Prenatal care

Prenatal care is care that women receive during pregnancy. Prenatal care tends to focus on the nutritional, physical, and emotional needs of a mother during her pregnancy in the hope of improving her chances of having a safe delivery and a healthy child. Earlier and more comprehensive regular prenatal care increases the likelihood of a successful pregnancy and birth. Comprehensive prenatal care includes screening, testing, and monitoring during the pregnancy to ensure that the mother and baby stay healthy.

Pregnant women who do not get adequate prenatal care are three times more likely to have a child with a low birth weight. Babies of mothers who do not receive prenatal care are also five times more likely to die, according to the US Department of Health and Human Services' Office on Women's Health.

Proper prenatal care includes regular appointments with health care professionals. These prenatal visits allow the mother to gather valuable information about nutrition, exercise, and weight gain during pregnancy. At the end of pregnancy, prenatal care visits offer information about how to care for a newborn. This basic information may include helpful tips about newborn sleep patterns, nutrition, the benefits of breastfeeding, and the importance of immunizations.

The length of pregnancy varies. Most healthy pregnancies last about forty weeks. The American College of Obstetricians and Gynecologists defines a pregnancy of thirty-seven to thirty-nine weeks as "early term," thirty-nine to forty-one weeks as "full term," forty-one to forty-two weeks as "late term," and anytime after forty-two weeks as "post-term." As pregnancy progresses, prenatal care visits increase.

Background

Most pregnant mothers in the United States receive prenatal health care. Young mothers are the most at risk of not receiving adequate prenatal care or of waiting until the end of their pregnancies to seek care. Mothers waiting until the third trimester to receive prenatal care have an increased risk of having a baby with health problems. Those who forego all prenatal care risk dying from pregnancy- or birth-related complications, such as seizures, hemorrhage (heavy blood loss), pre-eclampsia and eclampsia, and blood clots; the US Centers for Disease Control and Prevention (CDC) estimates at least seven hundred Americans die of such complications each year.

Overall, pregnant teenagers were the least likely to seek prenatal care. According to the CDC, in 2022, only 59.1 percent of pregnant females under twenty years old began prenatal care in the first trimester. Older women are more likely to receive prenatal care. For example, more than 80 percent of pregnant women over thirty years old received prenatal care in 2022. Other factors contributing to women obtaining late or no prenatal care included minority status, multiple prior births, having less than a high school education, out-of-pocket payment, and residence in the Deep South.

The number of women receiving prenatal care has been increasing in the United States since the 1970s. In the twenty-first century, prenatal care is more accessible, and some women can receive the care they need free of charge. For women who qualify, Medicaid provides prenatal care free of charge. Planned Parenthood offers prenatal care on a sliding scale, meaning that women pay what they can afford to receive the prenatal care they need. Some medical schools may also offer clinics that provide free or reduced-cost prenatal care to help local communities and provide hands-on training for medical school students.

Several types of medical professionals may be involved in providing prenatal care. Obstetricians are doctors who have completed four years of medical school and a medical residency to understand how to care for pregnant women and deliver children. These doctors are also trained to deal with high-risk pregnancies (which can involve patients of advanced maternal age or patients who have a chronic health condition) and to perform caesareans, or C-sections. A C-section is an operation in which a doctor cuts open a woman's abdominal and uterine walls to deliver a baby. This procedure may be necessary if the mother or baby is in distress or if a woman is having twins or high-order multiples.

Midwives are also trained in prenatal care and delivery. Many midwives have trained as nurses and then have gone on to receive additional training in midwifery to earn their certification. Midwives may participate in a delivery at a hospital with an obstetrician present, or they may oversee a birth at a birthing center or at a private residence. Unlike obstetricians, midwives are not trained to perform C-sections or use forceps or vacuums to assist in delivery.

Overview

Prenatal care can mean the difference between a healthy pregnancy and an unhealthy one. Preventative measures taken during pregnancy can increase the likelihood of good maternal health and the chances of giving birth to a healthy baby.

Pregnancy is broken into three trimesters. The first trimester consists of weeks 1 through 17 of pregnancy. Many women may not know they are pregnant during this time. For this reason, health care professionals recommend that women who hope to get pregnant take folic acid supplements (vitamin B9) beforehand. Some studies show that women taking folic acid daily for at least a year before they become pregnant reduce their chances of an early birth by 50 percent. Folic acid is important because it can play a large role in the baby's development during the first trimester. It helps produce red blood cells and helps the baby's neural tube develop into the brain and spinal cord. Pregnant women should also eat a diet rich in foods that contain folate (a naturally occurring form of folic acid), such as dark green vegetables and citrus fruits. Fortified cereals also contain high amounts of folic acid.

As soon as pregnancy is confirmed, the expectant mother should contact her health care professional and set up her first prenatal visit. The first prenatal care appointment is usually around week 8 of pregnancy. This visit may be longer than the appointments that follow. During this visit, the medical professional will take a family history, complete a physical exam, and may conduct a Pap smear. Blood and urine samples may also be taken and analyzed. The physician will also calculate the baby's due date based on the patient's last menstrual period and take the patient's weight and blood pressure. Weight gain and loss is monitored during prenatal care visits to help mothers maintain a healthy weight. Health care professionals can advise women on how much weight they should aim to gain during their pregnancy.

At the initial visit, mothers may be screened for conditions such as thyroid problems, anemia, sexually transmitted infections, or HIV (human immunodeficiency virus). Varicella (chickenpox) and rubella immunity will also be evaluated. Women who have Rh negative blood may need to have a blood test to look for Rh antibodies. In some cases, these antibodies can attack the baby's red blood cells; therefore, it is necessary for women who have this condition to complete this testing. Several screenings and tests may be offered to check for any genetic abnormalities. Expectant may also be screened for depression, anxiety, or other psychiatric disorders, as well as risk of domestic violence. Health care professionals may determine that other screenings are necessary later in pregnancy to meet the patient's needs.

Expectant mothers will usually visit their health care providers about once a month during the first trimester. However, high-risk patients may need to see their physician more frequently.

The second trimester of pregnancy includes weeks 18 through 30 of pregnancy. During this trimester, patients will have their weight and blood pressure checked regularly during their prenatal care visits. The physician can also listen to the baby's heartbeat with a fetal Doppler to ensure that the baby is doing well, and measure the baby's growth. Parents can also learn the sex of their baby during a fetal ultrasound if they choose.

Most mothers will also undergo testing for gestational diabetes at this time. Gestational diabetes is a condition in which women who were not previously diabetic have high levels of blood glucose (sugar) during their pregnancy. According to the CDC, gestational diabetes occurs in 2 to 10 percent of pregnancies annually in the United States. This condition can be dangerous for both mother and baby if left untreated. The high blood glucose levels in the mother can create high glucose levels in the baby, forcing the child's pancreas to make more insulin to combat this problem. Children born with high insulin levels are at risk for chronic conditions, such as type 2 diabetes and obesity, later in life. That is why it is important for pregnant women to be checked for gestational diabetes and for those who test positive to work with their doctor to manage their blood glucose levels throughout their pregnancy.

Between weeks 27 and 36, pregnant women are also advised to receive a booster vaccination for tetanus, diphtheria, and pertussis (whooping cough). Vaccines for hepatitis A and B, may be recommended for pregnant women as well.

Throughout most of the second trimester, patients will usually continue to visit their health care provider about once a month. At week 28, the frequency increases to twice monthly.

The third trimester includes week 31 through the end of the pregnancy. As a baby's due date approaches, health care professionals will monitor the mother's health and the health of the baby more closely. Prenatal care visits may involve checking the mother's urine for protein, checking the baby's heart rate, measuring the approximate length of the mother's uterus, and examining the mother's legs and hands for swelling, which can be a sign of a serious condition. Health care professionals will also check the position of the cervix to try to determine how close childbirth is and how the baby is positioned.

Mothers in the third trimester are also screened for group B streptococcus (GBS), a common bacterium. Although GBS is harmless to adults, newborns exposed to it during a vaginal birth can become very sick. Mothers who test positive for GBS are given antibiotics through an IV during childbirth to protect the baby.

Visits during the third trimester increase to twice monthly until week 36, when most pregnant women will begin to see their doctor every week.

In addition to receiving prenatal care from a health care professional, eating healthfully and exercising are especially important for pregnant women. A diet that includes fruits, vegetables, whole grains, and foods low in saturated fat is recommended. Iron and vitamin B12 supplements may also be recommended to prevent preterm labor and low birth weight. Pregnant women should also make sure to drink plenty of liquids throughout the day and consume 200 milligrams of caffeine or less a day.

Drinking alcohol and using tobacco, drugs, herbal supplements, or prescription medications during pregnancy may harm an unborn baby and should be avoided. Secondhand smoke, or smoke from the burning of tobacco products in a person's environment, can be dangerous to expectant mothers and their unborn children. Health professionals encourage pregnant women to avoid secondhand smoke. Pregnant women should also discuss all prescription and over-the-counter medications with their doctor before taking them.

To increase prenatal health, doctors generally recommend pregnant women get about two and a half hours a week of moderate aerobic exercise. Women who exercised regularly before pregnancy may continue their normal routines unless they start to feel poorly or their physician puts them on mandatory bed rest. Regular exercise during pregnancy has many benefits, including stress relief.

Prenatal care also involves helping women understand certain environmental dangers. For example, toxoplasmosis is an infection that can be caused by a parasite found in cat feces. If toxoplasmosis goes undetected, it can cause birth defects. Pregnant women should not change cat litter, and they should wear gloves while gardening to avoid toxoplasmosis. Listeria is an illness that can be caused by eating contaminated food that can be especially harmful to pregnant women. Expectant mothers should avoid eating undercooked meat, raw fish, and seafood containing high levels of methylmercury. They should always wash fruits and vegetables to protect themselves. Rat and roach feces, insecticides, paint thinners, and some chemicals can also be dangerous to pregnant women. In addition, doctors encourage women who are pregnant to get a flu shot. The flu can be extremely dangerous to pregnant women and their babies.

Education about birth is another important part of prenatal care. Childbirth education classes can offer opportunities for expectant mothers to learn about labor and delivery. These classes can help alleviate some stress and anxiety women may feel about childbirth and teach strategies to make the experience a positive one. Childbirth education can also help expectant mothers learn how to recognize the signs of early labor and develop strategies for pain management during labor and delivery.

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