How often do you do prenatals- esp. at the end? - Mothering Forums

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#1 of 11 Old 04-09-2007, 10:52 PM - Thread Starter
 
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Dear midwives I am in need of some perspective. I am wondering how often do you administer prenatals, especially when it comes to the end of pregnancy. I am also curious if this differs for you whenever your client is receiving concurrent care. I am seeing an ob as well as a dem due to the licensure laws of the state she has stated it is very difficult for her to obtain rhogram and I am rH-, of course I may or may not need it this go around, but already had a relationship with this ob from my previous birth. I also wanted to see him in the off chance I need a transfer I won't be stuck with one of the many ob's in town that I personally feel are either incompetent, or greatly lacking in bedside manner.

Happily Married to my : 11 yrs- Mama to wild-eyed monkey boy 7-04, fiery little girl 4-07, and the happy smiley baby that sleeps 11-09!
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#2 of 11 Old 04-09-2007, 11:14 PM
 
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I usually do weekly appts after the 36 week home visit.
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#3 of 11 Old 04-09-2007, 11:18 PM - Thread Starter
 
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I usually do weekly appts after the 36 week home visit.
would that change at all if your client was doing concurrent care?

Happily Married to my : 11 yrs- Mama to wild-eyed monkey boy 7-04, fiery little girl 4-07, and the happy smiley baby that sleeps 11-09!
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#4 of 11 Old 04-10-2007, 12:27 AM
 
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Not a bp, but I'm also receiving co-care at the birth center and my hbmw still comes weekly. HTH
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#5 of 11 Old 04-10-2007, 01:49 AM
 
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would that change at all if your client was doing concurrent care?

it would depend on if she wanted to see me that often, BUT

the "care" women receive from an OB is vastly different than what she'd receive with a midwife. Plus, I value prenatal care with a midwife as being more abotu knowing what she wants for her birth, building trust and communication skills, etc. If it was just about peeing in a cup or doing blood pressure then it would be a non-issue. It's not. I'm not going to push her to do vaginal exams or tell her how "huge" her baby is getting, but you can bet she'll get that kind of "care" in most OB offices in the last month.

So for me, I am adaptable based on what a woman wants, what she feels she needs and what I need as her midwife. It is very different from woman to woman.

But based solely on her seeing an OB, then no, it wouldn't change my desire to see her more often towards the end. If for nothing else to pick up the pieces of doubt that have been instilled by the medical model so close to her birthing time.
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#6 of 11 Old 04-10-2007, 02:08 AM
 
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when I practiced without a license- and we had women do concurrent care- we still saw moms on a weekly schedule starting at 36 weeks.
There were some moms we knew well that were 3rd or 4th births we did for them and some didn't always have the time so didn't want to see us as much.. but for the most part we followed a regular schedule.
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#7 of 11 Old 04-10-2007, 06:34 AM - Thread Starter
 
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Originally Posted by pamamidwife View Post
it would depend on if she wanted to see me that often, BUT

the "care" women receive from an OB is vastly different than what she'd receive with a midwife. Plus, I value prenatal care with a midwife as being more abotu knowing what she wants for her birth, building trust and communication skills, etc. If it was just about peeing in a cup or doing blood pressure then it would be a non-issue. It's not. I'm not going to push her to do vaginal exams or tell her how "huge" her baby is getting, but you can bet she'll get that kind of "care" in most OB offices in the last month.

So for me, I am adaptable based on what a woman wants, what she feels she needs and what I need as her midwife. It is very different from woman to woman.

But based solely on her seeing an OB, then no, it wouldn't change my desire to see her more often towards the end. If for nothing else to pick up the pieces of doubt that have been instilled by the medical model so close to her birthing time.
Thank you for putting into words what the care of a mw is supposed to be about. That is/will be very helpful to me.

One more question. For anyone willing to answer (please) would that change if you client was exhibiting no problems- I have absolutely no water retention, my HIGH bp has been 110/70, singleton pregnancy, ROA, no other medical conditions, normal weight gain-35lbs. I am assuming that most clients don't since hb's are generally for low risk mamas, but I really do not know what is normal for mw's as there just aren't any of them around here.

Happily Married to my : 11 yrs- Mama to wild-eyed monkey boy 7-04, fiery little girl 4-07, and the happy smiley baby that sleeps 11-09!
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#8 of 11 Old 04-10-2007, 06:37 AM
 
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Woman centered care is what we offer-
We see a woman once a week after 36 weeks and sometimes more often, if there is a problem or concern then I want to see a woman to rule out or work on that - and if a woman needs to skip an appointment fine up to her to a point not seeing a woman for a month at the end would cause me to be very uncomfortable -- is she checking her bp?heart tones? is she prepared/preparing for the birth? what else does she have going on?
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#9 of 11 Old 04-10-2007, 07:03 AM
 
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Most women are seen monthly until 30 weeks. At that point we ( the midwives ) see you ( the mommies ) every 2 weeks until 36 weeks. From that point you are seen weekly until you go into labor.
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#10 of 11 Old 04-11-2007, 08:13 AM
 
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I agree with the others--both on weekly visits starting at/near 36wks, and on homebirth midwife care being very different from OB care. Besides, for me, being a homebirth midwife means having a pretty close, warm relationship with my ladies/families. I find that in those later weeks, when seeing each other more often, is when our relationship really starts to come together in the needed ways. Hopefully, up to that point we have already begun to get to know each other, but those final, more frequent visits do add depth to our connection, to our trust and understanding with each other....and since birth is nearing, it is also when things are more likely to come up for the mom/family that may have seemed unimportant before, or just did not occur to anyone before that time. Not so much physical issues as emotional ones and/or preferences about the birth...we start talking much more in depth about birth and baby, people's roles at the birth, fears, expectations, wishes, changes to original plans for birth (like, who will be there, what will their jobs be)...so many possible things. There is a growing sense of becoming a team, that building excitement/anticipation...and the chance to cover anything at all that might not have been as well-addressed earlier as we now understand it needs to be covered.

Only once have I gone with a fam's wish to skip some of those weeklies--and I regretted it. The birth actually went fine, but dad just really wasn't as well prepared as he should have been. There were also so postpartum issues that I think could have been avoided. All in all, everything was ok--and both parents were intensely pleased with their birth. Still, I wished later that I had been a bit more firm about having those weekly visits (well, they did start care fairly late, so that might have made a difference, too). But at least this fam was willing and able to do mom's b/p and babies heart, and to stay in touch by phone. I do want to know just how both mom and baby are doing at the end, to be prepared for any changes in their status as can occur in the final weeks.

The main things seem to be: how happy are you, right now with the care situation and terms, and your level of trust with your midwife? And then, after the birth--I will wonder if you are still happy with that, or if you have realized through events that too much was taken for granted, and not enough care was provided, or not enough building of trust and good communication with your midwife--?

best!
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#11 of 11 Old 04-11-2007, 01:32 PM
 
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I've totally been ok with clients to stretch out their visits to every other week, etc. It's their decision.
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