Last Updated: 4 November 2014

 

What is Prenatal Care?

Why Do I Need Prenatal Care?

How Do I Get Prenatal Care?

Costs of Prenatal Care & Where to Get Free or Cost-reduced Prenatal Care or a Doula

Do I Need Someone To Go With Me to the Doctor?

What is Good Prenatal Care?

Prenatal Testing 

What Treatment Should I Expect From My Doctor?

What Will Happen When I Visit the Doctor?

What Are the Risks in Pregnancy Without Good Prenatal Care?

What Can I Do To Look After Myself and the Baby?

What About My Mental Health?

Doulas:  Emotional and Practical Support for Women during Pregnancy

Where Can I Get More Support and Information?

Help More Women Have Access to Good Prenatal Care

 

What is Prenatal Care?

If you are pregnant, you should receive regular health care from qualified health professionals (a doctor, nurse or midwife) called prenatal (or 'antenatal') care.  Prenatal care is a preventative care and wellness programme for you and your unborn baby. Health professionals will perform check-ups and tests using modern equipment.  Ideally this should start from the first month of pregnancy.

Your prenatal care should include: measurement of your weight and height; monthly urine tests; monthly checking of your blood pressure; several blood tests; monthly/weekly testing of your baby's heartbeat with a Doppler; professional counselling if you need it; measurement of your uterus (fundal height); ultrasound scans; prenatal classes in preparation for birthing and postnatal care for you and baby; checking of baby's position closer to birth, membrane sweep and/or induction of labour if needed.

 

Why Do I Need Prenatal Care?

Prenatal care checks regularly throughout your pregnancy that you and baby are healthy.  As your body is nourishing and nurturing a rapidly developing and growing baby, your doctor needs to make sure that your body is coping well or if there are any problems.  He/she can offer advice and treatment to keep you and your baby healthy.  Early treatment can cure many problems and prevent problems.

Women who receive no prenatal care are three to four times more likely to die of pregnancy-related complications than women who do.1  Those with high-risk pregnancies are 5.3 times more likely to die if they do not receive prenatal care'.2

Babies of mothers who do not get prenatal care are three times more likely to have a low birth weight and five times more likely to die than those born to mothers who do not get care.'3

 

 How Do I Get Prenatal Care?

As soon as you know that you are pregnant, contact a doctor/GP.  If you have never registered with a GP, call the GP nearest to your residential address or work and ask them how to register.  Arrange the necessary documents for the registration and immediately tell the staff that you are pregnant (and if you know, how far along you are) on the day you register.  This will help them to quickly arrange the first prenatal care appointment for you.

Prenatal Care in the USA

  1. For those who are employed and/or with private insurance.  The doctor will contact your insurance company for certification and payment of your prenatal care.  You may be responsible for some portion of payment yourself depending on what type of insurance you have.  Your doctor will usually have admitting privileges with a hospital and will co-ordinate the birth and post birth care.
  1. For those on low-income (or from a low-income family) or without adequate insurance.  You will be able to get access to prenatal care via Medicaid.  The American Pregnancy Association website provides information on how to apply for Medicaid  in pregnancy and how to get assistance if you are underinsured.
  2. For those who do not have insurance and do not qualify for Medicaid.  If you are uninsured, you can still go to the doctor who will typically negotiate with you some form of payment terms for prenatal care and birth.  The hospital will do the same.  The American Pregnancy Association offers some suggestions on how you can reduce your costs.

 Prenatal Care in the Philippines

  1. Health insurance paid for by employer.  You will need to make your prenatal appointments with the insurance company's accredited clinic or hospital.
  2. Employed but no health insurance coverage.  Contact and/or visit your preferred Ob/Gyn.  You will have to arrange the payment for all your prenatal visits, diagnostic tests and ultrasound scans.
  3. Unemployed or from a low income household.  As soon as you know you are pregnant, go to the nearest public health centre (or public hospital's outpatient department).  Please take note that the majority of diagnostic tests and ultrasound scans are not free of charge.

 

Costs of Prenatal Care & Where to Get Free or Cost-reduced Prenatal Care or a Doula

The cost of prenatal care in Australia, the USA and UK follows.  For more information on prenatal care services or in other countries please visit our Directory:

Australia:  Prenatal care is free through Medicare.

USA:  Prenatal care is free through Medicaid.  Natural birthing at a birth center costs much less than giving birth in a hospital.  You can find a birth center need you using this locator:  http://www.birthcenters.org/birth-center-locator

To find a doula in the USA here is a great source of available doulas:  http://doulamatch.net

UK:  Prenatal care is free through the NHS.  To get support from a doula in the UK, a mentored doula provides their services at a reduced cost:

http://doula.org.uk/find-a-doula

Or if you are receiving benefits and on a low income:

http://doula.org.uk/content/doula-access-fund

 

Do I Need Someone To Go With Me to the Doctor?

No, but taking your partner, a family member or a friend (if they are supportive of you in pregnancy) can be very comforting and helpful as you can discuss the information you get and share your pregnancy experiences.

If you are unsure about a lot of things, especially if you are a first time mum, you may ask your pregnancy counsellor (or a birth doula if you have hired one), if she can accompany you, if possible, to your prenatal care appointment.  He/she can ask for you the right questions about your pregancy.

 

What is Good Prenatal Care? 

Each woman is different and each baby is different, so attending staff should be sensitive to your individual needs during your pregnancy and treat you and your baby as two patients.

A good prenatal care program includes regular health assessments of yourself and baby by qualified staff through various diagnostic tests (blood tests, etc) and use of dopplers/ultrasounds to monitor baby's health.  The program should also include prenatal classes which will prepare you for labour (including pain management), birthing, breastfeeding and care of a newborn. 

 

Prenatal Testing

Prenatal tests include detailed ultrasound scans and other tests such as analysis of amniotic fluid and are performed to see if the unborn baby is developing and growing normally.  This information may be used to determine if the baby needs to undergo procedures such as an in utero operation or post-birth treatments or it is often used by doctors to recommend an abortion before a certain time in pregnancy when it is still legal and safe for the mother.  Women may feel very pressured to have an abortion based on prenatal testing (which is not always accurate).  Some common prenatal tests are:

Week 12:     Sonographer measures baby's head circumference and femur (thigh bone) to determine his age from conception.

Nuchal translucency screening test: The fluid at the back of the baby's neck is measured to detect the risk of a baby having Down's Syndrome.  According to research, the more fluid there is, the higher the risk of baby having Down's Syndrome.  This test is only 75% accurate.

Week 19-20:Anomaly scan.  Baby's body parts will be thoroughly checked that they are developing and functioning well.

Down's Syndrome Screening (blood test).  If the risk is high according to the medical calculation, you may be offered a further test called Amniocentesis.  Medical research says this test is over 90% accurate.  Amniocentesis is a very invasive procedure where the doctor will take a sample of the amniotic fluid surrounding the baby by inserting a syringe through your tummy.  There is a risk this may harm the baby.

  

What Treatment Should I Expect From My Doctor?

Your doctor is there to provide you with a service.  You have every right to ask questions, ask for information and in particular ask what all the options are available to you if you encounter problems in pregnancy.  He/she should treat both you and your baby with utmost care and respect and should not pressure you to have abortion or tell you you must choose one particular course of action.  If you do not feel happy with the advice of your doctor or level of care you are given, tell the doctor your concerns and ask to speak to the head of the department or go to another doctor.  

If you wish to seek a second opinion and you live in the US, you could use the AAPLOG directory to find a recommended doctor in your area.  Alternatively, talking to a local pregnancy counsellor (usually a free service from a pregnancy crisis centre), your birth doula or independent midwife (if you have employed one) can be helpful to get better informed in your situation and find another doctor who may provide you and your baby with better care.

Medical and technological advancements to treat pregnant women and their unborn babies in utero (in a woman's uterus, before birth) are improving all the time.  

Modern treatments available during pregnancy include:

  • In utero surgery for baby's tumour4
  • In utero heart surgery5
  • In utero treatment for spina bifida6
  • Laser treatment for Twin to Twin Transfusion Syndrome to correct blood flow between twins7
  • Chemotherapy and lead shields8

 

What Will Happen When I Visit the Doctor?

Pregnancy normally is 37 - 41 weeks.  You can read about what stage your baby is at each week of pregnancy here.  Assuming that you find out that you are pregnant at the earliest stage - about a month from the first day of your last menstrual period (LMP) - this is what may happen from the time you first contact a doctor (all in weeks since LMP):

Week 4:  You may see a doctor or a midwife who will ask you to provide a urine sample to test and confirm your pregnancy.  Your blood pressure will be checked, you will be weighed and your height measured.  You will need to fill out forms which ask you questions about your pregnancy, your family, your partner, your lifestyle/diet and your medical history.  You will be asked if you are taking folic acid supplements and/or any vitamins.  If you aren't, you should be provided some.  Appointments will be arranged for your blood tests and your first ultrasound scan.

Week 8:  The first ultrasound scan (between 8-12 weeks) will be performed to determine how old the baby is from conception (dating scan).  His/her head circumference and thigh bone (fumur) will be measured.  They will also check baby's heartbeat, his/her blood flow and spine if it (the neural tube) closed properly.  The ultrasound report will also show your estimated due date.

Week 9-11:  If the sonographer was able to determine that the neural tube of your baby did not close properly (spina bifida) based on your first scan, speak to your midwife.  You can ask your midwife to refer you to a consultant to get information about this disability, including in utero surgery for spina bifida (an operation that can be conducted on the baby while still in the womb).  If you need someone to support you, contact the staff at a pregnancy crisis centre before you sit down with the consultant.

Week 12:   You will be asked to provide a unine sample at your appointment.  Your urine will be checked to determine your blood sugar level to determine your risk for gestational diabetes.  Your urine will also be checked for presence of protein to getermine your risk for pre-eclampsia.  Your blood pressure will be checked.  Baby's heartbeat will also be checked through use of a Doppler.

At this stage, blood samples will be taken for comprehensive blood tests for the following: your blood group, whether you are Rhesus positive or negative (to check your blood compatibility with baby), your haemoglobin level (to determine your iron levels), presence of German Measles/Rubella antibodies, whether you have Syphilis, Hepatitis B, HIV or AIDS.  If you are at risk of Sickle Cell disease (this is a blood disorder), your blood will be tested for it.  If you consent to a blood test to determine your baby's risk of having Down's Syndrome, it will also be done at this time.

Week 16:  Your urine and blood pressure will be checked.  The baby's heartbeat will also be checked.  Your blood tests results should have arrived by now and the midwife or doctor will discuss these with you.  You may ask for a copy of your test results.

If your haemoglobin level is low, the midwife will prescribe or provide you with iron supplements.

Week 18-21:  The anomaly scan will be performed.  This is a very detailed examination of baby via ultrasound.  The baby's body parts are checked that they are developing properly and also the baby's movements and blood flow to see whether all is functioning well.

Week 24-32: A urine test and blood pressure check will be carried out and fundal height will also be measured.  Fundal height is a measurement of your uterus (normally the medical staff will use a tape measure).  This helps gives an indication if the baby is growing well, or if he is too large or small for his gestational age.  The baby's heartbeat will be checked.

Week 28:  You will have another urine test and blood pressure check and also a glucose tolerance test (GTT).  The GTT is to determine your risk of developing gestational diabetes during your pregnancy.  The baby's heartbeat will be checked.

Week 32:  Your prenatal classes should start now which will explain labour and help you prepare for it, including learning good positions and breathing exercises.  The medical staff might already encourage you to start packing your hospital bag and write your birth plan.

Week 34-40:  Your baby's position will be checked and in particular whether he is in a head down position or already in your pelvis (engaged and ready for birth).  The medical staff will try and determine where the baby's head.  If the baby is in a breech position (head up, feet down), you might be scheduled for ultrasound exams during your weekly appointments to check whether the baby has turned if a breech birth would be risky in your situation (e.g a twin pregnancy).

Week 35:  An ultrasound scan to check the baby's position will probably be performed around this week.  The medical staff will find the baby's head and measure your amniotic fluid index to see if this is at a safe level.  If the baby is not yet engaged, you may be scheduled for another ultrasound and/or an external cephalic version (ECV) to manoeuvre baby (change his position).

Week 36:  A urine test, blood pressure check and fundal height measurement will be done.  Baby's heartbeat will be checked.  If baby is not engaged, your doctor will probably discuss the risks involved and your options with you, e.g. a C-Section delivery.  

Week 37-41:  You have reached term in pregnancy and may go into labour at any time during this period.

Week 38:  A urine test, blood pressure check and fundal height measurement will be done.  Baby's heartbeat will be checked.  At this time, medical staff will probably discuss the options of a membrane sweep and induction of labour to get labour underway if you go past your due date.

Week 39:  A urine test, blood pressure check and fundal height measurement will be done.  Baby's heartbeat will be checked.

Week 40:  Baby is due.

Week 41-41:  There are significant risks involved with being overdue which your doctor should clearly discuss with you.  A membrane sweep and/or induction of labour may be performed.

 

What Are the Risks in Pregnancy Without Good Prenatal Care?

Without good prenatal care the risk of a woman dying as a result of pregnancy rises significantly if she has complications which are not appropriately treated.  This increases risks to a safe birth for mother and baby.  A pregnant woman without good prenatal care may have undiagnosed conditions which may all be life-threatening without treatment:

  • Ectopic Pregnancy
  • Gestational diabetes
  • Pre-eclampsia or other heart/blood problems
  • Problems with immunity

The mother may be unaware of warning signs that she and/or baby are not safe or healthy.  E.g. the baby is not moving enough, amniotic fluid is leaking, etc.  Without monitoring, the baby may not receive necessary care for:

  • An undetected disorder/disease
  • Breech position
  • Underweight or too big at birth

 

What Can I Do To Look After Myself and the Baby?

Here are some basic guidelines for health in pregnancy:

  • Eat small, regular meals.  Ensure meat, fish and egg products are well-cooked before eating and wash hands thoroughly after handing raw meat products, working outside or handling animals.  Avoid soft cheeses, raw shellfish, cold meats and pre-packaged salads (salad ingredients should be well-washed);
  • Sleep well;
  • Take multivitamin supplements and/with folic acid.  As soon as you know you are pregnant you should immedicately start taking a daily supplement of 400mcg or 4.0mg of folic acid (available from your supermarket or local chemist).  Taking folic acid or eating food which are high in folic acid is crucial as soon as you know you are pregnant as it is required for the baby's neural tube to close during the 4th week to avoid spina bifida10;
  • Avoid smoking and second-hand smoke;
  • Avoid alcohol intake;
  • Avoid food/beverage containing caffeine;
  • Excercise but don't overdo it.

More detailed information how you can care for yourself and your baby during pregnancy is provided in these websites:

http://www.bubhub.com.au/pregnancy-week-by-week.php

http://www.pregnancybirthbaby.org.au/foods-to-avoid-when-pregnant

http://www.babycentre.co.uk/a536361/10-steps-to-a-healthy-pregnancy

http://www.babycenter.com/pregnancy

http://americanpregnancy.org/pregnancyhealth

   

What About My Mental Health?

If you are in the situation of an unwanted pregnancy you are at risk of mental health problems.  This risk to your mental health exists regardless of whether you choose to continue in the pregnancy and parent or adopt your baby out, or if you choose abortion.11

If you have a history of mental health problems or have experienced mental illness before, you are at a greater risk of mental illness after an abortion than if you were to parent or choose adoption.11

The hormonal changes you experience in pregnancy may also affect you emotionally.  Other physical changes in pregnancy like your brain shrinking a little bit, may cause you to experience difficulty in retaining new information or remembering things.12  This is just a temporary issue.. your brain will return to its normal size after birth.  Understanding the physical changes your body is going through should help you be more patient with yourself.

 

 

Doulas:  Emotional and Practical Support for Women during Pregnancy

Doulas support women and their families during pregnancy, childbirth and early parenting.  This support is practical and emotional but non-medical in nature.  A doula's objective is to 'mother the mother'.

Doulas are great companions for pregnant women.  A doula will give you great emotional support during your pregnancy and birthing.  Some of them may have enough experience and be qualified to give you prenatal classes (on birthing) as part of your prenatal program.

During birthing, doulas are efective in making sure you get what you want for yourself and baby.  They are great advocates, especially if you are to give birth in a busy hospital or birth center where you think you won't get personalised attention by the staff.  They can prevent medical staff putting undue pressure on you when it comes to decisions in labour as they will understand your birth plan and can represent you.  Normally birth doulas are on call for you 14 days before you are due and 14 days after you give birth.

Doulas are not medically qualified.  If you do have questions about your pregnancy or baby that requires a professional medical opinion, ask your doula to help you get the right medical evidence-based information so you can make a properly informed decision.

A postnatal doula provides support to you after you have given birth.

 

Where Can I Get More Support and Information?

Talking to others can help you get information you are looking for.  Often, advice from other pregnant women/mothers can be very beneficial and you are likely to find other women who have experienced very similar situations to your own!  Start a new topic on our Forums or join an existing forum group such as:

 

US:

'Baby Centre US' http://www.community.babycenter.com/groups

'Birth Club' on www.community.babycentre/com

Australia:

'The Bubhub' http://www.bubhub.com.au/loungepregnancy.php

'Pregnancy, Birth and Beyond Forums'  http://www.pregnancy.com.au/forums/

 

UK:

'Baby Centre UK' http://www.community.babycentre.co.uk

'Netmums to Be' http://www.netmums.com/coffeehouse/pregnancy-64/netmums-52/

'Mumsnet'  http://www.mumsnet.com/pregnancy

Philippines:

'Smart Parenting' http://www.smartparenting.com/parentchat/

 

These sites also have online pregnancy tools:  

http://www.bubhub.com.au/loungepregnancy.php

 

Help More Women Have Access to Good Prenatal Care

Abortion Group's objectives include advocating for better support for women in pregnancy, including better prenatal care services, particularly in third world countries, poorer demographic regions (eg. Latin-America) and remote areas (like in remote parts of Australia).  Join AG today or there are other ways you can Get Involved.  

 

Footnotes:

1 Chang J, et al. Pregnancy-related mortality surveillance - United States. 1991-1999. MMWR surveillance summaries. 2003. February 21:[1-8].

2  Rosenberg D, Geller SE, Studee L, Cox SM. Disparities in mortality among high risk pregnant women in Illinois: a population based study.  Ann Epidemiol.  2006. 16:26-32.

3  Office on Women's Health, U.S. Department of Health and Human Services. Prenatal care fact sheet. 2012. https://www.womenshealth.gov/publications/our-publications/fact-sheet/prenatal-care.html#b Retrieved 9 August 2014. 

4  Luscombe R. Medical Research. 21 June 2012. Doctors save baby with rare tumor after performing first ever surgery in utero. http://theguardian.com/science/2012/jun/21/medical-research-health The Guardian.  

5  Grenoble R. 10 November 2013. Rare Fetal Heart Surgery a Success After Doctors Practice on Grape.  http://www.huffingtonpost.com/2013/10/11/fetal-ortic-valvuloplasty-heart-surgery-california-grape_n_4084859.html The Huffington Post.

6  Rochman B. 9 February 2011. Operating on Babies in the Womb: For Spina Bifida, It's the Better Option.  http://healthland.time.com/2011/02/09/operating-on-babies-in-utero-for-spina-bifida-its-the-way-to-go/ Time, 'Family Matters'. 

7  Liverpool Women's NHS Foundation Trust website. Unborn Twins Saved by Laser Treatment in the Womb at Liverpool Women's.  http://www.liverpoolwomens.nhs.uk/News_Centre/news/UnbornTwinsSavedByLaserTreatmentInTheWombatLWH.aspx  

8  Faulkner K. 15 November 2011. Cancer Mother First to Give Birth Following Chemotherapy After Pregnant Bump Encased in 1.5 Tonne Lead Shield. http://www.dailymail.co.uk/health/article-2061645/Cancer-mother-birth-following-chemotherapy.html Mail Online, Health.

9 Code R. Neuroembryology of Neural Tube Defects. Heritage College of Osteopathic Medicine, Ohio University. http://www.oucom.ohiou.edu/dbms-witmer/Downloads/Ped.Neurol.pdf

10 Recommended daily supplement of folic acid for pregnant women is 400mcg = 4.0mg per day: http://www.mayoclinic.org/diseases-conditions/spina-bifida/basics/prevention/con-20035356

11 AMRC, 2011. Induced Abortion and Mental Health. 8.

12 University of Southern California. (1997, 17 February) Researchers find 'Pregnancy-Induced Slowness is Real' http://www.independent.co.uk/news/pregnancy-makes-your-brain-shrink-1282270.html

 

 

 
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