Pregnancy

APM's Prenatal visits are comprehensive but relaxed and allow plenty of time for chatting, education and getting your questions answers (visits typically 40-60 minutes).  As holistic primary care providers we emphasize prevention and education along with getting to know you and your family personally.  We believe that by maintaining healthy lifestyles; eating right, exercising and avoiding harmful substances and stress; most of our clients remain low-risk. The physical exam follows with blood pressure, urine dip, measuring the baby’s growth, determining the position and listening to the heartbeat.  

Prenatal Visits

Initial Visit

1 - 1/2 hour visit including history, physical, risk screening & informed consent

Nutritional review and counseling

Preconception counseling and well woman visit if not pregnant yet

*If you have already began care with another provider, we can help you with obtaining copies of your medical records. 


First Trimester

Relaxed monthly visits with time to chat and get questions answered

Well woman visit including pap smear if needed

Lab testing or obtain medical records from prior provider

Ultrasound to confirm pregnancy, if desired

Genetic Screenings if desired.  APM offers Progenity. 


Second Trimester

Relaxed monthly visits with time to chat and get questions answered

Full OB ultrasound

Discussions of birth choices

Begin Belly Mapping


Second Trimester Group Prenatal Class

Now is the time to set the foundation and learn about the physiology of labor and birth, and how the choices you make affect the hormonal changes of labor.  We discuss the 28 week labs and complications that arise that could potentially risk you  out of midwifery care and what you can do to prevent them. The focus is on keeping you healthy, Belly Mapping, preventing gestational diabetes and GBS, reducing stress, sleep, relaxation and childbirth education.  It's a fun interactive class filled with aromatherapy, relaxation techniques and even dancing!


Third Trimester

Relaxed bimonthly visits from 28-36 weeks and weekly visits from 36 weeks until birth

28 week laboratory testing and 36 week GBS culture

Belly mapping & Optimal Fetal Positioning

Birth planning


Third Trimester Group Prenatal Class

During this group we will be touring your specific birth room and show you where everything is so when you arrive in labor, you can settle in and make yourself right at home!   We'll spend time discussing when to call the midwife, what to pack, when to come, the what if's and transport.  Your partner is strongly encouraged to attend this group meeting!! If you have a doula that has never attended an APM birth, we encourage her to come as well. 


Home Birth Home Visit

In lieu of the Third Trimester Class, Families planning a home birth will receive a Home Visit around 36 weeks.  At this visit we will do the normal prenatal visit but also deliver your birth kit (included), review how to prep your home, the tub, when to call the midwife and talk about any questions you might have about your upcoming birth.



 “Why spend an hour waiting for an obstetrician when you can be spending that hour with our midwife!” 


Laboratory & Ultrasound

We have lab privileges and can order any lab work or ultrasound that you may need. Blood will be drawn by the midwifery staff at the birth center or ordered at one of our affiliated labs including Quest. 


Women have the option of participating in or declining the CA Quad Marker Screening Program.  They also have the option of having the newer, more accurate Non-Invasive Pregnancy Testing through Natera. Progenity is a DNA screening test that can tell you important information about your pregnancy. You can find out if your baby is at risk for chromosomal abnormalities as well as the gender of your baby as early as 10 weeks of pregnancy. 


For women wanting ultrasound, we utilize a mobile sonography company that comes to the birth center as well as a sonography company in Rancho Cucamonga.


As midwives, we believe in the appropriate use of technology and informed consent.  You can opt for as many or few interventions as you like as long as you understand the risks and benefits of accepting or declining.  




Spinning Babies and Belly Mapping

Belly mapping is a technique we've learned to help mama determine what all the kicks and wiggles reveal  about her baby's position.  Each APM mama gets to borrow a Belly Mapping workbook in her last trimester.  This is a fun way to connect with your little one inside you, but more importantly, you gain awareness and understanding of his position.  It's important to know whether the baby is coming head (vertex) or bottom (breech) first.  In head down babies, the direction he's facing and how well his chin is tucked can often influence the course of your labor.  If the baby is not in an optimal position, we'll begin Spinning Babies exercises and positioning to help him to move.   Since most transports are a result of babies not navigating mama's pelvis well, belly mapping is an important part of our preventive , holistic care.


Note:  We don't always draw on mama's belly but will if she wants us to!

VBAC  (Vaginal Birth after Cesarean)

APM offers midwifery care and birth services for women with one prior, low-transverse cesarean section.  It’s best if you have had a year between pregnancies and understand the risks and benefits of VBAC versus the risk and benefits of repeat cesarean.  Women with a previous cesarean will need to provide copies of medical records and operation reports from their cesarean surgery as well as labor and delivery summaries of any subsequent births.


Some info on VBAC:  The risk of uterine rupture after one “bikini cut” cesarean is 0.2% – 0.4% and the risk of infant death or injury is 0.05%. (Landon 2004, Gonen 2006, Cahill 2006).  Risk of miscarriage from an amniocentesis is 5 – 20 times greater than the risk of infant death or injury from a VBAC. (March of Dimes, Landon 2004). 


A repeat cesarean section lowers your risk of uterine rupture in your current pregnancy, but it does not eliminate it.  Additionally, the risk of complications increases with each repeat c-section including your risk of uterine rupture in future pregnancies, whereas the risk of rupture decreases by 50% after your first VBAC. (Mercer 2008) (excerpt from VBACFacts.com).  


Clients who are working towards a VBAC do have the highest transfer of care rates - compared to clients without a previous cesarean, but if you'd like a trial of labor vs a scheduled repeat cesarean, midwifery care can be a great option. APM's VBAC rate is 80% since 2014. For more information on vaginal birth after a cesarean, go to VBACfacts.com.