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All aspects of care will be documented.
All homebirth clients will arrange for obstetrical, maternity and pediatric back-up care and such information will be documented on the client's chart by the attending midwife.
Prenatal care includes:
1. Complete history (medical, obstetrical, psychosocial)
2. Complete physical exam
3. Complete pelvic exam & assessment
4. Nutritional assessment and counseling
5. Lab work; standard prenatal screen is recommended:
6. Other lab work when appropriate which may include:
- 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
- Glucose testing
- Alpha fetal protein
- Amniocentesis
- Ultrasound
- Sickle cell
- HIV
- Gonorrhea
- Chlamydia
- Toxoplasmosis
- Group B Strep (GBS) culture
- Platelet & differential
- Pap test
- ...ect
Return visits
1. Frequency:
2. Visits more frequent as needed.
Every 4 weeks, up to 28 weeks LMP;
Every 2 weeks, from 28 weeks to 36 weeks;
Weekly from 36 weeks until the birth.
3. Assessment of client's general well-being:
4. 30 minute minimum visit (most visits may last about 45 minutes to an hour, sometimes longer, depending upon maternal issues needing discussion, educational birth preparation instruction and other factors)Weight gain assessment
Fetal heart tones
Fetal growth
Urinalysis for protein/glucose
Blood pressure
Nutritional review & counseling
Educational review & discussion
Psychosocial review & counseling
5. Lab update as needed:
28 - 36 weeks CBC with diff
Antibody screen
Urine culture
Group B Strep
...etc
36 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 abnormal conditions as outlined in the Risk Factor Guidelines.
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. Frequency2. Temperature, pulse, blood pressure repeated every 4 hours or as indicated.
B. In addition, it is beneficial to evaluate FHT'sMinimum 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.
Immediately after contractions
Intermittently through contractions
Upon rupture of membrances
With increasing frequency if any signs of risk factors develop
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 newborn examination
Offer eye prophylaxis
Offer vitamin K
Give postpartum instructions for first 24 hours
Encourage appropriate home environment
Ensure stable condition of mother and baby
The midwife should consult or refer the mother to her health care provider according toTransfer Criteria and Risk Factor Guidelines.
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 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.
MoonDragon's Birthing Guidelines Index