Prenatal Care Services
When You Should Seek Prenatal Care
- Personal and Family History
- Prenatal Lab Tests
- Common Tests
- Additional Prenatal testing
- Risks to Avoid While Pregnant
- How to Get Prenatal Care
- The WIC Program
Prenatal care gives you the opportunity to get advice and treatment from doctors to ensure a healthy pregnancy, mother, and baby. The sooner you start your care, the sooner health risks and physical problems that may affect your pregnancy can be identified and changed. Keeping regular prenatal visits allows your doctor the opportunity to monitor your health and the health of your baby. This is important in order to identify and treat problems as soon as possible. Remember, prenatal care is not just medical care. You also have the chance to learn many things about good health habits, counseling and community support services, childbirth preparation, and how to be a good parent. We want to assure you that all personal information shared with us throughout your pregnancy will be kept confidential. The American Health Insurance Portability and Accountability Act (HIPAA) says that healthcare providers cannot share your private medical information with anyone without your written permission.
Prenatal care should begin before you miss your second menstrual period. You will see a doctor 10 to 14 times during your pregnancy and have at least one checkup six weeks after the baby is born.
Most healthcare providers charge a set fee that includes all of your prenatal visits, the birth and aftercare. Your healthcare provider’s fee can be covered by your medical insurance plan. If you do not have health insurance, don’t give up—the “How to get prenatal care” section will tell you how to get the early prenatal care you and your baby need, including prenatal testing.
The first prenatal visit will probably be longer and more involved than later visits. A detailed medical, family, obstetric, and genetic history will be taken. Generally, your prenatal physical and lab tests will be done as well. It is a good idea to bring any medical records and a list of medications you are taking or have taken and any family medical history information that will give your doctor clues to family related problems is helpful to plan total care for you. Information on problems and outcomes of past pregnancies is very important. Any records or information on a history of genetic diseases in the family such as Down Syndrome and spina bifida should be brought to the visit.
Remember to inform your doctor of any use of alternative treatments such as herbal preparations or acupuncture. Since many questions, often personal, are asked during the history, most doctors will ask any friends or family to stay in the waiting room during the history and physical. This request is in agreement with HIPAA regulations. Physical
Your weight, blood pressure, and urine test will be done during your first visit and again at each prenatal visit. Height measurement and vital signs are usually done during the first visit in most offices and again in future visits if necessary. Your doctor or nurse practitioner will perform the prenatal physical and examine you from head to toe for any physical problems that could affect your pregnancy. A pelvic exam is performed to check your reproductive organs, identify infections, perform a pap smear, and get an idea about your pelvis size so that decisions can be made about delivery.
Uterine size in the early weeks gives us clues as to how far the pregnancy has progressed. The uterus is about the size of a soft ball when you are 10 to 12 weeks pregnant. After about 20 weeks of pregnancy, as your uterus enlarges, your doctor will measure the uterine height to get an idea of proper fetal growth. Using a tape measure, she will measure from the pubis bone to the fundus or top of the uterus. Each centimeter of measurement should closely agree with the weeks of pregnancy. This is only an estimate of the size of the baby. Sometimes ultrasound will be used in the 3rd trimester for a much more precise measurement of fetal weight. Fetal length measurement is not possible, even when using ultrasound.
During your first prenatal visit some doctors will perform an early ultrasound to make sure your pregnancy dates are accurate. Ultrasound in early pregnancy is usually done with a special probe that is gently inserted into the vagina. You will feel some pressure, but it should not hurt. This way a very small baby, sometimes only the size of a grain of rice with a heartbeat, can be seen. A full bladder is not necessary with this special probe. In the first 12 weeks of pregnancy, ultrasound dating is very accurate. The doctor will also use your last menstrual period date and the ultrasound date to give you a final due date or what is called your estimated date of delivery (EDD). This due date should not change for any known reason later in the pregnancy. Ultrasound has been safely used for about 40 years with no risks for mothers or babies. If you do have an early, dating ultrasound, ask your doctor for a picture. Your family members are usually welcome to view the ultrasound if you desire. If you do not have an early ultrasound, your doctor will give you a due date based on the first day of your last period. Because we date from the last menstrual period and not the date of conception, many women are surprised to find out at their first prenatal visit that they are approximately 2 weeks further into pregnancy than they thought. You should be able to hear your baby’s heartbeat with a special device called a doppler by 12 weeks and this is another way to confirm your due date. If there is any doubt about when you are due, ultrasound will be used to clear up differences and sometimes the date will be changed at this time. Remember, the due date is only an estimate of when your baby will come. Most women go into labor sometime within 2 weeks, plus or minus of their due date.
Throughout pregnancy you can expect to be scheduled to see your doctor as follows:
- Every 4 weeks from the first prenatal visit to 28 weeks
- Every 2-3 weeks from 28 to 36 weeks
- Every week from 36 weeks until you deliver
- Anatomy ultrasound at about 20 weeks
- Office visits and ultrasound more frequently if you have problems
Be sure to write down any questions you have and bring them to your prenatal visits. Remember, no question is silly!
Laboratory tests are a very important part of prenatal care. Many tests involve taking a small amount of blood out of your arm. Others, such as a pap test, are done during your prenatal physical with a pelvic exam and speculum. If you have never had blood drawn or a pap smear before, be sure to tell your doctor.
The lab tests that may routinely be performed by your doctor at your first prenatal visit include:
- Complete blood count (CBC)
- Blood type and antibody screen
- Blood Rh factor
- Rubella antibody
- Hepatitis B antibody
- Syphilis test
- HIV(with yourconsent)
- Thyroid function test
- Chlamydia and Gonorrhea cultures
- Pap test
- Wet mount for vaginal yeast and bacterial vaginosis
- Urine analysis and culture
- Urine drug screen
- Other tests as indicated by need or risk factors
• Cystic Fibrosis: Cystic fibrosis (CF) is a genetic disorder passed to children from both parents that causes babies to have too much mucous in their lungs and intestines. This is a lifelong problem that can have mild or severe symptoms. About 1 in 25 white people carry the gene for CF. The chance is less for other ethnic groups. Most people with CF live about 30-40 years. You may be offered the chance to have a blood test to determine if you carry the gene for this disorder.
• First Trimester Screening: In the first trimester, between 11 and 13 weeks of pregnancy, you may be offered a two-part test to screen your baby for Down syndrome and another genetic problem. This test includes a blood test from you and an ultrasound of your baby to measure the small area on the back of his or her neck. The ultrasound is usually done by placing a probe in to the vagina or birth canal. The information from both of parts of this test is used to tell if a baby has a risk for genetic problems. A positive test does not mean your baby has a problem. If you do have an abnormal test, you will be offered a chance to talk with a genetic counselor and a special doctor called a perinatologist at the medical center.
• Multiple Marker or Quad Screen: You will be encouraged to have a small amount of blood drawn that screens your baby for Down Syndrome, spina bifida and other abnormalities between 16 and 20 weeks of pregnancy. This blood test and information from the first trimester genetic screening test is often used together to give your doctors better information. This test also gives your doctor an idea of how well the placenta, your baby’s lifeline, is functioning. Even if you have an abnormal test, it doesn’t mean that anything is wrong with your baby. It could just mean that your due date is wrong. Just as with the First Trimester Screening test, if you do have an abnormal test, you will be offered a chance to talk with a genetic counselor and a perinatologist to talk about what this all means. If you haven’t had an ultrasound already, your doctor may suggest you have one and will talk about other tests that you may want to think of having to get more information about your baby. Remember, this is only a screening test and and an abnormal result doesn’t mean there is anything wrong with your baby. Most babies are born perfectly healthy.
• Anatomy ultrasound: This ultrasound, which views your baby’s body parts and organs is performed at about 20 weeks, or half-way through your pregnancy. We wait until this time because your baby needs to grow big enough so that the ultra-sonographers can see everything necessary to determine that your baby is healthy. Remember, they are looking at very small organs such as kidneys, heart, and brain features. They will be able to tell you if your baby is a boy or a girl, as long as your baby is in a position to see those parts. Keep in mind that ultrasound can only see about 75% of fetal anatomy and there may be things that can affect a baby that ultrasound cannot detect. Ask your doctor if they will videotape a part of the ultrasound for you.
• One hour glucose tolerance test (GTT): At 24-28 weeks of pregnancy, you should be tested for gestational diabetes known as the diabetes of pregnancy. Sometimes the high levels of hormones produced by the placenta can cause high blood sugar levels for both mom and baby that will last until after your baby is born. If you are at a high risk for diabetes, you may be tested earlier than 24 weeks. Gestational diabetes can be a problem if not identified early in pregnancy and properly treated. Babies of diabetic mothers can be large and more difficult to deliver. They often spend time in the nursery because it is hard for them to regulate their own blood sugar when mom is diabetic. It is important for you to know that many women who have gestational diabetes during pregnancy develop Type 2 Diabetes later in life. Watching your weight and eating healthy can improve your health as you age.
For the GTT, you will be asked to drink a very sweet tasting drink that is similar to orange soda. Your blood will be taken 1 hour later. You should get instructions from your doctor on whether to eat before you have this test. Be sure to ask so that you don’t have to reschedule the test. You may not have anything to eat or drink during the test. This includes smoking and chewing gum. If your blood results are too high, you will be scheduled for a similar test that takes 3 hours. Even if you are diagnosed with gestational diabetes, it can often be easily controlled. We have special nurses and dieticians that will help you change your diet and monitor your blood sugar at home.
• Group B Strep (GBS): At 35-37 weeks, your doctor will collect a culture from your vaginal and rectal area with a cotton swab. This test is important because if you have GBS, there is a small chance the baby can become infected. Unlike many other germs, this one does not usually make you sick. If you are positive for GBS, you will be put on antibiotics during your labor so that your baby is protected. Look for more information on GBS in the back of this manual.
Throughout your pregnancy, your doctor will be monitoring you and your baby for problems. Sometimes additional tests or procedures will be recommended. Some tests may require you to talk with a genetic counselor and a perinatologist, a special doctor who is an expert in problems of pregnancy and unborn babies. If that happens, they will be able to explain these tests and why they are important. Remember, your doctor or nurse practitioner is your best source for information regarding your pregnancy. If you have questions, just ask. Their most important consideration is the safety of you and your baby.
Additional tests you may hear about include:
- Human Chorionic Gonadotropin (HCG) (blood test)
- Progesterone(blood test)
- Herpes testing (blood test)
- Sickle cell testing (blood test)
- Infections that can affect your baby (blood test)
- Abnormal blood clotting factors (blood test)
- 11-13 week screen for Down Syndrome (ultrasound and blood test)
- Alphafetoprotein (AFP) (blood test between 16 and 23 weeks)
- ChorionicVillus Sampling or CVS (placenta is tested for genetics)
- Amniocentesis (amniotic fluid is tested for genetic problems or to determine if baby’s lungs are mature)
Here are ways you can help your baby get off to a healthy start.
- Avoid taking medications. It is wise to avoid taking any medications at all during your pregnancy, especially during the first 12 weeks. This includes prescription drugs and over-the-counter medications such as aspirin and laxatives. If you have the flu, a cold or a more complicated illness, your doctor will tell you which medications are safe to take.
- Avoid X-rays. Avoid having routine dental X-rays or any other type of X-ray taken, if at all possible. Make sure your doctor or dentist knows you are pregnant, and if an X-ray must be made, insist that your uterus is shielded.
- Stop smoking. When a pregnant woman smokes, she reduces the oxygen flow to her baby. The chemicals present in cigarette smoke reduce the blood flow through the placenta, which deprives your baby of nutrients. For that reason, smoking is directly linked to low birth weight. Smoking also has been linked to stillbirths and a higher incidence of Sudden Infant Death Syndrome (SIDS). Quitting smoking has immediate health benefits for you and your baby—the sooner you quit, the better off you both will be.
- Avoid drug use. Taking drugs while you are pregnant is the same as giving drugs directly to an infant. Using drugs such as marijuana, PCP, cocaine or heroin during pregnancy can cause miscarriage, stillbirth, premature birth, birth defects and mental retardation. If you use cocaine, PCP or heroin, your baby will be born addicted to these drugs and will have to go through withdrawal during the first weeks of life. There is no better time than now to seek help if you have a drug problem.
- Avoid drinking alcohol. The National Institute on Alcohol and Alcoholism warns that more than two drinks a day may harm unborn children. The more alcohol you drink, the greater the risk that your baby will born with serious physical problems. If you drink heavily, your baby could be born with Fetal Alcohol Syndrome (FAS). FAS babies can be mentally retarded and have abnormal facial features. Even if you are only an occasional drinker, you have a slightly higher risk of miscarriage than a non-drinker. It is best to give up alcohol altogether when you are pregnant.
Getting prenatal care can be a problem for some women in the East Tennessee region for any number of reasons, including the following.
- Lack of healthcare insurance
- Inadequate education or information about the importance of prenatal care
Recently, federal regulations have made it easier and faster for women who cannot afford prenatal care to get the medical coverage they need. Under this system, women who meet certain financial guidelines are automatically considered eligible for 45 days of care, starting from the first clinic visit. If your eligibility is confirmed after the first 45 days, care will continue throughout your pregnancy.
WIC is a supplemental food program for pregnant or breastfeeding women, infants and children to help them get enough nutritious food during the most critical growing periods of their lives. Through this program, you can get vouchers for foods that are high in protein and iron—the vouchers can be used at most grocery stores. Foods covered under the WIC program include juice, milk, eggs, cheese, cereals and iron-fortified infant formula. You also will receive nutritional counseling to help you have the nutrition you need. To find out if you qualify for the WIC program, call your county’s health department.