Prenatal Care With a Midwife: Weeks 4-18

After experiencing prenatal care/birth through both a physician (babies 1, 2 & 3) and a midwife (baby #4) we have chosen midwifery care again for baby #5! To be completely honest, I kind of miss that being our "secret". With my last baby, I didn't broadcast that information - that at 12 weeks we had switched care to a midwife and were choosing to birth out of hospital for the first time. It was a very personal choice and not one that I was open to hearing other people's opinions or judgement about, and I really liked getting to choose who we shared that information with. Also, there is of course, always a chance of that plan needing to change should an issue arise and I guess maybe I didn't want to "jinx" things by shouting it from the rooftops? Especially since that was a new/foreign experience for us. Since it's not really a "secret" this time, I want to share a bit about what my prenatal midwife appointments look like.

I think when people hear that a woman is receiving prenatal care with a midwife, the automatic assumption is that she is receiving LESS care than she would if seeing an OB. (I know I probably thought that at some point in my life!) This is in fact quite the opposite. (Obviously, I'm speaking about low-risk pregnancies, this would clearly not ring true in a high-risk situation.) After multiple experiences with an OB as well as a midwife, I can honestly say that as a low-risk pregnancy person I receive MORE care and attention, both medically and emotionally, through midwifery care than through standard healthcare. Over the course of 1.5 pregnancies, I have really loved not only how personal midwifery care is, but as someone who is fairly practical (and married to someone who is very practical) I really appreciate how thorough it is as well. 

So what does that mean? Before experiencing it myself, I just wasn't sure what to expect. "Does XYZ happen? What about ___? My OB tests for this... does a midwife do the same? What am I 'missing out on' by NOT seeing an OB?? What sort of routine testing actually occurs? Are we just totally winging it with a midwife, hoping and praying everything works out okay? How does all of this work?" I'll start from the beginning...!

Even when choosing a midwife for prenatal care, I personally still prefer to confirm the pregnancy through my OB with an ultrasound. This is mostly because I want to make sure everything is where it needs to be and if anything looks off right off the bat, then I'm already where I need to be to receive medical care (ex. ectopic pregnancy or another condition in which surgery might be required). Also, I DO want to maintain my status as an active patient at my OB's office, so that's a good way to "get a visit in" so they don't drop me as a patient after not seeing me for a certain period of time! So, I did that this time as well. When I found out about this current pregnancy (baby #5), my midwife did run blood work to test my hCG at 4 weeks and we set a date for my first official appointment with her. Then at 8 weeks I saw the CNM (midwife) at my OB's office for an ultrasound. (Though, I declined the bloodwork and STD vaginal swab/pap there at that time, since I had just had a pap a few months prior.)

First Midwife Appointment! - 10 weeks pregnant

At 10 weeks pregnant, I had my first official appointment with my midwife. Ryan was able to be there and somehow we didn't have to bring any kids with us! Each appointment always starts off with a urinalysis and weight check, just like at the doctor's office. I take down my own weight on the scale in the bathroom, and bring the urine test stick to my midwife for her to review. Since this first appointment was the initial intake, we also reviewed my medical history extensively and made sure nothing had changed in the last year and a half. We discussed what I typically eat for meals, how much water I drink and my exercise routines. We talked about how I had been sleeping, how I had been feeling physically and my midwife asked me a few more questions about my current physical health. We talked about prenatal vitamins/supplements and some ways to cope with heartburn! We also talked about my emotional health, how I was coping with the news of this pregnancy and just what had been going on in my life. Then I moved over to the exam table, where a physical exam was done. BP, HR and pulse are always taken at every appointment, but this being the first appointment it was a little more in depth. Then we listened to baby with a fetal doppler (that's abdominal not vaginal) and my midwife took my blood to run some bloodwork. Though, I again opted out of the vaginal swab/STD check, Ryan and I still chose to do genetic testing, so my midwife took additional blood for that as well. 

Note: Some OBs will do a nuchal fold scan (or NT scan) around 13 weeks, but a lot don't. This ultrasound examines the fluid at the base of baby's neck, and abnormal results can indicate a potential chromosomal abnormality. My OB is one that does typically offer this scan, so in the past I was used to having that. This is probably one of the only differences in care that I have noticed in my own experience with an OB and midwife. Since we already opted for genetic testing, and many people that I know personally do not get the 13 week scan, I have never felt concerned with "missing out" on this testing. The results of this particular scan wouldn't affect our decisions to proceed with the pregnancy anyways.

Appointment #2 - 14 weeks pregnant

Without going into too much detail, prior to my appointment there were some things that made that day very difficult. I was really struggling emotionally with feeling like this baby matters or that me or this pregnancy was/is a priority. I had been crying prior to arriving at my appointment, but once I sat down in my midwife's office and she asked me how I was doing I burst into tears again. (Ryan wasn't able to attend this appointment bc he needed to stay with the kids.) We probably spent about 15 minutes talking about what I was struggling with, while I cried and my midwife held my hands, listened and then prayed over me and baby. I then got up to go weigh myself and do the urinalysis. We discussed allll of the results from the bloodwork from my previous visit, went over my diet, water intake, exercise, sleep, etc. from the previous 4 weeks. My HR, BP and pulse were taken, we listened to baby, scheduled my next appointment and then I snapped a picture of the model of how big our baby is currently. 

Appointment #3 - 18 weeks pregnant

At this appointment, I met with a different midwife than I usually do. The birth center that I go to has recently started a "rolling" on call schedule, so of course they want you to be familiar with all of the midwives there! This was my first time meeting with someone else there but it was just as enjoyable. The appointment began with the usual weight check and urine test. We discussed whether anything had changed since my last visit whether with diet, exercise, water intake, etc. HR, BP and pulse were taken and we listened to baby's heart beat. Everything was pretty standard and not much different from my previous appointment. While, I of course missed "MY" midwife I enjoyed getting to meet with someone new! I will be meeting with another midwife next visit as well, but it's actually one that I have a previous experience with ;). Yay! I'm excited to continue to share more about our prenatal care moving forward!

Up next: Anatomy scan @ 20 weeks! 

Continued here: Prenatal Care With a Midwife: Weeks 20-28