What Happens at the First Midwife Appointment?

Midwives are an alternative to obstetricians for women who expect few complications from their pregnancy, labor and delivery. They are an especially welcome option for first-time mothers as midwives spend more time with a mother-to-be at each visit and give a woman more options. The first visit with a midwife is important because it is a chance for the midwife and mother to get to know each other and talk about how the relationship will work.

Introductions

• The licensing requirements for midwives vary with each state. The first appointment with a midwife involves an explanation of what the midwife is allowed to do and what she cannot do. She will explain whether there are doctors supervising the care provided or when she will have to refer the mother elsewhere for additional tests such as an ultrasound. A midwife will also use the first visit to explain her personal philosophy, ask the mother what her expectations are and give a summary of what services will be provided.

Birth Plan Discussion

• One advantage to using a midwife is that a mother has more input on how the birth will proceed. Some mothers want a delivery free of painkillers while others may want alternative forms of pain relief. Some mothers may want to have a water birth or be able to record the entire birth. Some mothers may want to have a home delivery or give birth in a birthing center rather than a hospital. The first midwife appointment is a time to discuss what choices the mother wants to consider for the pregnancy.

Physical Examination

• The first midwife appointment will include a physical exam to assess a mother's health and determine how the pregnancy is proceeding so far. The midwife will weigh the mother, take her blood pressure, check for the baby's heart beat and possibly measure the fundal height, depending on how far along the pregnancy is. She'll check the mother's ankles for swelling. She may also palpate the abdomen to check for the baby's position, again depending on how far along the pregnancy is. She'll also take a health history and talk about dietary needs.

Tests and Labwork

• While midwives tend to be less invasive in their procedures than obstetricians, there are still some tests and labwork that need to be done. Most midwives will order blood work to test HcG levels, screen for anemia or toxoplasmosis, determine blood type and test for sexually transmitted diseases. The blood tests will measure hemoglobin levels, glucose, iron levels and Rh factors. Some midwives may also offer to order blood work to screen for genetic disorders. A midwife will also conduct urine tests at the first and every subsequent appointment. The urine test looks for diabetes risk, bladder or kidney infections, preeclampsia and dehydration.