Care with Geneva Woods Midwifery

Prenatal care is the most important part of care with the midwives. It is quality time spent together discussing your pregnancy and getting to know one another. Women who wish to give birth at Geneva Woods Birth Center or at Providence with our midwives need to receive at least some prenatal care with our midwives. Geneva Woods Birth Center is a ‘closed facility’ meaning that only our midwives have privileges, so having your doctor or your midwife from another practice deliver your baby in Geneva Woods Birth Center is not an option. Our practice does accept transfers of care, even in the third trimester, as long as we have enough time to establish a trusting relationship. When deciding whether to choose Geneva Woods Midwifery for your care the midwives are happy to sit down with you for a brief, no-cost, no-obligation visit to see if we can meet your needs.

Prenatal Care
Women who start their care at our practice generally have between 10-13 visits in a pregnancy, beginning around 9 weeks (or earlier if you have lots of questions). The first visit lasts 90 minutes and the entire time is spent with the midwife who is there to answer all your questions. Each subsequent visit lasts 30-45 minutes. The ‘technical’ part of each prenatal visit takes about 5 minutes. The majority of the time is spent discussing important topics such as nutrition, exercise, stress, and what to expect at each stage in pregnancy, with the emphasis on education and getting to know you and your family as a unit. Care is individualized, and women can choose if they desire more frequent visits or, in the case of many returning clients, less frequent visits.

Testing
With each first pregnancy visit there is a prenatal panel of blood work done and a physical exam. Our blood panel does not include lots of expensive tests that you don’t need. Your midwife will also discuss all the available genetic and anomaly screening tests, and can order testing if it’s indicated. Your midwife will help you sort through the various tests to decide if they are right for you and your family. Between 26-28 weeks gestation we test for anemia again, and do a screening test for gestational diabetes. Women with no risk factors for gestational diabetes can decline this test if they choose. At 37 weeks we routinely offer screening for Group B Strep bacteria.

Induction
Inductions lead to more cesarean sections and this is something we try to avoid. We do not offer elective induction options to our clients before 41 weeks gestation. We do not recommend induction before 42 weeks (except for VBACs) but if a client desires induction after 41 weeks we will assist with that. We encourage the use of natural induction techniques for clients who are either approaching 42 weeks or are trying to get labor started for an elective reason after 41 weeks, such as using a breast pump, herbs and Castor oil. We can also schedule hospital inductions for medical indications. Clients wishing to continue a pregnancy beyond 42 weeks may do so, with the understanding that they are no longer eligible for the birth center, and that we adhere to a more frequent regimen of post-dates testing for prolonged pregnancy.

Scans
We have an ultrasound machine in our office and can perform simple scans such as early dating, and fluid assessments (AFI) if you go over 41 weeks. If you develop risk factors we can do non-stress testing (NST) in the office also, so you don’t have to go to the hospital for fetal monitoring. We will be happy to order a ‘first trimester screen’ and/or a 18-20 week scan if you choose at a local ultrasound testing office or your PPO hospital.

41 Week Testing
Babies born after 41-42 weeks can have problems with receiving inadequate oxygen and nutrients if the placenta grows old prematurely. It is hard to know which babies will be compromised, but we have two tests that we use at 41 weeks to see if the environment in the uterus is still healthy. Most midwives and doctors do this ‘postdates testing’ starting at 41 weeks.

Testing consists of:

1. AFI: This stands for amniotic fluid index. We use an ultrasound machine to measure the pockets of fluid surrounding the baby. Your baby should have at least one large pocket measuring 2.5 cms or a total of 5 cms fluid.

2. NST: This stands for non-stress test. We place you on the fetal monitor and watch for fetal movements. Each time your baby moves the heart rate should increase. We will monitor for a period of time and hopefully your baby will be awake and his or her heart rate will reassuringly increase when that happens.

3. Biophysical Profile: This test is only done if the above tests are not clearly reassuring. The ultrasound technician will look at your baby’s muscle tone and check to see if he or she is breathing.