Initial Labwork- 8-12 weeks or first visit

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• OB Panel- Blood type, Antibody Screen, Complete Blood Count (CBC), Rubella, Hepatitis B, Syphilis*

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• STI Panel- including HIV, Gonorrhea, and Chlamydia

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• Hepatitis C

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• Urinalysis / Culture

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• Vitamin D 

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• Hemoglobin A1C - (HA1C)

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• Genetic Screening - Non Invasive Prenatal Testing (NIPT)

 

* The only test you are required to consent to per AZ statute and the rules and regulations that govern licensed midwives, is the syphilis test which must be run by 28 weeks.

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Ultrasound- Offered at various times during pregnancy

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• First trimester scan- Up to 12 weeks to help determine an accurate EDD.

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• 20 week anatomy scan

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• Other Indications- Bleeding, measuring large or small for dates, or anytime there is something we are seeing that warrants gathering more info.

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• Biophysical Profile--see section below.

 

Preferred Local Ultrasound Providers:

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• Precious Predictions- A family-centered experience offered at affordable cash rates. The owner/ ultrasound tech is a fellow home birthing momma. Located in Mesa, AZ. 

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• Valley Perinatal - Several locations throughout the valley, accepts most insurance plans including ACCCHS.

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3rd Trimester Labwork- Around 28 weeks

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• Repeat Complete Blood Count (CBC)- checks for signs of anemia, adequate hemodilution, and more.

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• Gestational Diabetes Screening- A type of diabetes that develops only during pregnancy and usually disappears upon delivery, but increases the mother's risk of developing diabetes later in life. GDM is managed with meal planning, physical activity, and, in some cases, medication.

  • Article: Oral Glucose Tolerance Test

  • Article: Gestational Diabetes: Please Don’t Drink the “Glucola” Without Reading the Label by Dr. Aviva Romm

  • Article: Gestational Diabetes and the Glucola Test

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• Repeat Antibody Screen and RhoGAM® is offered to those with an Rh- negative blood type. If you are Rh- negative please click here to read about Rh sensitization, RhoGAM® , and the Rh- negative blood type.

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Late Pregnancy Labs- 35-37 weeks

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• Group Beta Strep- Group B Streptococcus (GBS) is a type of bacteria that can cause illness in people of all ages. In newborns, GBS is a major cause of meningitis (infection of the lining of the brain and spinal cord), pneumonia (infection of the lungs), and sepsis (infection of the blood) (CDC 1996; CDC 2005; CDC 2009).​

  • Article: GBS in Pregnancy: What's a Mom to Do? by Aviva Romm,MD

  • Article: Alternative treatment for GBS 

  • Article: Group B Strep in Pregnancy: Evidence for Antibiotics and Alternatives

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• Repeat CBC if indicated.

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Biophysical Profile/ Non-Stress Testing- 41+ weeks 

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At 41 weeks, or anytime there is a concern about how baby is doing, you will be offered:

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• Biophysical Profile (BPP)

• Non-Stress Test (NST)

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Cord Blood Banking - at the moment of birth (not routine)

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Licensed midwives are required by the AZDHS to offer information about cord blood banking, though we do not necessarily recommend this procedure for all families. Cord blood banking requires early cord clamping, while our standard of care is delayed cord clamping. You must arrange for private cord blood banking such as CBR  before the birth and have your kit on-hand. If you decide to bank your baby's blood please let us know in advance.

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• Video: Penny Simkin on the importance of delayed cord clamping. 

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• Website: Information about cord blood banking from the AZDHS. 

  • There are additional costs for the kit and storage that are not included in the global fee

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Vitamin K Injection- Offered within 2 hours of birth

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Routinely offered to prevent Vitamin K Deficiency Bleeding (VKDB), a clotting disorder, that causes spontaneous, uncontrolled bleeding which can cause death or permanent brain damage. Intramuscular injection of vitamin K prevents VKDB in almost all babies.

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• Article: Vitamin K for Newborns

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• Article: Evidence for the Vitamin K shot in Newborn ​

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• Article: Revisiting vitamin K and the newborn: what have we learned in a decade? 

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• Article: Vitamin K Shot at Birth - The Controversy Reignites

  • Cost is $25, not included in the global fee.

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Erythromycin Eye Ointment- Offered within 2 hours of birth

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Routinely offered to prevent a serious infection of the eyes, ophthalmia neonatorum (ON), which affects babies born to mothers with untreated gonorrhea or chlamydia.

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• Article: Is Erythromycin Eye Ointment Always Necessary for Newborns?

  • Cost is $25, not included in global fee.

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Newborn Screen- Bloodspot/Heel Stick Screening

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The Arizona Newborn Screening bloodspot test screens for 29 rare and serious disorders.

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• Offered twice; First screen at 24-48 hours and Second screen at 5-10 days. Both screens are recommended for the most accurate results. Some of the disorders are most accurate in the early screen timeframe while others are more accurate in the late screen timeframe. 

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• Website: AZDHS information about Newborn Screening

  • Cost of newborn screening is $36 for the first screen and $65 for the second. Not included in the global fee. The second screen can be billed to insurance, including ACCCHS however at this time AZHDS is unable to bill insurance for the first screen. 

 

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Pulse Oximetry- Offered at first postpartum visit 

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Newborn screening for critical CHDs involves a simple bedside test called pulse oximetry. This test estimates the amount of oxygen in a baby’s blood. Low levels of oxygen in the blood can be a sign of a critical CHD. The test is done using a machine called a pulse oximeter, with sensors placed on the baby's skin. The test is painless and takes only a few minutes.

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• Website: CDC- Facts about Critical Congenital Heart Defects

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• Website: AZDHS- Critical Congenital Heart Defects (CCHD) Resources

  • Included in global fee.

 

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Hearing Screen- Recommended < 1 month old

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Hearing screening takes a few minutes while your baby is sleeping. This screening is the first step towards identifying a hearing loss. Early identification is very important. Hearing loss is found in about three babies out of every 1,000 born. In Arizona, that means that between 200-300 babies with hearing loss are born each year.

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• Website: Information for Parents - Hearing Screening

  • Cost varies, insurance can be billed, and free screens are available. 

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