What Can I Expect From My Birth Attendants?

The following is a description of what you can expect from your birth attendants during prenatal and during the course of labor, delivery, postpartum and newborn evaluation.

Note: The client has the right to decline based on informed consent

During Prenatal:

Birth plans will be made and discussed
Screening and continual assessment of maternal and fetal health will be done. Screening for abnormalities or complications by checking blood pressure, pulse, fetal heart tones, baseline, and variability is determined, urine, weight, edema, position and lie of the fetus, obstetrical, personal, and family medical history taken, and reviewed
Labs and diagnostics discussed and ordered
Physical examination - vaginal and breast exams if indicated

Early Labor:

Walking and normal activity are encouraged as long as no contraindications exist
eating and drinking are encouraged
Sleep is critical. Nap or sleep in-between contractions

Active Labor (4-6 cm):

Attendants are contacted by client with updates on labor progress.
When attendants arrive fetal heart tones (FHT) are taken upon arrival; before, during and after a contraction. Listening for any abnormal declarations or accelerations. Evaluation of baseline FHT's. Monitoring FHTs every hour, and as labor progresses every 15 minutes
Evaluate progress of descent of presenting part, maternal psychological well-being, and fetal well-being
Vaginal exams are offered but will be done upon consent and always discussed with the client first. If membranes have released vaginal exams are not usually performed until signs of active labor are noted. Also with a change in FHT's when there is a strong urge to push.
Blood pressure and pulse will be taken, regularly in the case of unusual situations (v-back, tachycardia, etc.)
Urination is encouraged every hour
Enemas are not given unless necessary (constipation)
Drinking fluids often throughout labor, and eating is encouraged if it sounds appealing to the laboring woman

Pushing Considerations:

Delivery Considerations:

Immediate contact if no fetal distress is present
Immediate care of the baby – APGAR score given, warmth, and suction (suctioning is not routine, only done if secretions are thick)

Placental Considerations:

Spontaneous expulsion is encouraged – within a safe amount of time
The cord is allowed to stop pulsating- before the father or other designated person cuts the cord
Nursing is encouraged as this contracts the uterus and helps to minimize bleeding – we will help get you started
Inspection of the placenta for normalcy and completeness
Care of the placenta after expulsion is reviewed

Immediate Postpartum Considerations:

Bonding - we will give the family time alone for this to take place
Evaluation of the mother's blood pressure, pulse, fundal height, amount of blood loss, firmness of the uterus, alertness, and temperature will be done for two hours postpartum, or until vital signs are stable
Evaluation of newborn
Postpartum and newborn instructions are given before the birth team depart

Additional Information:

Within one to four days, a visitation will be done to re-evaluate all the above plus congenital heart screen and jaundice. Maternal nutrition and supplements are reviewed as well as the hygiene of both mother and baby
The PKU (newborn screening) is offered after the baby has ingested breast milk or formula
A newborn hearing test is available
Other labs are performed or referrals made if necessary
Assistants and students may be performing some of your prenatal, postpartum, newborn and labor assessments.
Your two-week and six-week postpartum visits take place at the office