Life's Work

Life's Work: Anissa's Prenatal Appointment

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Through the photos and audio clips below you can follow this prenatal appointment between Anissa (mother of four, currently pregnant) and Midwife Rebecca Polston at Roots Community Birth Center on February 5, 2019.

This is a real example of what it looks and sounds like to check in with a medical care provider during pregnancy. While the session flowed without a spoken agenda, for clarity, we break it down into “parts” based on what Anissa and Midwife Rebecca talk about and do.

How this works: Blue links lead to corresponding educational resources. The symbol points to where an audio clip (to the left, or below on mobile) corresponds with the images.


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Part #1: Discussing How Often to Have Ultrasounds

← Discussing the recommendation of weekly ultrasounds for pregnant people over 35 years of age

Pregnant people at or over the age of 35 are often referred to as being at “advanced maternal age.” The risks that come with this can change how someone approaches pregnancy and birth. Here, Midwife Rebecca begins to talk with Anissa about her options based on routine recommendations and Anissa’s exploration and preferences (and this is the resource Midwife Rebecca recommends Anissa look up).

← Anissa asks what the weekly ultrasounds would be looking for

For pregnant folks wondering what kinds of questions to ask during a prenatal appointment, Anissa gives a great example here: “What does XYZ test look for?”

Asking for more detailed explanations of tests, procedures, or recommendations that your care provider talks about can help you understand a process better, ease anxiety about something that makes you nervous, and help you decide what kinds of tests or procedures you want to say yes or no to, if possible.

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← Anissa expresses concern about the amount of monitoring and Midwife Rebecca responds

Both data and research and emotion and feelings play important roles in decision-making during pregnancy.

When Anissa expresses how monitoring can give her anxiety in the clip above, Midwife Rebecca first affirms that yes, it can be scary to go through testing during pregnancy, and then that the purpose will be to encourage more peace of mind by knowing what’s ahead.

Part #2: Discussing How baby is moving

← Discussing how baby is moving and kick counts

Keeping track of baby’s movements during pregnancy is an important way parents and medical providers understand more about how a baby is developing. The easiest, no-technology way to do this is by counting kick counts. Earlier on in pregnancy, a baby’s movements may be small and not so regular, but getting into the third trimester, they’ll become stronger and more predictable— that’s when a pregnant parent will really start counting.

Part #3: Discussing relaxation and mindfulness

← Midwife Rebecca asks Anissa about relaxation and discusses making room for mindfulness

Mindfulness is the state of being fully present and aware in a given moment. You don’t need to buy anything or find a class to begin practicing mindfulness. It’s a very simple practice anyone can do at any time. And research has shown that it can have benefits including helping people cope with pain, reducing stress, and improving moods.

While some levels of stress are normal in everyone, high levels of stress can play a major role in the health of a pregnancy. And though we don’t completely understand how stress affects pregnancy, we do know that it can be connected to pre-term labor, when labor begins before 37 weeks of pregnancy.

So if you’re pregnant and have concerns about stress in your life, whether from work, family, finances, discrimination, or whatever else, don’t hesitate to talk to your care provider about it, and find stress-reducing activities that work for you.

In addition to taking more mindfulness breaks while eating lunch, Anissa tells Midwife Rebecca she’s thinking about doing prenatal yoga, going to see a chiropractor, and getting acupuncture to take care of herself too.

← Midwife Rebecca gives Anissa two tasks: Limit to-do list and reframe the pregnant over 35 narrative

Similar to mindfulness, the kinds of thoughts that we have during pregnancy can make a difference in our experiences. When Anissa says that she feels “this last trimester is going to be hard because I’m old,” Midwife Rebecca gives her a challenge to “reframe that narrative.”

What does that mean? Instead of saying to herself, “It’s going to be hard because I’m older,” Midwife Rebecca suggestsAnissa says, “Isn’t it nice to have the life experience to know that I don’t have to run around?” or “Isn’t it nice to have older children where I don’t have to wipe their butts while I’m doing this?”

Part #4: Answering a Question about Donating Cord Blood

Anissa arrived to her prenatal appointment with three questions she knew she wanted to talk to her care provider about. This is the first one.

← Anissa asks, "What is donating baby's cord blood about?"

After a baby is born, blood flows through the umbilical cord from the placenta to the baby’s body. Blood taken from the umbilical cord at this time is known as “cord blood” and it’s unique because it has stem cells. Most cells in the human body can only make copies of themselves, for example, skin cells can only make more skin cells. But stem cells can become many different kinds of cells, and because of that it can be uniquely used to treat many kinds of illnesses, including some forms of cancer.

Cord blood can be donated or banked. Preparations do need to be made for either decision before birth, so pregnant people considering saving or donating cord blood should talk to their care provider during a prenatal appointment just like this.

Part #5: Answering a Question about Weight Loss During Pregnancy

Anissa’s second question was about some weight loss she’d experienced.

← Anissa asks, "Is it typical to lose weight during pregnancy?"

← Midwife Rebecca's first response to the question of weight loss during pregnancy

While there are a variety of reasons weight loss can happen during pregnancy, the real question when addressing this (or any other symptom or issue in someone’s medical care) is not why can this happen in general, but why is this happening in your specific situation?

Midwife Rebecca speaks to both the more general possibilities and she follows those up with questions that shed more light to Anissa’s specific situation.

← Midwife Rebecca asks Anissa to describe what she eats in a typical day

← Midwife Rebecca continues to respond to the question of weight loss during pregnancy

This discussion about why weight loss can happen during pregnancy opens a new piece of information about Anissa’s experience: gastrointestinal upset, aka, upset stomach, indigestion, nausea, vomiting, gas, etc.

← Midwife Rebecca discusses some options for how they can address Anissa's experience

Anissa adds that she also feels heaviness in her chest at times, not necessarily when she eats, but asks if that could be connected. Midwife Rebecca responds, “Well, I believe everything’s connected.”

← With Anissa's additional symptom, Midwife Rebecca readdresses options going forward

Anissa asks a very practical follow-up question to Midwife Rebecca’s recommendations to switch to a low-allergen diet: “What kinds of recipes should I be looking for?”

← Midwife Rebecca offers more concrete first steps toward a low-allergen diet

As a recap before moving on, what began as a question Anissa brought about weight loss turned into revelations that (1) Anissa has experienced gastrointestinal upset, (2) Anissa has a family history of these symptoms, (3) a blood test to check the health ofAnissa’s liver will be done, (4) a trial of a low-allergen diet will be done, and (5) Anissa and Midwife Rebecca will check in again before her next appointment to figure out how to move forward.

Part #6: Discussing Provider Preference

← Midwife Rebecca addresses provider preference

Whether seeing OBGYNs, midwives, or any other kind of medical professional within a practice, it’s common for pregnant parents to begin to feel more drawn to certain providers over others based on personalities, care-taking styles and a variety of other factors.

Anissa’s third question brings this up to Rebecca, expressing more about her own feelings about who she’s connected best with throughout prenatal appointments at Roots and who she hopes will be able to be present during her birth, and the likelihood of that given Roots’ on-call system. Rebecca candidly and openly responds.

Part #7: Lightning Round Questions

Swelling? Headaches? Visual disturbances? Nausea and throwing up? Vaginal changes? Baby’s movements? Urine? Anissa and Rebecca discuss or briefly revisit these topics before moving on.

Part #8: Discussing Gestational Diabetes Testing

← Midwife Rebecca discusses the why and how to address Gestational Diabetes testing

Gestational Diabetes is a condition that can develop in pregnant people that causes high blood sugar levels. It can impact pregnancy, birth, and even the later health of both pregnant people and their babies. There are multiple ways that people can choose to be screened or tested for gestational diabetes, and evidence has shown that treatment is effective, lowering the risks of potential birth-related complications like large birth weight and shoulder dystocia.

Midwife Rebecca walks Anissa through the definition, risks, and screening options at Roots for gestational diabetes, and later, gives Anissa a printed handout to continue to think about after her appointment.

part #9: Taking Blood Pressure

← Midwife Rebecca takes Anissa's blood pressure

A routine part of care, Midwife Rebecca takes Anissa’s blood pressure before she gets ready to examine baby.

Part #10: Feeling and Listening to Baby

← Midwife Rebecca and Anissa shift to feel and listen to the baby

Midwife Rebecca asks for permission to touch Anissa and talks through each part of this physical assessment.

← Anissa listens to her baby's heartbeat

After hearing the baby herself, Midwife Rebecca hands the stethoscope to Anissa so she can listen as well. It sounds, she says, “Like a softly ticking clock.” Not to be confused with the sound of the softly ticking clock in the appointment room.

Part #11: Recap and Having Blood Drawn

← Anissa has her blood drawn and chats with Midwife Rebecca

Anissa has her blood drawn in this appointment as a follow-up to her discussion with Midwife Rebecca about weight loss and indigestion. Tests that will reveal more information about the health and function of Anissa’s liver can guide future decisions to make sure the pregnancy progresses safely and healthily.

Part #12: goodbyes

With a brief additional recap on next steps, Midwife Rebecca and Anissa say goodbye until they next connect. In total, the appointment lasted one hour and one minute.

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