What Are The Essentials Of Good Prenatal Care?
How does prenatal care create better birth?
As a midwife or doula, what do you hope to accomplish
in the prenatal period of a pregnant woman?

Prenatal Care...a question we posed to midwives and doulas in our group and beyond.  Thanks to those who took the time to put into writing what is in their hearts about this important period of a woman, her unborn baby and her family's lives!

Prenatal care is essential because it promotes the physical and emotional health of the mother and baby. Careful monitoring and teaching help to ensure that the mother will be as healthy as possible and to detect potential problems early so that they can be deterred by gentle, holistic measures. Nutrition and healthy lifestyle choices help prevent complications such as high blood pressure, diabetes, anemia, urinary tract infections, inadequate growth of the baby, excessive weight gain, blood clots, pre-term labor, hemorrhage, and delayed postpartum recovery. Our goal as midwives is to help the mother actively participate in her own care! The midwifery model is unique in its emphasis on health promotion rather than passively waiting for high risk conditions to develop that may require aggressive medical intervention.

Midwifery-style prenatal care also addresses the emotional and spiritual needs of the mother. As research and experience seem to indicate, the mother's emotional state can affect her baby's development and behavior even outside the womb. Talking, answering questions, and just being available for the mother builds trust between the client and midwife. A nurturing atmosphere enables the mother to labor freely and helps the midwife to more intuitively customize her care for each woman.

Pregnancy is a time for healing of fears and hurts and for growing strong, vital relationships with her husband and God. We cannot force a woman to go to deep places in her heart, but we can ask gentle questions, suggest topics for reflection, give comfort and safety if she needs to cry, and recommend edifying books or counseling. Of course, we can pray for her that God would give her abundant grace as she transitions into the privilege and challenge of motherhood. We want to encourage a peaceful heart and a joyful embracing of the mothering role.

Effective prenatal care facilitates the mother's awareness of healthy living habits and motivation to make changes--not just for the pregnancy, but for the rest of her life. Many women who have always eaten low-quality food, rarely exercised, and relied on conventional medicine learn about pro-active, natural approaches to health during pregnancy and then extend this vision beyond the childbearing year and for the whole family.
~Hannah Mann, CPM

Prenatal visits are opportunities during which I hope to build a relationship of trust between the couple and myself. I stress the mother's role in good nutrition to build a healthy placenta that will well nourish and oxygenate the baby. The parents are given a notebook of information, but I do not think that over education is wise nor do I teach on complications (though I answer questions about whatever horror stories they may have heard). My enthusiastic posture is that birth is a safe and normal life event. We will not be "groping in the dark hoping baby comes out"; there are ways to assure that mother and baby are doing well and various techniques and suggestions for any challenges that may present.
~Nancy Crowley, Traditional Midwife of 25 years.

The essentials of good prenatal care involve a number of considerations.  Consistency in keeping appointments; Truth and openness between midwife and client; Excellent diet and a willingness to make whatever sacrifices it may take to keep Mom and baby healthy and happy.

How does prenatal care create a better birth?  Prevention is the best policy in pregnancy, labor and birth.  In order to prevent issues from happening, adequate and consistent prenatal care is necessary in order to attack issues before happening.  Adequate and consistent prenatal care is necessary in order to attack issues before they become problems.  The goal is not to treat symptoms but to get to the root and work to resolve any issues before they get out of hand, as well as to work to prevent any issues from occurring before they take place at all.
 
As a midwife, my goal is to teach my clients how to educate themselves so they can make informed and responsible decisions.  Their pregnancy, birth, and parenting is their responsibility as they are held accountable by God for these choices that are made.  If they learn all they can they are able to choose wisely what is best for them and will feel confident as they recognize their role in giving an account to their Heavenly Father for every action, word and deed.

It is also my goal to help in the educating process with regular teaching on nutrition, pregnancy information, newborn care and child training.  I also desire to train them how to participate more fully in the pregnancy and birth as well as with their children long term.  I desire to bring Mom and Dad closer together in this experience as it is truly one of the greatest bonding opportunities a couple can ever experience if faced in the right attitude of love and care.
~Kristi Zittle, DEM

To be very honest: In my practice, and for me as a midwife, the most essential goal of prenatal care is to develop a close relationship with the mom, her baby, and her support people if possible. I want to know this mother so well by the time she goes into labor, that I will be able to walk into her home, while she is in the midst of one of the most sacred, private experiences of her life, and create less than a ripple by my entrance and presence. I understand and believe that birth works best this way—as Michel Odent contends—in the most private and intimate of settings, with the least possible interference. I do understand what folks want to create when they plan to birth unassisted or unattended but I also acknowledge that, in our culture, most women want the reassuring presence of another woman who has given birth, and many are comforted and encouraged by the careful watch that providing the Midwives Model of Care offers. I consider it a formidable honor and responsibility to be called and asked (not to mention paid!) to do such a thing.

On the practical side, doing all the things we do at a prenatal visit helps to create this scenario in a couple of ways. Having experienced, with this family, their normal pregnancy, and documenting it all on paper, I know things on the practical and physical side that allow for the above scenario. It is reassuring to have had everything go well through the prenatal care, to have had my hands on this mom’s belly and have met her baby that way, and know in a more than usual way, their distinct characteristics. I am shocked at what I hear about prenatal care in the medical model lately. It seems so technologically-oriented, driven by things like ultrasound and lab work. Women tell me that no one feels her belly at her visits, or spends time talking to her. They collect “samples” and send her on her way. Her attendants at her birth will likely be people she has never met. It is no wonder the section rate is soaring. I am amazed that this set-up works as often as it does. It is a testimony to the amazing strength and adaptability of the human body. Sometimes I think that doing all the routine things I do, checking blood pressure, heart tones, belly measurements, baby’s position, are just a way to bide my time with a woman as she and her baby tell me both verbally and by what I feel with my heart and hands, what is going on for them. Even if something seems or is amiss, and this family needs to seek medical care, I can be with them to continue at some level of intimacy—at least that is my hope and belief about how it should happen.

The midwife who assisted us with our last baby’s birth told me once that she knew she had done her job well when she left a home and the family could not remember her name. I think of this often and believe it to be a basic truth regarding midwifery care. It is all about the family, the mother and baby, and rarely about the midwife. The prenatal care period serves mainly, I think, to develop the intimacy required for a smooth and beautiful birth.
~Leslie Payne, CPM

As a Childbirth Educator I feel compelled to reply that the most important thing in a woman's prenatal care is education; that being informed about all her choices and rights enables her to make the best decision regarding the birth experience she is looking to have. However- as a doula, I must reevaluate my first statement and go with my instincts. Compassion is by far the most effective and sought after element in prenatal care for expecting families around the country and world.

Look at this definition:
~Compassion essentially arises through empathy, and is often characterized through actions, wherein a person acting with compassion will seek to aid those they feel compassionate for. ~Wikipedia~

Yes, Education and wellness check ups are essential to prenatal care; but how successful are our endeavors to ensure a healthy pregnancy and delivery if these 'actions' of care are not founded in and on compassion? Expecting mothers tend to choose their labor support team and even doctors/midwives based on the compassion with which they serve and react to the expecting mother. Even from a historical approach, a common denominator in all races regarding childbirth is the mother and her family are surrounded throughout the pre-postnatal period by people of a compassionate nature; regardless of professional rank. Interestingly enough, women in today's world and all throughout history, when surrounded by compassionate care providers have the highest ranking satisfaction with their prenatal & birth experience and better birth outcomes. Mothers do indeed know best.
~Elizabeth Lugmayer Doula, CBE

~Prenatal care is the heart of midwifery.
~Trust forms during the time of pregnancy, weaving a blanket of safety.
~Excellence of education and informed consent lends security in  our clients' choices.
~Time together prenatally builds deeper and more meaningful relationships.
~Nurturing a  safe and sacred space during pregnancy, nurtures a safe and sacred space during birth.
~Time, respect, skill, honesty, open ears and hearts, honor, trust and a communal  faith in God...
             builds warmth, knowledge, good decision making and positive birthing outcomes.
~Susan Oshel, CPM