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Pregnancy care
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: Melanie N. Smith, MD, PhD, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
