Medical Care During Pregnancy

Why Is Prenatal Care Important?

Prenatal care is health care that a woman gets while pregnant. Going early and regularly for prenatal care can help moms-to-be — and their babies — stay healthy. Regular care lets doctors find and deal with any problems as soon as possible.

It's important to start prenatal care as early as possible — ideally, even before a pregnancy starts.

How Can I Find Prenatal Care?

Pregnant women who are healthy and not expected to have problems during their pregnancy or delivery usually are cared for by:

• obstetricians: doctors who specialize in pregnancy and childbirth
• obstetricians/gynecologists (OB/GYNs): doctors who specialize in pregnancy and childbirth, as well as women's health care
• family doctors: doctors who care for patients of all ages, from birth to the end of life. This can sometimes include pregnancy and childbirth (obstetrical care).
• midwives: providers who are trained in women's health care needs, including prenatal care, labor and delivery, and postpartum care for uncomplicated pregnancies. Different types of midwives have different levels of training. For example, some midwives have a nursing background and are called certified nurse-midwives. Midwives often work with doctors, but in some states they might work independently.
  

Your health care provider may refer you to a doctor with expertise in high-risk pregnancies — called a maternal-fetal medicine (MFM) specialist or a perinatologist — if you:

• have a chronic condition like diabetes or heart problems
• have an increased risk of preterm labor
• are age 35 or older
• are pregnant with more than one fetus
• have another complicating factor that might put you in a high-risk category

Routine Visits and Testing During Pregnancy

Call to schedule your first checkup during the first 6–8 weeks of your pregnancy, or when your period is 2–4 weeks late. Often, the first visit happens after 8 weeks of pregnancy unless there is a problem before then.

If you're healthy and have no complicating risk factors, you can expect to see your health care provider:

• every 4 weeks until the 28th week of pregnancy
• then, every 2 weeks until 36 weeks
• then, once a week until delivery

At each checkup, your weight and blood pressure are usually recorded. The size and shape of your uterus may also be measured, starting at the 22nd week, to see whether the fetus is growing and developing normally.

During one or more of your visits, you'll provide a small urine (pee) sample to be tested for sugar (glucose) and protein.

Prenatal Tests

Prenatal testing can help health care providers find things like a birth defect or a chromosomal problem in the fetus. It can also diagnose conditions in the pregnant woman that might affect her baby’s health, such as gestational diabetes, anemia, or infections. Prenatal tests are done in the first, second, and third trimesters.

Some prenatal tests are screening tests that can only reveal the possibility of a problem. Other prenatal tests are diagnostic tests that can accurately find whether a fetus has a specific problem. A screening test sometimes is followed by a diagnostic test. These can include blood tests, amniocentesis, CVS, and ultrasound exams.

Common Pregnancy Concerns

Some women worry about medical conditions they already have, such as diabetes, and how they could affect a pregnancy. It's important to talk with your doctor, who may recommend a change in medicines or treatments that could ease your concerns.

Other conditions that can come with pregnancy include:

• preeclampsia (also called toxemia of pregnancy): This refers to high blood pressure that develops in the second half of pregnancy or soon after the baby is born. A woman with preeclampsia might have problems with her kidneys (leading to protein in her urine), liver, eyes, lungs, and other organs, which can cause many different symptoms. Or she might not have any symptoms at all. If it affects the brain, it can cause seizures or coma. This is called eclampsia. Eclampsia can sometimes happen without prior signs of preeclampsia. If it's not treated, it can be life-threatening to both mom and baby, but this is very rare.
  
• Rh-negative mother/Rh-positive fetus (also called Rh incompatibility): Most people have Rh factor in their red blood cells (they're Rh positive). Those who don't are Rh negative. A simple blood test can determine your Rh factor. If your baby is Rh positive and you're Rh negative, problems can happen when the baby's blood cells enter your bloodstream. Your body may react by making antibodies that can pass into the fetus' bloodstream and destroy red blood cells.

These conditions are serious but manageable. So it's important to learn about them and discuss them with your health care provider.

Diet and Weight Gain During Pregnancy

Generally, women of normal weight who are pregnant with one baby should gain about 25–35 pounds during pregnancy. For women who start their pregnancy overweight, total weight gain should be closer to 15–25 pounds. Those who are underweight should gain 28–40 pounds. Women who are pregnant with more than one baby will need to gain more weight.

Controlling weight gain is harder later in a pregnancy, so try to avoid gaining a lot of weight during the first few months. But not gaining enough weight can cause problems too, such as poor fetal growth and premature labor.

Pregnancy is not a good time to start a diet, but it is a great time to enjoy healthier foods. Doctors recommend that women pregnant with one baby add about 300–400 calories to their daily intake in the second trimester, and a little more than that in the third trimester, to help nourish the developing baby. Protein should supply most of these calories, but also eat plenty of fresh fruits, grains, and vegetables. Good snack options include a glass of skim milk and half a sandwich, or a cup of yogurt with walnuts and a piece of fruit. Some people, such as teens or women who are pregnant with more than one baby, might need more calories.

Your health care provider may prescribe a prenatal vitamin to make sure you get enough iron, calcium, and folic acid. It's also a good time to get regular, low-impact exercise.

What Else Should I Know?

For your baby's sake and yours, it's important to take extra good care of yourself during your pregnancy. Follow these basics:

• Don't smoke, drink alcohol, or use drugs.
• Get enough rest.
• Eat a healthy diet.

It's also important to take precautions and know about:

• medicine safety
• food safety
  
• vaccines
  
• exercise safety

Talking to Your Health Care Provider

When your body is going through physical changes that may be completely new to you, it isn't always easy to talk to your health care provider. Maybe you're wondering whether you can have sex or what to do about hemorrhoids or constipation, or maybe you're feeling worried about the delivery.

You might feel embarrassed to ask these or other questions, but it's important to do so — and remember, your health care provider has heard them all before. Write down your questions to take with you to each visit.

Also, call your doctor right away if you have:

• heavy bleeding
• a sudden loss of fluid
• a noticeable absence of movement by the baby
• more than three contractions in an hour