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Guide for a Healthy Pregnancy

PRENATAL CARE

doctor listeningPregnancy is a time of change, and there is a lot to learn. Whether you hoped for this pregnancy for a long time or were surprised by it, you are bound to have many questions. This booklet talks about what you can do to have a healthy pregnancy and how your health care team will work with you. We also try to answer common questions, explain your baby’s growth and your changing body, and share ways to cope with discomforts you may feel.

Your clinicians will go over some of this during your check-ups. Another good way to learn is to find books, videos, web sites, and classes on topics like childbirth, breastfeeding, and infant care. In the coming months, we hope you’ll ask many questions and take good care of yourself and your baby-to-be.

Your Health Care Team

During your pregnancy, you may see a nurse practitioner, physician assistant, certified nurse midwife, or an obstetrician during your check-ups. We work together as a team. Registered nurses, medical assistants and childbirth educators may be part of that team too. All these people have one goal – to help you have a healthy, joyful pregnancy and birth.

Obstetricians (OBs) must finish four years of medical school after college. They also must do four to five years of practical training in a hospital (residency) caring for women, delivering babies, and learning surgical techniques. Like all doctors, obstetricians must be licensed by the state.

OBs are trained to care for women during and after pregnancy and childbirth. A woman may choose an OB as her primary clinician during pregnancy. Obstetricians do all cesarean sections and births that require forceps and most vacuum extractions.

Certified Nurse Midwives (CNMs) are registered nurses with advanced education in obstetrics and gynecology (often a master’s degree). They must finish studies in an accredited program, pass an exam given by the American College of Nurse Midwives, and be licensed by the state where they practice.

They find and treat common health problems in women of all ages. They do exams, order needed lab tests, and prescribe medicine. CNMs also teach women about how their bodies work and encourage them to participate in their health care.

CNMs also deliver babies in the hospital. Occasionally, some choose to practice only in the office and do not attend births. When complications arise, CNMs consult doctors. CNMs are trained to handle normal births. They do not do cesarean sections and generally do not use forceps or vacuum extractors during births. Some problems during labor require a nurse midwife to work with a doctor.

Ob/Gyn Nurse Practitioners (NPs) and Physician Assistants (PAs) Ob/Gyn NPs are registered nurses with advanced education in women’s health care (often a master’s degree). ObGyn PAs have completed a comprehensive training program. NPs and PAs must pass national certifying exams and be licensed by the state where they practice.

These providers find and treat common health problems in women. They do exams and order needed lab tests. NPs and PAs care for women with normal pregnancies before and after birth, but do not deliver babies. They also teach women to care for themselves and their babies and they can prescribe medication. When there are medical problems, NPs and PAs consult with MDs.

Registered Nurses (RNs) must finish three to four years of nursing education and training in an accredited program. They also must be licensed by the state. RNs teach classes, give test results, answer medical questions, and handle phone calls from patients. They also help with routine health care, exams, and procedures such as IVs and injections.

Licensed Practical Nurses (LPNs) must finish a one-year certification program at an accredited school and be licensed by the state.

LPNs also answer medical questions, help with procedures such as IVs and injections, renew prescriptions, and counsel patients.

Medical Assistants have had some medical training. They take your blood pressure and weight, and check urine samples for signs of sugar and protein (and sometimes infection). They schedule checkups, too.

Childbirth Educators are trained to teach about pregnancy and childbirth. Some are RNs or NPs. Others are certified childbirth educators. Their classes cover topics like the changes of pregnancy, labor and birth, and breastfeeding.

Your Plan for a Healthy Pregnancy

doctor taking blood pressure of pregnant womanPrenatal Care is Important

Regular checkups during pregnancy are very important. Such prenatal care lets us follow your baby’s growth and your health. We can help you learn about your pregnancy, too, and get ready for labor, birth, and parenthood. Please be sure to keep all your appointments, even if you feel fine.

Most pregnancies usually last about 40 weeks. Once you start getting prenatal care, you will have monthly checkups during the first 28 weeks of pregnancy. From weeks 28-36, your checkups will generally be every two weeks. In your last month, visits will be weekly. Your clinician may set up more visits if needed. If a problem arises, emergency visits are always possible.

Most pregnancies are healthy, and consistent prenatal care helps prevent problems. But sometimes problems do occur with little or no warning. If you have concerns or any of the warning signs identified by your clinicians, call your health care team for advice. Someone is on call 24 hours a day.

Discuss any problems with earlier pregnancies with your clinician.
If you’ve had problems with earlier pregnancies, talk with your primary or obstetric clinician. S/he will try
to find out what caused the problem and how likely it is to happen again. Your current pregnancy will be watched carefully and special tests may be done, if needed.

What happens during check-ups

You are welcome to bring your partner or a support person with you to prenatal check-ups.

Exams usually done once (often the first visit):

  1. Complete health history
  2. Physical examination, including gyn exam and testing.
    • Pelvic exam which estimates the size and shape of the pelvis
    • Vaginal and cervical exam
    • Pap smear and cervical cultures, if needed
  3. Blood tests: blood type, Rh factor, complete blood count (test for anemia); RPR (test for syphilis), hepatitis and rubella screen. HIV screening is offered to everyone regardless of risk. Additional tests will be offered for genetic trait testing, such as cystic fibrosis, depending on risk. Also, at 24-28 weeks, a gestational diabetes screen along with a repeat of your complete blood count will be done.
  4. Urine tests to check for a urinary tract infection.

Exams done at each check-up:

  1. Weight
  2. Blood pressure
  3. Urine tests for protein and sugar
  4. Abdominal exam for growth of the uterus and estimate size and position of the fetus
  5. Fetal heart check

Your due date will be estimated, counting from the first day of your last menstrual period (LMP). It will be 40 weeks from your LMP if you know that day and have regular periods. If you can’t recall the date your last period started, your clinician will estimate the due date by the size of your uterus or by ultrasound. Remember though, due dates are just estimates. Few women – only about one in 20 – give birth exactly on that day. Most babies are born during the two weeks before or after their due dates.

Between check-ups

You may find that you have questions you’d like your health care team to answer before your next check-up. Write down questions as you think of them so you don’t forget. Keep the list by the phone when you call, or take it to your next visit.

For urgent problems, call your health care team right away. If your regular clinician is not available, an on-call clinician will care for you.

Pregnancy, Childbirth, and Parenting Classes

A wide variety of organizations offer pregnancy, childbirth, and parenting classes. You will find that prices vary widely, too. Some classes cost a lot, but may be available at a reduced fee if you ask. Ask about classes offered at your site. Some community organizations may have free or low-cost classes, too. If you can’t find the class you want at the right price or location, talk to your clinician.

Childbirth education classes are very helpful for first-time parents, so try to take them if you can. (If you already are a parent, you may benefit from a shorter refresher course or a sibling class for your child.) During the classes, you will learn what to expect during pregnancy, labor, and birth. Often relaxation and breathing techniques to use during labor are taught. You learn about options for pain relief, too. Infant feeding and preparing for a new family member may be discussed. Common hospital procedures and a tour of the hospital where you’ll give birth might be included, too. The instructor may tailor topics to suit the specific needs of class members. For first-time parents, we highly recommend a breastfeeding class. Topics should include breastfeeding basics, instruction on how to make sure your baby is getting enough milk, and ways to avoid problems like sore nipples.

Be sure to register for classes early in pregnancy even though many don’t start until your sixth or seventh month. If you can’t take classes, try to learn more about pregnancy and childbirth and breastfeeding through videos and books.

Planning ahead for your baby’s birth

By your third trimester, you should start thinking about:

Talk to your clinician about these issues. Ask for the appropriate pamphlets.

Note: The gender of the baby is randomly referred to as either he or she.

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