Prenatal care in Mission

So now it is time to choose your prenatal care for your pregnancy, you have a choice of a Family Physician, and Obstetrician( OB) or a Registered Midwife.

A Family Physician:

Works largely in a community practice, typically offering maternity care as only one component of their medical services if by chance your own doctor does not provide maternity services they can make a referral for you, if you do not have a doctor you can go to a walk in clinic and they can make a referral for you to receive maternity services.

A Registered Midwife:

Will offer care to healthy low risk pregnant people from early pregnancy, through labor and birth and up to 6 weeks postpartum, they can offer labor and delivery care in a hospital or in your home( all depending on your views/health of yourself and the baby).

Like physicians, midwives are regulated and registered through a professional college and a referral is not required.

Obstetrician( OB):

Are physicians with specialized education and training in the medical management of pregnancy, labor and birth. they are qualified to manage serious complications of pregnancy and have surgical training to perform cesarean births if the need arises, if you will require specialized care, your family doctor or midwife will complete a referral form for you to see an OB.

Doula:

Some birthing people will choose to use a doula for extra support during their labor and birth. Doulas do not provide medical care and they do not deliver babies, instead they provide continuous emotional and physical support before, during and after birth to the pregnant person and their birth partner, and they are skilled in non-medical pain relief.

A. When to start prenatal care

The first prenatal appointment will usually take place in the second month between week 6 and week 8 but be sure to call as soon as you suspect you may be pregnant and have taken a pregnancy test, some practices will be able to fit you in right away while others may have a wait of several weeks or longer.

B. What to expect at your first visit

You may want to set aside some time for this first appointment as your health care provider will likely want to go over many things

-Your menstrual cycle, gynecological history and any past pregnancies

-Your personal and family medical history

-Exposure to potentially toxic substances

-Medication use, including prescription and over the counter medications or supplements

-Your lifestyle including the use of tobacco, alcohol and caffeine

-Travel to areas where Malaria, Tuberculosis and the Zika Virus or other infectious diseases are common

They may share information with you about sensitive topics such as domestic abuse, abortion or past drug use, this will help your provider take the best care of you and your baby.

-Your provider will also give you your due date( this is likely not the day you will deliver) only the day you will become 40 weeks pregnant, very few women will give birth on their due dates but still establishing your due date or your estimated day of delivery is important as it allows your provider to monitor your health as well as your babies growth and the progress of your pregnancy, and for the scheduling of various tests and procedures and the most appropriate times.

-Your provider will typically check your blood pressure, measure your weight and height and calculate your body mass index to determine your recommended weight gain for a healthy pregnancy.

-Physical exam, including breast and pelvic and screening exams of your heart, lungs and thyroids, you may also need a pap test to screen for cervical cancer.

-Will order lab tests to check your blood type( this includes your Rh status, an inherited trait that refers to a specific protein found on the surface of red blood cells, you may need special care if your Rh neg and the father is Rh positive),measure your hemoglobin( an iron rich protein found in red blood cells to carry oxygen from your lungs to other parts of your body, low hemoglobin can be a sign of anemia and can cause you to feel tired and could affect your pregnancy),check your immunity to certain infections(typically includes rubella and chickenpox or varicella, unless there is proof of vaccination or natural immunity documented in your medical history) and detect exposure to other infections( your provider will suggest a blood test to detect infections such as hep b, syphilis, gonorrhea, chlamydia and HIV and a urine sample to test for signs of bladder or urinary tract infection).

-Screening test for fetal abnormalities, prenatal tests can provide valuable information about your baby's health, your provider will typically offers a variety of prenatal genetic screening tests, which may include ultrasound or blood tests to screen for certain genetic abnormalities like down syndrome

-Lifestyle issues, they may discuss the importance of nutrition, prenatal vitamins, ask about exercise, sex, dental care, vaccinations and travel during pregnancy as well as other lifestyle issues, work environment and the use of certain medications during pregnancy, if you smoke as for suggestions to help you quit.

-Normal discomforts you may experience in early pregnancy, your breasts may be tender and swollen, nausea with or without vomiting( morning sickness)talk your provider if it severe.

c. Typical prenatal care schedule for pregnancy

8-12 weeks: Initial prenatal visit. The plan for your prenatal care at the practice you have chosen will be explained. A health history is taken, and a physical exam, including a pelvic exam is done. Lab work is completed, including your blood type and hemoglobin, sexually transmitted infection screening, a urine test, and a PAP test if you are due for one. You may be able to hear the baby's heart beat at this visit. If you cannot say with accuracy when you had your last period, an ultrasound might be scheduled to help determine how far along you are.

Optional genetic counseling visit: Early in your pregnancy, you may be offered genetic screening. This is commonly offered to women over the age of 35, or women who have a family history of genetic problems, but it is increasingly being offered to every woman. If you choose this screening, your care provider and/or genetic counselor may suggest additional genetic screening or diagnostic tests, including blood tests, chorionic villus sampling, ultrasound, and/or amniocentesis. These tests are done at specific times during pregnancy.

First two trimesters: Prenatal visits continue every 4-6 weeks through the first two trimesters, or until you are 28 weeks along. At each appointment, your care provider will weigh you and take your blood pressure, listen to the baby's heartbeat, and measure the growth of your uterus and baby. Some providers check your urine for protein and sugar at each visit.

15 to 20 weeks: At one of your appointments in this period, you will be offered the Quad Screen test, which screens for genetic and spinal cord abnormalities. You may also be offered an ultrasound between 18 and 20 weeks to view the baby's organs, and measure the growth of the baby and the placenta.

27 or 28 weeks: At an appointment in this period, you will be encouraged to take a glucose challenge test to screen for gestational diabetes. Your hemoglobin may be rechecked. Some providers do a pelvic exam. Expect to review warning signs of late pregnancy that would alert you to preterm labor or high blood pressure. You may be encouraged to sign up for prenatal classes, find a doctor or nurse-practitioner who will provide well-child care for your baby, and information may be provided about making plans for labor.

28 to 36 weeks: After 28 weeks, prenatal visits continue every 2-3 weeks until 36 weeks. Your doctor or midwife will continue to record the growth of the baby, listen to the baby's heartbeat, and will check the position of the baby.

36 weeks: At this visit, your midwife or doctor will do a pelvic exam, and encourage you to have a Group B Strep test. Screening tests for sexually transmitted infections may be repeated at this visit. The position and size of the baby are estimated. If your baby is not head down, your provider may suggest exercises to encourage the baby to turn, or suggest a physical manipulation called external version. The risks and benefits of this procedure should be carefully explained.

36 to 40 weeks: The usual monitoring of your weight and blood pressure, and the baby's size, position, and heart rate are done. Your care provider may offer to check your cervix for dilation.

40+ weeks: After your due date, your care provider may offer what is called "post-dates" testing, including nonstress tests, ultrasound, and biophysical profiles. Some providers start at 40 weeks, others not until 10 days past your due date.