Back-up

All homebirth clients are responsible to find medical care if they desire shadow care at the same time as midwifery care.

Normal Pregnancy

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
  
• Rubella
  
• Rapid plasma reagin (RPR) or veneral disease research laboratory (VDRL)
  
• Hepatitis B surface antigen
  
• Antibody screen
  
• Urinalysis (UA) culture & sensitivity
  

Prenatal Visits:

1. Frequency:

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.

Labor

1. Fetal Heart Rate Screening includes:

A. Frequency

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.

Birth

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.

8.Pap Smear

Birth Certificate: Assist parents with filing Birth Certificate within the required time frame.