Prenatal Care

Editor’s note: This article first appeared in Midwifery Today, Issue 124, Winter 2017.
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Continuity of carer is key to a normal, physiological, and empowered birth. Midwifery is about relationship which develops in the course of prenatal care. Most midwives do a long first visit to find out as much as possible about the mom and her concerns. When I had an active homebirth practice, I always went over previous births and her dreams for the upcoming birth. It is all about establishing relationship, which then leads to trust, which is crucial in a birth.

Dr. Diego Alarcon’s personalized prescriptions.
I love what my friend and colleague Carol Gautschi recommends. She says to make sure you talk with the baby each time you do a prenatal visit. You are getting to know the baby as well as the mother. Carol explains to the baby when she needs to do something and enlists the baby’s help, if needed. She says, “It is remarkable how they develop a trust between midwife and baby if you acknowledge their humanity and presence.” Also, always be very respectful of mother and ask permission before you touch her. Many women have been through horrible experiences.

In my practice I would evaluate my prenatal care by whether the mom felt better and was more assured and happier when she left than when she came in for her visit. Even before I learned how important a mother’s happiness is to the developing baby, it just seemed right. Now we know that babies’ brain wiring is very attached to the mother’s emotional state. Michel Odent recommends that moms “eat seafood and be happy!” His prenatal care at Pithiviers included mothers singing. This really got the oxytocin flowing and put moms in a perfect state of being.

Speaking of eating seafood, one of the most important elements we as midwives can help pregnant women with is getting good nutrition. So many complications can be avoided with proper nutrition. As we often say, “Prenatal care is what you do between visits to your midwife!” Having the mother complete at least a 5-day diet sheet of everything eaten (including a weekend, because people tend to eat worse on weekends) is so helpful in working with her to get the proper nutrition to feed her baby.

I had the privilege of attending births as well as prenatal visits with Dr. Diego Alarcon in Ecuador. I loved his practice and his respect for mothers and babies, as well as his philosophy. Like Michel, he made every effort to ensure that women were in a state of happiness and well-being, knowing the great effect this has on the baby. He spent his time taking photos of whoever in the family had joined the mom, usually the dad and her mother and sometimes guest midwives like Carol Gautschi and me. He made a prescription for each mom, each time. He would draw pictures of how she should strive to be. He drew and crossed out worried faces and prescribed happy faces. He tried to get the moms not to worry. He made pictures of the breast with hearts because he was encouraging breastfeeding. He would draw a picture of her walking for exercise with her baby in utero. He would also draw pictures of good nutrition. It occurred to me that this kind of visual prenatal care would probably be likely to stay with the woman better than words!

It must be so hard for midwives who meet the woman for the first time in labor. It is important to know her as well as possible; but sometimes we must deal with what is. It is even more important to quickly establish a relationship with a mom when you have not gotten to know her ahead of time. She is often so open in labor and looking for a friendly helper. It is important to stay calm and warm toward each laboring woman you work with. It even seems like the laboring mom’s calmness prevents some complications. She will remember, for her entire life, how she was treated in labor and at her birth. This is a huge responsibility for us. We must leave our own troubles at the door and be ready to serve her in love and kindness. When we were in Japan arranging details for an upcoming conference we met a woman in her 80s at the ryokan (a traditional Japanese inn) where we were staying. She recounted every detail of her prenatal care, labor, and birth. Her father-in-law had helped her through it. You never know where the best support will come from! But we must remember that we have a great responsibility to be respectful and loving to the families we are privileged to serve.

Toward better birth,
–Jan

About Author: Jan Tritten

Jan Tritten is the founder, editor, and mother of Midwifery Today magazine and conferences. Her love for and study of midwifery sprang from the beautiful homebirth of her second daughter—after a disappointing, medicalized first birth in the hospital. After giving birth at home, she kept studying birth books because, “she thought there was something more here.” She became a homebirth midwife in 1977 and continued helping moms who wanted a better birth experience. Jan started Midwifery Today in 1986 to spread the good word about midwifery care, using her experience to guide editorial and conferences. Her mission is to make loving midwifery care the norm for birthing women and their babies in the United States and around the world. Meet Jan at our conferences around the world!

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