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
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