Pregnancy Health Article

First prenatal visit

During a woman's first prenatal visit, the following diagnostic tests are usually performed:

• complete blood count (CBC), for anemia
• blood type, Rh, and antibody screen
• syphilis (VDRL)
• rubella titer (German measles)
• hepatitis B virus (HBV)
• urinalysis and culture
• Pap smear
• cervical cultures for gonorrhea and chlamydia
• recommendation of HIV antibody test, with counseling

A screening test for gestational diabetes is performed between 24 and 28 weeks' gestation by giving the woman a 50 g glucose drink, then drawing a blood sample one hour later to check the glucose level. A normal value is less than 130-140 mg/dL. A woman with a family history of diabetes, however, should be tested on her first visit to the obstetrician/gynecologist or nurse-midwife.

Treatment

Women with heart disease, diabetes, lupus, and some hereditary conditions should consult a health professional before getting pregnant, as these conditions increase the risk of morbidity and mortality for both the mother and child.

Prenatal care is vitally important for the health of the unborn baby. During the first trimester, the woman should receive 0.4 to 0.8 µg (micrograms) of folic acid daily to reduce the chance of neural tube defects. Ideally, this daily dose of folic acid should begin at least one month prior to conception. Generally, requirements for all vitamins are increased during pregnancy. Prenatal vitamins prescribed by a physician or midwife usually contain the recommended amount of folic acid, and some contain a stool softener to offset the constipating effects of iron. Following delivery, vitamins are also recommended for the breast-feeding woman. Most pregnant women need at least 2,300 calories a day; these should come from good sources of protein, green leafy vegetables, fresh fruit, and breads and cereals. Small meals may be eaten frequently throughout the day.

Since most medications can pass from the mother to the baby, no medication (not even a nonprescription drug) should be taken except under medical supervision. No drug should be considered completely safe (especially during early pregnancy), although many physicians and nurse-midwives approve their patients' use of some drugs, including acetaminophen. Drugs taken during the first three months of a pregnancy may interfere with the normal formation of a baby's organs, leading to birth defects. Drugs taken later on in pregnancy may slow the baby's growth rate, or they may damage specific fetal tissue (such as developing teeth).

To increase the chance of having a healthy baby, a pregnant woman should avoid the following:

• smoking
• alcohol
• street drugs
• large amounts of caffeine (more than a cup or two of coffee per day)
• artificial sweeteners (although clinicians debate this)
• more than 5,000 U of vitamin A

Prognosis

Pregnancy is a natural condition and not a disease. If a woman takes good care of herself, plans her pregnancy with medical counseling, maintains optimal health, and obtains good prenatal care, the pregnancy and birth experience will be joyful events. In choosing a caregiver, the pregnant woman must consider what she wants for herself and her baby. The standard hospital experience, despite the homey decorations and presence of family members, frequently demands that the woman in labor remain in bed attached to a fetal monitor. Bed rest and hydration by IV slow down labor, even when normal. The ability to walk and change position during labor alleviates discomfort felt during contractions.

Many health care facilities are now utilizing nurse-midwives to attend births; their approach permits fewer interventions. Nurse-midwives are nurses who have received additional training in order to care for women having normal pregnancies and birth. If any complications should arise, they are well trained to detect them early, and they will call in the physician with whom they work. The pregnant woman and her partner should make a birth plan for their experience and present it to their caregiver early in the pregnancy to determine if the individual meets their expectations. The American College of Nurse-Midwives, (202) 728-9860, can provide the pregnant woman with a list of midwives in her area.

Childbirth education classes for the woman and her partner are extremely important in helping a couple prepare for labor and delivery. Pregnant women should be made aware of the options for the location and circumstances for birth. Increasing numbers of women are having their babies in their own homes or in birthing centers, as opposed to a traditional hospital setting.

Prevention

There are many methods of contraception available to prevent pregnancy. In order of least to most effective, these include:

• spermicide alone
• natural (rhythm) method
• diaphragm or cervical cap
• condom alone
• diaphragm with spermicide
• condom with spermicide
• intrauterine device (IUD)
• contraceptive pill
• sterilization (either man or woman)
• abstinence