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Pregnancy care
Getting good care before, during, and after your pregnancy is very important. It can help your baby grow and develop and keep you both healthy. It is the best way to be sure your little one gets a head start on a healthy life.
PRENATAL CARE
Good prenatal care includes good nutrition and health habits before and during pregnancy. Ideally, you should talk with your health care provider before you start trying to become pregnant. Here are some things you will need to do:
Choose a provider: You will want to choose a provider for your pregnancy and childbirth. This provider will provide prenatal care, delivery, and postpartum services.
Take folic acid: If you are considering becoming pregnant, or are pregnant, you should take a supplement with at least 400 micrograms (0.4 mg) of folic acid every day. Taking folic acid will decrease the risk for certain birth defects. Prenatal vitamins almost always contain more than 400 micrograms (0.4 mg) of folic acid per capsule or tablet.
You should also:
- Talk with your provider about any medicines you take. This includes over-the-counter medicines. You should only take medicines your provider says are safe to take while you are pregnant.
- Avoid all alcohol and recreational drug use and limit caffeine.
- Quit smoking, if you smoke.
Go for prenatal visits and tests: You will see your provider many times during your pregnancy for prenatal care. The number of visits and types of exams you receive will change, depending on where you are in your pregnancy:
Talk with your provider about the different tests you may receive during your pregnancy. These tests can help your provider see how your baby is developing and if there are any problems with your pregnancy. These tests may include:
- Ultrasound tests to see how your baby is growing and help establish a due date
- Glucose tests to check for gestational diabetes
- Blood test to check for normal fetal DNA in your blood
- Fetal echocardiography to check the baby's heart
- Amniocentesis to check for birth defects and genetic problems
- Nuchal translucency test to check for problems with the baby's genes
- Tests to check for sexually transmitted disease
- Blood type testing such as Rh and ABO
Depending on your family history, you may choose to screen for genetic problems. There are many things to think about before doing genetic testing. Your provider can help you decide if this is right for you.
If you have a high-risk pregnancy, you may need to see your provider more often and have additional tests.
WHAT TO EXPECT DURING PREGNANCY
Your provider will talk with you about how to manage common pregnancy complaints such as:
- Morning sickness
- Backaches, leg pain, and other aches and pains during pregnancy
- Problems sleeping
- Skin and hair changes
- Vaginal bleeding in early pregnancy
No two pregnancies are the same. Some women have few or mild symptoms during pregnancy. Many women work their full term and travel while they are pregnant. Others may have to cut back on their hours or stop working. Some women require bed rest for a few days or possibly weeks to continue with a healthy pregnancy.
POSSIBLE PREGNANCY COMPLICATIONS
Pregnancy is a complex process. While many women have normal pregnancies, complications can occur. However, having a complication does not mean you will not have a healthy baby. It means your provider will monitor you closely and take special care of you and your baby during the remainder of your term.
Common complications include:
- Diabetes during pregnancy (gestational diabetes).
- High blood pressure during pregnancy (preeclampsia). Your provider will talk with you about how to care for yourself if you have preeclampsia.
- Premature or preterm changes in the cervix.
- Problems with the placenta. It may cover the cervix, pull away from the womb, or not work as well as it should.
- Vaginal bleeding.
- Early labor.
- Your baby is not growing well.
- Your baby has medical problems.
It can be scary to think about possible problems. But it is important to be aware so you can tell your provider if you notice unusual symptoms.
LABOR AND DELIVERY
Talk with your provider about what to expect during labor and delivery. You can make your wishes known by creating a birth plan. Talk with your provider about what to include in your birth plan. You may want to include things like:
- How you want to manage pain during labor, including whether to have an epidural block
- How you feel about episiotomy
- What would happen if you need a C-section
- How you feel about forceps delivery or vacuum-assisted delivery
- Who you want with you during delivery
It is also a good idea to make a list of things to bring to the hospital. Pack a bag ahead of time so you have it ready to go when you go into labor.
As you get close to your due date, you will notice certain changes. It is not always easy to tell when you will go into labor. Your provider can tell you when it is time to come in for an exam or go to the hospital for delivery.
Talk with your provider about what happens if you pass your due date. Depending on your age and risk factors, your provider may need to induce labor around 39 to 42 weeks.
Once labor begins, you can use a number of strategies to get through labor.
WHAT TO EXPECT AFTER YOUR CHILD IS BORN
Having a baby is an exciting and wonderful event. It is also hard work for the mother. You will need to take care of yourself in the first few weeks after delivery. The type of care you need depends on how you delivered your baby.
If you had a vaginal delivery, you will likely spend 1 to 2 days in the hospital before you go home.
If you had a C-section, you will stay in the hospital for 2 to 3 days before going home. Your provider will explain how to care for yourself at home as you heal.
If you are able to breastfeed, there are many benefits to breastfeeding. It can also help you lose your pregnancy weight.
Be patient with yourself as you learn to breastfeed. It can take 2 to 3 weeks to get the hang of it. There is a lot to learn, such as:
- How to care for your breasts
- Positioning your baby for breastfeeding
- How to overcome any breastfeeding problems
- Breast milk pumping and storage
- Breastfeeding skin and nipple changes
- Timing of breastfeeding
If you need help, there are many resources for new moms.
WHEN TO CALL YOUR HEALTH CARE PROVIDER
Call your provider if you are pregnant or think you are pregnant and:
- You take medicines for diabetes, thyroid disease, seizures, or high blood pressure
- You are not getting prenatal care
- You cannot manage common pregnancy complaints without medicines
- You might have been exposed to a sexually transmitted infection, chemicals, radiation, or unusual pollutants
Call your provider immediately if you are pregnant and you:
- Have a fever, chills, or painful urination
- Vaginal bleeding
- Severe belly pain
- Physical or severe emotional trauma
- Have your water break (membranes rupture)
- Are in the last half of your pregnancy and notice the baby is moving less or not at all
References
Bope ET, Kellerman RD. Pregnancy and antepartum care. In: Bope ET, Kellerman RD, eds. Conn's Current Therapy 2017. Philadelphia, PA: Elsevier; 2017:chap 18.
Cunningham FG, Leveno KJ, Bloom SL, et al. Preconceptional counseling. In: Cunningham FG, Leveno KJ, Bloom SL, et al, eds. Williams Obstetrics. 24th ed. New York, NY: McGraw-Hill; 2014:chap 8.
Cunningham FG, Leveno KJ, Bloom SL, et al. Prenatal care. In: Cunningham FG, Leveno KJ, Bloom SL, et al, eds. Williams Obstetrics. 24th ed. New York, NY: McGraw-Hill; 2014:chap 9.
Cunningham FG, Leveno KJ, Bloom SL, et al. Prenatal diagnosis. In: Cunningham FG, Leveno KJ, Bloom SL, et al, eds. Williams Obstetrics. 24th ed. New York, NY: McGraw-Hill; 2014:chap 14.
Williams DE, Pridjian G. Obstetrics. In: Rakel RE, Rakel DP, eds. Textbook of Family Medicine. 9th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 20.
