I created two new informed consents, one for ultraound, and one for hospital transfers. After hearing about a birth experience a midwife who practices in a different region had, I decided I needed an ultrasound informed consent to explain the risks and benefits of ultrasound. Having clearly spelled out information about what to expect in a transfer, what I do, and what my assistant does, makes transfers smoother and less stressful when they do happen.
I purchased ultrasound equipment and completed a course to gain a basic understanding of how to do ultrasound. I wanted to be able to do a quick check to confirm if baby is head down when I was unsure from palpating. I am not a sonographer, so I am not doing any other evaluations or assessments with ultrasound. If we need or want more information, I refer clients to a sonographer.
I have totally revamped how I chart. I feel more comfortable with my new charting. It gives a clearer picture of what was covered and discussed during prenatals, and it helps with being consistent with the care I offer clients during prenatals.
I now have multiple blood pressure cuffs, stethoscopes, and pulse-ox sensors so I don't have to remember to shift them from bag to bag, or use them in my office. It's nice to know my bags are always ready and I will always have access to equipment I need wherever I'm at while doing midwifery work.
I am doing more initial prenatal labs. I now check thyroid levels, Hemoglobin A1c and Vitamin D levels. Thyroid function can impact pregnancy if it is outside of normal ranges. Hemoglobin A1c gives a picture of what blood sugar levels have been in the past 90 days. This is helpful for evaluating if we want to do gestational diabetes testing or blood sugar tracking. Vitamin D is essential for both baby and Mom during pregnancy. I was surprised when I began checking Vitamin D levels that over 90% of clients were deficient.
I have made all these changes and additions to how I provide care to help clients have the healthiest, most amazing pregnancy possible. These changes help me in providing better and more consistent care as well as making life a little smoother for me as a midwife.