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Prenatal Care
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Prenatal care is a vital component in a comfortable, uncomplicated and healthy pregnancy and delivery. You will need to have regular appointments with your healthcare provider throughout your pregnancy to keep up with your own health as well as the health of your baby.

Choosing Who Delivers Your Baby
Choosing a Provider for Your Baby
Genetic Testing during Pregnancy

Choosing Who Delivers Your Baby
It’s best to start right away in choosing who you want to deliver your baby. This person will be the point of contact for you throughout your pregnancy—the healthcare provider that you meet with every month or more for your check-ups and to keep an eye on your pregnancy health and the health of your baby. That’s why it’s so important to pick the right person when it comes to delivering your baby.

The first thing to think about when you’re choosing a person to deliver your baby is whether you want an obstetrician-gynecologist (ob-gyn), a family practitioner, or a certified nurse-midwife (CNM).

Obstetrician. An obstetrician, usually called an ob-gyn, is a medical specialist who received extensive training in the specialties of gynecology and obstetrics after medical school and training. That means he or she is fully prepared to handle every aspect of your pregnancy, from preconception through postpartum care. Your obstetrician will also be able to answer any medical questions you have and will be prepared to handle most unpredictable situations. The obstetrician is also able to help you with your gynecological health, which means taking PAP smears and performing clinical breast exams. If you have a high-risk pregnancy—one that has health risks which could affect you or your baby—you might want to find an obstetrician who specializes in maternal-fetal medicine or high-risk pregnancies. Obstetricians are a sound choice for all women—from routine pregnancies to more complicated ones. The obstetrician is the most commonly chosen healthcare provider for pregnant women. Many women already have an ob-gyn they saw for routine check-ups even when they weren’t pregnant, and they have an established and trusting relationship they want to carry through pregnancy. Other women choose an obstetrician because they get a sense of security through the knowledge and training that comes with medical school, and the experience that comes from being a specialist.

Family practitioner. This is the doctor that specializes in general health for the whole family. You might already have a family practitioner whom you see for regular check-ups or when you feel sick. If you have specific chronic medical conditions, it’s often advised that you remain in contact with the family practitioner who is already familiar with your health status through pregnancy. A family practitioner can help you with many aspects of your health and pregnancy (some can deliver the baby) and can also serve as a pediatrician for your baby. If there are specific complications involved in your pregnancy, the family practitioner will recommend that you see an obstetrician.

Certified nurse-midwife. A certified nurse-midwife (CNM) is a certified nurse who has completed a graduate degree in nurse-midwifery and has been certified by the American College of Nurse-Midwives. The certified nurse-midwife is fully trained in delivering uncomplicated births and guiding a woman’s health throughout a low-risk pregnancy. The nurse-midwife can work at a hospital, in a birthing center, or she may even visit your home. Almost all nurse-midwives work with the backup of a physician, and many work in collaboration with a group of physicians or obstetricians. Most have a collaborative relationship with a physician.

Once you’ve decided which provider you want to provide your prenatal care and deliver your baby, there’s even more to consider. Ask the physician or midwife about who will see you during your pregnancy and who will be present for labor and birth. Find out which hospital your provider uses, whether it’s close to your home, whether the hospital has enough birthing rooms or labor and delivery rooms, and whether you feel comfortable in that hospital.

Talk candidly with your provider about your preferences for your pregnancy, labor and delivery. Make sure he or she is in agreement with your wishes and desires and that you can communicate effectively with each other. If your personalities seem to clash, it is better to reconsider your options now. Some of the important issues you may want to discuss with your provider, to gauge his or her opinion on, include:

  • Medication for pain relief during delivery
  • Breastfeeding
  • Induction of labor
  • Fetal monitoring

You will also want to talk with your provider to see how his or her medical practice handles deliveries. Some practices may have a physician at the hospital to deliver all the babies of their patients during a time frame. Others may have certain providers on "call" to come in and deliver the babies of their patients. By learning more about your provider's practice, you'll be better prepared for what to expect when you arrive at the hospital to have your baby. [back to top]

Choosing a Provider for Your Baby
Nine months may seem like plenty of time to figure out the right provider to take care of your baby, but the time will fly by. Having a provider who you trust and respect may help reduce your fears as a new parent. Some considerations when thinking about choosing your baby's healthcare provider—whether it's a pediatrician or family practice physician—include:

  • How problems or concerns are handled when the office is closed
  • Breastfeeding support
  • Antibiotic use and medication philosophy
  • Nurse-practitioner, internists and physician assistant visits
  • Hospital affiliation
  • Board-certification

By interviewing your baby's provider before the birth, you have the chance to find one who can best meet your needs, understand your concerns and guide you in making your best parenting choices. This can be a special comfort to you especially in the early days and weeks after your baby has arrived. [back to top]

On your first prenatal care visit, you will undergo many exams and tests, including an overall physical exam and a pelvic exam. You will also undergo a series of preliminary tests at the lab, including:

  • Blood type and screen test to determine your blood type and Rh factor. Determining blood type and Rh is crucial because if your baby’s blood type does not match yours, there may be problems during the delivery or a higher chance for miscarriage. Your body may not recognize the fetus as a baby and may begin producing antibodies that could threaten the fetus's development and health.
  • Testing for hepatitis B and Rubella to make sure you have immunity
  • Complete blood count (CBC) to check for blood problems and specifically anemia
  • RPR to screen for syphilis, an STD which can be life-threatening for an unborn child
  • HIV test to check for the human immunodeficiency virus that leads to AIDS and can be passed to the unborn child
  • Urinalysis to test for any bladder or kidney infections that could cause premature labor if left untreated; also to test for high sugar levels that may indicate diabetes

You may undergo other tests throughout your prenatal care, including:

  • Ultrasounds may be performed during your pregnancy to evaluate the health of the baby through the use of high-frequency sound waves. Ultrasound does not use radiation. Ultrasound can help to set your due date in the first trimester, and to see if you are having a multiple birth. Ultrasound also helps to check on the baby’s health and can even determine the sex of your baby.

  • Frequent urinalyses determine if you have protein in your urine, which may indicate that you have preeclampsia. Preeclampsia is uncommon, but can cause complications in the pregnancy.
  • Your blood pressure will be taken at every prenatal office visit. Pregnant women tend to have lower blood pressure than normal.
  • Gestational diabetes testing is recommended by almost all doctors at 28 weeks, unless you’re at a higher risk for gestational diabetes (over 35), in which case it’s done earlier. The test involves drinking a sweet glucose drink that tastes like very sweet soda, one hour before having blood drawn. Some women feel nauseous after drinking the glucose syrup and others love the stuff—depends on your sweet tooth. If you test positive, further testing will be done. Treatment includes dietary changes and often medication.

  • Other tests you may undergo include an MRI to get a clearer picture of the fetus, echocardiography to detect fetal heart defects, and percutaneous umbilical cord sampling (PUBS) to test for diseases that amniocentesis can’t detect or to double-check any abnormal results from an amniocentesis. Ask your doctor for more information on these tests if they are recommended. [back to top]

Genetic Testing during Pregnancy
Because many women are putting off getting pregnant until they’re over 35, genetic testing has become a common aspect of prenatal care. Genetic testing can be a daunting idea—do you really want to know bad news? Is the test going to hurt your baby? With new technology constantly being developed, genetic testing has come a long way. It’s important that if you decide to get genetic testing, you see a doctor who is experienced in the particular test so you can minimize any associated risks. Genetic testing isn’t for everyone—it’s generally recommended for women over 35, for families with a history of birth defects, for parents who have had high-risk results in genetic screening, for mothers who have had abnormal preliminary screening results and for mothers who have been exposed to harmful toxins or chemicals.

  • Amniocentesis is a form of genetic testing recommended on women over the age of 35 or those who have a higher risk of giving birth to a baby with a birth defect. Women have the right to decline this test. The test primarily identifies Down syndrome in the fetus by testing fetal cells from the amniotic fluid that surrounds the fetus in the womb. Amniocentesis is usually performed in the fourth month of pregnancy. The procedure is administered by inserting a small hollow needle through the abdomen and into the uterus and extracting a small amount of amniotic fluid. The amniocentesis is guided by simultaneous ultrasound, which minimizes the risk of injuring the fetus or placenta. There is a very slight risk of miscarriage from amniocentesis. Bleeding and spotting may accompany the amniocentesis.

  • Chorionic Villus Sampling (CVS) is performed very early in the first trimester, between nine and 12 weeks, and helps to determine if abnormal genes or chromosomes are present in your fetus. CVS is an alternative to the amniocentesis, which means you generally won’t need the amnio if you have already had a CVS. CVS is done early on in the pregnancy, which helps you if you’re faced with the decision to terminate pregnancy due to unexpected results.

    Many people might wonder why they should get any form of genetic testing, and the answer is that some believe it’s better to be aware of the defect so that it doesn’t come as a complete shock upon birth. CVS is used in genetic counseling and is helpful in detecting Tay-Sachs, sickle-cell anemia, cystic fibrosis and Down syndrome. CVS will also be able to accurately determine the sex of your baby. The CVS is done by sampling cells in the early placenta. The CVS is relatively uncomfortable. Talk with your doctor about these risks and make sure you see a doctor experienced in the procedure for your CVS. Bleeding or spotting may accompany the CVS.

  • AFP or maternal serum alpha-fetoprotein testing is a blood test that looks for the alpha-fetoprotein (AFP) produced by healthy fetuses. A high amount of AFP could indicate the baby has a neural tube birth defect and low levels could indicate Down syndrome. The test is performed from 15 to 20 weeks into the pregnancy and there are no potential side effects or risks to your fetus. Timing is important for this test because if the date administered is off, you’re more likely to get a false positive result.

  • The triple screen test is a blood test that tests for AFP as well as human chorionic gonadotropin (hCG) and estriol. The addition of the test for hCG and estriol can indicate other chromosomal abnormalities. The test is performed between 15 and 20 weeks into pregnancy and there are no potential side effects or risks to your fetus. Timing is important for this test because if the date administered is off, you’re more likely to get a false positive.

  • The nuchal fold translucency test screens for Down syndrome using ultrasound. It measures the amount of fluid in the nuchal fold–two layers of skin behind your baby's neck. Those with Down syndrome have a greater collection of fluid than those who don't. This measurement is then fed into a computer, along with your age (the risk of Down's increases naturally with age), your baby's heart rate and any blood test results. The result will give you a risk factor, for example, one in 300, of having a baby with Down syndrome.

In the case of genetic tests, there is a very slight chance that you’ll receive some devastating news about the health of your fetus. You have a few options after you hear this news. You can choose to continue with the pregnancy and be prepared to deal with the condition. Often times parents who choose this will use the pregnancy to prepare for special circumstances in caring for their child, or for coping with the possible loss of the child. Some couples realize the deformity or fatal condition of their unborn child is too much to bear and decide to terminate the pregnancy. Termination of the pregnancy can be done with the guidance of a doctor or a genetic counselor. Some conditions may be treated prenatally, through surgery, medication or blood transfusion. [back to top]

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