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Prenatal Care: an essential part of every pregnancy

Adeline Nukuna, PhD., M.D.

Prenatal care is a vital part of every pregnancy. Whether you are a first time mum, second time mum, or have had several babies before, prenatal care is a necessary component of your pregnancy. It gives an opportunity for medical care of both you and your growing baby throughout the duration of your pregnancy.

Some people often wonder how soon prenatal care should be started. Prenatal care should be initiated as soon as possible. Call your healthcare provider as soon as you find out you are pregnant. Early prenatal care is needed by everybody. After establishing care, it is important to get regular prenatal care. The advantages are manifold. During prenatal care, different types of laboratory tests and imaging are done. Some of these have to be done at specific times during the course of pregnancy. Regular prenatal care enables these tests and imaging to be done at the right time. If you start prenatal care late or miss your appointments, you might miss the appropriate time period for some tests. Regular prenatal care gives an opportunity for certain conditions that may develop during pregnancy to be diagnosed and managed appropriately. Some examples of such conditions include preeclampsia (a condition that is characterized by high blood pressure and protein in the urine), and gestational diabetes (that is, diabetes that develop during pregnancy). Also, it gives an opportunity for pregnant women with certain medical conditions that can complicate pregnancy, to be adequately monitored and closely followed. Examples include women with high blood pressure, diabetes, asthma, women with a history blood clots, just to mention a few.

Typically, you will have an initial prenatal intake visit. During this visit, your healthcare provider will obtain a detailed history and physical exam on you. The history taken will include your medical history (both current and past), history of previous pregnancies, surgical history, family history, social history, allergy, and any medication you might be taking or have taken since you got pregnant. A history will also be taken about the father of the baby. It is important that you share this information with your healthcare provider. The information obtained will guide the care offered to you and your baby. For example, pregnant women with a history of an excision procedure to their cervix (LEEP or cone biopsy), will need regular measurements of the length of their cervix; those with a strong family history of diabetes will need screening for gestational diabetes early on in their pregnancy; in people with a family history of genetic abnormality (either in the woman or father of the baby's family), genetic counseling and in some cases, special testing will be offered or made available.

Generally, in pregnancy that is without complication, you will see your healthcare provider every four weeks from the beginning of your pregnancy up to when you are 28 weeks. Thereafter, the appointments become every two weeks until 36 weeks. From 36 weeks until delivery, the prenatal visits are weekly. Women with complications during their pregnancy or with medical problems that can complicate pregnancy will be seen more often.

It is important that throughout your prenatal care, you should ask or discuss with your healthcare provider, any questions or concerns that you may have. No question is ever stupid. Do not be shy or afraid to ask questions or discuss concerns. Examples of questions that pregnant women have include, but are not limited to, laboratory tests and imaging studies, medications that are safe to use in pregnancy, exercise, sex, diet in pregnancy. You may also want to discuss the labor and delivery process, for example, how accommodating is the provider about a birth plan, does the provider and/or facility where you plan to deliver allow a vaginal birth after cesarean section (for women with previous cesarean section)? If not, can your healthcare provider refer you to a facility where it can be done. If you have a birth plan, take it and discuss the details with your healthcare provider. He/she will go over them and discuss with you what will be doable or not doable. Generally, most healthcare providers work with their patients to accommodate whatever they can. However, bear in mind that sometimes during labor, things might not always go as planned and in case of an emergency or in cases where problems arise, despite all the good intentions, your birth plan may not be followed as originally planned. So keep an open mind. The more you know about the birthing process and what to expect, the less will be the surprises, and the more rewarding your experience will be.

In summary, the importance of obtaining prenatal care cannot be overemphasized. It gives an opportunity for your healthcare provider to take adequate care of you and your growing baby. Write down your questions or concerns and discuss them at your prenatal visits. The more you know/are informed, the more you are able to actively participate in your care. This makes your overall experience of pregnancy and birthing enjoyable and rewarding.

For people who do not have insurance (or need free or low cost prenatal care), call 1 800 311 baby (1 800 311 2229); you will be connected to your state and will be given information on services available. For information in Spanish, call 1 800 504 7081. You can obtain more information and other helpful links about pregnancy at the pregnancy home page of the Centers for Disease Control, www.cdc.gov.