Monitoring Low-Risk Women
FETAL HEART TONES
Fetal Heart Tones (FHT): fetal well being is assessed with a hand-held doppler which will allow the laboring woman to move about freely. The fetal heartbeat can be heard while the belly is underwater! The best way to assess the baby is to listen before, during, and after a contraction. Never will a laboring person experience continuous fetal monitoring and the tight bands they require in the accredited birth center setting.
Pulse: is palpated on the wrist the good old fashioned way: two fingers, your wrist, and a watch. Your pulse is an indicator of well being and is assessed every 3-4 hours and anytime we think our doppler may be picking up maternal pulse instead of fetal pulse.
BLOOD PRESSURE (BP)
Blood Pressure (BP): is assessed with a BP cuff temporarily placed on your arm between contractions. This reading is more accurate & less distracting than taking it during a contraction. It is taken every four hours in a low risk person. It is removed after the blood pressure is taken.
DRINKING + EATING IN LABOR
Drinking and Eating During Labor: a continuous IV is not required. IV fluid with antibiotics may be needed for a person who is group beta strep (GBS) positive, vomiting, fatigued, unable to drink, or if the fetal heart beat is too high or low. If an IV is required, the fluid is delivered & the tubing is removed. The better way to stay hydrated is to drink fluids in labor: water, labor tea, Recharge, coconut water, electrolyte drinks, smoothies, broth, juice. Most people eat during labor to keep their vigor.
NON-EPIDURAL PAIN RELIEF
Non-epidural Pain Relief: in the out-of-hospital setting, epidurals are replaced with other pain relief techniques such as mind-body modalities, use of water, massage, continuous support, and nitrous oxide (also called gas & air). See section in FAQ for a full answer on pain-reduction support in labor.
SITTING ON TOILET
Sitting on Toilet: we prefer having our laboring people use the toilet. The toilet is a great labor spot. Humans are used to “letting it all go” there. A urinary catheter can increase urinary tract infections. Occasionally, they are used for good reasons at Alma: inability to urinate in labor and to reduce bleeding in the postpartum. They are used and immediately removed to reduce the chance of infection.
OBSERVATION OF LABOR
Observation of Labor: Intrauterine pressure catheter (IUPC) or external monitors are replaced with the watchful eyes & ears of an experienced midwife, who can often tell by gentle touch, listening, and labor progress how strong & effective the contractions are. No need to tether a person to a lead to get that information during a low-risk birth. This does require attunement to the laboring pair.