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Initial
Basic Physical Exam:
You need to plan on spending 1 hour at your first prenatal exam. I
do a very thorough initial exam including the following:
- Labwork-Prenatal Profile (HIV test, CBC, Hepatitis B, Blood
Type and RH, Antibody Screen-Indirect Coombs, Rubella Antibody Screen,
RPR)
- Urinalysis
- Initial History including family medical history, personal
medical and gynecological history, obstetrical history, contraceptive
history, current pregnancy history
- Menstrual History and Determination of Gestational Age
- Height & Weight
- Vitals: Blood Pressure, Pulse, Respirations, Temperature
- Reflexes
- Varicosities/Edema
- Fundal Height
- FHR-fetal heart rate with doppler and/or fetoscope
- Baby’s position
- EFW-estimated fetal weight
- Fetal movement
- Pelvic exam if needed
- Nutritional Assessment & Counseling
- Assessment of emotional status
- Assessment of educational needs
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Prenatal Care:
I schedule an hour each for the rest of your prenatal appointments.
I feel that it is not only important to know how you and your baby
are doing physically, but also how you are feeling emotionally.
I also want to know how well you are sleeping, eating, exercising,
etc… These are important factors in determining how well you
feel. Listed below is a list of the physical assessment that I perform:
- Urinalysis
- Weight
- Vital Signs-B/P, P, Temp
- Fundal Height/Fetal Heart Rate/Fetal Position, Activity and
Growth
- Varicosities
- Edema
- Risk Assessment-any signs or symptoms of pre-eclampsia
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Labor and Birth:
- Labor History-Contraction frequency, duration, and intensity
- Membrane status-intact or ruptured, if so-color, amount, odor, discharge
- Diet-yes, I like for you to eat and drink during labor!
- Vitals-B/P, P, Temp.
- FHR-I listen with my doppler every hour in early labor, every 30
minutes in active labor, and every 5 minutes or more frequently
during pushing
- Fetal Lie, Presentation, and Position-confirm that the baby is head
down and anterior
- Vaginal exams-dilation, effacement, station
- Pain Relief Techniques
I encourage as much family involvement during labor and birth as
is possible. I have a strong belief that there is a great opportunity
for a family to come together during a birth in order to help the
mother through her labor and to witness the birth of this precious
baby. This is a wonderful bonding time. I encourage the mother to
give birth in just about any position she feels comfortable in.
I believe that squatting is one of the best positions for labor
and birth because it opens up the pelvis to allow more room for
descent of baby and results in less tears. I do perineal massage
and apply warm herbal compresses to the perineum to reduce the chance
of tearing, not to mention it also feels great! I coach mom to slow
down her pushing as the head crowns in an effort to allow the perineum
to stretch. As soon as the baby is born, he/she is immediately handed
to the mother and I do all of my newborn assessments while mom is
holding baby. I use a bulb syringe to suction out the baby’s
mouth and nose if necessary. An Apgar score is done at 1 and 5 minutes.
I listen to the baby’s heart and lungs with a stethoscope
to make sure that the baby is breathing well, lungs are clear, and
the heart rate is within a normal range. I carry medical oxygen
with me in case the baby needs a little oxygen in order to "pink
up". I encourage breastfeeding as soon as possible after birth.
Breastfeeding helps to clear the baby’s lungs of any excess
fluid, keeps baby warm and content, and causes uterine contractions
to help birth the placenta.
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Newborn Exam:
A newborn exam is done when the baby is 1 hour old.
- Weight and Length; Head, chest, and stomach circumference
- Vitals-Respirations, Heart Rate, Temperature
- Reflexes-moro, grasp, suck, swallow, sneeze,etc.; Skin-color,
birthmarks, vernix
- Head and neck-fontanels, caput, molding, cephalhematoma; Back-normal
curve, hair tuft
- General Appearance-activity, muscle tone, cry-shrill or high-pitched
- Eyes-placement, reactive; erythromycin ointment applied to prevent
blindness
- Ears, nose, throat-placement, tags, nasal flaring, cleft lip/palate,
webbing
- Chest/breast- retractions, congestion, heart sounds, clavicles,
movement of arms
- Abdomen- rises with chest, masses, umbilical hernia, cord treatment
- Genitals-well developed, discharge in females, testes descended,
urethral meatus position, urination; Anus-patent, meconium
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Postpartum Care:
I stay after the birth for at least a minimum of 2 hours. By two hours
postpartum, all vitals of mother and baby will have returned to their
normal range. I make sure things are cleaned up-wet towels, sheets,
and blankets are in the washer, and you have eaten. By the time I
leave, you and the baby are tired and need your rest, not to mention
the rest of the family! I leave a Postpartum Instruction Handout that
includes a lot of information about what is normal during the immediate
postpartum period and what is not. I am still on call for you 24/7
for the first 2 weeks following birth.
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36 Hour Postpartum Checkup
- Baby-Wt. & Length
- Vitals-Respirations, Heart Rate, Temp.
- Abdominal Measurement
- Cord-check for proper healing and for any sign of infection
- Wet Diapers & Meconium
- Activity-sleeping, nursing, general appearance
- Newborn Screen
- Mother-Vitals-B/P, P, Temp.
- General Appearance-sleeping, eating
- Elimination
- Uterus- uterus firm and proper involution (shrinking)
- Lochia- Bleeding is within normal range
- Perineum-healing well
- Breasts- how well breastfeeding is going
- Nipples- any soreness
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Two Week Postpartum Checkup:
I do the same assessment as listed above
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Six
Week Postpartum Checkup:
I do the same assessment above, including a Pap Smear-
(lab
fee for pap is $35.00)
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