Here are some items I have been checking every so often. If you are choosing to do your own prenatal care feel free to copy and paste this list and adjust to your own needs. Occasionally I may skip some of the lab work for the following reasons: it is not available in home test kit form or private lab setting, is not really necessary, I have records of previous lab tests or symptoms can easily be resolved/prevented with therapies and treatments.
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PRENATAL CARE
Basic Equipment
-Fetoscope
-BP Cuff
-Stethoscope
-Watch with seconds
-Speculum
-Strips for testing protein or glucose in urine
-Sterile Gloves
-Lubricant
-Tape Measure
-Antiseptic soap
-Scales
1st Checkup: Date: ________________
History
LMP ___________________ Due Date __________________
Symptoms checklist:
1. Visual Disturbances Y/N/Slight 12. Breast Changes Y/N/S
2. Headaches Y/N/S 13. Abdominal Pain Y/N/S
3. Fevers Y/N/S 14. Heart Burn Y/N/S
4. Fatigue Y/N/S 15. Variation in heart Rhythm Y/N/S
5. Nausea Y/N/S 16. Constipation Y/N/S
6. Vomiting Y/N/S 17. Leg Cramps Y/N/S
7. Dizziness Y/N/S 18. Backache Y/N/S
8. Shortness of Breath Y/N/S 19. Edema Y/N/S
9. Back Pain Y/N/S 20. Infections Y/N/S
10. Pain when Urinating Y/N/S 21. Varicosities Y/N/S
11. Vaginal Discharge Y/N/S 22. Date Baby’s Movements 1st felt Y/N/S
If Yes describe:
___________________________________________________________
___________________________________________________________
___________________________________________________________
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Previous Pregnancies:
Date: Conditions:
Previous Medical History:
Allergies:
Nutritional Deficiencies:
Cancers, diabetes etc:
Family History:
Blood Pressure:_____________
Present Weight:______________
Protein in Urine: Y/N
Glucose in Urine: Y/N
Taking Prenatal Vitamins: Y/N/Sometimes
Edema in Feet Legs Vagina: Y/N/Slight
Thyroid Gland: Good/Bad
Pelvic Exam:
4-5 Weeks: (Hegar’s Sign) Soft cervix (like lips not nose): Y/N
5-6 Weeks: Paper Thin Junction between cervix and uterus: Y/N
6 Weeks: Larger than Normal: Y/N
6 Weeks: Cyanosis (Chadwick’s Sign - Blue color of birth canal): Y/N
10 Weeks: Size of a Tennis Ball: Y/N
Twelve Weeks Date: ___________________
Symptoms Checklist
1. Y/N/S 12. Y/N/S2. Y/N/S 13. Y/N/S
3. Y/N/S 14. Y/N/S
4. Y/N/S 15. Y/N/S
5. Y/N/S 16. Y/N/S
6. Y/N/S 17. Y/N/S
7. Y/N/S 18. Y/N/S
8. Y/N/S 19. Y/N/S
9. Y/N/S 20. Y/N/S
10. Y/N/S 21. Y/N/S
11. Y/N/S 22. Y/N/S
If Yes describe:
___________________________________________________________
___________________________________________________________
Blood Pressure: __________________
Weight: ______________
Fundal Height: ________________
Fetal Heart Rate: __________________
Lab Work:
CBC: ___________
HCT: ____________ (35)
Hemoglobin Blood Type: ______________ (about 11.0)
Coombs Test: __________
Rubella Titre: _______________
RPR: ______________
VDRL: ________________
Hepatitis B: __________________
Rh antibodies: ________________
I will continue on the twelve week pattern until 24 weeks, not including the lab work
At 28 weeks I will get the following lab work.
Lab work:
HCT: __________________
Hemoglobin: _______________
Glucose Screening: ________________
RH Anti-Body Test: __________________
At 32 weeks I will add the following to the twelve week pattern.
Baby Position ________________
I may or may not take the following lab test at 36 weeks. Heart and Hands has a simple recipe for antiseptic treatment.
Lab work:
Group B Strep Test:___________________
At 38 weeks and the following weeks I will add the following to the twelve week pattern.
Cervix condition:___________________
I will get a checkup on the following weeks:
1st (4-10 weeks), 12 weeks, 16 weeks, 20 weeks, 24 weeks, 28 weeks, 32 weeks, 36 weeks, 38 weeks, 39 weeks, 40 weeks.....birth!
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