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010: Common Concerns in Prenatal Care


24963852_sPrenatal care is very important for a healthy pregnancy. Lets review some common concerns about prenatal care and pregnancy management.

Where do I go for my Prenatal Care?

Deciding where to go for your prenatal care partly depends on where you would like to deliver your baby. If your choice is a hospital, you probably already have a place in mind; possibly a place where a friend has delivered or a place that has good reviews and a good reputation. Be sure to look into a place that has a reputable pediatrics department and NICU (neonatal intensive care unit), especially if your pregnancy is high risk. Other things to consider when choosing your hospital is how close it is to your home.

Here are some common questions you should be asking yourself when deciding on a specific hospital: Would you be able to get there easily and quickly if you had to? What kind of rooms do they have? Does the hospital provide services that are important to you? For example, circumcisions? Does it encourage breast feeding?

Another place where you can deliver your baby is a birthing center. A birthing center usually feels a little less technical than a hospital. They mimic the appearance of your home. They can have tubs for hydrotherapy or delivery in water. They generally don’t provide anesthesia with epidurals or spinals, but do provide other means of pain relief. If problems arise with your labor or delivery, or if a C-section is needed, transfer to a hospital will be necessary.

The last option for delivery is a homebirth with a person trained in doing deliveries such as a certified midwife. Home-birth is not encouraged in the United States because of possible adverse outcome in the event of an emergency.

After you have picked your referred place to deliver, you can decide on where you would like to have your prenatal care. Ask your hospital or birthing center about clinics or private offices where you can start your care. A good time to start your care is between 4 and 6 weeks. Visits in the early part of your pregnancy will be about once a month for the first 28 weeks. You can choose to join birthing classes or group meetings where you can meet other mothers with similar due dates. After 28 weeks, visits increase to about twice a month and then weekly as you approach your due date.

Blood tests are done at your initial visit to determine your blood count, blood type and lead level. They may also screen for sexually transmitted diseases such as HIV, Syphilis and Hepatitis.

There several tests done in the second trimester including a Quad screen which is a test that can predict the likelihood of genetic disorders. Some centers can test for possible genetics issues in the first trimester with a blood test and an ultrasound. This ultrasound measures the thickness of the baby’s neck (called nuchal thickness). Together, these tests can predict genetic disease. Keep in mind, however, that they can be false positive, meaning they can be abnormal in normal pregnancies.

The glucose challenge test (GCT) is done at about 26-28 weeks. This test consists if drinking a high sugar solution and later measuring your blood sugar. If the level is normal, it means that you are at low risk for developing gestational diabetes. If it is elevated, you will have a glucose tolerance test (GTT) where you will drink another sugar solution and your blood will be measured 4 times to determine your likelihood of gestational diabetes.

Group B Streptococcus (GBS) is a bacteria that is harmful to newborns. Some women have this bacteria as part of their normal vaginal flora and are tested at 36 weeks with a swab (Q-tip) to see if the bacteria is present. If you have a positive test for GBS, an IV antibiotic is given to ensure that it does not pass to your newborn.

Urine testing (in a form of a urine dip) is done at every visit during your pregnancy. The reason for frequent urine testing is to monitor for signs of gestational diabetes and pre-eclampsia. Glucose or protein in the urine is elevated in these disorders. Also signs of infection can be seen (elevated white blood cells or nitrites) which can signal a urine infection and ensure prompt treatment.

Prenatal care is essential for a healthy pregnancy and learning about the delivery options you have is as important as the different tests you can take to ensure that you are having a healthy baby. If you have questions about any of the previously mentioned tests, it is recommended you discuss them with your doctor and get all your questions answered. If you want to learn more about these subject and beyond, I highly recommend The Mayo Clinic Guide to a Healthy Pregnancy: From Doctors Who Are Parents, Too!

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