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

You should obtain laboratory, diagnostic imaging, and other tests or examinations in the following manner:

1. Whenever possible and practical, obtain and use the results of tests or examinations already performed by Kaiser Permanente.

2. When such tests or examinations have not been performed by Kaiser Permanente, or when more current results are needed, obtain them through Kaiser Permanente or Kaiser Permanente contracted facilities, whenever possible. Follow Kaiser Permanente procedures, including the use of the Kaiser Permanente Consultative Specialist Number, when ordering and scheduling tests or examinations.

3. When such tests and/or procedures are carried out at non-Kaiser Permanente facilities, provide copies of their results to the Managed Care Member’s Primary Care Provider, Obstetric Specialist or Pediatric Specialist when requested for consults and according to the terms defined in the Home Birth section of the Provider Manual.

Required tests:

• Hematocrit
• HIV
• Syphilis screen
• 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
• Spinal Muscular Atrophy (SMA) screening
• Varicella immunity, if maternal history of chickenpox or varicella immunization is negative or uncertain
• Cervical cancer screening
• Cystic Fibrosis carrier screening
• Hepatitis C screening

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
• 2nd Syphilis screen at 28 weeks

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