PRENATAL CARE

PRENATAL CARE

Prenatal care is designed to ensure that your pregnancy is as happy and problem-free as possible by keeping an eye on your general health and wellbeing. Any problems can be picked up at an early stage and quickly treated. Taking measurements and doing tests early in pregnancy give a base line against which changes are measured. Regular trips to the doctor can be reassuring, and give you the opportunity to get to know your doctor. Prenatal care should start as soon as possible so, once your pregnancy has been confirmed, visit your doctor. He will be able to advise you on the prenatal and childbirth choices available in your area.

WHERE TO HAVE YOURBABY

Types of prenatal care

 Choosing the type of care you receive during pregnancy and for the birth of your child is very important to your health and wellbeing.

                Discuss your options with a midwife doctor or
prenatal teacher. Talk it through your options locally: some types of care may be easier to obtain in your area than others.

Physician care

Most women are cared for by a physician, usually an obstetrician, but occasionally by a family doctor. In choosing a physician you should consider whether you would prefer a solo practitioner, a two- or three- person practice or a large group. Find out the type of hospital that the doctors you are considering are affiliated with. A community hospital with a nursery only equipped to handle normal full term infants would have to transfer your baby to another hospital should he be necessary. Some hospitals are staffed by nurses during the night except for emergency, some by doctors in training (residents) and others by house physicians. Women who are concerned about their baby’s health may prefer a hospital with an intensive care nursery and/or physician present all the time. Other women prefer the relaxed and friendly atmosphere of the community hospital. It is helpful to visit the hospital and see what the labor and delivery rooms look like and talk to women who have delivered there.

Midwife care

Having a midwife with you whom you know and trust is a priority choice for many women. With team midwifery you are cared for during pregnancy by a small team of midwives. You know when you check in that one of these women will deliver your baby and the same team will also look after you and your baby once the labor is finished.

The first visit

The first visit to your doctor or midwife is usually longer than later visits. A full medical history is taken, and you may also be asked for a family history to pick up the possibility of twins or illnesses that will be genetically linked. Particular attention will be paid to the presence of any medical condition which could complicate your pregnancy such as diabetes or hypertension. Be sure to tell your doctor or midwife if you are taking any medication, either prescription or non-prescription. A complete physical examination will be performed. Routine tests such as checking your urine and recording your weight will be done at each visit. Other tests such as taking blood samples will be done occasionally.

                The first visit is the time to talk about your preferences for childbirth and to find out about prenatal classes.

Asking questions

Your midwife or doctor is a good source of information both medical and local, so it’s worth thinking about what you want to discuss before you go to see her. You may feel that you definitely don’t want any pain relief, but during labor you could change your mind so find out what’s on offer. You may find the following list of questions helpful:

Labor and Birth

·         Will my partner or friend be able to stay with me throughout labor?

·         What pain relief will I be offered (see also pain relief options, page 57)? Are epidurals available?

·         Will I be able to move around freely during labor?

·         Can I give birth in any position?

·         What is your policy on Cesareans and episiotomies?

After the Birth

·         Can I breastfeed my baby immediately?

·         How long will I stay in hospital?

·         What are the visiting hours? Can my partner visit at any time?

·         Is there an infant intensive care unit? If not, where is the nearest one?

As your pregnancy progresses your doctor or midwife will be examining you on a regular basis to follow the growth and position of your baby and to ensure that you are not developing any complications of pregnancy. She will carefully examine your abdomen and estimate the size of your uterus. This is done by measuring the height of the fundus or top of the uterus. This will allow her to estimate the progress of the pregnancy. If the uterus is not growing as much as expected or seems larger than expected an ultrasound will be done to obtain more accurate information.

                Your abdomen will also be examined to determine the position of the baby. This is important since the position of the baby will affect labor and delivery. In the majority of pregnancies the baby is in the head down or vertex position. If the baby’s head is in the upright position, it is difficult and can be dangerous to deliver a baby in the breech position vaginally. Therefore, if the baby continues to be breech near the end of the pregnancy a Cesarean section is usually planned.

                If your baby is in the vertex position your doctor or midwife can determine of exam which of four vertex positions your baby is in. they are right occiput posterior (ROP), right occiput anterior (ROA), left occiput posterior (LOP) and finally left occiput anterior (LOA). The occiput is the back of the baby’s head. The back of the baby’s head will either point to the right or left of the mother.

                Anterior or posterior refer to whether the baby’s head is towards her back, posterior, or towards her front, anterior. So right occiput posterior (ROP)  would mean the baby’s head is lying slightly to the right with hid back against the mother’s spine. Your doctor or midwife can show you how the baby is lying. This can only be done late in pregnancy when the baby is quite large.

                It is important for your doctor or midwife to know the position of the baby when you go into labor. Posterior laying babies can be more difficult to deliver and sometimes a Cesarean section is needed.

                Pre-eclampsia is a complication of pregnancy consisting of hypertension (high blood pressure), the presence of albumin in the urine and edema, swelling of the hands, feet and legs. The blood pressure consists of two figures. Most people have a normal blood pressure in the region of 120 over 70. Some women find their blood pressure drops early in pregnancy and rises late. An increase of more than about twenty to thirty points in the lower figure may indicate pre-eclampsia, which is potentially dangerous for both mother and baby and requires treatment.