Serving San Antonio, Elmendorf, Floresville, Pleasanton,
La Vernia, and surrounding areas of South and Central Texas
Prenatal care is an integral part of the service we provide. Visits are scheduled every 4 weeks until the 28th week of pregnancy, every 2 weeks between 28 and 36 weeks, and then weekly until birth. Evening and weekend appointments are available. Family and friends are welcome during your visits. We enjoy meeting your 'birth team' during your pregnancy!
You will need to plan on spending about 2 hours at your first prenatal visit. Medical and obstetrical histories are taken and a physical exam is done. This allows the midwives to determine that you are low risk for complications and are a good candidate for a home birth. There will be plenty of time for talking and answering questions. At this visit and at all subsequent visits the following are done:
- Measurement of blood pressure and pulse and urine analysis
- Nutritional assessment and weight
- Assessment of any swelling
- Screen for signs or symptoms of infection or illness.
- Monitor the growth of the uterus (fundal height) and for normal growth of your baby
- Position of the baby
- Monitor and assess baby's heart rate and rhythm
- Monitor and assess baby's movement and activity level
- Other: common discomforts of pregnancy and remedies, emotional concerns, and anything else you or I believe needs addressing
- Laboratory testing as needed or required
Ultrasound is available but not done on a routine basis. I'll provide you with a referral for a sonogram if you choose, or if something arises during your pregnancy that we feel warrants diagnostic ultrasound.
At about the 36th - 38th week of pregnancy your midwife and any assistants will come to your home to make sure we know how to get there. We make sure all birth supplies are ready and that a transport plan is in place in the event a complication arises during labor which necessitates moving to a hospital for birth or treatment in the immediate postpartum period.
If you prefer to have prenatal visits in the comfort of your home this can be arranged.
Labor and Birth
Every labor is different and you will receive individualized care appropriate to your situation. We do our best to honor your wishes.
Both you and your baby will be monitored frequently during labor to assure that all is proceeding normally. All vital signs, urine analysis, nutrition status, membrane status, contractions, etc will be checked, and the baby's heart beat will be assessed. We normally use a doppler during labor although we are trained in the use of a fetascope if you prefer. You will be encouraged to remain active, moving at will and resting when necessary. Food and drink intake will also be encouraged since nourishment is vital to fuel your body. Labor is hard work!
Measures to help with discomfort will be utilized as necessary. Relaxation, massage, position changes, and the use of water are some of the common measures used to help you remain comfortable. You will receive lots of encouragement and support! You can do this!
You can choose any position or method, including waterbirth, in which to give birth to your baby as long as everything is proceeding normally. There is no need to hurry the birth as long as both you and your baby are doing well. We do not do episiotomies unless there is a real emergency that warrants it. We will guide you through the birth and assist as needed to prevent or reduce tears.
We believe strongly in the importance to our babies of a gentle birth and gentle transition from life inside the womb to life out here! Rarely is there any need for anything other than gentleness. We prefer for lights to be lowered and for there to not be a lot of loud background noise. As soon as your baby is born he will be given to you to hold. Normal newborn assessments, including APGAR scoring, drying, warming, stimulation, etc, can be managed just fine with your babe in your arms. We do not cut the umbilical cord until it stops pulsating. Most un-drugged babies are very alert right after birth and will nurse at this time, and we do encourage trying! It's good for your baby and good for you too. Nursing will stimulate your uterus to contract, helping you to not bleed more than normal. Once the placenta is born your birth is complete!
Midwives are trained to manage emergency situations that occasionally occur during labor, and are skilled in the art of preventing of complications. However, in the event of a complication during labor you may transfer care to our private back-up OB, Dr. Mayank Pandya.
The Immediate Postpartum Period
Both you and your baby will be closely monitored following birth. We'll do a complete head-to-toe examination and a gestational age assessment on your newborn, usually before the baby is two hours old. Your vital signs and bleeding will also be closely monitored. We never forget the importance of this time of family bonding and getting to know one another and try to keep assessments as unobtrusive as possible.
We normally remain with you in your home for 3 - 5 hours after birth. We will make sure you can urinate and have eaten. Complete instructions for your care will be given prior to our departure. We will also be available to you by phone 24 hours daily.
We love water birth! I am in awe of the calm and gentle birth these water babies experience. If you are interested in a waterbirth please follow the link for more information, or visit the Birth Options page. We can make arrangements for a birthing pool rental if necessary. Water births are also available at the birth center.
Vaginal Birth After Cesarean
The theory that mothers and babies would be better off with a repeat cesarean section vs. VBAC has proved to be wrong, and in fact, studies show that mothers and babies do significantly better with vaginal birth.
We completely support a mother's right to choose a vaginal birth and do accept VBAC clients. If you have had a previous cesarean and would like to birth your baby vaginally please follow this link to read more about VBAC or visit the Birth Options page.
Complete postpartum and newborn care is provided in the first six weeks after the birth. At each visit we exam both mother and baby. We check mom's vital signs, general appearance and mood, nutrition, elimination, uterus, lochia, and perineum. We will also discuss breastfeeding and how it is going, and anything else that needs to be addressed. We will re-examine your baby, doing another complete exam. I will also be assessing for respiratory difficulties, infection, jaundice, elimination, cord stump, measurements, feeding, and weight gain. We also perform the newborn screening tests as prescribed by state law.
Your baby's birth certificate will be filed within 5 days after birth as required by state law.
The Birth Center
We no longer offer birth center births for our clients. However, for some women, having their baby in a birthing center may be a more comfortable or convenient option than birthing in their home. The San Antonio Birth Center, located at Wurzbach and Babcock Rd, is now open,
asproviding families in the San Antonio area one more option when choosing their birth location.
Well Woman Care
Reasonably priced PAP testing for abnormal cervical changes, gonorrhea, Chlamydia, and HPV (most common cause of cervical cancer), and breast exams, are available. These are normally performed at your 6 week postpartum visit. If you have an abnormal result you will be referred to a physician or nurse practitioner for follow-up care.
Home birth preparation classes are included in my fee. These classes are designed for my clients planning a natural birth at home, although if space allows others may attend. If you desire more comprehensive birth preparation classes they are available through private childbirth preparation teachers. First time parents may especially benefit from more extensive classes.
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Fees and Insurance
Read here for basic information on my fee for maternity services, what that fee covers and doesn't cover, billing and insurance policies. Please contact me if you would like more information.
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Midwifery Services of South Texas
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