Prenatal Care

Prenatal Care at a Glance

• Medical care especially for pregnant woman

• Important for a healthy pregnancy

• Includes regular checkups and prenatal testing

• Best to begin as soon as you know you are pregnant

The key to having a healthy baby is taking good care of your own health. The healthier you are, the stronger you and your baby are likely to be.

We all want to be healthy, but sometimes it is hard to know what we should do. If you are pregnant, or thinking about becoming pregnant, you may have some questions. Here are some of the most commons questions we hear women ask about prenatal care.

What Is Prenatal Care?

Prenatal care is the care you receive from a health care provider, such as a doctor or midwife, during pregnancy. During prenatal care visits, your health care provider will make sure you and the developing fetus are healthy and strong. These regular checkups are your chance to learn how to manage the discomforts of pregnancy, have any testing you may need, learn warning signs, and ask any questions you may have.

It's best to begin before you are pregnant — this is sometimes called pre-pregnancy health or preconception planning. But if that is not possible, begin prenatal care as soon as you know you're pregnant.

What Will Happen During My First Prenatal Care Visit?

The first prenatal care visit is usually the longest. The examination is very thorough. You will be asked questions about your medical history. You will also be asked about your partner's medical history and your family's medical history. You will have a complete physical exam. Your health care provider will measure your height, weight, blood pressure, breathing, and pulse.
Usually, you will be given a gynecological exam that will include

• a breast exam

• a Pap test

• tests for chlamydia and gonorrhea

You may be offered blood or skin tests to check for

• anemia — including sickle cell anemia

• blood type

• certain inherited diseases, such as Gaucher's and Tay-Sachs

• cystic fibrosis

• hepatitis

• HIV/AIDS

• rubella

• syphilis

• thalassemia

• tuberculosis

You may also be given urine tests to check for diabetes or other infections.
Your health care provider may take this opportunity to discuss your lifestyle and habits and to suggest certain changes that may help make the pregnancy healthy. One of the most important things a woman can do is to take folic acid — a B vitamin — every day to prevent serious birth defects.

How Often Will I Have Prenatal Care Visits?
If you are 18 to 35 years old and healthy, you will probably have a "low-risk" pregnancy. If so, plan to have prenatal care visits about

• every four or six weeks, from the first to seventh month of pregnancy (the first 28 weeks)

• every two or three weeks in the eighth month (from week 28 to 36)

• every week in the ninth month (from week 36 until delivery)

If you have a high-risk pregnancy, your health care provider may ask you to come in for prenatal care more often.

What Will Happen During My Follow-Up Prenatal Care Visits?

Your health care provider will check that your pregnancy is progressing well. During prenatal care visits your provider may

• test your urine

• check your blood pressure

• check your weight

• check for swelling in the face, hands, or feet

• examine your abdomen to check the position of the fetus

• measure the growth of your uterus

• listen for the sounds of the fetal heartbeat

• offer prenatal testing

Each visit is also an opportunity to discuss any questions or concerns that have come up since your last visit.

What Is Prenatal Testing?

Your health care provider may offer you certain tests during your pregnancy. These tests are used to make sure that you are healthy and the fetus is doing well. Some tests identify possible birth defects.
The different tests are done at certain times. Your health care provider will let you know what tests you may want or need, and when you will need them.
Some common prenatal tests for birth defects and other abnormalities include

• ultrasound

• multiple marker screening

• CVS — chorionic villus sampling

• amniocentesis

Another common test is the biophysical profile (BPP). It is most commonly given during the third trimester. The BPP uses ultrasound combined with a fetal monitor to observe fetal heartbeat and movement. BPP allows your health care provider to evaluate the well-being of the fetus.

What Is an Ultrasound?

Ultrasound allows a health care provider to take pictures of the embryo or fetus as it develops. An ultrasound scan builds a picture of the embryo or fetus on a screen by bouncing sound waves into your uterus. Ultrasound is also called a sonogram. Depending on when it is done during pregnancy, it may

• confirm your due date

• find certain abnormalities

• find multiple pregnancies

• measure the length of your cervix

• show the position and size of the fetus

• show the position of the placenta

Ultrasound is a very safe procedure — no x-rays are involved.

Between 11 and 13 weeks of pregnancy, some providers combine a blood test with a special kind of ultrasound. Some providers refer to this as the combined test. It is used to screen for Down syndrome and other genetic birth defects.

How Ultrasound Is Done

There are two ways to do an ultrasound — through the abdomen or through the vagina. Ultrasounds may be performed by your health care provider or by a trained ultrasound technician.

During an abdominal ultrasound, your provider will place the ultrasound wand on your abdomen, using a small amount of gel to help lubricate the area. You may feel pressure during the exam, but it is not painful.

During a vaginal ultrasound, your provider will insert the ultrasound wand into the vagina. This may feel similar to a vaginal exam. You may feel pressure during the exam, but it is not painful.

What Is the Multiple Marker Screening?

The multiple marker screening is another type of prenatal testing and is sometimes called the triple or quadruple screen. It is usually performed between weeks 15 and 20. The health care provider will draw some of your blood to screen for Down syndrome, spina bifida, and other birth defects. Your health care provider will offer you other tests if the multiple marker screening reveals an increased risk of birth defects.

What is CVS (Chorionic Villus Sampling)?

Chorionic villus sampling, or CVS, is a kind of prenatal testing that examines the tissue attaching the fetus to the wall of the uterus. CVS is usually performed between 10 and 12 weeks of pregnancy.

You may consider CVS if

• you are over age 35

• you or your partner has a family history that reveals a risk of certain birth defects

• you have had a child with a major birth defect

How CVS Is Done

CVS can be done in two ways — a thin tube can be inserted through the cervix or a thin needle is inserted through the stomach. Ultrasound is used to guide the needle in both methods.

CVS is generally painless. However, you may feel cramping or have bleeding or spotting after CVS. Symptoms usually stop within a few days. Be sure to tell your health care provider if you have any discomfort or bleeding.

CVS is generally safe. After CVS, there is a slight chance of infection, injury to the fetus, or having early labor.

What Is Amniocentesis?

Amniocentesis is another form of prenatal testing. This test examines amniotic fluid — the fluid that surrounds and protects the fetus. Amniocentesis finds certain birth defects. It is usually done between 15 and 18 weeks of pregnancy.
You may consider amniocentesis if

• you are over age 35

• your multiple marker screening shows a need for more testing

• you or your partner has a family history that reveals a risk of certain birth defects or other disorders

• you have had a child with a major birth defect

How Amniocentesis Is Done

A health care provider inserts a long, thin needle into the abdomen to take out a small amount of fluid. Your health care provider will use the pictures from the ultrasound to guide the needle.

Amniocentesis is generally painless — many women report having no pain at all, but some women report mild discomfort.

Amniocentesis is also generally safe. However, as with CVS, there is a slight chance of infection, injury to the fetus, or early labor.

What Changes Can I Expect During Pregnancy?

There are many changes that occur during pregnancy. Your body will go through a lot of hormonal changes. Your uterus will grow up to 18 times larger than it normally is. Your breasts and nipples will become larger. And you will gain weight.

You may have increased and decreased sexual desire. You may have changes in the texture of your hair and in the amount of body hair you have. And you may experience other discomforts and changes that are new to you. You can discuss these changes at your prenatal care visits.

Common discomforts during pregnancy include

• nausea or vomiting

• heartburn

• constipation

• aches and pains in the abdomen and lower back

• tiredness

How Will I Know If Something Is Wrong?

Most pregnancies proceed without any problem. But problems can happen unexpectedly. Contact your health care provider right away if you think you may have been exposed to a sexually transmitted infection or if you have any of these warning signs:

• sudden weight gain of more than two pounds within one day

• severe swelling of the face, ankles, legs, or feet

• severe or frequent headaches that last more than two or three hours and do not get better after taking the medication your health care provider has recommended

• fainting

• blurred vision, flashes of light, or spots before your eyes

• pain or burning while urinating

• sudden increase in thirst

• dramatic increase or decrease in urination

• unusual vaginal discharge

• light vaginal bleeding or spotting

Very Dangerous Warning Signs

Premature Labor — Pregnancy takes about 40 weeks. If contractions cause your cervix to open earlier than normal — between the 20th and 37th week — it's called premature labor. Premature labor can be very dangerous.
The signs of premature labor include

• uterine contractions — strong tightening in the abdomen — every 10 minutes or less

• repeating or constant menstrual-like cramps in the lower abdomen

• abdominal cramps with or without diarrhea

• pelvic pressure that feels like the fetus is pushing down

• increase or change in vaginal discharge

• sudden gush of watery fluids from the vagina (water breaking)

• feeling like the fetus is "balling up"

Signs of other dangerous problems include

• heavy bleeding from the vagina

• constant severe lower abdominal pain or cramps on one or both sides

• dimness or blurring of vision that lasts two or three hours

• dizziness or double vision

• severe or continued vomiting

• chills and/or fever of 101°F or more

• fever of 101°F or more with pain or burning while urinating

• sudden severe swelling or puffiness of the face, hands, legs, ankles, or feet, especially if you have a headache or vision change

• after six months of pregnancy, the fetus moves a lot less than before

• after six months of pregnancy, you think the fetus hasn't moved in eight hours or more

If you are experiencing any of these signs, contact your health care provider or go to the hospital immediately.

Want to know more?