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Visits are scheduled every 4 weeks until 26 weeks of gestation, every 2 weeks from 26 weeks to 36 weeks and every week from 36 weeks until the birth.

Prenatal care includes: all routine lab work, a complete prenatal check at each visit including:

• Weight
• Blood pressure
• Urine (protein, glucose, and nitrites)
• Fundal height
• Palpation of position of the baby
• Auscultation of fetal heart tones with both fetoscope and Doppler
• Counseling in nutrition
• Pregnancy management and family situations
• Vickie's availability to answer your questions 24 hours per day

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Routine lab work is provided as part of our service at no additional cost.

This includes a standard OB Profile (CBC, type and RH with antibody screen, Rubella immunity, RPR), Hepatitis B screen and screening for HIV.

Additional lab work is available as needed.

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Referrals are available for:

• area midwives
• childbirth educators*
• obstetricians/gynecologists
• pediatricians
• family practitioners
• laboratories
• family centered hospitals
• public health services/programs
• chiropractic care
• birth centers
• lactation consultants

*Childbirth classes are recommended, Bradley classes are taught in our office at an additional fee.

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Call Vickie when you think you are in labor for ANY reason.

Labor monitoring includes:

• Checking maternal vital signs every 4 hours.
• Checking fetal position and heart rate (using the Doppler) every 1/2 hour during latent phase, every 15 minutes during active labor, and with every contraction during pushing.
• Assessment of cervical dilation only as necessary or requested.
• Urine check for ketones every 2 - 4 hours.

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Who May Attend the Birth?

Vickie's normal recommendation is to honor the requests of the mom giving birth as long as they do not interfere with her ability to labor effectively.

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Birth Positions

Vickie's moms have delivered in many different positions. This decision is highly personal, and what may work for one mom may not work for another. Some of the more common positions chosen by her clients include:

• Lateral (side lying)
• Kneeling
• Supine (lying on back)
• Sitting
• Squat
• Birth chair (This is a portable chair provided by Vickie.)
• Birth ball
• Hands and knees

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Avoiding Tears

During crowning of the baby's head, Vickie prefers to use controlled pushing, perineal support and massage with oil, and application of warm compresses. With these procedures, tearing is rare. Tears that do occur seldom are serious enough to require stitches. If stitches are required, Vickie has training, experience, and the necessary protocols to do them quickly in your home.

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Cutting the Cord

Except in an emergency, Vickie prefers not to cut the cord until the placenta delivers.

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Routine newborn care includes:

• Skin to skin contact - baby to mom's chest immediately after birth
• Bonding time with family - time alone for family after placenta delivers
• Infant bath - herb bath with mom if requested
• Neonatal examination - complete physical exam within 2 hours of birth
• Gestational age assessment - at newborn exam
• Administer eye prophylaxis - ointment instilled within 2 hours of birth
• Cord blood sample taken - at birth
• Vitamin K - as recommended by most pediatricians as necessary and prudent

Infant feeding method recommended is breastfeeding, however Vickie will support and advise according to the method chosen by the mom.

Vickie's recommendation for routine pediatric follow-up of the infant is that the parents interview caretakers in advance and follow the advice of the chosen caretaker as to timing of visits after birth.

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Routine maternal care after the birth includes:

Immediate Postpartum

Vickie stays with the mom at least 2 hours after the birth. She does not leave until all is stable, baby is nursing, and mom is having a nourishing meal.

• Checking vital signs, fundus and bleeding every 15 minutes for the first hour and every 30 minutes for the next 1-2 hours
• Shower or herb bath as requested after 1 hour
• Perineal assessment immediately after birth
• Help with beginning breast feeding

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Additional Postpartum Follow-up

• Home visit at 2 days to check mom's vital signs, position of uterus, lochia, condition of perineum and breasts, check of baby's vital signs, color, cord care, sleeping, eating, wet and meconium diapers, and first newborn screening.
• Home visit at 10 days for second newborn screening.
• Office visit at 2 weeks for check of mom's vital signs, position of uterus, lochia, condition of perineum and breasts, and hemoglobin level, check of baby's vital signs, weight, color, cord care, sleeping, eating, and wet diapers.
• Office visit at 6 to 8 weeks for check of mom's vital signs, position of uterus, lochia, condition of perineum and breasts, muscle tone, and a pap smear if needed, check of baby's weight, sleeping and eating patterns, counseling in family relations and birth control.

Vickie performs neonatal blood screening as required by Texas law according to the schedule above. (Go back to top of page.) 

Items provided by the parents includes sheets, towels, clean area for the birth and personal care products for mom and baby.

Equipment Vickie brings to the birth includes:

• scissors
• clamps/hemostats
• speculum
• sterile gloves
• non-sterile gloves
• urine strips
• povidone iodine
• povidone iodine scrub
• alcohol
• fetoscope
• stethoscope
• Doppler
• infant scales
• blood pressure cuff
• birth chair/ball
• peri-bottles
• bowls for placenta
• gauze
• oil for massage
• sterile field paper
• oxygen/resuscitation equipment
• mirror
• heating pad
• crock pot

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We file a standard birth certificate with the state of Texas required by state law after parents have provided and verified appropriate information.