Prenatal care
We will create a prenatal visit schedule to meet your needs, with up to one visit per month through month seven, two visits during month eight, and weekly thereafter until birth. Unless otherwise arranged, prenatal visits are held at Alma Birth Center. Your midwives will spend about an hour with you at each visit. Care provided during visits includes measurements of pulse, blood pressure, fetal heart rate, urine, uterine growth, fetal position, physical changes and complaints, medical and obstetrical history, nutrition advice, and other care when indicated such as gyn exams and cultures or hemoglobin checks for anemia. In addition to checking these physical factors, we can talk about any emotional or social issues, stresses, and dreams or hopes you have. We will supply the information you need to make informed decisions about your care, including prenatal testing. To help us become acquainted with your location, a home visit is planned around the 36th week of your pregnancy. If your partner is handicapped and wishes to participate in your care we can do all of your visits in your home. Also, let us know if you desire a handicapped friend or relative to attend an appointment, which can also happen in your home. Other people whom you have invited to attend your birth should come to meet us at the home visit.
Laboratory Testing
You are strongly recommended to have the following laboratory tests during your early pregnancy: Complete Blood Count (CBC), Blood Type and Rh Factor, Antibody Screen, RPR (VDRL) test (for syphilis), Hepatitis B screen, Rubella (German Measles) screen, and a random glucose. These are all performed at once, from a blood sample. We will supply you with information to make informed decisions about all testing available. Genetic screening tests such as the Triple Screen are available through our lab; amniocentesis is available through referral. Other tests, such as glucose tolerance testing, vaginal cultures, PAP smears and spun urinalysis can be ordered as needed. We use Quest Labs for tests or you can use your insurance-covered lab. Ultrasound imaging is not performed routinely, but can be obtained if indicated through Epic Imaging.
Equipment
We will supply the instruments and equipment necessary to provide prenatal care, facilitate a vaginal birth, evaluate the newborn and provide postpartum and well-woman gynecology care. We also provide equipment for emergency resuscitation (bulb syringe, a suction device, oxygen, bag-valve-mask set-up), to manage unusual bleeding (herbs, medications such as Pitocin and methergine), to treat shock (IV kit) and to suture perineal lacerations, including topical anesthetics.
Supplies
We will provide you with a list of birth supplies you must provide for your birth. These should be gathered at least four weeks before your due date. A birth kit can be ordered from a birthing supply company, which can be supplemented by additional supplies or you can gather everything yourself. If you are birthing at the Birth Center most items are supplied for you.
A midwife palpates the mother's uterus to feel what position her baby is in. |
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Childbirth Education Classes
Childbirth classes are available through Alma Midwifery. They are not included in the birth fee. Check out our community page for more details of upcoming classes, or ask the midwives. Referrals are available to other educators in the Portland area if you so desire.
Labor
We encourage our clients to call as soon as they are in early labor. During early labor we encourage women to eat and drink lightly and proceed with normal activities so long as you don't over-tire. Labor discomfort is alleviated using relaxation, position changes, breathing, use of warm water immersion, emotional support and other non-medical comfort measures. Pain relieving drugs are not safe options out-of hospital. By the time you require concentrated labor breathing to maintain comfort, it is time for one of your midwives to come to your house (if a homebirth is planned) or for you to come to the Birth Center. This allows plenty of time before the birth is imminent and provides ample monitoring of mother and baby during the most stressful parts of labor. Monitoring usually includes regular checks of fetal heart rate, and mom's pulse and blood pressure. We do not regularly perform vaginal assessments of the cervix, but will as necessary.
Birth
Give birth in the position that is most comfortable for you, surrounded by as many supportive friends and relatives as you desire. Use of water during labor is encouraged, it can help you relax while making labor contractions more effective and less painful. The birth itself can occur in bed, on the birthing chair, in water...wherever you wish. If you choose to have your children with you during the birth, someone of your choosing, that your children are familiar and comfortable with should be specifically appointed to care for their needs. Perineal support and warm compresses are used rather then an episiotomy (a cut in the perineum) to allow for the gentle birth of your baby. The cord is not usually cut until it has stopped pulsing, often not until after the placenta (afterbirth) is born. Newborn suctioning is not usually necessary. The infant is placed across the mother's stomach or in her arms for welcoming and breastfeeding.
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Mom and Dad welcome baby during a home waterbirth. The Midwives monitor Mom and baby's health without separating them from each other. |
Postpartum
In the immediate postpartum we will closely monitor the mother's condition, while being as unobtrusive as possible. After the placenta is delivered, we encourage a family bonding time. Your baby is thoroughly examined and eye prophylaxis and Vitamin K are administered, unless declined. At least one midwife and an assistant will remain approximately three hours after the birth, longer if needed. Return visits to your home usually occur at one day, three days and seven days. Additional postpartum visits occur at two weeks, four weeks and six to eight weeks at Alma Birth Center. These visits consist of weighing, measuring, snuggling, and taking your baby's pulse and respirations. We will also make sure mom's recovery is going smoothly, both physically and emotionally.
Breastfeeding
Breastfeeding is highly recommended, as it is extremely beneficial for both mother and infant. Nursing your baby will decrease the risk of postpartum hemorrhage, infections, newborn jaundice and improve your baby's weight gain. We will assist you with breastfeeding advice and support as needed.
Medical Back Up
We will make a personalized back-up plan to be followed in the unlikely event that medical transport is required during labor. Your back-up plan will be based on your unique circumstances: closest hospital, insurance coverage, finances, medical services required, and location of preferred physician, if any. It is rare for a transport to be a true emergency situation.
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~ ALMA Midwifery Service ~ Licensed Birth Center ~ Homebirth ~ Waterbirth ~ ~ Phone 503.233.3001 ~ FAX 503.233.7686 ~ 1608 SE Ankeny St. Portland, OR. 97214 ~ |
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