TheHolisticParent.ORG Prenatal Care

Prenatal Care

Good prenatal care is important. Of course, 95% of pregnancies are healthy
irregardless of the care received because pregnancy is not an accident waiting to
happen. If you’re receiving care, however, there are things that can be caught and
corrected, so it is pertinent to have at least some basic care. Of course, you can also
educate yourself and do all your own care if you choose. Most people don’t feel
comfortable with this, however, and that’s okay. It does take a lot of work to learn and
know everything to feel confident. I personally enjoyed having a midwife I could discuss
things with. Not all prenatal care is the same however. Midwives and obstetricians
usually provide prenatal care quite different from one another. I personally find
midwifery care to be superior. Obstetricians typically spend 5-15 minutes at each visit.
The visits are far from thorough, and sometimes, so basic in fact that you wonder why
you even bothered going at all. Obstetricians offer all types of sophisticated testing
measures, while ignoring some of the most fundamentally important aspects of
prenatal care such as nutrition. Midwives will spend about an hour with you. Care is
tailored to incorporate all aspects of a woman and meet her particular needs. It is
holistic and complete. While it is true that obstetricians can offer more technology, it
loses a personal touch and is often unnecessary. It is easy to fall into the trap of
thinking that obstetrical care is superior because of all the technology, but with greater
research, it is found not to be. The United States has horrible maternal and infant
mortality rates compared to other industrialized nations.

Instead of listing all the specialized medical tests, what they do, and if you should get
them, I am going to focus more on the care of a midwife. You can find plenty of
information elsewhere about what a physician does for prenatal care. As a general rule
of thumb, if you are healthy and you’re not experiencing complications during your
pregnancy, you can skip all the bells and whistles of obstetric care and go with the
basics of midwifery care, which incorporate the fundamentally important things while
presenting no risk. I assure you midwifery care is more than suffice.

My list presented here is basic. I include things from a typical midwife visit. There are no
bells and whistles, just necessities. I was not tested for GBS during my pregnancy. I
didn’t take a glucose tolerance test. The thought of invasive testing such as an
amniocentesis never even crossed my mind. I didn’t have one vaginal exam. I didn’t
find out if my baby was a boy or a girl (we discovered this the moment she came out). I
didn’t feel inclined towards any genetics testing. My midwife didn’t even need to weigh
me once! All midwives have their own protocols, and the care you may receive may
differ slightly. This is fine. Some of the sophisticated technology may even be legitimate
in some circumstances.

Urine Test

Each time my midwife visited, I urinated on a stick. These sticks weren’t the little low
tech piddly ones I was used to from the hospital. This was like a jumbo killer pee stick.
It tested for all sorts of neat things. My midwife could tell tons of cool stuff from looking
at this stick, including if I had recently had orange juice! She would even spend time
with me, teaching me what each one meant and what it told her. This was fascinating.
This one little test decreased the necessity of some of the other tests performed by
obstetricians. Go over your pee stick with your midwife. You’ll be amazed at what you
learn.

Iron

It is important to watch your iron levels during pregnancy. Your iron doesn’t need to be
tested at every visit, but certainly periodically. If your iron levels are too low during
pregnancy, you run the risk of you or your baby developing anemia. There’s more of a
risk of hemorrhage after birth. If your iron is low, most obstetricians will prescribe an
iron supplement. Some even recommend a supplement even if your iron is within
normal ranges. Iron supplements can cause constipation and are very difficult for the
body to absorb. If you are eating a diet rich in iron, you should not need
supplementation. The herbs nettles and dandelion root are great sources of iron. Leafy
greens have plenty of iron. Fruits and veggies truly do have all the iron you need.

Fetal Movement
How often the baby moves can be an indication of how well the baby is doing in the
womb. All babies have different patterns, and if you pay attention, you’ll soon begin to
understand your baby’s movements. Feeling your baby move is a monumental part of
pregnancy. Most babies tend to decrease their movement when the mother is active.
Usually when a mother lies down to sleep, the baby starts to go wild. At each visit, my
midwife and I would discuss my baby’s activity. If you or your midwife is concerned
about baby’s activity or movement, you can lie down and do something called kick
counts. For one hour, lie down and rest and count how many times the baby kicks. The
baby should kick or move at least five separate times.

Fetal Heartbeat
Each appointment with either a physician or midwife should consist of checking for the
baby’s heartbeat with the exception of very early visits. This is a really special day for
both mother and father. The baby’s heartbeat can be heard as early as 9 weeks in
some cases, but more closely to 12 weeks. If you haven’t heard the baby’s heartbeat by
12 weeks, however, it is not yet a cause for panic. Sometimes due to factors such as
excessive weight, it may take as long as 14-15 weeks to hear the baby’s heartbeat. In
the beginning of your pregnancy, the baby’s heartbeat will be somewhere in the vicinity
of 160 beats per minute. As your pregnancy progresses, the baby’s heartbeat will slow
to a range of 120-140 beats per minute. Your midwife or doctor should discuss these
things with you.

Weight Gain
I wish so much emphasis wasn’t placed on how much weight a pregnant women
gains. To be honest, my weight wasn’t checked by my midwife once while I was
pregnant. Even when a pregnant woman’s weight is consistently watched, some
women still gain up to 80 pounds. While excessive or inadequate weight gain may
pose risks, the advice of what a woman should do is consistently changing. My midwife
and I choose to focus more on what I was eating. She had me keep track of everything I
ate. I would then add up how much protein I was eating every day. We monitored that I
was receiving adequate nutrition and limiting those foods not good for me. This worked
and kept my pregnancy complication free. I weighed myself out of curiosity at the very
end of my pregnancy and found I had gained around 25 pounds. Clearly, it is more
important to be aware of good nutrition than it is to worry about weight.

Fundal Height

Each visit, my midwife would have me lie on my back so she could measure how big
my belly had grown. She also took measurements when I was standing. We compared
these measurements each visit to ensure my baby was growing properly. Fundal
height is the measurement from your pubic bone to the top of your uterus. You should
measure in centimeters roughly what you are in weeks. For example, at 20 weeks, you
should be around 20 centimeters. This can vary as much as two centimeters either
way. If you’re measuring larger, it can be your due date is off, you’re carrying twins, the
baby is breech, you have uterine fibroids, you have gestational diabetes, too much
amniotic fluid, you have looser abdominal muscles, or absolutely nothing. If you’re
measuring a little smaller, it can be baby’s growth is being restricted or there’s not
enough amniotic fluid. Basically, it’s just a measurement to determine if something
warrants further attention.

Fetal Positioning

Ideally, you want to give birth with your baby in the vertex (head down) position with the
baby’s back facing your front. This is called OA or occiput anterior, meaning the back of
the baby’s head is pointing towards the front of your body. Not all babies come out this
way, which is perfectly fine, but this is the easiest position. Babies that are breech have
their feet or bottom facing downwards. Transverse is when your baby is crooked in the
birth canal or turned sideways. 95% of babies will be vertex when they are born. At each
visit, a midwife will fell your abdomen to determine the baby’s positioning. It is easier to
determine the nearer to term you get. Usually one side of your abdomen will be more
firm than the other. This usually indicates the baby’s back is on that side. Conversely, if
one side is softer, that is usually the baby’s legs and feet. It is even possible to feel a
foot, elbow, or other body part on occasion. I always found this part of the visit incredibly
interesting. Remember though, babies can change all the way up until they are born.
Knowing the baby’s position beforehand, however, can be helpful. If the baby is in a
less than optimal position, there are ways to help encourage the baby to move to the
best position.

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