Typical things for a prenatal appointment

[Climbergirl]

Hope this is the right forum to post...

Anyway, I was reading Spiritual Midwifery and she was saying that the midwife should check a whole list of things. I noticed that my midwife is not checking those things (well, we have only had one appointment, but those are the usually more extensive appt). I asked a friend of mine who is using the same midwife, and she said she was not doing those things for her either.

So, the things that are not being done are:
1. checking protein and sugar in urine
2. checking thyroid

#2 could be a big one for my because I have hypothyroidism. I am also boderline hypoglycemic, and have pretty low blood pressure (the reading with the midwife - while I was a bit nervous that she would freak out about it being low - was 88/50).

She also did not talk about doing any prenatal blood work. I am rh- and DH is rh+. My only pregnancy resulted in a rh- baby. Should she still be checking for antibodies? Now, I know I am going to be getting a fair amount of thyroid blood work through my other doctor and am going to give her a copy of all of those. But is this stuff super important?

And what is the nice way to ask why she is not doing these things?

[wombjuice]

At the birth center that I apprentice at, we do not check thyroid hormones unless there is a reason. Your hypothyroidism would be a good reason!

Urine dip sticks are cheap. I do not think that they are always necessary to do at every single prenatal if mama has been healthy with no signs of sugar or protein at past visits. However, first prenatal? Yes, without question.

Prenatal bloodwork is essential to good prenatal care, in my opinion. If for no other reason, the midwife needs to be sure the mama does not have any STD's for both the safety of mama and midwife!

Are you sure the first appointment with your midwife was not just the initial interview, and you will be doing all lab work at the *next* appointment?

There is no mean or nice way to ask. You need to know exactly what kind of prenatal care you will be receiving with this midwife. Just ask her what types of labs she typically orders for her clients. No biggie.

Good luck!

[MommatoAandA]

I think dip sticks should be done at each prenatal, just something I would want as a future midwife from my pregnant mamas and as a pregnant woman. I have felt fantastic and still spilled some protein. Its just a good informational tool to reference from the last one.

ITA with Wombjuice about the Hypothyroidism. I also agree there is no special way to ask. Just ask with a smile and if she is not into testing then you may need to find a midwife with whom you are a little more in sync when it comes to what you do and do not want done at your prenatals. Does that make sense?

Good luck mama!

[Climbergirl]

I also forgot to mention that I am a VBAC. Would that change anything?

I have a consultation with another midwife at the end of the month. Unfortunately, with her, I would have to drive 1.5 hours to see her at every appt which would mean DH would not be able to make most appointments and he will be disappointed. And I have a 2.5 year old, so that will get a bit old. But then, my current midwife may want me to drive an hour to her new office so that may be neither here nor there.

The only other CNMs in the area said they would talk to me if I could not find anyone else because they don't come to my area (even though they are the closest ones to me by far).

I don't want a CPM because they are illegal in my state and I would want someone to be able to transfer with me if I have to go to the hospital.

Argh. I thought I had this all figured out and now I am not so sure.

[phathui5]

I used a CPM when I lived in Maryland and had a good experience.

[WaitingForKiddos]

As someone who has birthed twice with my midwives...

I do a urine dip at each appt.
I get my bp checked at each visit.
At my first appt of the pregnancy we talk about my bloodwork, done when I get my bfp. It's a general blood pannel with hcg count.
Around the time for GTT, 25 weeks-ish, she checks thyroid function and iron.
At 20 weeks there's a scan done at a nice mw friendly OB's fancy machine to check placenta location.

Also done at every appt...
Baby's heatrate
Lots of chatting
Fundal height after 20 weeks
More visiting!

Done at request or if needed..
Vaginal culture...actually I guess I do them. She hands me the swab.
Urine culture
Other bloodwork
Cervical checks

My midwives have a good setup for kids too. Lots of videos, toys, waiting room is kid safe. I've seen lots of kids, little ones too, playing with toys and watching a video as mama is in the exam room.

[sweetsadie77]

Usually in first visits I talk about the philosophy of midwifery care and what to expect from me and then answer any questions a client has. I'll also go through what is part of initial prenatal bloodwork and offer to draw it at the next visit if they choose to have it.
At the second visit I do a health history and offer a physical. If someone disclosed a thyroid issue in the health history or had an atypical thyroid during the physical I would offer a TSH (and copy the results to the family doctor, and tell them to see their family doctor for follow up or med adjustments). If someone is hypothyroid then the recommendation would be a TSH each trimester.
Urine dips.....I don't do them routinely, their is no good evidence to do this, particularly for glucose. I offer a MSU with urine biochemistry and culture in the early second trimester and do dips if a woman has a high BP reading or a history of gestational or essential hypertension.

[splath]

Many offices are not doing urine tests for protein and sugar at every appointment any more. With dd, I was checked at every visit, but my office now does not do them at every appointment.

I did however have routine bloodwork to check vitamin levels, as well as the STD check at my 2nd appointment.

[nia82]

You can buy urine stick at a good price online. I have them at home since I tend to get symptom-free UTIs that I don't notice til they move up to the kidneys! So it is a big help for me to have them at home (my urologist gave them to me).
My family has all sorts of thyroid issues so I asked my family practitioner to do a pre-conception check so I don't have to deal with it during pregnancy (I also had a CBC and checked my immunities). So all those tests won't be done at my first prenatal visit on Thursday. But if you have some thyroid issues, tell your mw and she will check it out.
As far as the other tests mentioned - it's all up to you. I just had a pap smear in December along with STD checks, so I will decline that. Especially since I don't allow internal exams during pregnancy. Never again! My first ob actually didn't recommend swabs in early pregnancy, and I had a preconception appointment for that back then as well. Just easier that way, if it's a planned pregnancy.

[Sijae]

We don't do urine dips routinely unless the mother requests them. They aren't evidenced based or shown to change outcomes. If we have a questions about the woman's health that we need to check urine for, we do a 24 hour urine collection and send it to the lab (much more accurate and indicative of what's really going on).

We do a standard prenatal panel which includes blood typing etc. at the beginning of pregnancy but it's not required and some women don't want it.

Most Rh- women we see do Rhogam which is given regardless of antibody status to protect the next baby. If you were given Rhogam after your last baby then you would be assumed to be fine unless something showed otherwise. On the other hand if a woman wanted to be checked we would certainly do it for her.

If you are worried about your thyroid you should ask to have it checked. It's not something we do unless there is a specific reason.

I just don't consider those two things to be routine for most people. If you have questions about the care they are giving you, you should have an open and honest conversation with them. It's better to communicate with your midwife than get advice from people online. She's going to be at your birth after all and you need to have a certain level of trust in her.

As for how to ask? Just ask these same questions straight out at your next prenatal appt. If she gets offended she shouldn't be in the midwifing business. Remember she is your consultant that you are using at your discretion to assist you with caring for yourself during your pregnancy. You hired her because she is more educated than you but you are still the mother. Better to find out now that you have a difference of philosophy than later.

Laura

[lilmiss'mama]

At my first appointment with my midwife this time & last time they didn't do much examination at all. If you like this person I would definitely see them again and see what happens & if she still doesn't mention anything then ask.
My midwife does not do blood work herself but she did want me to have it done, so I went to an OB for that (plus since it was through the OB my insurance paid for it!)