Basics of Prenatal Care
Prenatal care generally refers to the routine, preventative medical care that women receive during pregnancy. The primary objective of prenatal care is to promote the overall health of mother and baby and to identify, prevent, and/or manage complications or problems as they arise. Prenatal care is provided through regularly check-ups with the mother's OB-GYN. During these visits, doctors examine the mother and perform various screening and fetal monitoring tests to track the mother's health and progression of the pregnancy.
Prenatal and perinatal care includes:
- determining what tests are necessary and when and how often they should be administered
- administering and interpreting abdominal and vaginal ultrasound/sonography
- early and ongoing assessment of a woman's risk status and risk reduction measures
- health education, health promotion, and psychosocial support
- medical screening and related interventions
- accessing and addressing risk factors and or any other health problems that may emerge
Good prenatal healthcare has a very significant impact of the outcome of a pregnancy. According to estimates from the World Health Organization, over 99% of women who die in childbirth and 90% of stillbirths occur in "low-resource" countries where women receive little or no prenatal medical care. Numerous other studies have repeatedly shown prenatal care is one of the most important maternal and child health/public health interventions available today. Quality prenatal care is associated with meaningful decreased risk of maternal morbidity and mortality. Prenatal care is also strongly correlated with the greater weight of infants born at term and increased use of pediatric care and is also seen as a key strategy for engaging women in the maternal and child health (MCH) delivery system over the long term.
Prenatal care should ideally start as early as possible.Who Can You Go to for Prenatal Care?
You can get prenatal care from various types of healthcare providers:
- An OB-GYN is a doctor who specializes in caring for pregnant women and delivering babies. The American College of Obstetricians and Gynecologists is a good reference for a list of board-certified OB-GYNs in your area.
- A general practitioner or family practice doctor is a general practice specialist who provides primary care to all members of a family. GPs are qualified to offer medical care during and after pregnancy. However, most GPs will not have some of the advanced imaging equipment (e.g., sonograms, ultrasounds) in their office. For a list of GPs in your area visit the American Board of Family Medicine website.
- A maternal-fetal medicine specialist (MFM) is an OB-GYN with specialized education and training on caring for women with high-risk pregnancies. If you have certain health conditions or are older you may want to see an MFM specialist for prenatal care. The Society for Maternal-Fetal Medicine is a good resource for MFM listings.
- Certified nurse-midwives (CNM) are special nurses with training and education focusing on caring for women and pregnant women. The American College of Nurse-Midwives has a list of CNMs near you.
As important as prenatal care is important for reducing fetal-initiated poor health outcomes, many women do not have the resources to receive adequate prenatal care. We have to address this problem as a country because adverse perinatal events can lead to permanent injuries that impact the child the rest of their lives.
What options do these women have? The starting point is Medicaid. From there, you may also see aid from the Children's Health Insurance Program. The United States Department of Health and Human Services Maternal has a Child Health Bureau that can also be of help to expectant mothers looking for resources to help them get adequate prenatal care.What Happens at the First Check Up?
The first prenatal checkup appointment is usually the longest. Your doctor or healthcare provider will spend a long time going over your health history and asking a lot of questions. After the background information is finished, your doctor will typically perform the following tests/exams:
- Prenatal Physical Exam: this usually involves taking your weight and height to help track your weight gain during the pregnancy. Blood tests will be done to check for certain infections including syphilis and hepatitis B. Urine testing is used to determine your blood type and Rh factor and also to check for anemia. Anemia is a condition involving a lack of healthy red blood cells which limits your ability to deliver oxygen to your body. Rh factor is a protein that most people have on their red blood cells. Your doctor will also check your blood pressure (for the first of many times). Blood pressure is an important indication of a serious condition called preeclampsia. Preeclampsia is a special type of hypertension (high blood pressure) that affects women during pregnancy. Aside from high blood pressure, excessive protein in your urine is often an early sign of preeclampsia. Testing urine can also check for kidney & bladder infections as well as gestational diabetes.
- Pap Smear & Pelvic Exam: A pelvic exam is typically done to make sure your womb and pelvis and healthy and functional. The pap smear will test your cervix to check for cervical infections and cancer.
- Vaccinations: Sometimes your doctor will administer flu shots or other vaccinations on the first visit. It's safe to get a flu shot any time during pregnancy. But some vaccinations are best at certain times and some aren't recommended during pregnancy. Talk to your provider about what's best and safe for you and your baby.
- Due Date Calculation: Your provider usually uses your LMP to figure out your due date. But you may get an early ultrasound to confirm that you're pregnant and help your provider figure out your baby's age. An ultrasound uses sound waves and a computer screen to show a picture of your baby inside the womb.
- Prenatal Vitamins: This is a multivitamin made for pregnant women. Your prenatal vitamin should have 600 micrograms of folic acid in it. Folic acid is a vitamin that every cell in your body needs for healthy growth and development. If you take it before pregnancy and during early pregnancy, it can help protect your baby from birth defects of the brain and spine called neural tube defects (also called NTDs), and birth defects of the mouth called cleft lip and palate.
Later prenatal care checkups typically shorter than the first visit. Your doctor will typically go over how you have been feeling and discuss any concerns. Your doctor will also perform regular tests and exams including:
- Checking Weight & Blood Pressure: weight gain during pregnancy and blood pressure are both important indicators of certain potentially serious complications.
- Fetal Heartbeat: by about the 10th or 12th week of pregnancy your doctor should be able to hear your baby's heartbeat. Measuring fetal heart rate throughout pregnancy and childbirth is very important as abnormal readings can be a sign of fetal distress.
- Measurements: starting around week 20 your doctor will start taking measurements of belly and doing regular physical examinations to check your baby's position inside the womb. Abnormal positioning late in pregnancy can be dangerous.
- Prenatal Testing: between 18 and 20 weeks most doctors will do an ultrasound to get a look at the baby inside your womb. This is often when you can determine gender and identify other potential problems. Additional ultrasounds are sometimes done later on to check the amount of amniotic fluid or make sure everything is okay. Screening for gestational diabetes is usually done around 24 weeks and testing for group b strep is done after 35 weeks.
- Tdap Vaccinations: at some point, after the 26th week you will get a Tdap vaccination to prevent whooping cough (pertussis).
- Pelvic Exam: your doctor will always do pelvic exams at your visits to monitor for changes in your cervix as you get close to your due date.
- Tiruneh, GT, et. al: BMC Pregnancy and Childbirth 2019 19:214.
- Gaylord, Mark, et, al, Improving Perinatal Health: A Novel Approach to Improve Community and Adult Health, 28 J. OF PERINATOLOGY 91 (2008).
- Healy, A., et al. Early access to prenatal care: implications for racial disparity in perinatal mortality. Obstetrics and Gynecology. 2006; 107(3): 625-631.
- Mercer B.M. et al., The preterm prediction study: Effect of gestational age and cause of preterm birth on subsequent obstetric outcome, 181 AM. J. OBSTET. GYNECOL. 1216 (1999).
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- Alexander, G. and Korenbrot, C. The role of prenatal care in preventing low birth weight. In The Future of Children: Low Birth Weight, Behrman, R. editor, Center for the Future of Children, the David and Lucile Packard Foundation, Vol. 5, No.1, Spring 1995.
- Institute of Medicine, Committee to Study Outreach for Prenatal Care. Prenatal Care: Reaching Mothers Reaching Infants. (S. Brown, ed.) Washington, D.C.: National Academy Press, 1988.