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The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

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Overall Client Care Protocols

If you missed the segment about Orgasmic Birth, aired on ABC"s 20-20 on Jan. 2,
you can still catch the mini-segments:

Birth Orgasms: Women Speak Out - Is it possible to have an orgasm during childbirth?

Women Who Prefer Home Birth - For some, delivering a healthy child doesn"t involve a trip to the hospital.  [Note - the associated article says, "Modern medicine means not having to go through childbirth alone."  It"s more accurate to say "Responsible modern medicine means reserving risky interventions for when the benefits outweigh the risks." I know lots of responsible women who give birth at home with the perfect birth team . . . their partner, their midwife and their doula.  They are definitely not alone, and they have all the medical assistance they need, just like a woman giving birth with a midwife in a hospital!  Savvy people know the difference between midwife-assisted homebirth and unassisted birth.]

The Orgasmic Birth web site also has a lot of great information about birth in general:
Birth by the Numbers
The Director"s Blog
Birth Stories

This page has been blended into General Prenatal Care

Explain legal status of dems in GA
Explain protocol
Explain booklet
Explain birth supplies
Give and discuss diet sheet
Returned diet sheet
Met father
Explain contracts
Returned contracts
Explained birth certificate info
Digital Pager instructions
La Leche Info - 681-0142
Obtain copy of labwork
Circumcision
Eye prophylaxis
Vitamin K
Genetic screening
1 hour challenge for gestational. diabetes
Transport info
Pediatrician info
Siblings-Children at Birth video
Siblings- support person
Explain midwife backup
Discuss RhoGAM & titers
Childbirth classes
Emergency numbers posted
Postpartum care- Doulas 

Initial Discussion

_____Client Info and Consent Form discussed

_____Fees determined

_____Insurance form sent in

_____Diet Discussion/supplements


_____PNV rx?

_____Labs ordered

_____ Referrals (WIC, genetics, DSHS, etc.)


First Prenatal to 19 weeks

_____ STD screening desired?

_____AFP discussion

_____AFP ordered?

_____Diet review

_____Supplement review

_____ Exercise/Fitness


24-26 weeks

_____Discussion of 28 week labs

_____ Begin discussion of childbirth classes

_____Need library books?


28-30 weeks

_____Labs done

_____RhoGAM given, if needed

_____Review Preterm Labor sheet

_____Signed up for classes?

_____Diet review/ Ca+/Iron


32-34 weeks

_____Order birth kit

_____Start working on birth plan

_____Discussion of GBS

_____Discussion of prep tea

_____See videos?


36-37 weeks

_____Meet Debbie (my birth assistant)

_____Birth Supplies ready

_____Perineal Massage

_____Prep tea provided

_____Baby treatments/tests discussed

_____Need circ info?

_____Begin birth control discussion

                Method selected ___________


38+ weeks

_____Discuss/provide pp tea or sitz

_____Finalize contingency plans

        OB Group __________

        OB Hospital ________

        Peds Provider ________

        Peds Hospital _________

_____Finalize plans for PP care

_____Fetal movement counts

_____Arrangements for peds care

GUIDANCE AND COUNSELING

FIRST TRIMESTER SECOND TRIMESTER THIRD TRIMESTER

Hospital-Based Protocol

Routine prenatal appointment:

A prenatal in my practice entails the "clinical stuff" which usually doesn't take very long...pulse, Bp, urinalysis. I ask them if they've gained weight. I ask them how the baby is doing, how it is moving, how active, when, etc. I ask them if they have headaches, bleeding, unusual discharge, edema, nausea or vomiting. I have them to lie on the sofa, feel the baby, teach them the position, listen to the heartbeat, measure the fundus. We talk a lot about nutrition, especially if something is amiss, BP, sugar, low iron, etc, or if they haven't had a very good weight gain, or if I suspect that they don't have access to good food. We talk about natural alternatives for yeast infections and exercises and nutritional solutions for common problems. We talk about the family, children, husband. Sometimes problems in relationships come up. We discuss concerns about friends and relatives hostile to homebirth. At the first visit they have filled out an info sheet, and if it has unusual things on it, abuse, rape, stds, etc, we talk about that. With first time moms, i usually order blood work and find out blood types, etc. We get other lab work done as necessary throughout the pregnancy. I do one vaginal exam before labor, at 37 weeks, mostly to familiarize myself with the client, and to get her use to my touch. I often don't do one for repeat clients at all. That exam is in her own home on her bed, because we do our home visit at that time. Everyone attending the birth comes to that meeting, can ask questions of us, etc, and we can make sure birth supplies are in order. Throughout prenatal care we talk about her wishes and desires for the birth, how she envisions herself giving birth, why she wants a home birth, what she expects of her midwives, etc. We discuss and instruct perineal massage, breastfeeding, and any other questions or concerns the couple may have.

I see my clients once a month until the 28th week, then every other week until the 37th week, then every week until the birth, more often if there are any problems. I'm sure I'm leaving out critical stuff. Prenatals last about an hour. I do many or most in the client's home. Many of the midwives I work with have the couples come to their home or office.

Here is the AP checklist I use, which I got from NACC. I like it because it's pretty inclusive of most everything.

Continuous Quality Improvement Program for Birth Centers

Client Health Record Checklist

Name:
Orientation:

INITIAL VISIT

Draw Labs
AFP
Genetic Counseling, if indicated
Give diet history
Students
Appointments, phone contact
Consent forms discussed
Financial contract signed
Insurance forms signed
New OB pack
Self-care
Danger signs: UTI, bleeding, abdominal pain, cramping, headache
Habits: smoking, ETOH, drugs
Exercise; sexuality
Discomforts
Early pregnancy classes
Met partner
Registration Log/Bulletin Board

SECOND VISIT

Review lab results
Review diet history
Fetal development
AFP drawn
Consent forms signed

20-28 WEEKS

Give pediatrician letter
GTT scheduled/drawn
RhoGam scheduled/drawn
PTL signs
CB class Sibling class
Discomforts
Breastfeeding
OB visit scheduled

30-32 WEEKS

Hct
GBS
Danger signs: cramping, ROM, headache, visual changes
Circumcision
Labor support
Supply list
Fetal movement counts
Braxton-Hicks contractions
OB visit completed
Nipples/breast cups
Peds letter returned

34-36 WEEKS

OB chart review
Review call system
Directions to home
Records to hospital
Emergency childbirth

37-38 WEEKS

Signs of labor
When to call
Newborn prophylaxis
Complications classes
Early Home Care class
Circumcision choice
Birth plan

40-42 WEEKS

PP support
Breastfeeding
Ready for baby
Post-dates routine
NST 

36-Week Home Visit for Homebirth Clients

The Birth Plan meeting at 36 weeks gestation is an opportunity for the woman and her family to be together and talk over any housekeeping tasks before the big day.  It is also a time for the midwife to see the woman in her own space, know where the spare towels, the coffee, the bathroom and laundry are, work out the quickest route to the woman's house and generally focus on the imminent birth.  It is a family occasion and often the couple have invited significant other people to the birth plan so that they might ask questions and give their support to the family.

 


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