguard role involves watchfulness for deviations from
normal which might jeopardize health in non-pregnant women seeking services,
or in childbearing women and their infants, and the ability to take corrective
action when it becomes necessary to prevent harm to anyone in the midwife's
care.
