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
• RPR/VDRL
• 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