Becoming a parent is a major commitment filled with many challenges, and rewards. Pregnancy can be an exciting, fulfilling, delightful time. It can also be a time of uncertainty and change. Many aspects of pregnancy are part of the natural process over which you have no control. However, you can control many important factors in determining your health and the health of your baby. The best way to get the most out of your pregnancy is to obtain the most accurate information and be well informed for the many important decisions you are soon to face. Being well informed will help prevent anxiety and worry and make your pregnancy more pleasant and secure.
By making some plans and adjustments prior to becoming pregnant, you can significantly impact the success of your pregnancy and the health of your baby. The advancements in modern obstetrical care have provided you with the opportunity to significantly impact the outcomes of your pregnancy. We have reached a level in prenatal care where the optimal time to assess, manage, and treat many pregnancy conditions and complications are before pregnancy occurs. Preconception counseling of patients prior to becoming pregnant is an important opportunity to identify, educate, and treat many conditions that may complicate pregnancy. At this time, questions about the individuals expectations with regard to pregnancy can be discussed, family histories can be explored, and past medical histories obtained. The opportunity to discuss diet, exercise, and the use of medications can be helpful in improving overall health. Immunization to Rubella (Measles) can be given to non-immune individuals and appropriate genetic screening can be offered for individuals at risk for certain diseases such a Tay Sachs disease and others. Specific medical conditions can be discussed, optimally managed, and the possible effects on pregnancy explored. Conditions such as hypothyroidism, diabetes, asthma, and hypertension can be fully evaluated and treated before pregnancy. Potential occupational environmental exposures can be identified and discussed. The risk of certain birth defects can be reduced. Folic acid supplementation prior to becoming pregnant has been shown to reduce the incidence of spine and brain defects. Prior complications with pregnancy can be discussed and the risk of reoccurrence can be accessed. By investing time prior to becoming pregnant, you can improve the overall outcome of your pregnancy.
Choosing who will care for you during your pregnancy and delivery may be one of your first decisions. Ideally, you will have already chosen a doctor prior to becoming pregnant and had a chance to discuss preconception issues. If not, you may want to schedule a get acquainted visit with your potential new physician so that you have an opportunity to learn about the practice and the doctor, and to meet the staff. Make sure the physician is qualified by asking question about his or her credentials. Referrals from friends and co-workers are an excellent source, but their specific needs may differ from yours. Be sure to evaluate your needs and concerns prior to your visit and discuss them with your doctor.
There have been tremendous strides in medicine to improve the health and well being of every newborn. Modern medicine has reduced the dangers and discomforts of pregnancy through years of research and technological advances. Although most pregnancies proceed normally, every pregnancy poses some degree of risk. Assessing the risk on an ongoing basis is a central part of prenatal care. While no two pregnancies are alike, prenatal care will help you prepare for the changes to come.
Regular visits to your doctor are central to your care. Your first visit will be longer and more involved than other visits. It will include a medical history, laboratory tests, and physical examination. Many physicians prefer to see you for your first obstetrical visit between 8 and 12 weeks from the first day of your last menstrual period. The average length of pregnancy is 280 days, or 40 weeks from the first day of the last menstrual period. A normal full term pregnancy can last anywhere between 37 and 42 weeks gestation. The estimated date of delivery (EDD), or estimated date of confinement (ECC) as it is sometimes called can be estimated by taking the date your last menstrual period began, adding 7 days, and then counting back 3 months. Your doctor will use an obstetrical wheel to calculate your exact date during your first visit. Often an early ultrasound will be scheduled to confirm your pregnancy and the estimated date of delivery. Ultrasound scans done in the first 13 weeks of pregnancy are excellent at diagnosing the baby’s age, possible twins, and ruling out potential miscarriages. In addition a special ultrasound can be preformed, Nuchal Translucency scan, combined with blood hormone levels to help evaluate the fetus for possible chromosomal abnormalities.
After your first prenatal visit, the following visits are usually monthly till 28 to 30 weeks. These visits are shorter and generally used to see how you are doing and how the baby is growing. During these visits, your weight and blood pressure are checked, and a urine sample is taken for analysis. Testing offered during this time will vary but in general consist of two blood tests and possibly an ultrasound. The first test is an alpha- fetoprotein (AFP) test. This test is used to help identify fetuses that may have abnormalities of the brain and spinal cord. The two most common abnormalities are anencephaly and spinal bifida commonly referred to as neural tube defects. Anencephaly occurs when the brain and the head do not develop normally. Spinal bifida occurs when the lower part of the spinal cord is open and the spinal cord and nerves are exposed. This test, the AFP, is often combined with two other blood tests and called a triple test. The AFP combined with three blood hormones can estimate the risk of the baby having Down syndrome. In the United States, the majority of babies are born healthy. Birth defects occur in 2 to 3 percent of babies born each year. Neural tube defects occurs in 1 to 2 babies per 1000 births and Down syndrome is seen in 1 in 800 babies born. The second blood test is a glucose tolerance test to help rule out diabetes that may develop in pregnancy. This test is usually done between 24 and 28 weeks gestation. In some pregnancies, a second trimester (14 to 26 weeks) ultrasound may be done to assess the babies anatomy and growth. Women over the age of 35, and those with medical conditions such as diabetes, high blood pressure, or thyroid disease will usually have this high level scan done.
Visits from 28-30 weeks to 36 weeks are generally every two weeks. A vaginal culture is often done between 34 and 36 weeks gestation for group B Streptococcus. Group B Streptococcus (GBS) is a type of bacteria that can be found in up to 40% of pregnant women. A woman can pass GBS to her baby during delivery. Most babies who get GBS from their mothers do not have any problems. Some babies can get sick and have major health problems or even die. If group B Streptococcus is recovered by culture, it is often treated at the time of labor to try and prevent infection of the baby.
Visits from 36 weeks to delivery are usually weekly. During this time a cervical exam is often preformed. The events to occur in labor and delivery should be discussed and labor warnings are given.
Awaiting the birth of a child is an exciting and anxious time. Most women give birth between 37-42 weeks of pregnancy. However, there is no way to know exactly when you will go into labor. You should ask your doctor when you should call if you think you are in labor. Ask how you should reach him or her and if you should go directly to the hospital or call the doctor first. Questions about the use of monitors, IV’s, episiotomy’s, and pain relief options are best discussed prior to the onset of labor. Indications for cesarean section should be discussed and any questions answered. Hospital policies regarding the number of family members allowed to attend delivery may be considered and any special request should be discussed with your doctor. As is every pregnancy different, every labor is also different. Your past experience or the experiences of a family member or friend may not be the same as your pending one. Your concerns and fears should be discussed with your doctor.
By participating in your care prior to becoming pregnant, during your pregnancy, and during delivery, you can insure your pregnancy will be exciting, fulfilling, and healthy.
J. Kyle Mathews MD is a board-certified physician in Obstetrics and Gynecology in private practice at Presbyterian Hospital of Plano. 972-781-1515
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