Diseases

Pregnancy: Prenatal Care and Tests Information

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 acesarean 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.
• A doula (DOO-luh) is a professional labor coach, who gives physical and emotional support to women during labor and delivery. They offer advice on breathing, relaxation, movement, and positioning. Doulas also give emotional support and comfort to women and their partners during labor and birth. Doulas and midwives often work together during a woman's labor. A recent study showed that continuous doula support during labor was linked to shorter labors and much lower use of:
  • Pain medicines
  • Oxytocin (ok-see-TOHS-uhn) (medicine to help labor progress)
  • Cesarean delivery

• 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

High-risk pregnancy

Pregnancies with a greater chance of complications are called "high-risk." But this doesn't mean there will be problems. The following factors may increase the risk of problems during pregnancy:

• Very young age or older than 35
• Overweight or underweight
• Problems in previous pregnancy
• Health conditions you have before you become pregnant, such as high blood pressure, diabetes, autoimmune disorders, cancer, and HIV
• Pregnancy with twins or other multiples

Monitor your baby's activity

After 28 weeks, keep track of your baby's movement. This will help you to notice if your baby is moving less than normal, which could be a sign that your baby is in distress and needs a doctor's care. An easy way to do this is the "count-to-10" approach. Count your baby's movements in the evening — the time of day when the fetus tends to be most active. Lie down if you have trouble feeling your baby move. Most women count 10 movements within about one hour. It is rare for a woman to count less than 10 movements within two hours at times when the baby is active. Count your baby's movements every day so you know what is normal for you. Call your doctor if you count less than 10 movements within two hours or if you notice your baby is moving less than normal. If your baby is not moving at all, call your doctor right away.

Paying for prenatal care

Pregnancy can be stressful if you are worried about affording health care for you and your unborn baby. For many women, the extra expenses of prenatal care and preparing for the new baby are overwhelming. The good news is that women in every state can get help to pay for medical care during their pregnancies. Every state in the United States has a program to help. Programs give medical care, information, advice, and other services important for a healthy pregnancy. To find out about the program in your state:

• Call 800-311-BABY (800-311-2229) – This toll-free telephone number will connect you to the Health Department in your area code.
• Call 800-504-7081 for information in Spanish.
• Call or contact your local Health Department.

• Local hospital or social service agencies – Ask to speak with a social worker on staff. She or he will be able to tell you where to go for help.
• Community clinics – Some areas have free clinics or clinics that provide free care to women in need.
• Women, Infants and Children (WIC) Program– This government program is available in every state. It provides help with food, nutritional counseling, and access to health services for women, infants, and children.
• Places of worship

Places to deliver your baby

Many women have strong views about where and how they'd like to deliver their babies. In general, women can choose to deliver at a hospital, birth center, or at home. You will need to contact your health insurance provider to find out what options are available. Also, find out if the doctor or midwife you are considering can deliver your baby in the place you want to give birth. Hospitals are a good choice for women with health problems, pregnancy complications, or those who are at risk for problems during labor and delivery. Hospitals offer the most advanced medical equipment and highly trained doctors for pregnant women and their babies. In a hospital, doctors can do a cesarean delivery if you or your baby is in danger during labor. Women can get epidurals or many other pain relief options. Also, more and more hospitals now offer on-site birth centers, which aim to offer a style of care similar to standalone birth centers. Questions to ask when choosing a hospital:

• Is it close to your home?
• Is a doctor who can give pain relief, such as an epidural, at the hospital 24-hours a day?
• Do you like the feel of the labor and delivery rooms?
• Are private rooms available?
• How many support people can you invite into the room with you?
• Does it have a neonatal intensive care unit (NICU) in case of serious problems with the baby?
• Can the baby stay in the room with you?
• Does the hospital have the staff and set-up to support successful breastfeeding?
• Does it have an on-site birth center?

Prenatal care and test facts

*Prenatal care and test facts Medically Edited by: Melissa Conrad Stoppler, MD

• The definition of prenatal care is the health care of women throughout the course of pregnancy. Good prenatal care helps ensure the health of both the mother and the baby. Regular checkups and prenatal testing are important parts of prenatal care.
• Prenatal care practitioners include obstetricians, family practice doctors, certified nurse-midwives (CNM), certified professional midwives (CPM), and doulas.
• A woman can give birth in a hospital, birth center, or at home. The presence of certain health problems or pregnancy complications may prohibit a home birth.
• Typically, a woman's age, family history, medical history, and pregnancy risk factors are assessed during the initial prenatal doctor visit. A breast exam, Pap test, pelvic exam, and cervical exam may also be performed.
• Part of prenatal care is screening also will be assessed for conditions like
  • anemia,
  • Rh factor incompatibility,
  • toxoplasmosis,
  • hepatitis B,
  • syphilis,
  • Chlamydia, and
  • HIV.
• Blood type and immunity to rubella (German measles) and chickenpox will also be assessed.
• Prenatal tests are performed to monitor the health and development of the baby. Prenatal tests include
  • amniocentesis,
  • ultrasound,
  • quad screen,
  • chorionic villus sampling,
  • group B strep screening, and
  • a urine test.
• Certain factors, such as gestational diabetes, preeclampsia, and being over the age of 35 increase the risk of having a high-risk pregnancy. Women who have a high-risk pregnancy may need more frequent doctor visits and special care.
• Prenatal care costs can be expensive. Programs and services are available to help women get the care they need.

Prenatal care and tests introduction

Medical checkups and screening tests help keep you and your baby healthy during pregnancy. This is called prenatal care. It also involves education and counseling about how to handle different aspects of your pregnancy. During your visits, your doctor may discuss many issues, such as healthy eating and physical activity, screening tests you might need, and what to expect during labor and delivery.

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

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

Prenatal tests

Tests are used during pregnancy to check your and your baby's health. At your fist prenatal visit, your doctor will use tests to check for a number of things, such as:

• Your blood type and Rh factor
• Anemia
• Infections, such as toxoplasmosis and sexually transmitted infections (STIs), including hepatitis B, syphilis, chlamydia, and HIV
• Signs that you are immune to rubella (German measles) and chicken pox

• Age
• Personal or family health history
• Ethnic background
• Results of routine tests

• Down syndrome
• Cystic fibrosis
• Spina bifida

• Chromosomal disorders, including Down syndrome
• Genetic disorders, such as cystic fibrosis

• Chromosomal disorders, including Down syndrome and trisomy 18
• Other problems, such as heart defects

• Chromosomal disorders, including Down syndrome and trisomy 18
• Neural tube defects, such as spina bifida

• Urinary tract infection (UTI)
• Diabetes
• Preeclampsia