OB

Preconception

Preconception care can improve your chances of getting pregnant, having a healthy pregnancy, and having a healthy baby. If you are sexually active, talk to your doctor about your preconception health now. Preconception care should begin at least three months before you get pregnant. But some women need more time to get their bodies ready for pregnancy. Be sure to discuss your partner’s health too. Ask your doctor about:

• Family planning and birth control.
• Taking folic acid.
• Vaccines and screenings you may need, such as a Pap test and screenings for sexually transmitted infections (STIs), including HIV.
• Managing health problems, such as diabetes, high blood pressure, thyroid disease, obesity, depression, eating disorders, and asthma. Find out how pregnancy may affect, or be affected by, health problems you have.
• Medicines you use, including over-the-counter, herbal, and prescription drugs and supplements.
• Ways to improve your overall health, such as reaching a healthy weight, making healthy food choices, being physically active, caring for your teeth and gums, reducing stress, quitting smoking, and avoiding alcohol.
• How to avoid illness.
• Hazards in your workplace or home that could harm you or your baby.
• Health problems that run in your or your partner’s family.
• Problems you have had with prior pregnancies, including preterm birth.
• Family concerns that could affect your health, such as domestic violence or lack of support.

Bring  a list of talking points (PDF, 182 KB) to be sure you don’t forget anything. If you run out of time at your visit, schedule a follow-up visit to make sure everything is covered.

Choosing a prenatal care provider

You will see your prenatal care provider many times before you have your baby. So you want to be sure that the person you choose has a good reputation, and listens to and respects you. You will want to find out if the doctor or midwife can deliver your baby in the place you want to give birth, such as a specific hospital or birthing center. Your provider also should be willing and able to give you the information and support you need to make an informed choice about whether to breastfeed or bottle-feed.

Health care providers that care for women during pregnancy include:

• Obstetricians (OB) are medical doctors who specialize in the care of pregnant women and in delivering babies. OBs also have special training in surgery so they are also able to do a cesarean delivery. Women who have health problems or are at risk for pregnancy complications should see an obstetrician. Women with the highest risk pregnancies might need special care from a maternal-fetal medicine specialist.
• Family practice doctors are medical doctors who provide care for the whole family through all stages of life. This includes care during pregnancy and delivery, and following birth. Most family practice doctors cannot perform cesarean deliveries.
• A certified nurse-midwife (CNM) and certified professional midwife (CPM) are trained to provide pregnancy and postpartum care. Midwives can be a good option for healthy women at low risk for problems during pregnancy, labor, or delivery. A CNM is educated in both nursing and midwifery. Most CNMs practice in hospitals and birth centers. A CPM is required to have experience delivering babies in home settings because most CPMs practice in homes and birthing centers. All midwives should have a back-up plan with an obstetrician in case of a problem or emergency.

Ask your primary care doctor, friends, and family members for provider recommendations. When making your choice, think about:

• Reputation
• Personality and bedside manner
• The provider’s gender and age
• Office location and hours
• Whether you always will be seen by the same provider during office checkups and delivery
• Who covers for the provider when she or he is not available
• Where you want to deliver
• How the provider handles phone consultations and after-hour calls

Prenatal checkups

During pregnancy, regular checkups are very important. This consistent care can help keep you and your baby healthy, spot problems if they occur, and prevent problems during delivery. Typically, routine checkups occur:

• Once each month for weeks four through 28
• Twice a month for weeks 28 through 36
• Weekly for weeks 36 to birth

Women with high-risk pregnancies need to see their doctors more often.

At your first visit your doctor will perform a full physical exam, take your blood for lab tests, and calculate your due date. Your doctor might also do a breast exam, a pelvic exam to check your uterus (womb), and a cervical exam, including a Pap test. During this first visit, your doctor will ask you lots of questions about your lifestyle, relationships, and health habits. It’s important to be honest with your doctor.

After the first visit, most prenatal visits will include:

• Checking your blood pressure and weight
• Checking the baby’s heart rate
• Measuring your abdomen to check your baby’s growth

You also will have some routine tests throughout your pregnancy, such as tests to look for anemia, tests to measure risk of gestational diabetes, and tests to look for harmful infections.

Become a partner with your doctor to manage your care. Keep all of your appointments — every one is important! Ask questions and read to educate yourself about this exciting time.

Common prenatal tests

Test	What it is	How it is done
Amniocentesis (AM-nee-oh-sen-TEE-suhss)	This test can diagnosis certain birth defects, including: Down syndrome Cystic fibrosis Spina bifida It is performed at 14 to 20 weeks. It may be suggested for couples at higher risk for genetic disorders. It also provides DNA for paternity testing.	A thin needle is used to draw out a small amount of amniotic fluid and cells from the sac surrounding the fetus. The sample is sent to a lab for testing.
Biophysical profile (BPP)	This test is used in the third trimester to monitor the overall health of the baby and to help decide if the baby should be delivered early.	BPP involves an ultrasound exam along with a nonstress test. The BPP looks at the baby’s breathing, movement, muscle tone, heart rate, and the amount of amniotic fluid.
Chorionic villus (KOR-ee-ON-ihk VIL-uhss) sampling (CVS)	A test done at 10 to 13 weeks to diagnose certain birth defects, including: Chromosomal disorders, including Down syndrome Genetic disorders, such as cystic fibrosis CVS may be suggested for couples at higher risk for genetic disorders. It also provides DNA for paternity testing.	A needle removes a small sample of cells from the placenta to be tested.
First trimester screen	A screening test done at 11 to 14 weeks to detect higher risk of: Chromosomal disorders, including Down syndrome and trisomy 18 Other problems, such as heart defects It also can reveal multiple births. Based on test results, your doctor may suggest other tests to diagnose a disorder.	This test involves both a blood test and an ultrasound exam called nuchal translucency (NOO-kuhl trans-LOO-sent-see) screening. The blood test measures the levels of certain substances in the mother’s blood. The ultrasound exam measures the thickness at the back of the baby’s neck. This information, combined with the mother’s age, help doctors determine risk to the fetus.
Glucose challenge screening	A screening test done at 26 to 28 weeks to determine the mother’s risk of gestational diabetes.Based on test results, your doctor may suggest a glucose tolerance test.	First, you consume a special sugary drink from your doctor. A blood sample is taken one hour later to look for high blood sugar levels.
Glucose tolerance test	This test is done at 26 to 28 weeks to diagnose gestational diabetes.	Your doctor will tell you what to eat a few days before the test. Then, you cannot eat or drink anything but sips of water for 14 hours before the test. Your blood is drawn to test your “fasting blood glucose level.” Then, you will consume a sugary drink. Your blood will be tested every hour for three hours to see how well your body processes sugar.
Group B streptococcus (STREP-tuh-KOK-uhss) infection	This test is done at 36 to 37 weeks to look for bacteria that can cause pneumonia or serious infection in newborn.	A swab is used to take cells from your vagina and rectum to be tested.
Maternal serum screen (also called quad screen, triple test, triple screen, multiple marker screen, or AFP)	A screening test done at 15 to 20 weeks to detect higher risk of: Chromosomal disorders, including Down syndrome and trisomy 18 Neural tube defects, such as spina bifida Based on test results, your doctor may suggest other tests to diagnose a disorder.	Blood is drawn to measure the levels of certain substances in the mother’s blood.
Nonstress test (NST)	This test is performed after 28 weeks to monitor your baby’s health. It can show signs of fetal distress, such as your baby not getting enough oxygen.	A belt is placed around the mother’s belly to measure the baby’s heart rate in response to its own movements.
Ultrasound exam	An ultrasound exam can be performed at any point during the pregnancy. Ultrasound exams are not routine. But it is not uncommon for women to have a standard ultrasound exam between 18 and 20 weeks to look for signs of problems with the baby’s organs and body systems and confirm the age of the fetus and proper growth. It also might be able to tell the sex of your baby.Ultrasound exam is also used as part of the first trimester screen and biophysical profile (BPP).Based on exam results, your doctor may suggest other tests or other types of ultrasound to help detect a problem.	Ultrasound uses sound waves to create a “picture” of your baby on a monitor. With a standard ultrasound, a gel is spread on your abdomen. A special tool is moved over your abdomen, which allows your doctor and you to view the baby on a monitor.
Urine test	A urine sample can look for signs of health problems, such as: Urinary tract infection Diabetes Preeclampsia If your doctor suspects a problem, the sample might be sent to a lab for more in-depth testing.	You will collect a small sample of clean, midstream urine in a sterile plastic cup. Testing strips that look for certain substances in your urine are dipped in the sample. The sample also can be looked at under a microscope.

Understanding prenatal tests and test results

If your doctor suggests certain prenatal tests, don’t be afraid to ask lots of questions. Learning about the test, why your doctor is suggesting it for you, and what the test results could mean can help you cope with any worries or fears you might have. Keep in mind that screening tests do not diagnose problems. They evaluate risk. So if a screening test comes back abnormal, this doesn’t mean there is a problem with your baby. More information is needed. Your doctor can explain what test results mean and possible next steps.

Source: Office On Women’s Health