The sooner one begins prenatal care, the healthier they and the baby will be. Even if you have been pregnant before and had a healthy baby, skipping prenatal care can truly be dangerous to both a woman and her baby. If you haven’t started prenatal care, it is not too late to begin.
Adoption STAR can assist you in obtaining free prenatal care, identifying a doctor and if you desire, will be able to take you to your medical appointments.
Finding Medical Care
Pregnant women usually are cared for by:
- An obstetrician – a doctor who specializes in pregnancy and childbirth.
- An obstetrician/gynecologist (OB/GYN) – a doctor who specializes in pregnancy and childbirth and women’s health care issues.
- A family practitioner – a doctor who provides a range of services for patients of all ages sometimes also practices OB/GYN responsibilities as well.
- A nurse or midwife – someone who is not a doctor but who has received special training and certification in women’s health care needs, including prenatal care, and labor and delivery.
Those women who are considered at high-risk for pregnancy complications are women who have chronic health problems such as diabetes or heart problems, have had a history of pre-term labor, and are older than 35 years of age, or have other mitigating factors or behaviors that make them more susceptible to a complicated pregnancy and/or delivery.
Your First Visit
Visiting your health care provider can be exciting or it can be intimidating. Your first exam, should you be beginning pre-natal care during your early pregnancy, will be 6 to 8 weeks into your pregnancy which means your period will be 2 to 4 weeks late. Whether you begin prenatal care then or later, typically the first prenatal visit includes:
- A complete background history of those who are related to the pregnant women to assess if there is a history of diabetes or other medical concerns that may be a factor during pregnancy.
- A complete physical including a pelvic and rectal exam.
- A complete blood cell count (CBC.)
- Blood typing and screening for Rh antibodies (antibodies against a substance found in the red blood cells of most people.)
- Blood test for syphilis, hepatitis, gonorrhea, chlamydia, and other sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV.)
- Blood work for evidence of previous exposure to chickenpox (varicella), measles (rubeola), mumps, or German measles (rubella.)
- Blood testing for cystic fibrosis.
- Blood sampling to determine if the women has the sickle cell trait particulary if she is of African or Mediterranean descent.
- A urine sample.
- A Pap test/ Pap smear if one is due to determine health of the cervix.
Routine Prenatal Visits
If there are no risk factors involved, a pregnant woman can expect to see her health care provider approximately every month until the 28th week of pregnancy and then every two weeks until week 36 of pregnancy and then once a week until delivery.
Typically the pre-natal appointments will consist of:
- Stepping onto the scale for a weight check.
- Taking blood pressure.
- Measuring the size and shape of the uterus.
- Providing a urine sample.
- Listening for the baby’s heart beat.
There are so many prenatal tests that help health care practitioners to determine or predict if there will be any concerns with the woman or the baby. It is very important to keep in mind that low or high test results don’t automatically indicate a problem; rather, they indicate the possible need for further testing. Often follow up tests determine there are no concerns. There is no need to be anxious about the testing or test results. Here are some of the tests that a pregnant woman should expect during her pregnancy:
Alpha-fetoprotein screening (AFP): Taken between 16 and 18 weeks, the level of alpha-fetoprotein, a protein produced by the fetus, can be measured in the woman’s blood. The AFP is often not reliable especially if the baby’s due date was miscalculated or if the woman is expecting twins. The purpose of the AFP is to test for disabilities such as spina bifida (high AFP level) or Down syndrome (low AFP level.)
Multiple marker screening (also known as maternal serum screening, triple screen, triple marker, quadruple screen, quad screen, quadruple marker, or quad marker): Taken between 16 and 18 weeks, this measure the levels of certain hormones in a pregnant woman’s blood. For this screening, a sample of blood is drawn to measure the level of AFP, as well as the levels of hCG (human chorionic gonadotropin) and estriol, which are produced by the placenta. The levels of these three substances (which is why the test is often referred to the triple screen or triple marker) in the blood can help identify certain birth defects and chromosomal abnormalities. The test is called a quadruple screen (or marker) when the level of an additional substance, called inhibin-A, is also measured.
Amniocentesis (also known as an amnio): Often performed at 15 to weeks, this test is done to identify certain disabilities such as Down syndrome or other chromosomal abnormalities. A needle is used to remove a sample of the amniotic fluid. An amnio is recommended when there is reason to believe that the risk for abnormalities is higher than it should be or because a woman has increased risk factors. There is a small risk with having an amnio for causing preterm labor and inducing a miscarriage, however the large majority of these tests are performed without problems.
Chorionic villus sampling (CVS): This procedure is used during the first trimester for the same purposes as an amniocentesis. A sample of the tissue that attaches the amniotic sac to the wall of the uterus is taken. The reason it may be used over having an amnio is that results tend to arrive sooner. Just like the risks involved with an amnio, CVS has similar risks, though rare to occur.
Ultrasound (Often referred to as a sonogram, and sometimes known as a sonograph, echogram, or ultrasonogram): This test is commonly done at least once during pregnancy especially when everything appears to be going well. Sometimes it is used to confirm the expected due date, but usually it is to check on the baby between 18-20 weeks along and to examine the anatomy. There is no documented risk of having one or more ultrasounds during pregnancy. An ultrasound technician or a nurse will coat the abdomen with a gel and then run a wand-like instrument over it. High-frequency sound waves “echo” off the body and create a picture onto a computer screen. The ultrasound is the easiest test to determine if the rate of growth of the baby is healthy. It also records heartbeat and breathing. Ultrasounds have become so high tech over the years that often they can detect different abnormalities that may cause the need for further testing of the woman and/or baby. There are two types of ultrasosunds one is the abdominal ultrasound as described above and the second is the transvaginal ultrasound where an ultrasound transducer is inserted into the vagina and rests against the back of the vagina to create an image. A transvaginal ultrasound is more often used in early pregnancy.
Glucose tolerance test: Screening for gestational diabetes usually takes place at at 24 to 28 weeks. A woman is provided with a sugar drink and waits one to three hours and than has blood drawn. If the sugar level is normal no further testing is required. This test will be done at 12 weeks for women who are at higher risk of having gestational diabetes (diabetes that occurs during pregnancy). That includes women who have previously had a baby that weighed more than 9 pounds and/or who have a family history of the disease and/or who are obese.
Group B strep culture: Testing for Group B Streptococcus (GBS), a bacteria found in the lower genital tract of about 25 percent of all women, is recommended between 35 to 37 weeks. GBS infection usually causes no problems in women before pregnancy, but can cause serious illness for the woman during pregnancy and the baby after delivery. Urinary tract infections caused by GBS can lead to preterm labor and birth. Treatment includes antibiotics.
Today there are so many genetic abnormalities that can be diagnosed before birth. In addition there are so many pre-natal tests that are utilized to diagnose abnormalities early in pregnancy. Many question the reason for these tests. Diagnosing an abnormality is not only for a woman to decide if she should continue with the pregnancy or to consider adoption, but also to increase the chances of having a healthy baby as well as to learn as much as possible about the diagnosis to be as prepared as possible for raising a child with such a diagnosis. Sometimes prenatal intervention is an option, such as the amazing surgery in place today when there is a diagnosis of spina bifida. Though not in every diagnosis can spina bifida be corrected, but this surgical intervention has successful corrected this disorder before birth.
Here is a list of genetic disorders that can be diagnosed before birth:
- Cystic fibrosis
- Duchenne muscular dystrophy
- Hemophilia A
- Sickle cell anemia
- Spina bifida
- Polycystic kidney disease
- Tay-Sachs disease
- Trisomy 21 (Down Syndrome)
- Trisomy 13
- Other chromosomal abnormalities
Fetal heart rate monitoring is a method of checking the rate and rhythm of the fetal heartbeat as well as contractions. The average fetal heart rate is between 110 and 160 beats per minute. The fetal heart rate may change as the fetus responds to conditions in the uterus. An abnormal fetal heart rate or pattern may mean that the fetus is not getting enough oxygen or there are other problems. An abnormal pattern also may mean that an emergency or cesarean delivery is needed.
How is fetal monitoring performed?
Using a fetoscope (a type of stethoscope) to listen to the fetal heartbeat is the most basic type of fetal heart rate monitoring. Another type of monitoring is with a hand held Doppler device. This is often used during prenatal visits to count the fetal heart rate. During labor, continuous electronic fetal monitoring is often used, especially if an abnormal rhythm is heard with the fetoscope. There are times when internal fetal monitoring is necessary for a more accurate reading of the fetal heart rate. Internal fetal monitoring involves inserting an electrode through the dilated cervix and attaching the electrode to the scalp of the fetus, called a fetal scalp electrode.
Pre-existing conditions: If a woman has already began prenatal care she would have shared her background history with the health care provider. There is no reason to believe that something will go wrong in the pregnancy. Pre-existing medical conditions, such as diabetes and heart disease can certainly put a woman at-risk but being open with the health care provider and sharing all background information and current habits will help decrease the cause for concern. Most pre-existing medical conditions are manageable. With honesty and education, a healthy pregnancy is possible.
Weight gain: It is recommended that a woman of normal weight gain approximately 25 to 30 pounds during pregnancy. This will vary if a woman is underweight, overweight or obese.
Pregnancy is known to cause some discomfort, these common concerns include:
- Nausea and vomiting
- Water retention especially in the feet and legs
- Varicose veins
- Problems sleeping
Remember these are common ailments.
It is often helpful to speak to others who have experienced these annoying parts of pregnancy. It is normal to feel embarrassed to ask a health care specialist some questions, but it is important to just ask because he or she has heard it all before and can truly help. It is a good idea to write down questions before prenatal appointments.
When Something Goes Wrong
Women should call their health care provider immediately if they experience:
- Heavy bleeding
- A sudden loss of fluid
- A noticeable absence of movement by the baby
- More than three contractions in an hour