Pregnancy care

Answer 1

Information

Prior to modern medicine, many mothers and their babies did not survive pregnancy and the birth process. Today, good prenatal care can significantly improve the quality of the pregnancy and the outcome for the infant and mother.

Good prenatal care includes:

• Good nutrition and health habits before and during pregnancy
• Frequent prenatal examinations
• Routine ultrasounds to detect problems with the baby
• Routine screening for:
  • Blood pressure problems
  • Blood type problems (Rh and ABO)
  • Diabetes
  • Genetic disorders, if a family history or the age of the mother presents a high risk
  • Rubellaimmunity
  • Sexually transmitted diseases
  • Urine protein

Women who choose to have an abortion usually do so in the very early stages of the pregnancy (usually before 12 weeks gestation). Abortion is legal through the 24th week of pregnancy. The abortion procedure, however, becomes more difficult with advancing gestational age, and many providers do not perform pregnancy terminations in the second trimester.

Women who plan to continue a pregnancy to term need to choose a health care provider who will provide prenatal care, delivery, and postpartum services. Provider choices in most communities include:

• Doctors specializing in obstetrics and gynecology (OB/GYN)
• Certified nurse midwives (CNMs)
• Family practice physicians
• Family nurse practitioners (FNPs) or physician assistants (PAs) who work with a doctor
• Perinatologists (doctors who specialize in the very high risk pregnancy)

Family health care providers, or generalists, can help manage women throughout normal pregnancies and deliveries. If there is a problem with the pregnancy, your doctor will refer you to a specialist.

The goals of prenatal care are to:

• Monitor both the mother and baby throughout the pregnancy
• Look for changes that may lead to a high-risk pregnancy
• Explain nutritional requirements throughout the pregnancy and postpartum period
• Explain activity recommendations or restrictions
• Address common complaints that may arise during pregnancy (such as morning sickness, backaches, leg pain, frequent urination, constipation, and heartburn) and how to manage them, preferably without medications

Women who are considering becoming pregnant, or who are pregnant, should eat a balanced diet and take a vitamin and mineral supplement that includes at least 0.4 milligrams (400 micrograms) of folic acid. Folic acid is needed to decrease the risk of certain birth defects (such as spina bifida). Sometimes higher doses are prescribed if a woman has a higher than normal risk of these conditions.

Pregnant women are advised to avoid all medications, unless the medications are necessary and recommended by a prenatal health care provider. Women should discuss all medication use with their providers.

Pregnant women should avoid all alcohol and drug use and limit caffeine intake. They should not smoke. They should avoid herbal preparations and common over-the-counter medications that may interfere with normal development of the growing baby.

Prenatal visits are typically scheduled:

• Every 4 weeks during the first 32 weeks of gestation
• Every 2 weeks from 32 to 36 weeks gestation
• Weekly from 36 weeks to delivery

Weight gain, blood pressure, fundal height, and the baby's heart beat (as appropriate) are usually measured and recorded at each visit, and routine urine screening tests may be performed.

WHEN TO CALL YOUR DOCTOR

• Call for an appointment if you suspect you are pregnant, are currently pregnant and are not receiving prenatal care, or if you are unable to manage common complaints without medication.
• Call your health care provider if you suspect you are pregnant and are on medications for Diabetes, thyroid disease, seizures, or high blood pressure.
• Notify your health care provider if you are currently pregnant and have been exposed to a sexually transmitted disease, chemicals, radiation, or unusual pollutants.
• Call your health care provider if you are currently pregnant and you develop fever, chills, or painful urination.

CALL YOUR DOCTOR IMMEDIATELY

It is urgent that you call your health care provider if you are currently pregnant and you have any amount of vaginal bleeding, severe abdominal pain, physical or severe emotional trauma, or your water breaks (membranes rupture).

References

Johnson RBT, Gregory KD, Niebyl JR. Preconception and prenatal care: part of the continuum. In: Gabbe SG, Niebyl JR, Simpson JL, eds. Obstetrics - Normal and Problem Pregnancies. 5th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2007:chap 5.

Simpson JL, Holzgreve W. Genetic counseling and genetic screening. In: Gabbe SG, Niebyl JR, Simpson JL, eds. Obstetrics - Normal and Problem Pregnancies. 5th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2007:chap 6.

Niebyl JR, Simpson JL. Drugs and environmental agents in pregnancy and lactation: embryology, teratology, epidemiology. In: Gabbe SG, Niebyl JR, Simpson JL, eds. Obstetrics - Normal and Problem Pregnancies. 5th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2007:chap 8.

Richards DS. Ultrasound for pregnancy dating, growth, and the diagnosis of fetal malformations. In: Gabbe SG, Niebyl JR, Simpson JL, eds. Obstetrics - Normal and Problem Pregnancies. 5th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2007:chap 9.

Alto WA. No need for glycosuria/proteinuria screen in pregnant women. J Fam Pract. 2005;54(11):978-983.

Rhode MA, Shapiro H, Jones OW. Indicated vs. routine prenatal urine chemical reagent strip testing. J Reprod Med. 2007;52(3):214-219.

Answer 2

Information

Before modern medicine, many mothers and their babies did not survive pregnancy and childbirth. Today, good prenatal care can significantly improve the quality of the pregnancy and the outcome for the baby and mother.

Good prenatal care includes:

• Good nutrition and health habits before and during pregnancy
• Frequent prenatal exams
• Routine ultrasounds to detect problems with the baby
• Routine screening for:
  • Blood pressure problems
  • Blood type problems (Rh and ABO)
  • Diabetes
  • Genetic disorders
  • Immunity to German measles (rubella)
  • Sexually transmitted infections
  • Urine protein

Women who plan to continue a pregnancy to term need to choose a health care provider who will provide prenatal care, delivery, and postpartum services. Provider choices in most communities include:

• Doctors specializing in obstetrics and gynecology (OB/GYN)
• Certified nurse midwives (CNMs)
• Family medicine physicians
• Family nurse practitioners (FNPs) or physician assistants (PAs) who work with a doctor
• Perinatologists (doctors who specialize in the very high risk pregnancy)

Family health care providers or midwives can help you if you have a normal pregnancy and delivery. But if there is a problem, your doctor will refer you to a specialist.

The goals of prenatal care are to:

• Monitor both the mother and baby throughout the pregnancy
• Look for changes that may lead to a high-risk pregnancy
• Explain nutritional requirements during and after pregnancy
• Explain activity recommendations or restrictions
• Discuss common pregnancy complaints such as morning sickness, backaches, leg pain, frequent urination, constipation, and heartburn and how to manage them, preferably without medications
• Give support to the pregnant woman and her family

Women who are considering becoming pregnant, or who are pregnant, should eat a balanced diet and take a vitamin and mineral supplement that includes at least 0.4 milligrams (400 micrograms) of folic acid. Folic acid is needed to decrease the risk of certain birth defects (such as spina bifida). Sometimes higher doses are prescribed if a woman has a higher than normal risk of these conditions.

Pregnant women are advised to avoid all medications, unless the medications are necessary and recommended by a prenatal health care provider. Women should discuss all medication use with their providers.

Pregnant women should avoid all alcohol and drug use and limit caffeine intake. They should not smoke. They should avoid herbal preparations and common over-the-counter medications that may interfere with normal development of the growing baby.

How often you need to see your doctor depends on whether or not you have a high-risk pregnancy. Usually, prenatal visits are scheduled:

• Every 4-6 weeks during the first 28 weeks of gestation
• Every 2-4 weeks from 28 to 36 weeks gestation
• Weekly from 36 weeks to delivery

Your health care team will usually check your weight gain, blood pressure, fundal height, and the baby's heart beat (as appropriate) at each visit. Routine urine screening tests may be done.

WHEN TO CALL YOUR HEALTH CARE PROVIDER

Call your health care provider if you are pregnant or think you are pregnant and:

• You take medicines for diabetes, thyroid disease, seizures, or high blood pressure
• You are not getting prenatal care
• You cannot manage common pregnancy complaints without medication
• You might have been exposed to a sexually transmitted infection, chemicals, radiation, or unusual pollutants

Call your health care provider immediately if you are pregnant and you:

• Have a fever, chills, or painful urination
• Vaginal bleeding
• Severe belly pain
• Physical or severe emotional trauma
• Have your water break (membranes rupture)
• Are in the last half of your pregnancy and notice the baby is moving less or not at all

References

Cunningham FG, Leveno KJ, Bloom SL, et al. Preconceptional counseling. In: Cunnigham FG, Leveno KL, Bloom SL, et al, eds. Williams Obstetrics. 23rd ed. New York, NY: McGraw-Hill; 2010:chap 7.

Cunningham FG, Leveno KJ, Bloom SL, et al. Prenatal care. In: Cunnigham FG, Leveno KL, Bloom SL, et al, eds. Williams Obstetrics. 23rd ed. New York, NY: McGraw-Hill; 2010:chap 8.

Cunningham FG, Leveno KJ, Bloom SL, et al. Prenatal diagnosis and fetal care. In: Cunnigham FG, Leveno KL, Bloom SL, et al, eds. Williams Obstetrics. 23rd ed. New York, NY: McGraw-Hill; 2010:chap 13.

McDuffie RS Jr, Beck A, Bischoff K, Cross J, Orleans M. Effect of frequency of prenatal care visits on perinatal outcome among low-risk women. A randomized controlled trial. JAMA. 1996 Mar 20;275(11):847-51.

Reviewed By

Review Date: 09/13/2011

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

Answer 3

It's always important to take good care of your health, but never more so than when you're pregnant. You're not only caring for your own body, you're also nurturing and growing a new human being. Let's talk about pregnancy care.

During the nine or so months of your pregnancy, you'll see a lot of your ob/gyn. In fact, you should visit your doctor once a month during the first seven months of your pregnancy. Then you should see your doctor once every 2 or 3 weeks until your ninth month, and finally every week until you deliver. You might also see your regular doctor, a nurse midwife, or, if you have any complications, a perinatologist who specializes in high-risk pregnancies.

That might sound like a lot of visits, but the goal is to keep a close eye on both you and your growing baby. Your doctor will check your baby's heart rate, and measure how quickly you're gaining weight. You'll likely have at least one ultrasound, where you can actually get to see your baby and find out the gender, unless you want it to be a surprise. Throughout your pregnancy, your doctor will monitor you for any health problems, such as high blood pressure or diabetes.

At your regular prenatal visits, your doctor can give you advice about what to eat and how much to exercise. You can also ask about all those weird symptoms you've been having, like morning sickness, food cravings, and the constant urge to use the bathroom.

There are a few things you need to do while you're pregnant to make sure you and your baby are healthy. First, you have to take 400 micrograms of folic acid every day. Folic acid is especially important right before you get pregnant, and during the first trimester of your pregnancy because it helps your baby's brain and spinal cord form. Taking folic acid can help prevent birth defects like spina bifida.

One thing you need to avoid is alcohol. When you're craving a glass of wine or beer, have some sparkling water, Grape Juice, or Ginger Ale instead. Alcohol can be very dangerous for your baby. Also don't take any medicines without talking to your doctor first. That includes over-the-counter medicines like aspirin and cold relievers. Caffeine is okay, but only in moderation. Limit yourself to one cup of coffee, instead of your regular two or three. Don't smoke and stay away from anyone who is smoking. Cigarette smoke deprives your baby of oxygen. It can stunt your child's growth, and lead to birth defects such as a cleft lip or palate.

If you're pregnant and you haven't seen a doctor yet, now is the time to call. The sooner you get prenatal care, the more likely that your baby will be born healthy. Let your doctor know if you have a condition like diabetes, seizures, or high blood pressure, or if you've been exposed to a sexually transmitted infection, chemicals, or radiation.

Get medical help right away during your pregnancy if you have a fever, painful urination, vaginal bleeding, or severe stomach pain. Call if your water breaks, or you're not feeling your baby moving and it's near the end of your pregnancy.

Reviewed By

Review Date: 10/25/2011

Alan Greene, MD, Author and Practicing Pediatrician; also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.