A Prenatal Appointment With a Home Birth Midwife

Reader Contribution by Antonette Vasseur
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I am often asked what makes prenatal care with a midwife so different than that of an OB. The Midwifery Model of Care is something that is women centered. It not only focuses on the well being of the baby, but the mother as well, in a very holistic model of mind,body and soul. Midwives treat a pregnancy and birth as a normal life process, not an illness that needs to treated.

A typical appointment with a home birth midwife is pretty routine. Your midwife might come to your home, or you will go to her office. Your appointments can be very personal and private, or can be a family event if you wish! I think being able to have your family there is an important part of the process. It allows every member to feel involved and to be able to ask questions or vocie concerns they may have about a homebirth.
During a prenatal check up with your midwife you can expect to have all, if not some of the following checked:
Urine Test– At my Midwives office the patient gets to do this herself. It’s the first test you get and by handing this to you it shows that you trully are in the drivers seat of your own care. It seems such a small gesture, but you feel empowered that you are a part of your birthing team and not just the oven. A urine test strip tests many things and can allow a Midwife to tell a lot about what is going with your body nutritionally. Are you drinking enough water? Are their traces of protein or sugar in your urine? Your Midwife will go over the results with you.
Blood pressure– Your blood pressure is taken at every visit and compared to your initial blood pressure from your first visit.
Weight– This is something the midwives know you are keeping an eye  (what pregnant woman doesn’t?) so they might not weigh you every visit, but simply ask you what you weight is. They can also gauge just from looking at you if they feel you are gaining enough, to much, or not enough at all. 
Fetal Heart Rate– Your midwife will also listen to your baby’s heartbeat and placenta. You can choose to have the midwife listen with a Doppler machine, or a fetascope, which is a special stethoscope designed to listen to babies in utero. Some women don’t have a preference, and other’s prefer the midwife use only the fetoscope. 
Fundal Height– This is measurement taken with a small measuring tape (think small craft tape from Joann’s) from the top of your pubic bone to the top of your uterus. It is measured in cm and usually coincides with your gestational week. Meaning if you are 30 weeks, your fundal height would be around 30 cm. 
Fetal Position– As soon as your baby is big enough, somewhere around 32-36 weeks, your Midwife will start to check baby’s position. She will palpate your abdomen and feel for the baby’s head and map out the location of the baby. She will be able to tell if baby is head first, breech (butt first), or transverse (sideways). She can also feel if baby is anterior (towards the front of the body), or posterior (towards the back of the body). For more information on Belly Mapping and how to do it yourself at home, check out Spinning Babies
Physical Check In– Your midwife will want to know about any physical symptoms you may have been having, such as nausea, fatigue, and shortness of breath. She will also ask you if you have had any spotting or bleeding. She will want to know about your diet and what you have been eating, and if you have been eating well.
Emotional Check In– This something I feel that truly sets an appointment with a midwife a part from one with an OB. When she asks you “So, how are you feeling?”, she isn’t just talking about aches and pains so that she can diagnose you. She wants to also know how you are feeling, emotionally. This is the time to talk about you. Are you getting enough sleep? How are feeling during the day? What are your emotions about this pregnancy as it progresses? Are you excited/scared/nervous about the upcoming birth? Your midwife can give you suggestions on situations you are having. Your appointments are for you, ask for what you need!
I recently went in for my 32 week prenatal check up with my home birth midwives at Riverside Midwifery. It was nice to see their friendly faces, hear their calm voices and recieve a gentle touch during the stress and chaos of moving to a new home. Baby V’s heart rate sounds good and strong, 150. For those who are playing the “Guess the Gender of Baby V Game” at home, it is said that the fetal heart tone of girls is usually 140 and above. This isof course an old wives tale, but fun to keep in mind. I have had four dreams now of holding a boy after delivering him in the birth pool, so my money is on a boy.
Baby V is head down, and likes to roll from side to side. You can see their but rise in the air and go over to the other side like a wave, making it quite hard for the midwives to get a good fundal height measurement. We have never been quite sure about my due date. I was nursing my daughter at the time that we conceived so I am uncertain what my cycles were, and if they were even normal. My fundal height is measuring much smaller than what my assumed gestational age is. At my appointment I was thought to be 34 weeks, but only measured barely a 30 (meaning the measurement, in cm, from the top of my pubic bone to the top of my uterus was 29 to 30cm). My original due date was July 9th, but we have also had a feeling that I might be due more near the end of July, putting me at 32 weeks instead of 34. Meaning I was only about two weeks behind in my measurement, which is pretty typical for me. At 40 weeks with my daughter, I only measured 37 weeks, and a week later I delieverd a 8 1/2 lb baby. As long as I grow 2 cm by the next visit (2 weeks) we can go ahead and assume that baby is growing just fine, and we probably had the due date wrong. Im confident in my body to give me signs when I am getting close to delivering this baby. Part of planning a home birth is trusting in not only your Midwives, but your own body as well. They trust your ability to birth your baby when it is the right time, so why shouldn’t you?
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