Gentle Arrival Midwifery

Introduction: Services: * Prenatal care The experience of midwifery is quite different from the obstetric model of care. We combine the best of the current evidence-based practice, yet keep your birth personal. We provide an initial consultation to discuss your desire and expectations for home birth. At your first prenatal visit, we do the medical portion of the visit, and also go over any choices available at that point in your pregnancy. We offer the same genetic screening, blood tests, ultrasounds, and newborn procedures as you would be offered when seeing a hospital-based care provider, but these are always optional and never required. We believe in informed choice, and trust that if we provide our families with the information needed to make decisions, you will choose what is right for you and your family. We offer initial prenatal visit, including a full medical history, nutrition and lifestyle counseling, and physical exam. We offer routine laboratory testing, and we are available to clients by phone and e-mail for questions and concerns. Prenatal visits are offered every month to 28 weeks, then every two weeks to 36 weeks, then every week until delivery, or as necessary according to your individual needs. Home prenatal visit is at 36 to 37 weeks. Medical consultation and referral are available as necessary. We have an extensive local resource network available for doula services, childbirth education, massage, chiropractic care, etc. * Labor and birth: When your labor begins, the personal care and attention that you will have come to expect at Gentle Arrival Midwifery continues. Your midwives are on call for you, and will plan with you when it is the right time for us to come to your home. Through experience and research, we have learned that women do best surrounded by people they trust in a comfortable environment. Birthing at home means you can control your environment, and can include candles, food, music, children, loved ones, and whatever you need to feel comfortable and safe. Home birth services is from 37 weeks to 42 weeks of pregnancy. We offer round-the-clock availability of the midwife, and continuous care and support during active labor and the birth. We offer water birth - labor and/or deliver your baby in a birth pool. Qualified midwife and birth assistants to assist during the birth. We offer continued support by the midwives in the hospital if transfer is necessary. * Postpartum care for mother and baby: Postpartum care is one of the things that makes midwifery care so different from care you would receive when seeing a hospital-based provider. We ensure mom and babe are comfortable and recovering well, and the baby is nursing prior to leaving. We will do a visit within 24 hours of birth to reassess you and your baby’s status, and provide any newborn testing you desire within the first week of life. We will continue to be available, and provide referral services through the first three months after a birth. This is often referred to as the fourth trimester, and we believe that the length of our postparum care is a helpful tool in monitoring for postpartum depression and continuing breastfeeding support, along with any other issues that may come up in your postpartum journey. We offer continuous care and support by the midwife team in the immediate postpartum period (3 to 4 hours after the birth), complete physical exam of the newborn after birth, administration of vitamin K and eye ointment for the newborn, and breastfeeding support. We also offer postpartum education and informational handouts for the new family. We are available to clients by phone for questions and concerns. We also do regular postpartum visits for the mother and baby, newborn screening tests, and we provide extensive local resource network available for postpartum doula services, breastfeeding support, parenting groups, chiropractic, massage, etc. * Well-woman gynecological care: Gentle Arrival Midwifery offers well-woman exams and gynecological exams, including pap smears, and evaluation and treatment of STIs, common vaginal infections, and a full range of contraceptive options including hormonal birth control. We provide gentle and respectful gynecological care for women, preconception care, and education concerning a woman's body and fertility. For most women, the reproductive years persist for some 30 to 40 years. If you choose not to have children for at least part of that time, then you will need to make some decisions about contraception, or the prevention of a pregnancy. However, with so many contraceptive options now available, finding the method/s that are right for you can often be challenging endeavor. Gentle Arrival Midwifery will take the necessary time to discuss your unique reproductive circumstances, and help you find the contraceptive method/s that best support your health and lifestyle. Contraceptive methods include: - Combination pill - Progesterone-only pill - Depo-Provera injection - Skin patch - Vaginal ring - Implant - Condoms and other barrier methods - Male condom - Diaphragm - Cervical cap - Sterilization - Tubal ligation - Vasectomy - Natural family planning - Fertility awareness method - Calendar (rhythm method) - Lactation amenorrhea method - Intrauterine devices - Copper IUD - Hormonal IUD - Emergency contraception Gentle Arrival Midwifery is eager to serve women between pregnancies, or women who have not had, or do not intend, a pregnancy. There are a number of services we offer related to an annual exam or well-woman exam. An annual exam or well-woman exam is an opportunity to focus just on you and your needs or concerns. We schedule a full hour for these exams, because we want the time to fully understand and evaluate your specific situation. We view this exam as a time to discuss and exchange new health information about women’s health concerns. While a physical exam is involved, the majority of the time is spent in reviewing your specific history and questions, and responding to those. We have a particular interest in working with young women who may be obtaining a Pap test or pelvic exam for the very first time. It is important that the first time be a positive experience, not a frightening or painful one. We know the idea of a pelvic exam can cause anxiety, and we are committed to spending lots of time educating a young woman about exactly what’s involved, how it is done, and what she can learn about her body. We take extra time with the physical exam, and move at the pace set by the client herself. This is also true for women who have had prior negative experiences with pelvic exams, or who have had pelvic trauma of some sort in the past. An annual exam or well-woman exam includes the following: - review of personal health history - review of pregnancy history and gynecologic history - review of menstrual history and current menstrual cycles - review of contraceptive history and current contraceptive use and/or needs - review of health and safety habits - review of selected family history factors - review and discussion of specific concerns or questions - physical exam, which includes, at a minimum, examination of the following: thyroid, breasts, heart and lungs, skin, abdomen, pelvic exam, including a speculum exam and bimanual exam * any tests that are necessary (Pap smear, tests for vaginal or pelvic infections, etc.) An annual exam may also include contraceptive counseling or provision of contraceptive devices, such as a diaphragm or birth control pills. It may include testing for specific health concerns, such as anemia, diabetes, or thyroid problems. Sometimes, women have sexual concerns or questions that can be evaluated and discussed. The range of topics is as varied as women themselves. * Preconception counseling: Preconception care is a critical component of health care for all women of reproductive age, both before a first pregnancy, as well as between pregnancies. The main goals of preconception care are the following: - to promote good health behaviors - to screen for potential obstacles to pregnancy - to take steps to reduce risk factors that might affect future pregnancies Many women are not even aware that they are pregnant until after the critical period of fetal organ development that takes place in the first 4 to 10 weeks of pregnancy. Preconception care allows time for appropriate interventions to reduce risks and prevent a number of maternal and child health problems (some of which can be serious). Reproductive health planning is about being intentional around preparing for and starting a family. It includes making decisions about when to have children, how many to have, how to time pregnancies, and how to ensure the healthiest pregnancies and families. It sometimes involves contraception, sometimes fertility-promoting actions, and sometimes implementing difficult lifestyle and behavioral changes. A preconception counseling visit with Gentile Arrival Midwifery typically addresses the following topics: - promoting a healthy lifestyle - important nutritional issues, especially folic acid - awareness of your body’s fertility signals, and how to work with them to achieve pregnancy, or a discussion of options to avoid pregnancy until you’re ready - your social support network - your stress levels - the quality of your relationships with regard to parenting - whether you have been a victim of abuse or violence - your genetic background - your health history - your present health status (inclusive of a physical exam and/or lab tests as needed) - health screening Many women who seek gynecologic care do not have a primary care provider, and sometimes have questions about other health concerns. The midwives at Gentle Arrival Midwifery can perform or arrange for basic screening tests for the following concerns: - Thyroid problems - Anemia - Genetic screening/counseling for cystic fibrosis or other inherited diseases - Screening for immunity to common childhood diseases, such as rubella, chicken pox, parvovirus B19, (fifth disease), CMV, toxoplasmosis, and so on - Endometrial biopsy - Osteoporosis - Cholesterol and other lipid levels - Diabetes - Menopausal and perimenopausal hormone levels - Cancer screening of the colon (stool testing or sigmoidoscopy or colonoscopy) - Urinary tract infections - Mammograms and evaluation of breast masses If you come for a well-woman exam or annual exam, please feel free to inquire about the need for evaluation of concerns that are not gynecologic. If we cannot properly address your concern through our office, we can help you find the right kind of provider to attend to it.