Prenatal Appointments
caring for you before the birth
A prenatal appointment with a returning client at Magnolia Birth House. @magnoliabirthhouse
Most of the care you get during pregnancy happens before birth. So what's a prenatal appointment like anyway?
at the start
When a pregnancy test shows a positive result — that's how soon you can book a first appointment with a care provider.
The first prenatal visits are often used to check the health of the pregnant person, obtain medical history, perform some basic blood tests and to confirm the pregnancy for good measure. You may also have meetings to cover nutrition counseling, exercise during pregnancy, your birth plans, taking childbirth education classes and the benefits of hiring a doula. This is a perfect time to discuss any hopes, dreams and fears with your provider. And it's a perfect time to make sure you're at the right place and with the right medical team for you.
the model of care
Your experience with prenatal care will depend in large part on the model of care your care provider practices. The midwifery model of care presents pregnancy as a state of wellness rather than illness and focuses on the individual. Prenatal care in this model not simply a checklist. It is proactive, engaging, and focuses on information and lifestyle change. The medical model of care tends to focus on how to treat problems when something is the body is not functioning correctly — and this easily affects the medical approach to caring for pregnancy. In the medical model, pregnancy can be treated similarly to illness, by looking for ways to manage it. Of course, there are instances when conditions surrounding pregnancy may really need medical treatment. It's best when these are managed case by case and not as a part of routine care. Do all doctors follow the medical model of care? No. Some OBs also use the midwifery model, which has been proven most effective in saving lives and reducing maternity and infant mortality and morbidity rates in low-risk pregnant people.
in the middle
The American College of Obstetricians and Gynecologists (ACOG) suggest 14 visits during the full term of pregnancy as a bare minimum. A bare minimum visit can look like 5-10 minutes in the office to get weighed, check vitals, have fundal height measured, deposit urine in a cup and listen to the baby’s heartbeat. Sometimes a birthing person spends more time in the waiting room than actually being seen by the doctor or midwife. But it doesn't have to be that way. Proactive care can reduce preterm labor, reduce the risk of miscarriage and always includes and centers on good nutrition and hydration.
In addition to in-person visits, patients can often leave messages for care providers via a personal online portal. These may not result in extra in-person visits but are important, too.
In a healthy relationship with a care provider, questions are always answered, and the care provider is accessible. Even something as simple as how to handle the common cold or flu might lead to a discussion on increasing vitamin C and D. A question about constipation can lead to the client adding more vegetables to their diet. Mental health checks should always part of the conversation, too, with attention to anxiety that could lead to depression down the line. Even if there aren't any risks of mental health disorders, all pregnant peopel should feel comfortable discussing their emotions with their provider. Common pregnancy ailments and sleeping relief can also be addressed and resolved. You should never feel like a burden.
A prenatal appointment with midwife Christine Taylor of Birth by Grace Midwifery in Georgia. @birthbygrace
the home stretch
At about 37 weeks of pregnancy, you'll start to hear about the possibility of or ways to reduce inductions (starting labor using some kind of intervention) or augmentation (helping labor speed up using some kind of intervention).
Depending on what you want, natural methods can be reviewed and implemented for your labor. Your care provider may talk to you about exercises to open the pelvic inlet and outlet. You may discuss changes to your diet, such as consuming Mediterranean dates or using intimacy and nipple stimulation to promote natural induction or cervical ripening (when the cervix softens in preparation labor). Late term testing according to ACOG and evidence-based alternatives are offered and reviewed.
Dues dates are often discussed at this time, and it's good to be sure you and your care provider are on the same page. Do they see due dates as estimates, or is pressure being placed to have medical inductions?
tests + techniques
One of the things I disliked during my pregnancies many moons ago was being given prescriptions to be tested elsewhere. Traveling several cities away for basic testing and waiting for weeks for results was never fun. It doesn't always have to be that way either. Some providers have ultrasound technicians right on the premises. This means that information about viability; growth and qualitative diagnostics can be performed in office with your doctor interpreting the data. While this may not always cover all needs, it's great when it is available.
Quality testing can be vital to determining risks to the wellness of both a growing baby and a pregnant person. That being said, a patient’s rights are always top of the list. So alternative medicines and treatments are often also given as options.
Many childbirth classes review true informed consent and evidence based birth science and practices. Education is the best way to make informed decisions and be empowered to see your choices through.
referring out to meet your needs
Supporting pregnant people sometimes means referring them to other care professionals who can offer different types of support. Pelvic floor therapy, nutrition and diet counseling, acupuncture, massage, and chiropractic care are all great examples.
These professionals, working alongside your main care provider, can help you reach health goals during pregnancy and set you up for positive outcomes during and after birth.
and what about after the birth?
In the hospital, postpartum care is provided by nurses, who often check-in with patients over a 24-48 hour period before discharge. Birth center patients are often discharged much earlier, between 4-6 hours following birth, but that's not all the postpartum care they're given. Phone calls and/or additional in-person visits are common in the first days after a baby's birth. These help to determine the immediate needs of hte family and babies can be seen by pediatricians within 48 hours. Most clients are seen within the first week of birth and 2-3 times more before the 6th week of postpartum.
It is so important for new parents to have a professional staying in touch with them. Doulas are highly recommended not only as labor support but to offer more postpartum support, too.
above and beyond
Your prenatal care should go above and beyond to ensure that the values and the goals of you and your family are honored. You should have all the options you need to choose the birth that best fits you via the model of care that best fits your needs.
A cohesive unit of care, whether that includes midwives, doctors, doulas, nurses, technicians, nutrionists, chiropractors, or anything more completes a full package of care.
michelle gabriel-caldwell
special thanks to dr. nicola pemberton
and kate keller, cnm for contributing
