"What do you do to monitor me and baby?"

Safety is often a question that comes up in regards to home birth. How do we know if there is a problem? How do we decide when to transfer? What do we do during prenatal care and labor to monitor? These are important questions! Let’s break it down into what home birth midwives do to monitor during each prenatal care, labor, and postpartum.

Monitoring During Prenatal Care:
We see you on the frequency as an OB/Gyn during pregnancy, and we take vitals as a part of every visit to make sure you and your baby are safe and well. 
Here are the things we are tracking:

• Blood Pressure
• Pulse 
• Weight
• Baby’s growth by measuring your fundal height (the distance from the top of your uterus to your pubic bone)
• Baby’s heart rate
• Baby’s position

One of the most beneficial things we look at in midwifery care that is often not monitored in other settings is the position of your baby. Every visit we palpate your belly to feel for the position of baby. If your baby is not in an optimal position as we get closer to the end of pregnancy, we can recommend lots of exercises and techniques to encourage your baby to be in a great position during labor. Positioning plays a huge role in how labor can go, so we pay a lot of attention to it!

We can run standard prenatal blood work, do urinalysis in office, order ultrasounds, and consult with a doctor or perinatalogist if there are any concerning signs in your pregnancy.

Monitoring During Labor:

We check your vitals every 2-4 hours during labor, more often if there is anything concerning. We check blood pressure, pulse, and temperature to make sure you are handling labor well. For your baby, we use handheld dopplers to listen to their heart rate about every 15-30 minutes unless we hear anything concerning. We listen more often if needed and see if we can resolve any minor issues easily at home before recommending a transfer.

Did you know “continuous EFM (electronic fetal monitoring) is associated with many known medical risks to women, without providing any benefit to the fetus in low-risk pregnancies (Alfirevic, Devane, & Gyte, 2006; ACOG, 2009)”? Continuous monitoring requires you to be strapped to a monitor and your movement is quite restricted. We use intermittent monitoring, which allows for freedom of movement, utilizing water, and is adequate in low risk, unmedicated settings to monitor your baby. We are able to follow you around and listen as needed, in water, or out of water during labor.

Monitoring During Postpartum:
Immediately postpartum we are monitoring your blood loss and vital signs and we are also watching baby’s vitals as well. We count baby’s respirations and heart rate, and we assign APGAR scores based on how your baby is transitioning. For the average smooth, low risk births, vitals remain steady and normal for both you and baby, and we monitor for 2-4 hours after birth. If all is well, we go over things to watch for that could be signs of distress for you and baby and we tuck you into bed to get some rest. You have our phone numbers to call at anytime if you have a concern. 

We return in 24-48 hours to check vitals again on you and your new baby. We track your baby’s weight, feedings, diaper output, respiration rate, heart rate, and temperature. We can do the newborn metabolic screen where we take a blood sample to make sure your baby doesn’t have any rare metabolic disorders that need to be addressed early on. We use a pulse oximeter to screen for congenital heart defects and make sure your baby is oxygenating well.

During the first six weeks, we see you and your baby 4-5 times to make sure breastfeeding is well established, your baby is gaining weight normally, and to monitor both of your vitals. We spend a lot of time talking about how you’re coping with postpartum and run labs if needed for you. Each time we see you in those first six weeks, we monitor for any signs of postpartum depression or anxiety, we check in about your bleeding, any pain you’re having, and refer you to any support that may be needed to relieve any problems you may be facing. 

Our monitoring is thorough through all phases of our care, and we are trained to recognize whether you are having a low risk, normal pregnancy, or if there are circumstances that would make it safer for you to birth in a hospital setting.

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