Home birth antenatal care

Initial antenatal visit:

  • Complete health history and family genetic history
  • Review of patient orientation information
  • Physical examination, including pelvic (or documentation of recent examination)
  • Discussion of optional screening tests available to the patient
  • Plan of care developed with the patient
  • Lab work and testing (including, but not limited to, tests listed below)

Antenatal lab work and testing

Required tests:

  • Hematocrit
  • Blood type
  • Rh antibody screen
  • Determination of Rubella immunity
  • Hepatitis B surface antigen
  • Hepatitis C
  • Hgb A1c
  • Early GDM screen if:
    • BMI >30
    • Prior baby weight of 4500 grams or more
    • History of GDM
    • First degree relative with Diabetes
    • Ethnicity at high risk (e.g., LatinX, African-American, Native American, South Asian, Pacific Islander)

Tests, as indicated:

  • Urinalysis with culture
  • HIV testing offered and encouraged; risks and benefits of testing discussed
  • Sickle cell prep
  • Varicella immunity, if maternal history of chickenpox or varicella immunization is negative or uncertain
  • Cervical cancer screening
  • Cystic Fibrosis carrier screening
  • Hepatitis C screening
  • Depression screening (2-3 times during pregnancy)

Subsequent visits

We recommend the U.S. Public Health Service schedule of core visits for low-risk pregnancies or the American College of Obstetricians and Gynecologists (ACOG) Committee opinion for a schedule of visits.

As appropriate:

  • Blood pressure, fundal height, and position or lie
  • Auscultation of fetal heart tones
  • Confirmation of gestational age
  • Evaluation of abnormalities
  • Nutritional review and counseling
  • Patients with history of morbid obesity, eating disorders, or both will need an OB-Gyn consultation
  • Rhogam offered to Rh negative women at 28 weeks

Teach and counsel the following topics:

  • Awareness of fetal movement
  • Process of labor and delivery
  • Newborn care
  • Antenatal testing for genetic-risked disease such as Tay-Sachs, sickle cell disease, cystic fibrosis, and option of first-trimester screening for aneuploidy
  • Breast-feeding
  • Family relationships
  • Childbirth preparation, including classes, community resources, and resources for self-teaching
  • Information on possible complications during labor and delivery; the early postpartum period; the time immediately following birth; the first few days of the newborn's life
  • Possible physician referral and hospital transfer: hand-off summary prenatal and intrapartum records and documents to receiving hospital physicians and staff in the event of such transfer

Lab work and tests including, but not limited to:

  • Regular screening for depression with at least PHQ-9 at initial visit, 16 weeks, 32 weeks and postpartum visit
  • Maternal serum prenatal risk screening between 15 and 20 weeks (unless declined)
  • Referral for genetic counseling and prenatal testing for mothers 35 years old or older at delivery (unless declined)
  • One-hour glucose screening test at 26 to 28 weeks for normal risk, followed by a three-hour glucose tolerance test if screening test is abnormal
  • Hematocrit and antibody screen at 26 and 28 weeks
  • Appropriate Group B strep (GBS) screening at 36 to 37 weeks if not known to be GBS positive
  • One ultrasound
  • Other diagnostic tests consistent with care for low-risk pregnancies

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