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| |    Getting Good Prenatal Care by Marjorie Greenfield, M.D. reviewed by Marjorie Greenfield, M.D. Congratulations! You are embarking on one of the most amazing events in the course of human life. If this is your first child, you may not yet think of yourself as a parent, but prenatal care is a chance to start being a good parent before your baby is even born. Research has shown that women who see a doctor or nurse-midwife for regular prenatal checkups are less likely to have premature and low birth-weight babies than those who do not. For many generations, pregnant women received health advice from family, friends, and midwives; it's only fairly recently that formal prenatal care has come into practice. Initially the purpose of prenatal care was to identify moms-to-be who were developing high blood pressure in the third trimester. The visits then expanded to include screening for risk factors early in pregnancy, establishing a clear due date, and watching for signs of other developing problems. Now prenatal care often includes counseling about diet and lifestyle, discussions about how to tell normal symptoms of pregnancy from those that can be worrisome, and education about what to expect in the course of pregnancy and birth. The first prenatal visit If you haven't had a preconception visit or if you have any medical problems or obstetrical risks, the first prenatal visit should take place as early as possible. If you saw your practitioner before conception, prenatal care should still begin by the 10th to 12th week. Information such as the date of your last period and the regularity of your menstrual cycles will help establish your due date. Routine blood and urine tests also will be obtained, you will undergo a physical examination, and your cervix will be checked for sexually transmitted infection. This visit also provides a chance to get to know your practitioner and her practice and to see how your styles and values match up. Routine prenatal appointments Prenatal visits are usually scheduled at four-week intervals through the seventh month, then at two-week intervals, and finally weekly in the last month. Your practitioner may need to see you less often if you are at low risk, more often if there are potential problems developing. At each visit, the medical staff will check your blood pressure, weight, and urine. Your practitioner will do a "tummy check" to see how the baby is growing, listen to the fetal heart rate, and ask you about fetal movement, contractions and any problems you may be experiencing. Be sure to report how you are feeling, and don't hesitate to ask lots of questions. Toward the end of the pregnancy, your practitioner may start to check your cervix with an internal examination to see if your body is readying itself for labor. Fathers and prenatal care Dads should feel welcome at the prenatal visits. This is a time for both of you to get to know your doctor or midwife and to discuss your ideas and preferences for your baby's birth. In addition, a father-to-be will get to listen firsthand to what the practitioner recommends for his partner, rather than hearing what she remembers the evening after the appointment. This is particularly valuable for the preconception appointment, the first prenatal visit, the visit around the time of genetic screening (about 16 weeks), and if any problems are developing in the pregnancy. Any appointment where an ultrasound is scheduled is also a great chance for a dad to bond with his baby-to-be. Genetic screening Genetic risk factors should be identified at the preconception or first prenatal visit. Depending on your age, family history, and other factors, you may choose to have a triple check test (also called the alpha-feto-protein) or amniocentesis. While ultrasound is often not considered necessary in a low-risk pregnancy, it may be recommended if your due date is unclear, if your uterus measures surprisingly big or small, or if there are questions about the well-being of the baby. Third-trimester testing Besides routine early pregnancy blood work and genetic screening, most practitioners will test for gestational diabetes and group B strep in the third trimester. If there is concern about the baby's well-being, his status can be monitored using techniques of fetal assessment.
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