DIY Prenatal care builds confidence, builds understanding of physiology (and imbalance), and improves outcomes.  Prenatal care is more than the 8-10 visits you have with a practitioner before birth.  Prenatal care includes all the choices you make between these visits.  For a healthy mom and baby, the most beneficial part of prenatal care is wellness counseling.  Most women aren't receiving this valuable part of prenatal care from their primary maternity practitioner (even if they're seeing a midwife).  Mothers that are unhealthy and malnourished, drug-addicted, or truly high risk may really need the regular medical evaluation, but for most women holistic support is the key part of a birth team.  Intuition, alignment, and balanced nourishment (emotionally and physically) are your best approaches to prenatal health.

Some families choose DIY Prenatal Care for the following reasons:

• Allows better communication with your care providers and birth team
• Reduces fear-based acceptance of procedures by increasing your understanding of average changes in pregnancy
• Provides yourself with a baseline and in-between care knowledge to have a wider range of information
• Increases your choices of care providers with the opportunity of reducing prenatal appointments by giving you the knowledge to take notes about changes happening and communicate that information to your birth team via webinar and phone
• Increases your ability to receive prenatal care when your potential care provider doesn't provide routine care (or is otherwise unavailable) prior to 20 weeks, or 3 months, or 8 weeks or whatever week that provider has deemed their time frame for typical care.  Unfortunately, this is popular in home and hospital settings and a lot of moms are dealing with early pregnancy questions, fears and complications (including loss) without an available care team
• Increases your knowledge for unassisted birth or free birth
• Improves your ability to understand how your body communicates with you and listening to your instincts.  Mothers get these signals before external sources, and the more you tune in to this communication, the more you will hear it in labor when needed... and the more you will trust your mama brain to make decisions for caring for your child
• Reduces the opportunity of others to make you feel like you have to have a special licensed person to understand normal physiological changes in your body

DIY Prenatal Care doesn't have to mean you don't choose to receive care from another provider (but it can mean that).  You can choose as little information to track as you'd like, or you can do most of the prenatal routines a typical care provider would offer just for the sake of continuing care at home and knowing a little more of what to expect when you arrive at our appointment.

I want to also preempt this article by saying that some of these guidelines here are conservative ranges and an experienced provider may have different thresholds as they get to know a mother, so in that sense, you can find a lot of wisdom from someone with experience; however, this also means that if you go out of this conservative range, seeking guidance from an experienced provider may be valuable until you yourself gain more experience in the wide variations seen throughout perinatal stages.

What You Need for DIY Prenatal Care

What you need is really up to you.  It depends on the type of care you want to provide yourself.  The following items can be helpful for DIY Prenatal Care:

• Journal (or general prenatal record)
• Blood Pressure Monitor
• Scale
• Fetoscope
• Clock/Watch with a Second Hand
• Fabric Tape Measure
• 10 Point Urinalysis Strips
• Your Hands & a Partner's Hands if Possible
• Nourishment for your whole body, herbs, or supplements as needed

Schedule for DIY Prenatal Care

In general, much of prenatal care prior to 20 weeks is emotional support and taking vital signs.  There's not a lot you can feel about baby's position and movement prior to this average time.  After 20 weeks, you'll start feeling changes that will be more noticeable as the weeks go on.

A typical Prenatal Care Schedule looks like:

• Until approximately 30 weeks - once a month
• 30-36 weeks - every other week
• 36 weeks until birth - every week

Of course, anytime there is a question or concern, check out what's concerning you and always ask for support when anything just doesn't feel right.

Journal for DIY Prenatal Care

Get a beautiful one.  OK, it really doesn't matter - use a general Prenatal Record Chart, OneNote or don't write anything down - it really doesn't matter.  If your phone is an extension of your body, use that.  Whatever works, this journal is going to be counter-piece to any type of DIY Prenatal Care you provide yourself.  If Dad or anyone on your birth team can keep their own journal and join in the fun, I encourage it.  Dads are often uneasy about all aspects of pregnancy and prenatal care (especially for home birth and unassisted birth) and the more they can become confident in the normalcy of pregnancy, the more increased oxytocin you both will have and the more safety will be at a normal level due to reduction of fear. It is a win-win for everyone.  The following is a suggestion for what to document in your DIY Prenatal Care Journal:

• Date
• Week of Pregnancy (We're not focusing on your E4W (EDD), but the weeks gestation you are to compare the average changes to other women and babies of the same gestational age which gives a guide as to how well baby is growing and the changes you should be noticing throughout pregnancy).
• Intuition (How is your body communicating with you?  Are you listening to the communication and adjusting your life as needed?  How are you feeling today emotionally?  How are you feeling physically? Any specific discomfort points like round ligament pain, back pain, nausea, heart burn, baby in your ribs...etc.?)
• Soul - How is your faith in this moment?  Are there frustrations, or joys, that keep coming up that God might want you to notice.  What are you learning about who you are?  How are you maturing in your faith, or do you need supported in fellowship or by a strong spiritual guide?  Are your thoughts and decisions rooted in biblical truth?
• Nourishment (What are you ingesting?  Write down all the foods and drinks you're consuming daily for at least a week and any time you opt for DIY Prenatal Care or attend a prenatal appointment.  Also include cosmetics, essential oils, lotions and other externally-applied ointments that your liver will be filtering).
• Movement (Write down your activity level from daily lifestyle movement of cleaning and working to intentional movements of miles walked, stretches and specific exercises or bodywork.  Remember to include your outside time and natural sunshine time)
• Clinical Notes (Information gathered through specific tests and assessments - Keep your baseline information at the beginning for easy reference - see sections below)
• General Notes (Document feedback from your birth team.  What are your thoughts?  What are your questions?  Leave room for answers.  Write a poem. Write a note to your baby.  Write a note to your partner.  Whatever feels good here.)
• Sleep - How has your sleep been?  When are your sleep times and wake times?  What are you dreaming and is the Holy Spirit helping you work through stresses or fears through your dreams or are they just a jumble of hormonally-driven images?  Can you see points of stress or joy in your dreams that can enable you to reduce stress and have a better insight into how you are feeling or food, movement or stress triggers causing these dreams.  How are you feeling when you wake up?
• Space to doodle in the margins - or sketch on a whole page.  (Because FUN!!!  Because it gets you into your instinctive brain and turns off logic enabling your primal reactions to enhance which is what you need for labor.  It is relaxing and can help you retain more information.  More oxytocin, woooooo!)

General Guidelines for DIY Prenatal Care

It is good to create a routine around any clinical notes you're taking for your DIY Prenatal Care.  While there may be times you want specific information at random times throughout the day, if you have a routine of time and place and how information is noted, you'll see a better comparison to your baseline.  It is the changes from your baseline that are typically the most important.  If noting information outside of your baseline, mark a symbol in a notable area or write (Atypical) beside your Date section at the top of your journal entry for future reference.  Use the same devices for accurate comparison. Use the same sofa or chair for accurate comparison.  Use the same time of day and before/after eating so that all your comparisons to your baseline are the most accurate.  If you need to write down all these routines on your baseline page, do so to reduce any confusion.

In addition to how you provide your DIY Prenatal Care, it is important to keep a few things in mind:

• Each piece of information is part of a bigger picture
• Each moment in time is part of a bigger experience
• Put all the information together over multiple days, weeks, and months to get a good overall view
• Never put clinical aspects above any other part of your care.  Numbers do not show us how we feel inside.  Numbers are a moment in time and can be very inaccurate, or very accurate. Always use these together with your intuition and reference your nourishment and movement awareness to see what personal choices could be influencing your pregnancy.  Reach out to a skilled provider when there is anything outside of the norm or whenever you feel like you need additional information and support

Taking Vital Signs for DIY Prenatal Care

Vital signs are the foundation of clinical maternity care.  In essence, vital signs outside of your baseline or conservative ideal ranges are red flags and need addressed quickly.  Your vitals give you a quick overview of aspects influenced by hydration, nourishment, toxic load, stress levels, illnesses or infections and complications.  Vitals outside of ideal ranges are symptoms of disease and complication.  However, if you choose to pay attention to your internal body and Holy Spirit communication, and to seek balance in your body, you will almost always notice imbalance before your vitals catch the emergency symptoms that most practitioners are checking at a typical prenatal visit.

What is shared here are ideal ranges.  If you fall outside of these ranges, pay attention to the other areas of assessment and seek additional support.

Resting Blood Pressure

Note your blood pressure in your journal.  Note any changes from your baseline.  Ideally, you will also have a pre-pregnancy baseline to note any changes specific to pregnancy (not just changes through the trimesters)

An ideal blood pressure is between 110/60 and 130/80 (these are spoken as 110 over 60 or 130 over 80).  This will typically drop from your personal baseline around mid-pregnancy and then will increase back up to your baseline through the third trimester, but should always remain within this ideal range.  You need to notice how your whole body feels with the blood pressure you have so that you can recognize changes of your blood pressure.

The top (or first) number is the systolic pressure, which is the pressure in your arteries during the contraction of your heart muscle.  The bottom (or second) number is the diastolic pressure, or the pressure in your arteries between beats.  When your heart contracts it is causing more force, which is why the top number is higher than the bottom number.  Blood pressure is only a response to what your body is doing.  It is not "health" or "disease" on its own.  It is always a symptom, so always pay attention when it isn't in the ideal range.

High blood pressure can mean multiple things - the heart muscle itself is actually contracting harder and/or your arteries are constricted.  Your nourishment, stress and movement will influence both.  Vasodilation (and vasodilating warming water, food, herbs, and medications) widen the blood vessels by relaxing smooth muscle in the veins, large arteries, and smaller arterioles.  Vasoconstriction (and vasoconstricting cooling water, foods, herbs and medications) narrow the blood vessels.  Stress can increase hormones that make the muscle contract harder (like adrenaline, fear, stress, and busyness).  Nourishment can cause muscle cramping and fatigue (like lack of electrolytes such as real salt, magnesium, potassium, and calcium, for instance).  Knowing why your blood pressure may be high (or low) is very important into balancing any issues.

There are a few ways of monitoring high blood pressure, which is what is most often the concern.  One way is the generic form noting that anything 140/90 or higher is considered elevated blood pressure.  The other more accurate form of determining high blood pressure in pregnancy is to note 30/15 points higher than YOUR baseline.  But if you're blood pressure is 130/80 or above, it needs addressed because the goal is to not get to emergency levels when non-medical lifestyle changes will no longer be enough.

When taking your own blood pressure be sure you have an accurately calibrated device (check it against your provider's device for an accurate comparison), a cuff that fits you (be sure the lines on your cuff fall within the guidelines of that specific cuff) and you're relatively rested.  Of course, stress is something that blood pressure can indicate, but in general, don't go up and down the stairs carrying laundry and then stand in your kitchen to take your blood pressure.  Find a chair to sit in, keep your arm about heart level and be sure you haven't eaten or drank something stimulating within about 30-60 minutes of taking your blood pressure.  Now, sometimes you may find this necessary to see what your body is doing at these times, but make your routine the same for your general clinical notes.  If you do anything outside of that routine (including what time of day, where you're at, if an older child just threw something at your head...etc.,) note that down.  Follow the manufacturer's instructions for use of the blood pressure cuff or machine.

Pulse & Respiration

Note your bpm, respiration per minute, and respiration strength in your journal.  Note any changes from your baseline.

Expected non-pregnancy pulse is approximately 70 beats per minute (bpm).  You can expect your pulse to increase by 10-20 bpm from your baseline during pregnancy.

Expected respiration is 12-16 breaths per minute.  Your respiration should be neither faint nor labored in quality as well.

Your pulse and respiration can be taken similarly.  Find your pulse, and count your beats for 6 seconds.  Add a zero at the end of this number and you’ll have your bmp.  Or, count for an entire minute, which is more accurate.

Same with your respiration (which can be easier when someone else monitors your in and out breaths so you're less likely to change your breathing patterns).  Count your inhalations for 6 seconds and add a zero to this number or count for an entire minute.

Fluid Retention vs. Swelling

Having balanced fluids during pregnancy is vital.  You typically build extra fluids as you get closer to birth which supports your body in the work of labor and allowing you to lose some level of fluids.  While it is cruel to restrict a mother's eating and drinking during labor, there typically comes a point the further progressed she is where she is no longer desiring to eat or drink.  Being well hydrated prior to labor is important for the safety of birth.

Normal fluid retention is not lopsided and when you push on your shin and release, the skin should return to its typical shape quickly.  If the indentation remains, this as pitting edema and further evaluation is necessary.  If you’re feet and legs are getting swollen at the end of the day, this swelling should be gone by morning.  Adequate movement, hydration (which is more than just drinking water… you need nutrients), and a balanced diet with healthy protein, fat, and carbs is ideal.

Fetal Heart Tones for DIY Prenatal Care

Note the Fetal Heart Rate (baby's beats per minute) in your journal.  If you're having contractions, note the time you listened to heart tones and note the beats per minute during a contraction and after the contraction and listen through 2-3 contractions for an average.

Listening for baby's baseline beats per minute (bpm) especially if you begin to feel contractions closer to labor can allow you to monitor baby's well being with enhancement.  I do not recommend using a doppler for DIY Prenatal Care, especially in the first trimester, as doppler is a form of [continuous] ultrasound posing risks like vibrating the hundreds of thousands of neurological cells created every second in a gestating baby and heating up fetal tissue.  We can only speculate risk (like neurological damage, ADHD/Autism Spectrum Disorders and similar) as we've barely went through a full generation of ultrasound use in pregnancy.  This is still in its testing phases when it comes to short and long term risks.  While it may be easier to hear tones with a doppler, and you can typically hear by about 12 weeks gestation, a fetoscope can be used around 20 weeks gestation (as well as a pinard horn or a stethascope as you are later in your pregnancy, and eventually just your ear up to your belly) reduces any additional technological risks.  You can listen as much as you want with non-doppler devices and these devices are a more accurate portrayal of a heart tone rather than an echo.  It really is a delight to hear the actual heart tone.  Fetoscopes are inexpensive as well.

A baseline fetal heart rate is the heart rate that occurs 20% of the time.   Variations in the heart rate should occur from 6-15bpm (just like your pulse changes as you move around or stress occurs). 110 to 160 bpm is the conservative range of Fetal Heart Rate, though baby's heart rate is usually faster during early pregnancy.  You sometimes will pickup mom's heart tones which will be slower (if her pulse is normal), so you're looking for that 110-160 range and may need to move around a bit to find it.  Palpating your belly to determine baby's position will help choose where to start.  Your baby’s heart rate should remain around their baseline.  A baby that normally has a FHR of 145-160, and is now experiencing a FHR of 110-125, could need to be evaluated further.  Likewise, we want to listen for a range of heart rates.  Count the beats in 6 seconds, and then add a zero to the end.  Do this multiple times for a few minutes and you should hear a variation in their heart rate which provides you with around a 6-15 beat range.  A fetal heart rate without variation (or drastic variations) should be evaluated further.

If you feel contractions closer to labor, listen to baby's heart rate before, during, and at least 30 seconds after a contraction for the best range of recovery.  A baby's heart rate may accelerate or decelerate during a contraction (both of these meaning different things) and should always go back to baseline as the contraction releases.  Decelerations (drops from baseline at least 15bpm for at least 15 seconds) need to be further evaluated.  Continuously not recovering after a contraction, or continuously dropping too low during a contraction, and especially not recovering after a contraction can indicate fetal distress.

Fetal Positioning DIY Prenatal Care

Note baby's position in your journal.  Note any changes/similarities to previous documentation.

Feeling your baby within your uterus is a great way of connecting with baby or simply better determining fetal position to encourage movement and alignment for birth.  Many baby's are all over the place well into late pregnancy - head up, down, sideways.  By around 37 weeks, most providers desire baby to be in a head down position since you're considered ready to birth at any time.  However, since many baby's decide to be born after 40 weeks gestation, it is good to know that almost all babies (with no outside intervention) will be head down by the time labor spontaneously begins and external version likely won't stick until about 40 weeks anyway (not to mention, breech babies can be born vaginally - we simply live in a culture where many providers are not taught these often hands-off patient skills).  Knowing baby's position early gives you a good idea of how to tell position later which also enables you to determine if your alignment, movement, and tension could improve for optimal fetal positioning supporting a smoother birth.

There are many variations to baby's position.  Our ideal goal is to have baby in a Left Occiput Anterior (LOA) position.  This means the back of the baby's head (occiput) is down and towards mom's left side just a little to the front (anterior).  Remember that babies are in all different positions and will move all around, but positions often indicate hard tissue like spinal and pelvic alignment as well as soft tissue imbalances (often felt as round ligament pain, back pain, SPD or PGP and common pregnancy "symptoms" that are not actually an intended part of pregnancy).

Fetal Growth DIY Prenatal Care

Note the measurement in centimeters from the tip of the symphysis pubis to the top of the fundus.  Note any changes/similarities to previous documentation.  This is usually easier for someone else to do for you.

Find your symphysis pubis (the pubic bone).  Measure from the top of the pubic bone - making sure to measure from the same point each time you measure.  If you go from the top one time and the bottom the next, your measurements will be off when you compare them. Crawl your fingers up your uterus until you feel it dip in and measure to this same spot each time you measure for the same reasons. Place the end of the fabric measuring tape at the point of the pubic bone and draw it straight up your belly, through your naval, to the same part of your fundus and note the measurement in centimeters.

Average fetal growth from the symphysis pubis to the top of the fundus (the top of the uterus near your belly button around 20 weeks and near your breast bone later in pregnancy) is typically +/- 2 in comparison to your week of pregnancy.  For instance, when you are 32 weeks, the measurement from your symphysis pubis to the top of the fundus will be an average of 29-34 centimeters.  Keep in mind that your movement, the shape of your body, and especially the baby's position while moving around can influence this number quite a lot.

Maternal Weight Changes for DIY Prenatal Care

Note your weight and any changes from your baseline.  Note any changes/similarities from previous documentation.

Average western recommendations are that a a mother gains around 25-30 lbs during pregnancy.  Weight gain of 3+ lbs per week can be a sign of pre-eclampsia, especially when accompanied by increased fluid and a headache that starts in the back and radiates forward.  Most women, especially those nourished well, anecdotally note feeling better when gaining 30-40 lbs during pregnancy.  This weight is from baby's weight, a 50-60% increase in blood supply, placenta, fluid, organ growth, fat and maternal tissue.  Let me note here by saying if you gain 60 lbs through moving well and nourishing yourself will balanced foods, then it doesn't matter.  Pay attention to how you're feeling, what you're putting in and on your body, and the energy you expend through aligned movement.

Use the same scale each time you weigh yourself and weigh yourself at the same time of day as your baseline (including if you weighed yourself before or after you ate).

Urinalysis Strip Testing for DIY Prenatal Care

Note a general "expected" for your urinalysis test as well as any specifics that may be different than desired.

Urine test strips come in various forms.  They are actually not an evidence-based practice, though they can show you a quick look into daily habit impact on wellness balance  A 10 point urinalysis strip can provide you with the most information to be compared to your baseline and throughout your pregnancy.  Decide if you will pee in a small cup (shot glasses or small disposable bathroom cups work well for this) or if you'll catch your mid-stream urine.  If you decide to pee on the stick, be sure to move the strip around, urinating on all the test squares.  If peeing in a cup, catch your mid-stream urine and then dip the test strip into the urine.  Pour the remaining in the toilet and wash or dispose of your cup.  Once the test strip squares are saturated, use the comparison chart provided on your test strip container to match the colors of each test as closely as possible to the color on the chart which will indicate the following:

• Leukocytes - Increased concentration may indicate infection in kidneys and urinary tracts or the immune system fighting any illness or allergies. (You will see an uptick in leukocytes towards the end of your pregnancy as your cervical fluid/mucous plug increases in discharge).
• Nitrite - Positive test result may indicate UTI when coupled with leukocytes and blood in the urine.
• Urobilinogen - Increased concentration may indicate liver cell damage or increased bilirubin excretion to intestines.
• Protein - May indicate kidney disease or pre-eclampsia.  Are you eating enough protein or too much sugar?  Did you recently have intercourse?
• pH - Indicates urine acidity level.  Acidic urine may be caused by kidney disease and often an acidic diet (i.e. coffee or black tea intake, processed foods, dairy, heavy meat, high natural or added sugar...etc.).  More likely to have yeast infections, group B strep, or other bacterial imbalances.
• Blood - Increased concentration may indicate UTI, infection or disease in the kidney or bladder.  (If you're closer to labor, some blood may end up mixed with your urine from cervical fluid due to dilation and bloody show - often able to tell the difference when wiping and noticing blood on the tissue).
• Specific Gravity - Increased concentration often indicates various levels of dehydration from low water intake or low amounts of trace minerals.  It may also indicate kidney overload due to toxin levels in the body from food or pollution or from kidney disease such as pre-eclampsia or diabetes.  May also give information on the kidney's ability to concentrate urine in relation to plasma.
• Ketones - Increased concentration may be associated with diabetes, low-carb diets or starvation; however, urine tests for ketones really aren't that accurate as far as actually being in a ketogenic state, and therefore blood tests are really the only way of knowing this.  How long has it been since you've eaten anything at all?  What about healthy fats and carbs?
• Bilirubin - Increased concentration may indicate liver damage.
• Glucose - Increased concentration may indicate diabetes.  Are you eating enough protein?  Are you eating too much sugar, pasta, breads, crackers, and unbalance carbohydrates?

This information is not entirely accurate.  They aren't definitive answers, but just a basic guide which many women like because they are quick and easy to obtain.  Most of the urinalysis tests indicate varying levels of dehydration and lack of nourishment often in terms of a lack of dark greens that support detoxification, liver and kidney health.  Always compare this information to your previous documentation as well as your nourishment, movement and intuition notes.

If you're interested in learning more about what to do with the information you've learned from your DIY Prenatal Care, join the Online Esali Birth Class or sign up for Esali Birth Private Mentoring Sessions.  You can also contact me for Prenatal Care in addition to or in lieu of your current care.  Enjoy your confident empowered pregnancy!

Learning unassisted birth techniques can further your knowledge and confidence.  Join the NEW Esali Birth Online EmerGently Birth Class.