Below you'll find information and resources related specifically to pregnancy, including routine testing, options about your care provider, and simple ways to manage pregnancy aches. Some of what's below is more pertinent to my midwifery clients, and other information to doula clients. My midwifery clients will have opportunities to go over all of this (and more) in prenatal appointments. As always, contact me by text, phone or email with any questions you have.
There are two broad models of care currently practiced: the medical model of care and the midwifery model of care. These models shape how providers are educated and how they practice, as well as the populations best served by each. Consider interviewing different types of providers to get a sense of different approaches.
For low-risk pregnant people, the midwifery model care has been shown to result in better outcomes and greater satisfaction, largely because there is less routine reliance on medical interventions that introduce risk into a normal physiological process.
This one's for my doula clients. Thoroughly research the options available in your area. If you are planning an unmedicated, low-risk birth, then identify a provider or group practice that demonstrates a commitment to supporting you. Don't be afraid to switch providers--they work for you, you don't work for them.
You can learn a lot about a practice by looking at their cesarean rates and VBAC rates and comparing them to other practices. Lower is better! You can also learn about providers by asking local doulas, childbirth educators, prenatal yoga teachers, etc.
If you're interested in genetic screening, ask about Non-Invasive Prenatal Testing (NIPT). NIPT is a recently developed test that pulls fetal cells from maternal blood from a simple blood draw. The test, actually a screen, tells you the likelihood that that your baby has a given disorder (such as Trisomy 13, 18, or 21). It can also tell you the sex of your baby--with 100% accuracy--by 10 weeks of pregnancy. NIPT has vastly reduced the need for riskier forms of testing, including amniocentesis.
The amount of ultrasound (U/S) offered to you will depend on the practice that you're working with.
I offer an initial dating U/S, which is most accurate prior to 12 weeks. This is helpful if you're not sure when your last period started. Around this time I might also suggest an U/S if you've had bleeding or cramping and we want to confirm your pregnancy. If you're doing genetic testing, you may be offered an optional nuchal translucency screen, which measures the thickness of the tissue behind the baby's neck and may identify cases of Down's Syndrome.
Next up is a mid-pregnancy "fetal survey," a head-to-toe visualization of the baby's body that can identify the baby's sex, placement of the placenta, and other features, as well as rare congenital abnormalities.
After that, U/S is unnecessary unless there are questions about whether the baby may be breech, concerns about the pregnancy, or if we want to check in on how the baby is doing if you've gone past 41 weeks of pregnancy (what's called a "Biophysical Profile").
Lots of stuff comes up in pregnancy. Contact me at any point (preferably during business hours, unless you have a concern that needs to be immediately addressed) and I'll give you suggestions for things like fatigue, nausea, restless legs and leg cramps, indigestion, heartburn and so on.
In terms of achiness, it's not unusual to feel uncomfortable as your body changes; things are stretching, squishing, adjusting, and getting heavier. Reflect on your posture and ways you tend to hold your body; are the ways that you habitually holding you body contributing to how you feel physically?
Listen to "Why Body Alignment Matters: What Every Pregnant Woman Should Know" from the Taking Back Birth podcast.
Another practice I find helpful is gentle core and pelvic floor strengthening, which protects the abdominal muscles from splitting, reduces splitting, and restores strength postpartum. The Tummy Team provides simple exercises to protect your core, prevent and heal diastesis recti, strengthen your pelvic floor, and prevent, reduce, or eliminate incontinence postpartum.
Look for a local chiropractor who specializes in prenatal and postpartum care, a pelvic floor therapist, or an acupuncturist.
Prenatal yoga is another excellent practice, which grounds us in our bodies, connects us to our breath, and builds community (though watching videos at home is great too).
Below you'll find information relating to basic lab work offered as part of routine care, whether you're birthing in the hospital or at home with me as your midwife. The information below is meant to provide a quick reference and links, and doesn't take the place of the conversations that we'll have in person with me as your midwife.
For my midwifery clients, the basic information that I need is your blood type and Rh factor, your hemoglobin and hematocrit, and your blood-borne pathogen status. However, standard prenatal lab testing also includes your rubella immunity status. I also recommend checking your vitamin D levels, and possibly your thyroid hormones. I also like to check your iron levels around 28 weeks to make sure that your blood volume is expanding normally.
For my doula clients, vitamin D testing is not routinely offered and is something that you'll need to request if desired.
"All About Prenatal Testing in the First Trimester," Taking Back Birth (podcast)
What do I do if my iron is low? Your iron levels are considered low if your hemoglobin and hematocrit are below the normal range. If your iron is low and you're in an OB or hospital midwife practice, your provider will likely recommend that you take an iron supplement. Iron supplements can cause constipation, which can contribute to other pregnancy challenges such as hemorrhoids. I recommend taking a food based iron supplement, such as Megafoods Blood Builder or a liquid based supplement called Floradix.
Why should I get my vitamin D levels checked out? Recent research has shown that Vitamin D deficiency may be linked to preeclampsia, risks to the baby around growth, immunity, dentition, and bone density, and fetal brain development. It also plays a role in adult brain development and mood disorders. If you live in New England or anywhere with a long winter, and/or if you cover most of your skin or hair when you go outside, then I strongly recommend including this easy blood test.
Do I need to get my thyroid hormones tested? If you have ever had an issue with a thyroid disorder or have close relatives who have, then it's worth checking your thyroid hormone levels in each trimester. Related issues include difficulty getting pregnant or maintaining a pregnancy, and postpartum mood disorders. Check out "Thyroid in Pregnancy" from Aviva Romm.
Gestational Diabetes (28 weeks)
Gestational diabetes screening is offered at 28 weeks and checks to see whether blood sugar is higher than normal. This is typically associated with risk factors (family history of diabetes or gestational diabetes, diet) but can sometimes indicate an issue with the placenta.
If someone has an abnormal value on the GD screen, they will go on to have diagnostic testing. Most cases of borderline or true gestational diabetes can be managed through diet, and some people will need insulin to control it.
Group B Strep (GBS, 36 weeks)
The GBS test is offered at 36 weeks and screens for the level of Group B Streptococcus bacteria. It's normal to have it present in the urogenital tract, but high levels have been associated with infection. When someone is "GBS positive," there is a 1:200 risk of infection for the baby.
There are different approaches to screening and treatment depending on where you birth (or what country). I recommend checking out Evidence on Group B Strep in Pregnancy from Evidence Based Birth for more information.
If you're birthing at home (and we'll discuss this in depth), you can choose not to test, or you can choose to test and then decide whether to treat with antibiotics or take a more "risk-based" approach (as they do in the UK). In the United States, hospital protocol is to universally test for GBS and to universally treat GBS+ status with IV antibiotics in labor, typically at least 2 doses, 4 hours apart.