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Medical Care During Pregnancy Millions of women give birth every year. Nearly one third of them will have some kind of pregnancy-related complication. Those who don't get adequate prenatal care run the risk that such complications will go undetected or won't be dealt with soon enough. That, in turn, can lead to potentially serious consequences for both the mother and her baby. These statistics aren't meant to alarm you, but rather to convey the importance of starting prenatal care as early as possible - ideally, before you even get pregnant. Of course, this isn't always possible or practical. But the sooner in your pregnancy you begin, the better your chances of ensuring your own health and that of your baby.
Prenatal Care Before Getting PregnantIdeally, prenatal care should start before you get pregnant. If you're planning a pregnancy, see your health care provider for a complete checkup. He or she can do routine testing to make sure you're in good health and that you don't have any illnesses or other conditions that could affect your pregnancy. If you've been experiencing any unusual symptoms, this is a good time to report them. If you're already being treated for a chronic condition, such as diabetes, asthma, hypertension (high blood pressure), a heart problem, allergies, lupus (an inflammatory disorder that can affect several body systems), depression, or some other condition, you should talk to your doctor about how it could affect your pregnancy. In some cases, you may need to change or eliminate medications - especially during the first trimester (12 weeks) - to reduce risk to the fetus. Or you may need to be even more vigilant about managing your condition. For example, women with diabetes must be especially careful about keeping their blood glucose levels under control, both before they begin trying to conceive and during their pregnancy. Abnormal levels increase the risk of birth defects and other complications. This is also a good time to talk with your health care provider about other factors that can pose a risk to your baby, such as drinking alcohol or smoking. Ask about starting a prenatal vitamin that contains folic acid, calcium, and iron. If you have or your partner has a family history of a significant genetic disorder and you suspect either of you may be a carrier, then genetic testing may be advisable. Talk this over with your health care provider, who can refer you to a genetic counselor if it is necessary. If you find out that you're pregnant before you do any of this, don't worry. It's not too late to get the care that will ensure your health and that of your baby.
Finding Medical CarePregnant women are typically cared for by obstetricians (doctors who specialize in pregnancy and childbirth; they may or may not also be gynecologists, doctors who specialize in women's health care), family practitioners, or certified nurse-midwives. If you are happy with your gynecologist and he or she also does obstetrics, then there's probably no need to switch, unless there's something that makes your pregnancy high risk. For example, if you have a chronic condition like diabetes or heart problems, have an increased risk of preterm labor, are older than 35, or have some other complicating factor that might put you in a high-risk category, your obstetrician/gynecologist (OB/GYN) may refer you to a doctor with expertise in high-risk pregnancies. You also may choose to receive your care from a certified nurse-midwife or a family practitioner. A certified nurse-midwife is an advanced practice nurse specializing in women's health care needs, including prenatal care, labor and delivery, and postpartum care for "normal" pregnancies. Family practitioners are doctors who provide a range of services for patients of all ages - in some cases, this includes obstetrical care - instead of specializing in one area. Any of these care providers is a valid choice if you are healthy and there is no reason to anticipate complications with your pregnancy and delivery. However, nurse-midwives do need physician backup for the delivery in case a cesarean section has to be performed.
Care Provider Visits and TestsYour First Visit Your first examination should take place during the first 6 to 8 weeks of your pregnancy, or when your menstrual period is 2 to 4 weeks late. Seeing your health care provider during this time will help him or her estimate the duration of the pregnancy and predict the delivery date. During your first visit, you can expect to have a full physical, including a pelvic and rectal examination. A blood sample will be taken and used for a series of tests: a complete blood cell count, or CBC; blood typing and screening for Rh antibodies (antibodies against a substance found in the red blood cells of most people); laboratory tests for syphilis, hepatitis, gonorrhea, chlamydia, and other sexually transmitted diseases (STDs); and testing for evidence of previous exposure to varicella, measles, mumps, or German measles (rubella). A test for human immunodeficiency virus (HIV) is also recommended. You also can expect to provide a urine sample for testing and to have a Pap test for cervical cancer. Women of African or Mediterranean descent are usually tested for sickle cell trait or disease because they are at higher risk for having sickle cell anemia - a chronic blood disease - or carrying the trait, which can be passed on to their children.
Routine Visits and TestingIf you are healthy and there are no complicating risk factors, you can expect to see your health care provider every 4 weeks until the 28th week of pregnancy, then every 2 weeks until 36 weeks, then once a week until delivery. At each examination, your weight and blood pressure are usually recorded, and the size and shape of your uterus are measured to determine whether the fetus is growing and developing normally. During one or more of your visits, you will be asked to provide a small urine sample to be tested for sugar and protein. Sugar in the urine may indicate diabetes, and protein may indicate preeclampsia (a condition that develops in late pregnancy and is characterized by a sudden rise in blood pressure and excessive weight gain). Screening for diabetes usually takes place at 12 weeks for women who have previously had large babies, an unexplained miscarriage, or a relative with diabetes and at 28 weeks for everyone else. Many expectant parents also choose to have one or more of the following tests, which can help predict the likelihood, or even detect the presence, of certain developmental or chromosomal abnormalities in the fetus:
Common ConcernsMany women are concerned about preexisting medical conditions, such as diabetes, asthma, and high blood pressure, and how they could affect a pregnancy. It's important to discuss these concerns with your health care provider. He or she may recommend a change in medication or treatment approaches that could ease your concerns. Whether or not you have a preexisting condition, you may be concerned about some of the other conditions that can be associated with pregnancy. They include:
These conditions are serious but manageable, so it's important to educate yourself about them and discuss them with your health care provider. Another common concern for pregnant women is weight gain. It's generally recommended that a woman of normal weight gain approximately 25 to 30 pounds during pregnancy - about 2 or 3 pounds each month. Gaining more than 30 to 35 pounds can put a woman at higher risk for prolonged labor, which increases the likelihood of fetal distress and a cesarean delivery. Any extra weight gained during pregnancy can also have a major effect on a woman's health after the baby is born if she does not lose the weight. It can put her at increased risk for diabetes, heart disease, high blood pressure, or stroke. Controlling weight gain is more difficult later in a pregnancy, so try to avoid gaining a lot of weight during the first months. However, not gaining enough weight can cause problems too, such as inadequate fetal growth and premature labor.
Taking Care of YourselfTake especially good care of yourself during your pregnancy. Don't smoke, don't drink alcohol or take drugs, get enough rest, and eat a healthy diet. Doctors generally recommend that women add about 300 calories to their daily intake to provide nourishment for the developing fetus. Although protein should supply most of these calories, your diet needs to be well-balanced, including fresh fruits, grains, and vegetables. Your health care provider will likely prescribe a prenatal vitamin to make sure you get enough folic acid, iron, and calcium. Over-the-counter medications are generally considered off-limits because of their potential effects on the fetus. Most doctors will recommend that you don't take any over-the-counter medications at all or they may offer a list of those that they think are safe to take. Be sure to discuss any questions about medications, including natural remedies, supplements, and vitamins, with your health care provider. Pregnancy also can cause a number of uncomfortable, although not necessarily serious, side effects. These include nausea and vomiting, especially early in the pregnancy; leg swelling; varicose veins in the legs and the area around the vaginal opening; hemorrhoids; heartburn and constipation; backache; fatigue; and sleep loss. If you experience one or more of these side effects, keep in mind that you're not alone! Talk to your doctor about strategies for alleviating any discomfort.
Talking to Your Health Care ProviderTalking to your health care provider isn't always easy, especially when your body is going through physical changes that may be completely new to you. Maybe you're wondering whether you can have sex or what to do about hemorrhoids or constipation, or maybe you're feeling a great deal of anxiety about the delivery. You might feel embarrassed to ask these or other questions, but it's important to do so. Try to keep in mind that obstetricians went into this field because they were interested in taking care of women. There are very few questions that we haven't already heard. Keep a running list of questions between your appointments, and take that list with you to each visit. You should call your health care provider immediately if you experience heavy bleeding, a sudden loss of fluid, a marked absence of movement by the baby once he or she has begun moving, or more than three contractions in an hour.
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alpha-fetoprotein screening
(AFP): Between 16 and 18 weeks, the level of alpha-fetoprotein, a protein produced by the fetus, can be measured in the woman's blood. If the level is high, she may be carrying a fetus with spina bifida or other neural tube defects (problems with the normal development of the spine and nervous system) or more than one fetus. A high level also can indicate that the date of conception was miscalculated. If the level is low, the fetus may have chromosomal abnormalities, such as Down syndrome. It's important to keep in mind that low or high results do not automatically indicate a problem; rather, they indicate the need for further testing, which in many cases yields normal results. Your health care provider may also measure the levels of certain hormones in your blood, along with AFP - this is called multiple marker screening. Although such screening is
elective.
