Prenatal Care

Description

Thorough prenatal care helps ensure the birth of a healthy baby.

Shortly after you become pregnant, you should begin seeing your physician or midwife on a regular basis. During these prenatal visits, you will undergo certain routine examinations, and you will have an opportunity to discuss with your caregiver any matters that concern either of you. This is also the time to introduce your ideas for a birth plan and begin to work with your physician or midwife in planning your birth experience.

At some time during your pregnancy, your partner should accompany you to meet your caregiver and discuss the partner's role at the birth. You should also try to meet the other doctors or midwives in the practice, since one of them might be on call when you are in labor. If this is not possible, discuss with your caregiver any differences in philosophy or practice that exist among the other caregivers.

Reducing the Risk in Any Pregnancy

Good Medical Care. Even a low-risk pregnancy is at high risk if prenatal care is absent or poor. Seeing a qualified practitioner regularly, beginning as soon as pregnancy is suspected, is vital for all expectant mothers. But just as important as having a good doctor is being a good patient. Be an active participant in your medical care - ask questions, report symptoms - but don't try to be your own doctor.

Good Diet. The effects of diet can be far-reaching. What a pregnant woman eats or doesn't eat can have an effect on her baby's developing organs. For example, lack of protein and calories in the last semester can interfere with brain development, and a lack of folic acid, it is believed, may be linked to spinal tube defects. What she eats can also affect her baby's general growth (eating too little or the wrong kinds of food can retard growth in the uterus.)

Fitness. It's best to begin pregnancy with a well-toned fit body, but it's never too late to start deriving the benefits of exercise. Regular exercise can prevent constipation and improve respiration, circulation, muscle tone, and skin elasticity, contributing to a more comfortable pregnancy and an easier, safer delivery.

Sensible Weight Gain.

A gradual, steady, and moderate weigh gain may help prevent a variety of complications, including diabetes, hemorrhoids, low birth weight, and difficult delivery due to an overly large fetus.

No Smoking. One should not smoke or should quit as early in pregnancy as possible to reduce its many risks to mother and baby, including prematurity and low birth weight.

Abstinence from Alcohol. Drinking very rarely or not at all will reduce the risk of birth defects, particularly fetal alcohol syndrome (the result of heavy drinking) and fetal alcohol effect (the result of moderate drinking).

Avoidance of Drugs. All illicit drugs are dangerous to the fetus and should be avoided during pregnancy. Medication should be used only when its benefits outweigh its risks, and only when it has been approved or prescribed by a physician who is aware that you are pregnant.

Avoidance of Environmental and Occupational Toxins. Though everything we touch, breathe, eat and drink is not hazardous as newspaper headlines would have us believe, avoiding known hazards (such as excessive x-rays, lead, and so on) is prudent.

Prevention of and Prompt Treatment for Infection. All infections - from the common cold to urinary tract and vaginal infections to the increasingly common sexually transmitted diseases - should be avoided whenever possible. When contracted, however, infection should be treated promptly by a physician who knows that you are pregnant.

Be Wary of the Superwoman Syndrome. Often well established in their careers and highly motivated in everything they do, today's mothers tend to be overachievers and overdoers. Getting enough rest during pregnancy is far more important than getting everything done, especially in high-risk pregnancies.

Do not wait until your body starts pleading for relief before you slow down. If your doctor recommends that you begin your maternity leave earlier than you had planned, take his advice. Some studies have suggested a higher incidence of premature delivery among women who work up until term, if their job entails physical labor or long periods of standing.

Prenatal Diagnosis

Until recently, the question, "Is my baby OK" could only be answered at birth. Today, it can be answered as early as 6 weeks after conception through prenatal diagnosis, such as ultrasound and amniocentesis. Women who are good candidates for prenatal diagnosis include those who:

• Have a family history of genetic disease and/or have been shown to be carriers of such a disease

• Have been exposed to infections such as rubella or toxoplasmosis that could cause a birth defect

• Have been exposed since conception to a substance or substances that they fear might have been harmful to the developing baby

• Have had unsuccessful pregnancies previously, or have had babies with birth defects.

Nutritional Needs

The mother's nutritional needs are unique. It has been estimated that it takes approximately 55,000 calories to support the growth of a full-term baby. This translates into 300 extra calories a day during the second and third trimester. Because the baby is so small and requires so little energy for development during the first trimester, experts now agree that pregnant women do not need extra calories during this period.

Protein is required to form all new cells. By the time the baby is born, 925 grams of protein will have gone into the cells of his body and into the extra tissue that has been produced in various parts of the mother's body, like the breasts, placenta, and uterus. Calculated over an entire pregnancy, the mother needs 10 extra grams of protein a day.

Vitamin C is the "cementing agent" that holds new cells together. It helps to form the baby's connective tissue, skin, and tendons. An additional 10 milligrams a day will easily meet the increased need.

The need for folic acid, a B vitamin, more than doubles during pregnancy. This makes sense when you realize that this vitamin is involved in the process of normal cell division. Folic acid is now given routinely to pregnant women to prevent birth defects.

The need for iron is high enough to enable mother and baby to form new red blood cells. These cells are responsible for carrying oxygen in the body and allowing the mother to deliver the necessary oxygen to the placenta for the baby. Not only is the baby producing new red blood cells but a supply of iron is being stored away in the baby's body for use in early infancy. At birth, a normal-weight infant has about 246 milligrams of iron in his blood and body stores. An additional 134 milligrams of iron are stored in the placenta and about 290 milligrams of iron have been used in the expansion of the blood supply.

Meeting adequate iron needs is a challenge, since it is estimated that the average American diet supplies approximately 6 milligrams of iron per 1,000 calories eaten. It is recommended that pregnant women get 30 milligrams of iron daily throughout pregnancy. Because many women enter pregnancy with less than adequate iron stores, many doctors routinely recommend an iron supplement to their patients.

Calcium is important during pregnancy to ensure the development of bones and teeth. The baby will need the most calcium in the last trimester when the bones are hardening. To maintain the health of the mother's skeleton and to help build the baby's skeleton, experts recommend that the mother get 1,200 milligrams each day during pregnancy.

Energy (calories), protein, vitamin C, folic acid, iron, and calcium, are the "right stuff" - the key nutrients that help to ensure a successful pregnancy.

It is important throughout pregnancy to have adequate amounts of these key nutrients. To meet these demands, the mother needs to eat a wide variety of healthful foods every day.

Questions to Ask Your Doctor

Is there a probability of a low risk or high-risk pregnancy?

How much weight gain is too much or too little?

Are there any foods that should be eliminated from the current diet? Is coffee or soda OK?

How much milk should be consumed?

Should vitamins be taken?

What can be done to decrease morning sickness? Can morning sickness be harmful to the pregnancy?

What pregnancy books can you recommend?

Are there any signs or symptoms that the doctor should be aware of immediately?