Pregnancy care with midwife - measuring blood pressure

Measuring a pregnant belly

Pregnancy Midwifery Services South Texas

Birth & Midwifery Care With an Experienced, Skilled Home Birth Specialist


Claudine Crews LM, CPM

Licensed and Certified Professional Midwife

San Antonio, Floresville, and surrounding areas in South Central Texas



·     Prenatal Care

·     Labor and Birth

·     Waterbirth

·     Postpartum Care

·     The Birth Center

·     Well-Woman

·     Childbirth Classes

·     VBAC - Vaginal Birth After Cesarean

·     Fees and Insurance


·     Qualifications

·     Personal

·     Affiliations


·     Forms

·     Nutritional Assessment

·     Preparing for Your Birth

·     Supplies




·     What is a midwife?

·     What is a Certified Professional Midwife?

·     Midwives Model of Care™

·     Texas Midwives

·     How to Choose a Midwife


·     Home Birth - Is it safe?

·     Advantages of Birth Outside of a Hospital

·     American Public Health Association Support


·     Waterbirth

·     VBAC

·     Cord Clamping

·     Preparing for Birth - Childbirth Education

·     Doulas



·     Induction

·     Continuous Fetal Monitoring

·     Cesarean Section

·     Epidurals

·     Immediate Cord Clamping Vs. Delayed Cord Clamping


·     Home Pregnancy Tests

·     Estimating Your Due Date

·     Common Discomforts

·     Warning Signs

·     Prenatal Testing

·     Ultrasound

·     Breech?

·     Induction

·     Childbirth Classes


·     Why good nutrition

·     Nutritional needs

·     Sample Diet

·     Nutritional values of foods

·     Food Safety

·     Salt - Yes, you do need it!


·     Breastfeeding

·     Circumcision

·     Immunizations

·     Childproofing Your Home




Prenatal exam listening to baby's heart beat

Complete prenatal care in San Antonio or Elmendorf-Floresville area offices. Evening and weekend appointments available.

Mother And Son


Serving the San Antonio, Boerne, New Braunfels, Elmendorf, Floresville, Karnes City, Pleasanton and surrounding areas, including: Atascosa, Bexar, Comal, Kendall Guadalupe, Karnes,  Wilson, and surrounding counties, including parts of Comal and DeWitt in South Central Texas.




Topics Located on Other Pages

Childbirth Education


Vaginal Birth After Cesarean





Warning Signs

You should call your midwife or doctor if you experience any of the following:

  • Vaginal Bleeding

  • Severe pelvic or abdominal pain

  • Persistent and severe back pain

  • Swelling of the face

  • Severe headaches or blurred vision

  • Epigastric (under the rib cage) pain

  • Gush of fluid from the vagina

  • Regular contractions before 37 weeks gestation

  • Initial outbreak of blisters in the perineal or anal area

  • Cessation of fetal movement





Pregnancy is counted from the first day of your last menstrual period and lasts on average about 40 weeks. Of course, this is assuming you have a 28 day menstrual cycle! "Term", or "Full Term" is considered to be anywhere from 37 weeks to 42 weeks of gestation.

Prenatal Care


Mothering begins during pregnancy, not after your baby is born. By taking good care of yourself during your pregnancy you are taking good care of your baby. This care is the foundation for all care during pregnancy, labor, birth, and the postpartum and newborn period. Prenatal care includes both the care provided by your midwife or physician, and most importantly, the care you give yourself.


The prenatal care that you give to yourself includes several things:

  • Eating a healthy, nutritious diet designed to provide both you and your growing baby with everything needed for optimum health. Your diet is probably the most important factor in having a healthy pregnancy and growing a healthy baby

  • Adequate and common-sense exercise

  • Avoiding tobacco, alcohol, recreational drugs, unnecessary medications, and toxins or chemicals that may be hazardous to your developing baby

Prenatal Care Schedule

The normal schedule of visits for routine prenatal care is as follows:

  • Every 4 weeks until the 28th week of pregnancy

  • Every 2 weeks from the 28th week - the 36th week

  • Every week from the 36th week until birth


Nausea and Vomiting Of Pregnancy (NVP)

Tips and Suggestions For Coping

NVP, or "morning sickness", can be just plain miserable. Since one of the causes is hypoglycemia, or low blood sugar, there are some specific measures you can try to alleviate the symptoms.

  • Eat small amounts very frequently. The more nauseous, the more frequently you should eat.

  • Take extra B vitamins, specifically B6

  • Ginger in any form has been helpful. You can try ginger in capsules, candied ginger root, ginger tea, etc.

This is a VERY short list out of many ideas. You can view, download, or print this brochure which has a comprehensive list of specific suggestions to try. Most women will be able to find something to help! In addition, don't forget to try and get some fresh air and mild exercise, which can also help stabilize blood sugar and in general help you to feel better.

Nausea and Vomiting of Pregnancy





There have been several trials of routine ultrasound examinations during pregnancy. The largest, a prospective, randomized one of routine vs indicated ultrasound examinations, was the RADIUS study. [Ewigman BG, Crane JP, Frigoletto FD, LeFevre ML, Bain RP, McNellis D, The RADIUS Study Group. Effect of prenatal ultrasound screening on perinatal outcome. N Engl J Med. 1993; 329:821-827] This study included 15,530 pregnant women. One group underwent routine ultrasound at 15-22 weeks and again at 31-35 weeks. The other group underwent ultrasound only if a specific indication arose, such as uncertain dating or positive triple screen. The primary outcome measure was adverse perinatal outcome (fetal or neonatal death or moderate or severe neonatal morbidity). The secondary outcomes were multiple gestations, birth weight, and incidence of preterm delivery. This trial found no difference in perinatal outcome between the groups. There was, however, a 3-fold increase in the detection of fetal anomalies, which did not have an effect on perinatal outcome, the investigators' primary outcome variable. Therefore, they concluded that, "The adoption of routine ultrasound screening in the United States would add considerably to the cost of care in pregnancy, with no improvement in perinatal outcome."


Field Notes in Obstetrics and Maternal-Fetal Medicine
Unnecessary Testing in Obstetrics, Gynecology, and General Medicine: Causes and Consequences of the Unwarranted Use of Costly and Unscientific (Yet Profitable) Screening Modalities
by Martin Donohoe, MD, FACP

posted April 30, 2007 [on Medscape]


..."Other monitoring tests may be misused. One example of this is fetal ultrasonography. Although it is helpful in estimating gestational age, identifying twin pregnancies, and detecting genetic anomalies, the American College of Obstetrics and Gynecology (ACOG) position is that routine ultrasonographic screening during pregnancy is not mandatory. They deem routine use reasonable when requested by a patient.[11] Most women in the United States undergo at least 1 or 2 ultrasounds during pregnancy; this level of exposure has never been associated with significant risk and use may provide significant benefits. However, some expectant couples have followed the lead of actors Tom Cruise and Katie Holmes and purchased (for costs ranging between $15,000 and $200,000) their own ultrasound machines, which they use daily.[12]

There are some data (mostly from other vertebrates) suggesting that prolonged and frequent use of fetal ultrasound can cause abnormalities in fetal brain development, behavior, and body weight.[13] Even though such findings have not been substantiated in humans,[13] the US Food and Drug Administration (FDA) considers promotion, selling or leasing of ultrasound equipment for the purpose of making "keepsake fetal videos" an unapproved use of a medical device.[14] Such use may also violate state laws and regulations."

Ultrasound, used appropriately, is wonderful technology. It is not necessarily risk-free though, so the benefits should outweigh any potential risks. What are the potential risks? Most women have no idea there are any! However, several studies have shown that ultrasound heats cells, especially brain cells, which increases intracranial temperature, and may cause brain damage. No one really knows for sure what the possible consequences are, although it is known that male babies who have undergone ultrasound while in the womb have a higher incidence of left-handedness. A study published in August 2006 found that prenatal ultrasound exposure to ultrasound waves has a definite impact on neuronal migration in the brains of mice. The implications to the human fetus are still unclear. You can read the entire study:  Prenatal ultrasound exposure to ultrasound waves impacts neuronal migration in mice. Some researchers believe that ultrasound may be the culprit in the unexplained dramatic increase in the numbers of autistic children, although this is mainly speculation at this point. The fetus also "hears" the ultrasound waves through vibration. This is similar to you 'hearing' your finger being lightly tapped near your ear. No one near you would hear it - you are actually hearing the vibration of the tapping. Dr. Mustapha Fatemi, a medical engineer at the Mayo Foundation's Ultrasound Research Laboratory in Rochester, Minnesota, concluded from his studies that ultrasound vibrations sound like the high tones of a piano, at about the same volume as an approaching subway train. Could this cause hearing problems? Again, no one really knows.

  • The FDA prohibits unapproved, non-medical uses of the ultrasound.  The FDA policy states that "keepsake" fetal videos are an unapproved use of a medical device.

  • The American Medical Association officially adopted the current Food and Drug Administration policy on the use of non-diagnostic fetal ultrasound in July of 2005.

  • The American College of Obstetricians, in their guidelines on routine ultrasound in low-risk pregnancy, concludes "In a population of women with low-risk pregnancies, neither a reduction in perinatal morbidity [harm to babies around the time of birth] and mortality nor a lower rate of unnecessary interventions can be expected from routine diagnostic ultrasound. Thus ultrasound should be performed for specific indications in low-risk pregnancy" (ACOG 1997).

In spite of all of these recommendations routine ultrasound during pregnancy is the norm, with many women being scanned multiple times during their pregnancy. In addition to ultrasound scanning, the use of the hand-held doppler to listen to the fetal heart beat during pregnancy is also routine, which is also ultrasound. With so many unknowns regarding ultrasound, and benefits dubious, it seems prudent to at the very least limit exposure to ultrasound to the medically indicated reasons.

Medical indications for diagnostic ultrasound (with the understanding that ultrasound may not be conclusive) may include: suspected ectopic pregnancy, pregnancy dating when usual methods are not adequate, suspected fetal anomalies, to confirm or rule out multiple gestation, placenta previa or abruption, mal-presentation, abnormal amniotic fluid levels.

Sonograms Safe If Done Properly 

A press release from the Society of Diagnostic Medical Sonography Aug. 8, 2006






© Copyright 2007 Midwifery Services of South Texas

Permission to reprint pregnancy and childbirth information contained within this website with attribution

No photographs may be copied or used without written permission







What You Need

To Know



Mother's Naturally

A website for mothers who desire a natural pregnancy and a natural birth


How soon after a missed period can I take a home pregnancy test and get accurate results?

Many home pregnancy tests (HPTs) claim to be 99% accurate on the day you miss your period. But research suggests that most HPTs do not consistently spot pregnancy that early. And when they do, the results are often so faint they are misunderstood. If you can wait one week after your missed period, most home pregnancy tests will give you an accurate answer. Ask your midwife or doctor for a more sensitive test if you need to know earlier.

When a home pregnancy test will give an accurate result depends on many things. These include:

How long it takes for the fertilized egg to implant in the uterus after ovulation.


Pregnancy tests look for the hormone human chorionic gonadotropin (hCG) that is only produced once the fertilized egg has implanted in the uterine wall. In most cases, this happens about 6 days after conception. But studies show that in up to 10 percent of women, the embryo doesn't implant until much later, after the first day of the missed period. So, home pregnancy tests will be accurate as soon as one day after a missed period for some women but not for others.

How you use them -


Be sure to follow the directions and check the expiration date.

When you use them -


The amount of hCG in a pregnant woman's urine increases with time. So, the earlier after a missed period you take a HPT, the harder it is to spot the hCG. If you wait one week after a missed period to test, you are more apt to have an accurate result. Also, testing your urine first thing in the morning when it is more concentrated may boost the accuracy.

Who uses them -

The amount of hCG in the urine at different points in early pregnancy is different for every woman. So, some women will have accurate results on the day of the missed period while others will need to wait longer.

The brand of test -

Some home pregnancy tests are more sensitive than others. So, some tests are better than others at spotting hCG early on.



Estimating Your Due Date

Estimating your due date (EDD) is usually quite easy, but keep in mind that it is just that: an estimate. Even ultrasound, especially if done after the 12th week of pregnancy is only an estimate!


The simplest, though not always accurate way to estimate the date of birth is to take the first day of your last normal menstrual period (LMP) and then add 7 days to it. Then count back 3 months. That is your EDD. For example, if your LMP was December 1st, you would subtract 3 months from December 8th, making your EDD September 8th.


To get the best estimate possible you need to know when your last normal menstrual period (LMP) began. If your last period was shorter and lighter than normal for you than it may be implantation spotting and your previous period, if normal, may be the date you need to use. You also need to know the length of your cycles, or how many days from one period to the next, since most methods and "gestation wheels" are based on women who have 28 day cycles and who ovulate on the 14th day of that cycle. If you have a shorter cycle your pregnancy will have begun earlier than the 14th day; if your cycle is longer then your pregnancy will have begun later. This is easy to compensate for when estimating your due date. Simply add or subtract the difference from 28 days to your LMP.


For example:

  • If you have a 24 day cycle and your LMP was December 1st, use November 26th as your LMP, add 7 days (Dec. 3rd) and then count back 3 months for an EDD of September 3rd.

  • If you have a 33 day cycle and your LMP was December 1st, use December 6th as your LMP, add 7 days (Dec. 13th) and then count back 3 months for an EDD of September 13th.

Confirmation of your EDD is on-going throughout your pregnancy and will be weighed against the growth pattern of your uterus, when you first feel the baby move, when the fetal heart beat is first heard (by doppler and by fetascope), and ultrasound if needed.




Common Discomforts in Pregnancy

A list of common discomforts or concerns in pregnancy and helpful ideas to deal with them. Be sure an let your health care provider know what is going on since some minor concerns may progress to major concerns if not dealt with appropriately!


Common Pregnancy Concerns



Breech Presentation

Have you been told your baby is breech, or butt/feet first? Don't panic. There are several methods to try and get your baby to turn head down. If your baby is breech at 32 weeks you should go a head a begin doing the breech tilt. Once a baby turns head down he will usually stay that way. For details on tricks to get your baby to turn print out:

Breech Turning Techniques





On Choosing Genetic Screening

Deciding on whether to have tests that screen for genetic disorders is not always easy. This sheet can be printed out and used to help you make your choices.


Click here for information on childbirth education options