Selectively choosing standard procedures

[UrbanCrunchyMama]

We're gonna try conceiving Baby #2 soon. (DH is actually more antsy than I am about conceiving sooner than later. Anyway...)

I had a hospital birth last time and realized the hard way that it was over-kill for a healthy mother and baby. We're staying home this time!

In preparation for pregnancy and birth, I would like to research further on common tests and procedures. Here's a (short and) quick list I came up with. What else would you add to it?

(Please feel free to direct me to another thread if this has already been started somewhere else.)

Pregnancy
- Ultrasounds
- Glucose test
- Group Beta Strep

Birth
- Vaginal exams

Immediately After Birth
- Vitamin K shot
- Suctioning of nose and mouth

Thanks,
Lydia

[the_lissa]

Immediate cord clamping and cutting.

[JesiLynne]

During pregnancy, BP and protein in urine, super important in my opinion. PIH is something you don't want.

After birth, the eye drops.

[Mainstream Hippie]

Standard procedures at home birth are different than standard procedures at hospital births. I am including everything, because you will want to research all of it, so you are prepared if you risk out or transfer from home birth to a hospital.

Pregnancy
- Standard pregnancy panel blood screen, including immunities, pre-existing conditions and for STDs
- PAP smear
- Triple screen/ quad screen/ AFP screen
- Ultrasounds - 12 week nuchal translucency, 20 week developmental screen
- Glucose test
- Group Beta Strep
- Urine screening
- Blood pressure checks
- Weight checks
- Fetal heart tones by doppler

Birth
- Vaginal exams
- saline lock, heparin lock, or IV
- fetal monitoring via intermittent doppler, EFM belly band, IFM (IFM is not standard, but something to research)
- electronic contraction monitoring with a belly band
- artificial rupture of membranes
- antibiotics under some circumstances
- birth in lithomy

Immediately After Birth
- cord clamping and cutting
- gentle cord traction
- Vitamin K shot
- Suctioning of nose and mouth
- Hep B vaccination
- prophylactic antibiotic eye ointment drops
- uterine massage
- pitocin injection
- blood stick on the baby for blood sugar if over a certain weight (8 to 8.5lbs)
- blood stick on the baby after 24 hours for jaundice
- blood stick on the baby after 24 hours for PKU
- warming baby on the warmer, doing newborn exam there, including weight and measure
- baby bath

Most of these are standard only for hospitals, I think. You can discuss them all with your midwife, as well, as part of your research.

[barefootpoetry]

The only things my MWs recommended were U/S, glucose test, GBS test, and PKU. We did all of those and the Vit K as well since DS2 had birth injuries. I told them I did not want vaginal exams unless absolutely necessary, and I only had one done during labor because I had started pushing and the MW wanted to be sure I was fully dilated.

[UrbanCrunchyMama]

Oh, I knew you ladies would be on top of this. :

[devon]

One thing I wanted to mention about the Glucose testing - both my midwife and dr (who I am seeing a few times just in case of transfer) has said that new protocols say that if you do not have a family history of diabetes and did not have it in prior pregnancies, AND you had a GTT within the last 4 years during pregnancy that was normal, means you don't need to have the glucose test. I know other dr's are not telling their patients this new research.

[*MamaJen*]

Midwives typically do the PKU/metabolic screening test on the third day after birth. I think you'll find just about everyone supports that one. There's no risk to it -- just a quick heel prick for a few drops of blood -- and it screens for a number of devastating diseases that are very rare but can be sucessfully controlled if caught early.
I think the difference is hospitals do it immediately after birth, and it's more crap that interferes with bonding, while midwives wait a few days.
Also, the eye ointment. I actually wound up doing that, because it seemed to have very limited risk and could possibly avert a nasty eye infection. My midwife used a gel which she said wasn't painful and didn't cloud vision (she tried it on herself) and again, we didn't do it immediately after birth, we waited about three hours.
One more thing to ask about -- I did the glucose test, but it wasn't the whole orange syrup thing. I basically ate a really awesome breakfast that included simple carbs, complex carbs, and protein (say, eggs and pancakes with syrup) and then she did the blood draw right after that. That apparently is just as good an indicator.
Oh, and a few midwives will rupture your membranes. I'd definitely not consent to that unless she had a really compelling reason. My babe was born en caul and I think it made the labor a lot easier.

[DahliaRW]

There are points where MWs will rupture membranes, with the mom's consent, after discussing pros and cons. Though rare. I opted for AROM after 15 hours of labor, facing exhaustion, and stuck at 8cm for 2 hours. Baby was born 1 hour later. But I knew the risk, my MW was confident it would get him out asap, etc. So I think it is good to know the details on all the procedures, even if you think it's really rare.

[*MamaJen*]

Originally Posted by DahliaRW

There are points where MWs will rupture membranes, with the mom's consent, after discussing pros and cons. Though rare. I opted for AROM after 15 hours of labor, facing exhaustion, and stuck at 8cm for 2 hours. Baby was born 1 hour later. But I knew the risk, my MW was confident it would get him out asap, etc. So I think it is good to know the details on all the procedures, even if you think it's really rare.

Yeah, I agree. That's a situation where an intervention actually had a medical indication, and you as the mother were able to give truly informed consent -- because you had done your research well before labor started. Which is exactly why it's so smart to get educated on birth way ahead of time.

[UrbanCrunchyMama]

Original poster here. Where are you reading up on all of these test and procedures? In one book? Or in separate studies in online databases? Where exactly?

Thanks,
Lydia

[DahliaRW]

Both. But one of my favorite "overview books" is Henci Goer's "A Thinking Woman's Guide to a Better Birth".

[UrbanCrunchyMama]

I have Goer's book and skimmed through it again, but it looked like it consisted mainly of birth stuff that would happen in a hospital (e.g. Pitocin induction, C-section for breech, routine rupture of membranes, etc.) Stuff like that. Any others out there simliar in style to Goer's, that covers the tests and procedures we've mentioned in this thread?

Which databases do you use. Cochranes?

[DahliaRW]

Yeah, just glanced and realized that. I have read a lot of articles online and elsewhere by here that covered other things, and I think I was thinking of that. But it's good to review the hospital procedures in case you have to transfer.

[*MamaJen*]

"Pushed" by Jennifer Block is more a political/journalistic book, but it goes through a lot of the interventions one by one.
The Dr. Sears books can be good. You might want to get a copy of The Birth Book.
Evidence Based Maternity Care is long and oriented towards a professional readership, but very good.
And this website, for me, has been a very good jumping off point for research. Of course you can't trust everything you read online, but I've found that the level of knowledge here tends to be really high. It's a good pool of information.

Of course, with a midwife the routine set of tests will be largely different than the hospital's. But one thing to remember is that the crux of midwifery is really supposed to be informed consent. Any good midwife will assist you in finding out the information to make an informed choice.