Prenatal Care and Delivery in the Monadnock Region

Husband and wife holding wife's pregnant stomach

Expecting mothers and their families have many decisions to make. From the seemingly simple questions like what foods to eat during pregnancy, to issues like if or when to return to work after the birth, there is a lot to consider. Friends and relatives offer anecdotes and advice and there are numerous books dedicated to telling pregnant women and their families what to expect. Wading through the information can be daunting, making the decisions around choice of healthcare provider and birth location particularly important. Having a team that understands your values and helps you stay well-informed may provide the experience you desire.

Expecting mothers in the Monadnock Region are fortunate to have choices when it comes to prenatal care and delivery locations. The region is home to hospitals providing obstetrical care, midwife attended birth centers, and home births.

In contrast, a number of rural hospitals in neighboring regions are no longer providing obstetrical care or labor and delivery, creating a gap in services for women living in those areas. The Women’s Health team at Cheshire is working to help close that gap in the surrounding area with a prenatal clinic at Valley Regional Hospital in Claremont, NH. Cheshire’s midwives travel to Claremont weekly to provide prenatal and postpartum care to local patients. Even though Valley Regional no longer provides delivery services, families in that community can still receive their prenatal and postpartum care where they live.

The midwife-led prenatal care and labor and delivery services of Women’s Health at Cheshire Medical Center provide individualized care that can flex to meet your needs. From volunteer doula services to highly specialized care through membership in the Dartmouth-Hitchcock Health system, the Women’s Health team at Cheshire is empowering expecting mothers and their families during this life-changing experience.

Prenatal care is the healthcare received during pregnancy. Getting early and regular prenatal care is key to a healthy pregnancy for both a mother and her baby. Cheshire Medical Center offers expecting mothers and their families the choice between a group model of care that develops community, individual prenatal screenings and appointments, or a combination of both. The goal is to provide the care that is right for each individual family.

Centering Pregnancy is a model of prenatal care put forth by the Centering Health Institute. It’s prenatal care bringing women and families due at approximately the same time together in a group setting. Published studies on Centering Pregnancy (Centering) indicate that families who go through Centering for prenatal care are less at risk for pre-term delivery and low birth weight babies. Participants in Centering benefit from the social support the women and families provide to each other. It’s also a way to receive a great deal of education and time with your provider during your pregnancy in a dynamic environment of discussion and feedback.

The individual prenatal care seen in most other healthcare settings is an option for women receiving their prenatal care at Cheshire. Patients may also choose to have both types of prenatal care, participating in Centering Pregnancy and having individual prenatal appointments with providers. This is especially helpful for families who are experiencing a pregnancy that is medically complicated. They can participate and benefit from the Centering program and receive individual specialized care.

We emphasize babies going right to their mothers during delivery. We do everything reasonable and safe to not interfere with the first few minutes of bonding with mom.

Linda Glasschroeder, BSN, RNC-OB, CBC, Director of OB/GYN Services at Cheshire Medical Center

Labor and delivering a baby are a unique experiences for every mother. What types of support you require or want are driven by your personal health, the health of your baby, and if this isn’t your first pregnancy, the experiences of previous births. Cheshire Medical Center offers services that meet the needs of most birthing mothers and their families.

The philosophy of care provided during labor and delivery is heavily influenced by the collaborative model between midwives and obstetrician physicians. “This collaboration provides women that holistic touch while still having the ability to provide medical interventions if needed,” explains Linda Glasschroeder, BSN, RNC-OB, CBC, Director of OB/GYN Services at Cheshire Medical Center. The team prioritizes immediate skin-to-skin contact for mothers and babies, and will delay non-urgent procedures for an hour or more to give mothers, babies, and family time to bond.

All expecting mothers are asked to complete a birth plan which is printed at the time of delivery and distributed to nursing staff so that the entire team is aware of your preferences. Patients may choose options such as hydrotherapy during labor or epidural. One of the most unique options laboring mothers and families enjoy is the presence of a volunteer doula. The Cheshire Doulas are trained professionals who, at the request of a woman in labor, provide non-medical support to birthing women and their families.

Sometimes, the need for medical intervention is necessary. While the cesarean section rate in New Hampshire is 31% according to CDC data, Cheshire’s c-section rate is only 22.6%. Glasschroeder attributes Cheshire’s low rate to the midwifery model and the collaborative care with physicians, the volunteer doula program, and the 1:1 nursing care during labor. Even after a c-section birth, the team will initiate skin-to-skin for mother and baby in the moments immediately after birth whenever possible.

“It’s a personalized experience. While we work hard to honor your wishes, safety is always our top priority,” says Glasschroeder.

The transition to home and the weeks following are a very important time in the health of both you and baby. Some families may find settling in to be an emotional and challenging time.

While it seems like breastfeeding should be instinctive and one of the most natural things, it is a skill that both mother and baby have to learn and master. The learning curve of breastfeeding usually takes about 4-6 weeks. Cheshire’s Certified Lactation Counselors are available 7-days-a-week to support moms and babies throughout breastfeeding.

Having your first baby can be an isolating time for moms. Cheshire’s Certified Lactation Counselors host a weekly Mom’s Club, where mothers and their babies gather for connection and education.

Sometimes, social connection isn’t enough. Postpartum depression is a complication in childbirth for 1 in 8 women. It’s caused by her body’s drop in hormone levels after childbirth, leading to chemical changes in the brain which may cause mood swings. Sleep deprivation can compound these symptoms.

While postpartum depression isn’t a result of something a mother does or does not do, many women struggle with acknowledging their symptoms and getting help.

“Postpartum depression is a real thing. I think people feel they can’t talk about it because they think, ‘I have this healthy baby and I should be grateful’, so they’re not always forthcoming with those feeling of depression or anxiety” says Glasschroeder. Some moms experience postpartum anxiety, which Glasschroeder describes as more prevalent than depression and is when moms are extremely anxious about leaving their babies or are consumed with worries that harm will come their baby.

These complications are generally temporary and manageable with support and intervention. Cheshire uses depression and anxiety screening tools which are administered at key times during and after pregnancy: before labor and delivery, before discharge, and again at the first postpartum visit.

For women dealing with challenges such as postpartum depression or anxiety, or other behavioral health concerns such as postpartum post-traumatic stress disorder, Clinical Psychologist Amanda Hitchings, PsyD, is available to support women and their families, partnering with providers to establish plans of care that meet their needs.