Prenatal Care

Detailed and thorough care through every phase of pregnancy

Benefits of our care

Quality prenatal care is a team effort which depends largely on how well you take care of yourself. But that’s only possible if you have good information so you know how to keep yourself and your baby healthy.

At your first prenatal visit, we will draw standard prenatal labs to determine things like your blood type and whether you have any infections that could impact your pregnancy. We also like to take a more proactive approach to care and will check you for vitamin deficiencies like Vitamin D, B-12, and folate as well as thyroid problems that could impact your baby’s growth and development or increase your chance of miscarriage or preterm birth. We also check progesterone levels on each client at their first visit since low progesterone left untreated can lead to miscarriages and preterm birth.

You will be given our 24 hour call line number at your first visit and you may call our midwives 24/7 with medical concerns. This can make such a difference if you wake up spotting at 22 weeks and you aren’t sure if you should go back to bed, go to the emergency room or rely on Google. Our clients talk about how much of a comfort it is to hear one of the midwives answer the phone, know who you are and what your history is, and talk you through what’s happening, if you need to be concerned or not, and what to do.

Throughout your pregnancy, routine checks to assess you and your baby’s well-being are performed at all your visits, including blood pressure, pulse, weight, urinalysis, fetal heart tones, uterine measurement, and position (once your baby is big enough). At your routine office visits, we discuss diet, exercise and activity, stress, preparation for birth, and answer any questions you may have. We’ll educate you about your current stage of pregnancy and what to expect and what to watch out for. We’ll have suggestions for safe and natural things you can do for common pregnancy complaints and discomforts. Our midwives typically spend 30-60 minutes with you at each prenatal appointment getting to know exactly what is going on in your life and with your health, as well as just knowing you and your concerns, wishes and fears personally.

Labor and Delivery

Our labor and delivery team has years of experience in all birth settings and the midwives have collectively attended thousands of births. We strive to be alert, sensitive, supportive, and professional throughout the birth process. We want you to feel right at home and among friends who know you and care about you when you walk into FBW in labor. We want to know your wishes for birth and accommodate you and your personal preferences as much as we possibly can while still remaining within safe parameters for care.

We recognize that there is a large range of variations to normal labor and do not have a time limit on how long you can labor at FBW as long as you and your baby are doing well and other risk factors are not present.

We do intermittent fetal monitoring, which means that we listen to your baby’s heart beat for several minutes at a time with a hand held doppler on a regular basis throughout labor, rather than strapping a continuous monitor to your belly for labor. We do not routinely place I.V.’s in labor, but they are available if someone needs or requests one. We realize that sometimes vaginal exams can provide us with very helpful information (like realizing that a baby’s head is not presenting correctly and you need to try some position changes, or your cervix is not dilating due to scar tissue and we need to work on that) that cannot be obtained otherwise, but we try to keep them to a minimum and rely on watching you for signs of labor progressing normally. We encourage you to eat, drink, and move about freely during labor. We encourage many different position changes to facilitate your body in moving your baby down effectively. Pushing and birth happens in about as many positions as you can imagine… standing, squatting, in the tub, side-lying on the bed, in the shower, hands and knees – whatever is working best for your body.

Complications in labor or birth

Labor and birth is unpredictable and is impossible to have a certain plan, but we want you to feel empowered and prepared to make decisions and deal with potential challenges that you may face in labor. Many people have their beautiful “dream birth” at Family Birth and Wellness and everything works perfectly, but sometimes labor is faster and more intense than you expected, or labor is far longer and more exhausting than you ever imagined. Or your baby may be presenting in a position that is creating extra pain and making it harder for him or her to fit through your pelvis. Or some unexpected medical complication may arise – perhaps you are showing signs of having a uterine infection during labor, or your baby’s heartrate isn’t responding favorably to the contractions you are having, or your blood pressure is climbing in spite of our best efforts to keep it down. Or perhaps your labor went perfectly, but your baby is showing signs of respiratory distress after birth and it looks like assessment by a neonatologist at the NICU may be necessary. When unexpected things happen, these are the times you really want to trust your midwife and birth team and know that they have your best interest at heart and are alert and knowledgeable about everything going on. And these are the times you want to know that you are getting clear, accurate information about what is going on so you can feel empowered to make the best decisions for you and your baby. If a transfer to the hospital is necessitated during labor or after birth, your midwife normally goes with you and makes sure all of the correct medical information is relayed to the people who will be taking over and also to support you and help you navigate information and decisions. In the event of a transfer, your midwife will call ahead to let the doctor on call know what is happening so the hospital staff are ready and waiting for you as soon as you arrive. Many of our clients tell us how much better they felt about making decisions in the midst of a critical moment when they knew their midwife was still by their side, happy to explain things as needed and continue advising them and helping them stay calm.

Birth is such an emotional and life-changing event and we desire for each client to be able to carry happy memories of their birth experience for years to come.

Pain Management in Labor

“How will I handle labor without an epidural?” is a frequent concern for those choosing to birth outside of the hospital.

Most of the hospital staff and setting are geared around women using epidurals for pain relief there. That is the norm and that is what they are skilled at. The women who choose to labor naturally in the hospital find themselves to be the anomaly, sometimes making the doctors and nurses uncomfortable. At FBW, all we do is natural birth, so labor withOUT an epidural is what we are experts at helping you with! Everything we do keeps in mind that you will be laboring without an epidural and we want to help you be as comfortable as possible.

At Family Birth and Wellness, we encourage you to get into whatever positions are working for you, to move freely in labor, to eat and drink, to have people with you who can support you physically and emotionally, and our midwives have a wealth of knowledge about what positions and comfort measures to recommend, depending on what you are feeling and what stage of labor/position your baby is at.

We provide all sizes of birthing balls and recommend lots of positions that can be done with them to keep you more comfortable.

We have a large walk-in shower with multiple shower heads and plenty of room for you and your significant other, doula, or whoever to spend time in there working through contractions. Some of our moms love sitting on a ball in the shower with the water streaming over their back and their support person providing counter pressure on their back or hips through contractions.

Family Birth and Wellness is close to a nature trail and some moms choose to go walk there in early labor.

Our birth tubs are the most popular choice for pain relief in labor. Approximately 90% of our clients choose to spend at least some time in labor utilizing the tub to relax, reduce pain and distract themselves with the soothing sensations of the warm water. Not nearly everyone stays in the tub for the actual birth, but some do.

We provide essential oils and diffusers in labor, and make recommendations about great oils to diffuse if that is something a client desires.

We also have speakers for your iPhone in each room so you can play your favorite playlist and distract or inspire yourself in labor.

Breathing and relaxation exercises are taught in our childbirth classes and our nurses and midwives will help remind you of these techniques in labor.

Nitrous oxide is another option that some women find very helpful in labor and is available at Family Birth and Wellness. It is the pain relief of choice in much of Europe and unlike IV pain medications or an epidural, it does not have the same effect on baby and has been considered a safer, less invasive option in labor. The mother simply holds a mask to her face and inhales it as needed during her strongest contractions. If they express interest in the possibility, we pre-screen clients prenatally to see if they will be good candidates for using it in labor.

At the hospital, you are typically positioned in a way that is most comfortable and convenient for the doctor - you are typically positioned on your back or semi-sitting with feet in stirrups where the doctor can easily sit between your legs on a stool and deliver. At FBW, we work around what’s working for you as much as we possibly can. If hands and knees is the only way you can stand your back labor, we are going to stretch and reach to get to your belly with the Doppler to listen to Baby’s heartbeat rather than telling you to lay back so the monitor will stay in place and pick up the heartbeat. If you are pushing in a standing squat, the midwife is going to get down on the floor under you and catch the baby. If you are in the tub, we are typically able to do vaginal exams, monitor Baby’s heartrate and catch the baby while you stay right there in the spot that’s working for you!

We will encourage you and help you through breathing or moaning through your contractions in a productive way rather than feeling panicked and screaming.

Fear also amplifies pain. If you are afraid and anxious about what is happening, it makes the physical sensations register in a much more negative way. However, when you feel confident and prepared, supported and loved by everyone surrounding you in labor and you know what is happening and why, it allows your mind to rest and be at peace while you focus on getting through the physical sensations that are happening in your body. As you finish a marathon, it can be painful, but when you remove the element of fear, and instead there is excitement and elation coursing through your body, that incredible thing you just did is typically remembered in a positive way, instead of a traumatizing way. Labor is much the same way.

Your midwives and nearly all of the nurses have all given birth themselves, and they remember what it feels like and can be that reassuring voice when it feels like you are being swallowed in the crashing waves of labor. Just having someone say, “I know” when you tell them how much it hurts or “Just do this next contraction… You can do anything for a minute” or having someone look deep into your eyes and help you breathe through it can ground you and calm you again if you feel like you are losing control.

Very rarely do our clients decide to transfer to the hospital for an epidural because they feel they cannot handle the pain of labor any longer. There are exceptions from time to time when someone experiences an unusually long and brutal labor and decides that the best thing to do is get an epidural. If that is what you decide, we continue to support you by going with you to the hospital and staying with you for the birth and helping you get baby latched afterwards.

Postpartum Care

Once you have had all the time you desire to snuggle and feed your baby, your birth team will help you use the bathroom and get cleaned up. Some of our moms like to soak in a postpartum herbal bath in the tub. If you had a perineal or labial tear that needs repairing, the midwife will numb the area with lidocaine and suture. Your vitals (and baby’s vitals), uterine tone, and amount of bleeding will be assessed every 30 minutes, or more often if indicated during the first four hours after birth. You will be encouraged to eat a delicious meal after the hard work of labor. Sometimes families prepare their own food in the kitchen at Family Birth and Wellness, but many opt for one of the many take-out options close to FBW.

Newborn Care

When your baby is born, we delay cord clamping until the cord stops pulsing, or longer if desired. Your baby goes immediately into your arms, skin to skin with you. We discreetly monitor baby to make sure it is pink and breathing and acting normally, but try to leave you as undisturbed as possible so you can just love on and bond with your baby. The midwife will deliver your placenta and make sure that your bleeding is normal while you focus on the baby.

We try to make sure you are able to latch baby for his or her first breastfeeding session during the first hour after birth when babies are most alert and far more likely to breastfeed effectively. Weighing and measuring and the newborn exam can wait until you’ve had all the time you want with baby! And even then, weighing your baby happens right next to your bed where you can participate and watch. During the newborn exam, the midwife examines your baby from head to toe to make sure that everything looks and functions normally and there are no concerns. She can explain this to you step by step as she does it, if you want to know what she is assessing.

If your baby needs to be resuscitated (needs help getting started breathing) at birth, we don’t take baby across the room to a warmer. Instead this happens with the cord still attached and right next to you or even in your arms if possible.

Breastfeeding Support

Breastfeeding Support – Our midwives and nurses have many years of experience helping mothers with breastfeeding and troubleshooting problems. We assess each baby for anterior and posterior tongue ties as well as lip ties since those can create a lot of problems and pain with breastfeeding. We have an International Board Certified Lactation Consultant on staff if you need a specific lactation consultation visit. And you can reach the midwives 24 hours a day if you are struggling to get your baby to latch and breastfeed correctly. Our goal is for every mom to be able to breastfeed successfully. Almost all of our clients do succeed with breastfeeding, because they have support to get them through the first few sometimes difficult weeks. If you have a history of breastfeeding challenges, the midwives want to discuss those with you during pregnancy and help you make a plan for what we might be able to do differently to help you this time.