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Time For your Twenty-Week Check-Up? PDF Print E-mail
Written by Laura Maxson   


“It’s time for your twenty-week check-up.” This isn’t the twenty-week anatomy scan so many care providers offer, this is a different kind of check-up -- a prenatal care check-up to help minimize surprises in late pregnancy, birth and postpartum. Decisions about pregnancy care are often hastily made when a woman first finds she is pregnant. Choices may have been based more on a friend’s recommendation, an insurance list, or who provided her last Pap test than an actual informed choice.

Midway through pregnancy is the perfect time to apply a critical eye to a woman’s prenatal care experience and expectations. During pregnancy, families can become much more educated about birth issues and available services, and may find their needs are changing. See which topics below are part of your check-up:


Is my care provider worth the wait?  How does time spent in the waiting room and exam room compare to time with the care provider? Emergencies do happen and appointments can sometimes be late or rescheduled, but is this the norm?


Do I leave with more questions than answers?  There should be enough time at prenatal visits for a pregnant couple to ask questions and understand tests, test results and care plans. Asking friends is not prenatal care.


Who will be there for the birth?  The OB or midwife a woman has been seeing may not be on-call when she goes into labor. Different care providers share call with different medical offices and sometimes, different types of providers. Find out now how the on-call system will work. For instance, some midwives share call not only with other midwives, but also with family practice MDs, and/or obstetricians. This shouldn’t be a surprise.


Is the birth plan still a go?  Some expectant parents find that in early pregnancy everything is fine: Natural birth? No induction? Go past 41 weeks of pregnancy? “No problem.” However, as the pregnancy progresses, limits may unexpectedly appear (especially if parents ask): natural birth is fine, but, “We’ll need you to be on the electronic fetal monitor for the first 45 minutes at least and then we’ll see about intermittent monitoring.” – or perhaps electronic fetal monitoring is considered part of their “natural birth plan” with no opt-outs. Are IVs standard for most women? Ask about how many women in the practice go into labor spontaneously. Are they working to reduce their cesarean rates? Do they offer vaginal birth after cesarean (VBAC)? How many women in the practice go past 41 weeks?


Are birth doulas encouraged?  Any doctor or midwife who doesn’t welcome a birth doula at labor and birth may not be experienced in achieving natural (physiological) birth for his or her patients. Instead, the care provider may want to be in charge of all information and options presented to a laboring woman, seeing the doula as competition or someone who gets in the way. Some care providers may have had a difficult time with a specific doula or birth experience that colors his or her opinions on having a doula, but studies show overwhelmingly that a birth doula brings many benefits to the laboring woman and her partner. If a care provider is against birth doulas, perhaps it is time to consider one who is not.


Are childbirth classes encouraged?  For many of the same reasons mentioned above for doulas, some care providers do not recommend childbirth classes anymore. Some may feel a woman should just come in and get an epidural and they will take care of everything else so a class is not necessary. Or a woman can get all the info she needs online or in books. The truth is that women and their partners greatly benefit from taking a childbirth class, not only to prepare for the birth, but also to meet and learn from other new parents. Independent childbirth classes (not associated with a hospital or clinic) can offer the most complete information. Classes sponsored by hospitals often limit what (even great) teachers can include in their outlines.


Have your needs changed?  Now is the time to look at changing: to a more responsive practice, to a planned homebirth, from an OB to a hospital midwife, to an OB with a lower cesarean rate – whatever meets each pregnant woman’s specific needs. Scheduling an interview or appointment to explore these options will help parents either feel more confident with their current situation or confirm that it is time for a change – before the baby comes!


Twenty weeks is a great time to ask questions – of your care provider, of other new parents and of the birth community. Attend the Bellies, Birth & Babies Expo and Meet the Doula events. Watch the Business of Being Born, Birth Day, Organic Birth, My Body, My Baby, My Birth and other birth videos that explore options. Get educated, ask questions and make changes!



Side Bar

Bellies Birth & Babies Winter Expo - Jan 31, 7-9pm at Peachwoods

Meet the Doulas – Feb 12, 4-6pm at Sutter Maternity & Surgery Center

Go to www.birthnet.org for more information



Laura Maxson, LM, CPM, the mother of three grown children, has been working with pregnant and breastfeeding women for over 20 years. Currently she is the executive director of Birth Network of Santa Cruz County and has a homebirth midwifery practice. Contact her at This e-mail address is being protected from spambots. You need JavaScript enabled to view it or This e-mail address is being protected from spambots. You need JavaScript enabled to view it .



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