About Prenatal Care




Prenatal Visits

Prenatal visits are scheduled regularly throughout the pregnancy. All prenatal visits are scheduled for thirty minutes, except the initial appointment that is scheduled for one hour. Our prenatal care is medically thorough. We include all the usual procedures: weight, vital signs, urinalysis, fundal height, fetal heart rate, position of the baby, physical changes and complaints, medical and obstetrical history, and nutritional analysis. We try to explain what we are checking for with all of these things, but if you don.t fully understand something, please ask. We want to work with you as partners in your care. You will need to get an initial group of tests and subsequent tests if warranted. The results are sent within one week. Any abnormal results will be relayed to you. Please keep track of any questions you want to ask at your next prenatal. There will be plenty of time allowed to address all of your concerns. We will be happy to give you a copy of your test results if you wish.


Back to the Top

Childbirth Preparation Classes

We recommend that all first-time parents take childbirth classes. If you have had a baby before in the hospital, then you could take a refresher course more geared for out-of-hospital births. The classes teach you about what happens during pregnancy and birth, nutrition, self-care, relaxation techniques, emergencies and complications, psychological aspects of childbearing, postpartum and newborn topics. They also give you a chance to focus on each other and the baby and to meet other pregnant parents. Classes also help fathers feel more involved with the pregnancy.


Back to the Top

Community Resources

It is a good idea if this is your first baby to make contact with your local nursing mothers group. We have the contact numbers for different areas. You should also read The Womanly Art of Breastfeeding from La Leche League. It's the best breastfeeding book available. It should be in any bookstore or library. The local Health Department has a Woman-Infants-Children (WIC) program to help provide supplemental foods to mothers while they are pregnant and up to a year after the birth if the mother is breastfeeding. They also provide supplemental foods to children up to age five. You will find their number in the blue pages of your local phone book. Call to see if you qualify.


Back to the Top

Nutrition

The important items of prenatal nutrition are adequate protein, iron, and calcium. We recommend at least 80 grams of protein per day. You should also concentrate on iron-rich foods: molasses, dark green leafy vegetables, dried fruits, meat, etc. We have a handout to help you. Try to include calcium rich foods: dairy, fish, dark green leafy vegetables, sesame seeds, etc. Drink plenty of fluids, including at least eight glasses of water per day. Concentrate on eating whole natural foods with no chemicals or refined sugars.

We are not as concerned with how much weight you gain as what kind of foods are you eating to gain the weight. If you are already overweight, watch the fat and sugar content of your diet. An average weight gain for women ranges between 25 and 35 pounds. Most pregnant women discover that they cannot get all the nutrients they need by diet alone and that it helps to take prenatal vitamins and supplements. We can assist you in choosing appropriate vitamins, supplements, and herbs.

If you experience constipation from extra iron, try increasing your fluid intake, roughage and exercise. Change the form of iron if your stools are dark and become difficult to pass. If you are bothered by heartburn, digestive enzyme tablets, such as papaya, can be quite helpful. Do not lie down after you eat and avoid acidic and spicy foods. If your physical symptoms indicate that you may be tending towards toxemia, we will suggest an appropriate diet designed to help alleviate this condition. Below is a suggested pregnancy diet for you to follow. Eat as many servings of each group as indicated per day. Remember that a serving can be counted for one group only.

Water

 1/2 gallon per day

Protein - 8 servings

 1 oz. Lean beef or pork
1 oz. Chicken or turkey
1 oz. Fish
1/4 C canned salmon or tuna
3 sardines
3 1/2 oz. Tofu
1/4 C nuts or nut butter
1/2 C beans with 1/4 C rice
1/2 large potato and 1 oz. cheese

Whole grains - 5 servings

 1 slice of whole grain bread
1/2 completely whole grain roll, muffin or bagel
1 whole grain waffle or pancake
1 corn tortilla
1/2 C oatmeal or Wheatena
1/2 C brown rice or bulgur wheat
1 shredded wheat biscuit
1/2 C bran flakes or granola
1/4 C wheat germ

Milk and Milk Products - 4 servings

 1 C milk: whole or buttermilk
1/2 C canned evaporated milk
1/3 C powdered milk
1 C yogurt
1/4 C cottage cheese
1 large slice cheese (11÷4 oz.)

Fats and oils - 3 servings

 1 T butter
1T mayonnaise
1 T olive or canola oil
1/4 avocado
1 T peanut butter

Fresh, dark green vegetables - 2 servings

 1 C broccoli
1 C brussel sprouts
2/3 C spinach
2/3 C greens: collard, kale, etc.
1/2 C endive
1/2 C asparagus
1/2 C sprouts: bean, alfalfa

Vitamin C - 2 servings

 1/2 grapefruit
2/3 C grapefruit juice
1 orange
1/2 C orange juice
1 large tomato
1 C tomato juice
1/2 cantaloupe
1 lemon or lime
1/2 C strawberries
1 large green pepper
1 large potato, any style

Eggs - 2 servings

 poached
soft-boiled

Yellow or Orange vegetable/fruit - 1 serving

 3 apricots
1/2 cantaloupe
1/2 C pumpkin
1/2 C winter squash
1 sweet potato
1/2 C carrots

Table salt - use sparingly

 sea salt
iodized salt


Back to the Top


Birth Supplies

All clients are required to purchase a birth kit from a supplier in Reading. This will be shipped to your home. If you are birthing at the office, please bring this kit with you when you come in labor. If you are birthing at home you will need these additional supplies:

To make up a birthing bed for a homebirth: You will need two sets of sheets. You can purchase them at the Goodwill Store or any other thrift store. This way you will not ruin any good sheets during the birth. Wash the sheets in hot water and dry in a hot dryer or hang outside in sunshine. Bag these in a plastic bag until the birth.
  1. Make up the bed normally with the first set of sheets.
  2. Cover with a fitted plastic sheet (Ames has them, an inexpensive item) or an old shower curtain.
  3. Make up the bed with the other set of sheets.
  4. Fold back the top sheet.
We will continue making up the bed from your birth box when we arrive. Some people have found it helpful to cover their pillows first with plastic bags and then covering with pillowcases. Please have four receiving blankets available to use for the baby after the birth. Again, you may want to purchase used ones from a thrift store as meconium and bloodstains can be difficult to get out. We will also need a complete set of baby clothes: undershirt, socks, sleeper and diaper.


Back to the Top

People at the Birth

It is totally up to you how many or how few people you want at your birth. We suggest, though, that you ask someone to attend only if you really feel comfortable with that person. It's a good idea to tell everyone you invite that you may change your mind when you actually go into labor. This is your birth experience and it is not your job to provide a nice "experience" for someone else. Some studies indicate that you will labor an extra hour for every extra person you invite. This is food for thought.


Back to the Top

Helpful Activities in the Last Six Weeks

1. Perineal massage - One of the things that you can do to prevent any tears at the time of the birth is to start stretching your perineum during the last six weeks of pregnancy. Please follow the enclosed instructions and ask us if you have any questions about doing it properly. While you are doing perineal massage, it is a good time to practice your breathing and relaxation. The intense stretching in that area is a real sensation you will encounter during pushing.

2. Breast preparation - It is essential to start preparing your nipples for breastfeeding at least six weeks before the birth. Soreness around the nipples is very common during the first two weeks of breastfeeding and sometimes longer. Little babies have a strong sucking reflex! If your nipples are flat or inverted, start wearing breast shells inside your bra as much as possible during the day. You can purchase these at the pharmacy. After showers, do nipple rolls and apply vitamin E drops.


Back to the Top

The Baby's Doctor

It is important to think about who will care for your baby's medical needs after it is born. We recommend you see the doctor within the first two weeks. You will see our doctors here at the office for the first check-up and then you may continue to see them or make an appointment elsewhere.


Back to the Top

Postpartum Planning

You will need someone to be with you 24 hours a day for the first three days. If the father of the baby can do this, that's wonderful. If not, someone must be asked to do this loving task. This person will take care of the house, any other children, and attend to your needs. After the first three days, day help is probably all that is needed. It is very important for you to take it easy after the birth. This is a time when your body and emotions are very vulnerable. It makes good sense to prevent problems than deal with them after they occur. Your milk supply is being established and your body is trying to get back to its old self. If you overdo it, you will bleed longer and heavier and possibly be prone to breast infections. We have often joked that the only thing missing in the birth kit is the duct tape to keep women resting! Try to plan for six weeks of limited activity.


Back to the Top

Carseat

It is the law in Pennsylvania that all infants and children are in a car seat while in a moving vehicle. Fines are very expensive and the risk of injury is very great. Try to select a carseat that is easy to use and move in and out of the car.


Back to the Top

Preparing for Labor

You want to make sure that when you start labor you are well rested. Since you never know when labor will start, take it easy as your due date approaches and regularly take naps. Take stock of your groceries and make sure you have what you need. The house should be clean, with a clean sink and bathtub with plenty of fresh towels. Make sure you have nourishing food on hand for you to have during labor and after the birth. If it is a long labor, we'll be happy to do some cooking for you- pizza and rice pudding are our specialties. Frozen meals prepared in advance save much time and energy later. Keep the Pedialyte and juices handy. You can even pour some into ice-cube trays to make small bite size portions to suck on in labor.


Back to the Top

When You Start Labor

Labor usually begins with mild contractions. Try as long as possible not to let them interfere with your usual activities at that time. If this starts at night and it is your first baby, please go back to sleep if you can. It is important to rest while you can, since you may easily be up later when contractions are too strong to sleep through. The contractions will usually be getting stronger and closer together. Contractions are timed from the beginning of one to the beginning of the next. If you are not sure whether this is .real. labor, try changing your activity by taking a shower or walking around. Do not take a bath if your water bag is broken. Rest if you can and eat and drink as it suits you. Drinking fluids is very important. It keeps your energy up and your body hydrated. Some mothers like to do an enema, but this is not necessary. Do not do an enema if your water bag has broken. At this time, you can make up your birthing bed if you wish and get baby clothes ready.


Back to the Top

When to Call Us

Please call us as soon as possible if you think you may be going into labor. If your water bag breaks, call immediately. If you have had a baby before, do not wait to call the midwife for any reason.

First time mothers usually have plenty of time before their baby comes, so don't panic! Dads are often afraid that the baby will appear before the midwife appears. This is incredibly rare for first time mothers. First time mothers can usually wait until contractions are five minutes apart and lasting 45-60 seconds before calling. Women who have had babies before should call even if they just feel "funny". We would much rather come for false labor and end up making you breakfast, then miss the birth due to a delayed phone call.


Back to the Top

If Your Water Breaks

In ten percent of all labors, the water breaks before contractions occur. In the remaining births, the water bag breaks somewhere along the way or is broken by the birth attendant. Things to note before calling the midwife:

Once the membranes have ruptured, you may start to have contractions, if you're not already doing so. The protective sac the baby lives in is gone so the possibility of infection becomes greater. We like to see people in active labor by twelve hours and have given birth somewhere between 24 and 36 hours after the bag has broken. If we have warned you at the prenatal visit that the baby's head was very high, you must call immediately to let us know if your bag of water has broken. Keep track of the baby's activity. Restrictions after your bag has broken: Drink lots of fluids, take extra vitamin C and check your temperature every four hours and relax knowing that your baby is on its way!


Back to the Top

At The Birth

We will come and be with you whenever you start active labor or feel you need us. We carefully monitor labor to make sure it is proceeding as smoothly as possible. This includes taking the mother's vital signs, the baby's heart rate and checking vaginally for progress. We carry emergency equipment and are experienced at handling the more common complications of labor and birth. Most births proceed with only minor variations from the norm, but we will not hesitate to recommend going to the hospital if that seems the safest course. A healthy mother and baby are more important than where the birth occurs. One of us will be primarily responsible for the mother during the birth while the other midwife will be responsible for the baby. We use warm compresses and perineal massage to prevent tears and would only do an episiotomy if the baby was compromised and needed to be born quickly.

We do all that we can to see that your baby's birth is gentle and joyful for all present. We try to give the family plenty of time to bond after the birth. We can help you initiate breastfeeding and include other siblings in getting to know the baby. Before leaving, we will do a complete newborn exam and make sure that mother and baby are just fine. In the unlikely event that you should give birth at the same time as another client, each midwife would go to one of the births and call in other experienced assistants to help us.


Back to the Top

Postpartum Care

We will telephone you at 24 hours after the birth to check on you and the baby. You will need to come to the office for a three-day postpartum visit for you and the baby. We will do the baby's Pennsylvania Newborn Screening at this time and one of our doctors will examine the baby. If you want a circumcision, it can be done then as well. At eight weeks postpartum, you will come to the office for your last checkup. You should always call us if there are any problems. Do not feel bad about calling even if it is the middle of the night. If we didn't want to get up at night, we would not be midwives.


Back to the Top

Exercise and Rest

Pregnancy is a time to take care of your body. Labor is a very challenging physical event, and you must be ready for it, so exercise and stamina is important. Pregnancy is also a time to decrease stress in your life as much as possible and to be gentle with yourself emotionally. You need to include both physical exercise and emotional relaxation in your life at this time. Your goal should be to do 100 Kegels (contractions of the vaginal muscles) per day. Practice squatting and tailor sitting every day. Pelvic rocks each evening before bed will help to relax your back muscles and get the baby into a good position for sleep. It is best for circulation if you sleep on your left side. If you have trouble sleeping, try some hops or chamomile tea or a bath with warm milk. Remember when you get up to roll onto your side first so as not to stress your back and stomach muscles.

You should try to get some form of good physical exercise at least 3 or 4 times a week. Swimming is perfect since it is a non-weight bearing aerobic activity. Invigorated walking is also very good. The YMCA offers special exercise classes for pregnant women. They are designed to be safe during pregnancy and are less strenuous than most aerobics classes. Stretching and exercises are excellent ways to release stress and put emotional ups and downs in perspective. Also try to provide time to talk with those you are close to and to straighten out any relationship problems you are having. Make quiet time to reflect. Put your feet up several times per day. Take naps. Remember that you are already mothering this baby and that it requires a lot from your body.


Back to the Top

Intercourse

You should not have intercourse if you are leaking amniotic fluid, bleeding or spotting, or cramping. Any other time is fine. You do not have to quit making love six weeks before your due date unless there are signs of early delivery or infection. Sexual intercourse is a good way to get labor started. Semen has prostaglandins in it that encourages the cervix to soften and dilate. Female orgasm initiates the rise in levels of oxytocin; this is the hormone that maintains labor contractions. As you get bigger, you may find intercourse to be less comfortable, and you may have to work out some alternate positions. Talk to us if you have any questions or want to discuss any aspect of your sexuality. Remember that physical affection is the key. Your need for closeness and open communication is greater when pregnant.


Back to the Top

Family Support

You may have some reservations about openly discussing you plans for an out-of-hospital birth. Childbirth often triggers people's fears about life and birth. They can then try and share these with you. It is important to receive positive support at this time rather than negative worries, so think carefully before sharing this part of your excitement. If you find yourself trying to convince your friends or parents about what you are doing, feel free to direct them to us or bring them with you to your next prenatal visit.


Back to the Top

Perineal Massage

Massaging your perineum (the tissue between the vagina and the anus) during the last weeks of pregnancy can help prevent tearing during the birth. Massaging oil into the tissue and stretching it can result in less resistance to the birth of the head and help you to learn to relax the pelvic floor muscles. You can do this massage yourself, but in the last six weeks of pregnancy it is easier to have help from your partner.

  1. Make sure your bladder is empty and that your legs are propped up comfortably (some women find that a warm bath before perineal massage helps to soften the tissues).
  2. Massage natural oil like Vitamin E, olive or safflower into the tissues of the perineum and lower vaginal wall. Pay special attention to any scar tissue from previous episiotomies.
  3. Your partner should put both index fingers about 3 inches into the vagina and press downward toward the rectum (six o'clock).
  4. While maintaining steady pressure, the fingers can be moved upward along the sides of the vagina in a "U" type of movement (between three and nine o'clock).
  5. As you massage each night, your tissue will relax and stretch. Have your partner gently stretch the vaginal opening as wide as possible each time until you feel a tingling or burning sensation that indicates "far enough". This will help you recognize the burning sensation that indicates when to stop pushing for the crowning of the head at the birth.
  6. Hold this stretch, without hurting the mother, for a minute or two, then release.
  7. Massage with more oil, stretch again to the maximum, hold and then release.

If you do this faithfully, your partner will be able to insert more fingers and perhaps the whole fist as the perineum becomes more elastic during the approach to your due date. This assures that your tissues are supple and creates the confidence that a baby's head can surely fit through. Do a Kegel (contraction of the vaginal muscles) and feel where the pubococcygeal muscle lies and how strong it is. Feel how difficult the stretching is when you are tensing the muscles of the pelvic floor. Try to relax and release them as your partner does the stretching (hint: keep your mouth and throat relaxed as well). This is a good way to practice relaxing your bottom for the birth.


Back to the Top