prenatal care essay

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What is prenatal care and why is it important?

Having a healthy pregnancy is one of the best ways to promote a healthy birth. Getting early and regular prenatal care improves the chances of a healthy pregnancy. This care can begin even before pregnancy with a pre-pregnancy care visit to a health care provider.

Pre-Pregnancy Care

A pre-pregnancy care visit can help women take steps toward a healthy pregnancy before they even get pregnant. Women can help to promote a healthy pregnancy and birth of a healthy baby by taking the following steps before they become pregnant: 1

Develop a plan for their reproductive life.
Increase their daily intake of folic acid (one of the B vitamins) to at least 400 micrograms. 2
Make sure their immunizations are up to date.
Control diabetes and other medical conditions.
Avoid smoking, drinking alcohol, and using drugs.
Attain a healthy weight.
Learn about their family health history and that of their partner.
Seek help for depression, anxiety, or other mental health issues.

Prenatal Care

Women who suspect they may be pregnant should schedule a visit to their health care provider to begin prenatal care. Prenatal visits to a health care provider usually include a physical exam, weight checks, and providing a urine sample. Depending on the stage of the pregnancy, health care providers may also do blood tests and imaging tests, such as ultrasound exams. These visits also include discussions about the mother's health, the fetus's health, and any questions about the pregnancy. 3

Pre-Pregnancy and prenatal care can help prevent complications and inform women about important steps they can take to protect their infant and ensure a healthy pregnancy. With regular prenatal care women can:

Reduce the risk of pregnancy complications. Following a healthy, safe diet; getting regular exercise as advised by a health care provider; and avoiding exposure to potentially harmful substances such as lead and radiation can help reduce the risk for problems during pregnancy and promote fetal health and development. 4 Controlling existing conditions, such as high blood pressure and diabetes, is important to prevent serious complications and their effects. 5
Reduce the fetus's and infant's risk for complications. Tobacco smoke and alcohol use during pregnancy have been shown to increase the risk for Sudden Infant Death Syndrome . 6 Alcohol use also increases the risk for fetal alcohol spectrum disorders, which can cause a variety of problems such as abnormal facial features, having a small head, poor coordination, poor memory, intellectual disability, and problems with the heart, kidneys, or bones. 7 According to one recent study supported by the NIH, these and other long-term problems can occur even with low levels of prenatal alcohol exposure. 8 In addition, taking 400 micrograms of folic acid daily reduces the risk for neural tube defects by 70%. 2 , 9 Most prenatal vitamins contain the recommended 400 micrograms of folic acid as well as other vitamins that pregnant women and their developing fetus need. 1 , 10 Folic acid has been added to foods like cereals, breads, pasta, and other grain-based foods. Although a related form (called folate) is present in orange juice and leafy, green vegetables (such as kale and spinach), folate is not absorbed as well as folic acid.
Help ensure the medications women take are safe. Women should not take certain medications , including some acne treatments 11 and dietary and herbal supplements, 12 during pregnancy because they can harm the fetus.

Learn more about prenatal and pre-pregnancy care .

Centers for Disease Control and Prevention. (2015). Preconception health and health care. Retrieved May 20, 2016, from http://www.cdc.gov/preconception/planning.html
Centers for Disease Control and Prevention. (2011). Fetal alcohol spectrum disorders. Retrieved August 1, 2012, from http://www.cdc.gov/Features/FASD
Eckstrand, K. L., Ding, Z., Dodge, N. C., Cowan, R. L., Jacobson, J. L., Jacobson, S. W., et al. (2012). Persistent dose-dependent changes in brain structure in young adults with low-to-moderate alcohol exposure in utero. Alcoholism: Clinical and Experimental Research, 36 (11), 1892–1902. PMID: 22594302
Centers for Disease Control and Prevention. (2016). Folic acid. Data and statistics. Retrieved December 12, 2016, from https://www.cdc.gov/folic-acid/health-equity
NIH Office of Dietary Supplements. (2016). Folate.Dietary supplement fact sheet. Retrieved May 20, 2016, from http://ods.od.nih.gov/factsheets/Folate-HealthProfessional
Office on Women's Health. (2012). Prenatal care fact sheet. Retrieved May 20, 2016, from http://www.womenshealth.gov/publications/our-publications/fact-sheet/prenatal-care.html

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Healthy Pregnancy: The Importance of Prenatal Care

Prenatal care is key for a healthy pregnancy.

Finding out you are pregnant is exciting news, often followed by many questions about what to expect and what comes next. Whether you are a first-time mom, or have multiple children, seeking prenatal care early in pregnancy is key to a healthy pregnancy for you and your baby.

What is prenatal care?

Prenatal care is the healthcare you receive while pregnant. Regular prenatal care throughout your pregnancy helps to catch potential concerns early and reduces the risk of pregnancy and birth complications.

As soon as you suspect you are pregnant, make an appointment with your OB/Gyn. If you don’t have one, call your health insurance to determine which obstetricians are covered by your insurance. (If you don’t have health insurance, reach out to your local community health center or county health department for your health care coverage options.)

You can expect to see your healthcare provider often and regularly throughout your pregnancy. Typically, you will be scheduled for your first prenatal appointment when you are at least 8 weeks pregnant. For pregnancies without complications, prenatal visits are usually scheduled as follows:

Up to week 28: 1 prenatal visit a month
Weeks 28 to 36: 1 prenatal visit every 2 weeks
Weeks 36 to 40: 1 prenatal visit every week

Your doctor will want to see you more often if you had any preexisting health conditions like diabetes or high blood pressure before you became pregnant, if you are over the age of 35, or if problems develop during your pregnancy.

What to expect at your prenatal visits

At your first prenatal visit, your doctor or healthcare provider will review your medical history. She likely will perform a complete physical examination as well as urine and blood tests during this visit.

At each visit, your healthcare provider will check you and your baby. She will talk with you about the things you can do help you and your baby stay healthy, such as eating healthy foods, staying active and gaining the right amount of weight during pregnancy. Your healthcare provider may also order blood tests and imaging tests, such as an ultrasound.

Each prenatal visit is important for a healthy pregnancy

Even if you are farther along in your pregnancy, prenatal care is still important. It is not too late to begin to seek care, so call your doctor today to schedule a visit. Babies of mothers who do not get prenatal care are three times more likely to have a low birth weight and have birth complications. Seeing your doctor regularly helps ensure you have the healthiest pregnancy possible.

Kim Tustison, MD is a UCR Women’s Health OB/Gyn.

The Importance of Prenatal Care

Every woman wants to have a healthy pregnancy. Putting as little stress on the baby while it’s in the womb is important, and it starts with excellent prenatal care. Learn more about the importance of prenatal care from Peconic Bay Medical Center.

Reduce the Risk of Complications

Prenatal care reduces complications during pregnancy and prevents problems during delivery. Regular medical care during pregnancy provides you with vital information about changes in your body that could put the pregnancy or your health at risk. Ideally, you want to get prenatal care early in the pregnancy and regular care throughout.

Prenatal care is especially crucial for women with high-risk pregnancies. Pregnancies with a greater chance of complications are called high-risk. These factors may increase the risk of problems during pregnancy:

Very young age or over age 35.
Overweight or underweight.
Problems in previous pregnancies.
Pregnancies with twins, triplets, etc.
Current or past health conditions, such as high blood pressure, diabetes, cancer, HIV, and autoimmune disorders.

If your pregnancy is considered high-risk, you’ll need to see your doctor more often to prevent further complications during pregnancy and labor. Even though you’re meeting with your doctor weekly, if you suspect there’s something wrong with your baby, go to the nearest medical health center immediately.

What Happens during Prenatal Visits

At your first visit, your doctor will ask you questions about prior pregnancies, previous operations, and any diseases. Providing your doctor with a complete health history during early prenatal visits gives him or her the information needed to make sure you get the best care possible during your pregnancy. Your doctor will perform a physical exam, take your blood and urine for lab tests, and check your weight, height, and blood pressure. Your doctor might also do a breast exam, pelvic exam to check your uterus, and a cervical exam, including a Pap test. Subsequent visits will include checking your blood pressure and weight and checking your baby’s heart rate and growth. You will also get to hear your baby’s heartbeat and ask questions about your pregnancy during your prenatal appointments.

Regular prenatal care is important because during your routine visits, your doctor will check for anemia, preeclampsia, gestational diabetes, and other harmful infections that may affect your pregnancy, health, and baby’s health. During your prenatal care, your baby will be monitored for problems that may affect his/her health.

When Is the Right Time to Schedule a Prenatal Visit?

You want to schedule prenatal visits as soon as possible. Most ob-gyns recommend scheduling your first prenatal appointment 8 weeks from your last menstrual cycle. Most women don’t know they’re pregnant until between 4-6 weeks after conception. Before your prenatal visit, it’s normal for your doctor to order blood work. So, be prepared to schedule this appointment as part of your first prenatal visit.

It can be overwhelming searching for a doctor or medical center to deliver your baby. Get started early in your pregnancy to find the right facility for you, so you’re not stressed about your baby’s care or delivery. To learn more about prenatal care and to find a physician, contact Peconic Bay Medical Center for a list of family medical centers in Suffolk County, NY .

The Significance of Prenatal Care

Prenatal/ antenatal care is an essential aspect of healthcare that focuses on the health and well-being of pregnant women and their babies. It involves regular check-ups, some screenings, and education to ensure a healthy gestation and safe delivery. By monitoring the pregnancy, addressing pitfalls, and furnishing guidance on nutrition and emotional well-being, antenatal care aims to promote the overall health of both the mama and the baby. Its significance lies in establishing a solid foundation for a positive and successful gestation trip.

When discussing prenatal care with Mary, two critical areas to concentrate on could be nutrition and prenatal visits. Regarding nutrition, it would be essential to ensure that Mary knows the significance of a healthy diet during pregnancy. A balanced and nutritious diet is vital for the growth and development of the fetus. It would be necessary to check the significance of consuming fruits, vegetables, whole grains, and protein sources to meet the nutritive conditions of both the mama and the baby( Leal et al., 2020). The discussion could also include information about the significance of taking prenatal vitamins and avoiding dangerous substances like alcohol, tobacco, and certain specifics that could negatively impact the baby’s development.

Regarding Antenatal visits, comprehending the significance of regular check-ups with a healthcare provider would be essential. These visits give an occasion to cover the progress of the gestation, address any complications that may arise, and ensure the well-being of both the mother and the infant( Leal et al., 2020). Mary should be informed about the recommended frequency of antenatal visits and the tests and screenings that may be conducted to assess the baby’s health and development. It would also be essential to emphasize the significance of following the healthcare provider’s advice and attending to all listed movables to ensure the possible modern outgrowth for Mary and her baby.

It is vital to understand Amish values and beliefs to discuss perinatal care in a culturally harmonious manner. The Amish community generally emphasizes simplicity and maintaining a close-knit community. Respect for nature, modesty, and a preference for natural remedies are generally observed values( Leal et al., 2020). When agitating perinatal care with Mary, it would be essential to approach the content with perceptivity and respect for these values.

One aspect to consider is using traditional herbal remedies that the Amish community may prefer. It would be precious to learn about specific herbal remedies or practices generally used during gravidity and parturition within the Amish culture ( Madden et al., 2020). This knowledge will enable healthcare providers to converse with Mary about these practices’ implicit benefits and risks and provide applicable guidance grounded on current medical knowledge.

Another important consideration is the Amish community’s preference for home births and the involvement of midwives in the childbirth process( Madden et al., 2020). Understanding the cultural significance of home births and the part of midwives can help healthcare providers have deferential conversations with Mary about her preferences and plans for parturition. It would be essential to discuss the potential pitfalls and benefits of home births and ensure that Mary is informed about the available medical interventions and support that can be handed into a medical centre if necessary.

When preparing for antenatal education classes with Amish cases, it is essential to admire and understand their values and beliefs. Originally, admitting their preference for simplicity and natural remedies is vital ( Leal et al., 2020). providing information on natural birth ways, indispensable pain operation styles and incorporating conversations on nutrition and herbal remedies can align with their desire for natural approaches to healthcare. Emphasizing the significance of community support and involvement is also vital( Madden et al., 2020). Encouraging the active participation of family and community members during the gestation period, including antenatal visits and childbirth, resonates with their strong sense of community.

Lastly, showing respect for authority and decision-making by acknowledging the role of religious leaders and giving information in a regardful manner is essential for effective communication. By incorporating these creative considerations, healthcare providers can establish trust, give applicable information, and ensure that prenatal education is harmonious with Amish values.

Reference(s)

Leal, M. D. C., Esteves-Pereira, A. P., Viellas, E. F., Domingues, R. M. S. M., & Gama, S. G. N. D. (2020). Prenatal care in the Brazilian public health services. Revista de Saúde Pública, 54. https://www.scielo.br/j/rsp/a/ztLYnPcNFcszFNDrBCFRchq/abstract/?lang=en

Madden, N., Emeruwa, U. N., Friedman, A. M., Aubey, J. J., Aziz, A., Baptiste, C. D., … & Ona, S. (2020). Telehealth uptake into prenatal care and provider attitudes during the COVID-19 pandemic in New York City: a quantitative and qualitative analysis. American Journal of Perinatology, 37(10), 1005-1014. https://www.thieme-connect.com/products/ejournals/html/10.1055/s-0040-1712939

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Home — Essay Samples — Life — Development — Prenatal Development: The Incredible Journey Before Birth

Prenatal Development: The Incredible Journey before Birth

Categories: Development Universal Health Care

About this sample

Words: 668 |

Published: Sep 12, 2023

Words: 668 | Page: 1 | 4 min read

The germinal stage, the embryonic stage, the fetal stage, factors influencing prenatal development, the importance of prenatal care.

Maternal Nutrition: Adequate maternal nutrition is essential for proper fetal development. A balanced diet rich in essential nutrients, vitamins, and minerals is crucial for the growth of the fetus.
Maternal Health: Maternal health conditions, such as diabetes, hypertension, and infections, can affect prenatal development. Regular prenatal care helps identify and manage these conditions.
Substance Use: Smoking, alcohol consumption, and drug use during pregnancy can harm the developing fetus and lead to a range of physical and cognitive problems.
Environmental Toxins: Exposure to environmental toxins, such as lead, mercury, and certain chemicals, can have detrimental effects on prenatal development.
Stress and Mental Health: Maternal stress and mental health can impact fetal development. Chronic stress and untreated mental health conditions may lead to adverse outcomes.

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Prenatal Care, Essay Example

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Prenatal refers to the period between conception and giving birth. This is the pregnancy period in which a lot of attendance and care is taken for the woman awaiting birth to ensure the wellbeing of the child to be born and the mother. Basically, staying healthy is the main part of prenatal.

There are various operations and tests carried out by doctors during the appointments within the prenatal period and patients behave differently towards these tests when being attended. One of the screening tests carried out is the alphafetoprotein (AFP) test. It is mainly done for screening complications or problems like spinal Bifida and to help in finding out babies who suffer from neural tube diseases i.e. NTD commonly referred to as Down syndrome and it’s done between the 14 th and the 17 th week of pregnancy.

Another critical test taken during the prenatal is that of the ultrasounds. It helps in screening for genetic defects as well as predicting the weight of the fetal. Prenatal testing can be exciting and at same time very scaring and disturbing to the patient. Some women are so positive about knowing the status of their babies to be. It however gets complicated as the patient does not know what to expect from the tests. Sometimes it’s very difficult for the doctors to give the test results especially where they are negative. Some patients even go to the extent of breaking down in tears and worse of even faint after testing positive for downs test. It becomes completely difficult for the patient to interpret the results, details and the decisions outlined by the doctor and very hard to accept and deal with them.

Some of frequently asked questions by the doctors and the patient are based on the body changes and transformation and feeding habits of the expectant mother. For instance, a doctor may ask whether the patient experiences upper-abdominal pains or less frequent urination than in normal conditions. Some of these questions are meant to identify any ailments of the patient that she might not have discovered. For instance, those conditions signify that the patient might be suffering from preeclampsia, a condition of extreme blood pressure which can be fatal to the baby or even to the mother. Despite the mixed reactions and tension involved in the prenatal tests, the importance of taking these tests cannot be overemphasized all for the good of the baby to be born and the mother.

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NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

Institute of Medicine (US) Committee to Study Outreach for Prenatal Care; Brown SS, editor. Prenatal Care: Reaching Mothers, Reaching Infants. Washington (DC): National Academies Press (US); 1988.

Prenatal Care: Reaching Mothers, Reaching Infants.

Hardcopy Version at National Academies Press

Chapter 5 Conclusions and Recommendations

At the outset, the focus of this study was outreach for prenatal care. The Committee's charge was to determine which outreach techniques most effectively draw women into care early in pregnancy and maintain their participation until delivery. For this study, outreach was defined to include various ways of identifying pregnant women and linking them to prenatal care (casefinding) and services that offer support and assistance to help women remain in care once enrolled (social support).

Early deliberations, however, made it clear that outreach could not be studied in isolation and that the Committee's inquiries had to cover the larger maternity care system * within which outreach occurs. At least four considerations led to this expanded scope of study. First, many projects conventionally labeled outreach (that is, programs of casefinding or social support or both) were found, on closer examination, to be actively involved in such problem-solving activities as trying to help women arrange financing for an in-hospital delivery—activities that are not included in conventional understandings of outreach. Second, the goals and content of outreach programs are so heavily influenced by the larger systems within which they operate that it would have been difficult, if not useless, to analyze them apart from their surrounding environment. Third, a variety of approaches other than outreach can accomplish the goals of earlier registration in prenatal care and improved continuation in care.

These activities include reducing financial barriers to care, making certain that system capacity is adequate, and improving the policies and practices that shape prenatal services at the delivery site. Finally, the Committee reviewed the larger maternity care system because it makes little sense to study ways to draw women into care if the system they enter cannot, or will not, be responsive to their needs. Because of this expanded scope of study, many of the recommendations contained in this chapter are directed at the maternity care system as a whole rather than only its outreach component, although specific recommendations on outreach are presented.

Revising the Nation's Maternity Care System: A Long-Term Goal

The data and program experience reviewed by the Committee reveal a maternity care system that is fundamentally flawed, fragmented, and overly complex. Unlike many European nations, the United States has no direct, straightforward system for making maternity services easily accessible. Although well-insured, affluent women can be reasonably certain of receiving appropriate health care during pregnancy and childbirth, many other women cannot share this expectation. Low-income women, women who are uninsured or underinsured, teenagers, inner-city and rural residents, certain minority group members, and other high-risk populations described earlier in this report are likely to experience significant problems in obtaining necessary maternity services.

Securing prenatal services in particular can be especially difficult for these groups, as shown by the data in Chapters 1 and 2 ; moreover, there is evidence that utilization is actually declining among certain very high-risk groups. Recent efforts to expand eligibility for Medicaid and numerous state and local initiatives to strengthen maternity services may improve use of prenatal care somewhat, but given the modest scale of most initiatives and the magnitude of the problem, major inequities in the use of prenatal services are likely to remain. These data are deeply troubling in light of the value and cost-effectiveness of prenatal care.

Achieving major improvements in the maternity care system, particularly in the use of prenatal care, will be neither quick nor easy. Significant improvement must begin with a fundamental recognition that pregnancy and childbearing are profoundly important events requiring carefully formulated social policies and supports.

• We recommend that the nation adopt as a new social norm the principle that all pregnant women—not only the affluent—should be provided access to prenatal, labor and delivery, and postpartum services appropriate to their need. Actions in all sectors of society, and clear leadership from the public sector especially, will be required for this principle to become a clear, explicit, and widely shared value . *

A consensus of this nature means that maternity services must be viewed not as a consumer good, available only to women with certain financial and personal assets, but as an essential part of the country's social and health services, comparable to public education—easily available, valued, and used by virtually all women. The merit of such social policy is amply supported by data on the effectiveness—including the cost-effectiveness—of prenatal care (see the Introduction). It is also consistent with basic civility and compassion, with the concept of adequate investment in future generations, and with the need to provide special care during a particularly vulnerable phase of life—pregnancy and childbirth. All subsequent recommendations in this report are subsumed under this one. We suggest it as a standard against which to measure a wide array of policy suggestions—ours and others'.

Attaining this goal requires major reform in the way maternity services are organized, financed, and provided in this country, particularly for low-income and other high-risk groups. Continuing to make marginal changes in existing programs is unlikely to meet the standard of universal participation that we advocate. Slowly implemented, often small expansions in Medicaid eligibility, brief bursts of publicity about infant mortality and the importance of prenatal care, efforts in a few communities to increase the number of clinics offering prenatal services—these actions, while laudable, are too limited, sporadic, and uncoordinated to overcome the pervasive barriers to care detailed in this report. Rather, the current situation dictates more purposeful action:

• We recommend that the President, members of Congress, and other national leaders in both the public and private sectors commit themselves openly and unequivocably to designing a new maternity care system (or systems) dedicated to drawing all women into prenatal care and providing them with an appropriate array of health and social services throughout pregnancy, childbirth and the postpartum period. Although a new system might build on existing arrangements, long-term solutions require fundamental reforms, not incremental changes in existing programs .

Several ways of designing a new system are feasible, once the political will to create one has been mustered. For example, Congress could appoint a commission of experts knowledgeable about the maternity care system and public policy; a group of experts within the U.S. Department of Health and Human Services could be assembled; Congress could itself develop alternative proposals using existing data and opinions, drawing on the expertise of established congressional committees and such resources as the Office of Technology Assessment and the Congressional Budget Office; or an independent group could be asked for advice.

In making this recommendation, the Committee emphasizes that a commitment to enact major reforms must precede the establishment of any commission or other mechanism. * Too often, studies are funded or panels appointed without such a commitment; as a consequence, change may be postponed or fail to take place altogether.

We urge that the group chosen to work out the specifics of a new system be a technical, expert body charged only with defining the components and costs of a new maternity system, not with describing current problems yet again or with developing the political momentum needed to accomplish major changes .

Once the components of the system have been defined, action to implement the recommendations must follow; otherwise, the effort will be futile and may actually be destructive, by raising false hopes among those in need.

In recommending a new maternity system, the Committee recognizes that problems of access to maternity care are only part of the larger problem of access to health services generally. It may well be that far-reaching reforms in the overall health care system will overtake the efforts recommended here to improve access to maternity care. For example, the increasing pressures of the AIDS epidemic alone may lead to significant changes in the health care system. Nonetheless, the focus here is on maternity care, as dictated by the Committee's mandate.

Although the Committee was not asked to specify the elements of a new system or systems of maternity care, our work over the last 2 years has indicated the principles essential to significant improvement in the use of prenatal services. We presume that these same attributes would also improve the care women receive during childbirth and the postpartum period. We urge that the new system :

— accommodate the maternity care needs of all women, not only women in privileged economic or geographic subgroups ;
— embrace the full continuum of maternity services (prenatal, labor and delivery, and postpartum care), erasing the gap that currently exists between systems that provide and finance prenatal care and those that support care for childbirth ;
— be closely coordinated with other health services used by women, improving the quality and accessibility of these related services as much as possible ;
— offer a uniform, comprehensive package of maternity services that can accommodate variations in individual needs, as suggested by the Select Panel for the Promotion of Child Health, 1 the American College of Obstetricians and Gynecologists 2 and the American Academy of Pediatrics, 3 and the forthcoming report of the Public Health Service's Expert Panel on the Content of Prenatal Care ; 4
— address the liability pressures currently driving providers out of the practice of obstetrics ; 5
— be administered separately from the welfare system ;
— rely on a wide array of providers, including both physicians and certified nurse-midwives, each of whom may practice in a variety of settings and systems ;
— be financed adequately ;
— ensure that financing mechanisms support appropriate clinical practices;
— include a large-scale, sustained program of public information and education about maternity care ;
— support education and training of providers to deepen their understanding both of the obstacles women can face in securing prenatal care and their perceptions of care once enrolled ;
— include reliable, accurate means of collecting data on unmet maternity care needs and on the performance of the new system or systems, at local, state, and national levels; and
— specify a structure of accountability and responsibility under the control of a federal agency, with state agencies assuming leadership.

Many of these issues, such as the urgent need to address liability pressures, are taken up again and in more detail in later sections presenting the Committee's short-term recommendations. Here, we wish to emphasize two in particular. First, the separation of maternity care financing from the welfare system is emerging as a key element of initiatives to improve use of prenatal care among poor women, as demonstrated by recent Medicaid reforms ( Chapter 2 ). Although Medicaid and welfare obviously need to be coordinated, the links between the two programs have had the unfortunate effect of attaching a welfare "stigma" to a health care financing program. Therefore, the notion of separating the programs administratively is important. Second, we emphasize the need for national standards of maternity care. Increased communications, rapid dissemination of new information and technologies, and increased use of national standards in malpractice suits make it ever more unreasonable for maternity care to differ widely among geographic or socioeconomic groups, although care must always accommodate variations in individual need.

It is also apparent that a deeper national commitment to family planning services and education should accompany major revisions in the maternity care system. Women with unintended pregnancies are particularly likely to delay seeking prenatal care and more than half of all pregnancies in the United States are unplanned ( Chapter 2 ). Therefore, reducing rates of unplanned pregnancy could lead to lower rates of late entry into prenatal care. The Committee recognizes that progress in this direction is complicated and that a large literature exists on both the antecedents of unintended pregnancy and ways to reduce it. Nonetheless, a firm commitment to extending family planning services is an obvious, essential first step, particularly for those populations most at risk of unintended pregnancy (and, subsequently, poor participation in prenatal care)—low-income women, teenagers, and minorities. Such services should be easily available in numerous settings, should be provided for free or at very low cost, and should be carefully linked to prenatal services (as discussed in more detail below). High-quality, widely disseminated public information and education about family planning is also important and should be coordinated with messages about prenatal care. In fact, it might be possible to develop information and education campaigns around broad issues of reproductive responsibility and health, encompassing both family planning and prenatal care.

Developing a Comprehensive, Multifacted Program: a Short-Term Goal

While consensus grows on the need for a major restructuring of the maternity care system in the United States, and while the specifics of a new approach are being defined, several more immediate steps should be taken to increase participation in prenatal care. Although some of them are quite far-reaching, they all derive from and are based on the existing maternity care system. As such, they differ fundamentally from our recommendation in the preceding section, which argues for a more profound and complete reorganization of this health care field.

• We recommend that more immediate efforts to increase participation in prenatal care emphasize four goals: eliminating financial barriers to care, making certain that the capacity of the system is adequate, improving the policies and practices that shape prenatal services at the site where they are provided, and increasing public information about prenatal care .

The Committee has concluded that these four reforms promise significant improvement in the use of prenatal care. The first of the four—eliminating financial barriers—is undoubtedly the most important. Indeed, we believe that if this single barrier were removed, many of the other problems noted throughout this report would decrease appreciably. Ample data indicate, however, that it is not only financial problems that keep women out of care. Other problems can impede access as well and also require attention. Thus, removing financial barriers should be viewed as a necessary—but not entirely sufficient—step in improving the use of prenatal care.

We urge that leadership for this comprehensive approach come from the federal government. Individual states and communities should not have to both develop and fund programs to improve access to care, even though some states have been particularly innovative in doing so—by offering health insurance to those with inadequate or absent coverage, for example, or by constructing new programs to supplement Medicaid and federal funds for maternal and child health. Leaving the entire task of program innovation and support up to the states is certainly consistent with political trends in the 1980s, but the federal government should nonetheless play a stronger role.

• We recommend that the federal government provide increased leadership, financial support, and incentives to help states and communities meet the four goals we advocate. In a parallel effort, states should accept the responsibility for ensuring that prenatal care is genuinely available to all pregnant women in the state, relying on federal assistance as needed in meeting this responsibility .

More specifically, we urge a stronger federal role in providing funds to state and local agencies in amounts sufficient to remove financial barriers to prenatal care (through such channels as the Maternal and Child Health Services Block Grant and other grant programs) and in providing prompt, high-quality technical consultation to the states on clinical, administrative, and organizational problems that can impede the extension of prenatal services. The federal government should also take more leadership in defining a model of prenatal services for use in public facilities providing maternity care; and supporting related training and research.

States should assume direct responsibility for ensuring that all women within the state have full access to prenatal services. Backed by adequate federal funds, support, and consultation, the states should invest generous amounts of time and money in extending this basic health service. This would involve states more deeply in assessing unmet needs by surveying existing prenatal services and identifying the localities and populations for which they are inadequate; contracting with various providers to fill gaps in services; and in some instances, providing prenatal services directly, through such facilities as health department clinics. In addition, the Committee suggests that each state pass legislation making the maternal and child health agency of the state health department responsible for ensuring that prenatal services are reasonably available and accessible in every community.

Financial Barriers

Removing financial barriers to care is the cornerstone of the comprehensive program we recommend. Surveys of pregnant women and of maternity care providers, and program experience over many years uniformly demonstrate the importance of economic circumstance—especially the presence or absence of insurance—in predicting use of prenatal services. Although expansions of Medicaid and creative state initiatives have made some progress recently in lowering financial barriers to care, the pace of progress needs to accelerate, and remaining financial obstacles need to be removed. Accordingly, as a critical first step:

• We recommend that top priority be given to eliminating financial barriers to prenatal care .

This broad recommendation has specific implications for all the major networks, public and private, that underwrite prenatal care. For the Medicaid program:

We recommend that the federal government require all states to provide Medicaid coverage of prenatal care for pregnant women with incomes up to 185 percent of the federal poverty level, * to be followed by eligibility expansions beyond 185 percent to cover more uninsured or underinsured women .

Detailed discussions of how states and the federal government can accomplish this and other expansions in Medicaid eligibility for pregnant women and other groups are contained in Medicaid Options: State Opportunities and Strategies for Expanding Eligibility , prepared by the American Hospital Association. 6

For the various federal grant programs (particularly the Maternal and Child Health Services Block Grant and the programs funding Community Health Centers, Rural Health Centers, and Migrant Health Centers) and for state and local health departments :

We recommend that federal and state authorities provide these service systems with sufficient funds to offer free or reduced-cost prenatal care without delay to all pregnant women requesting it in these settings.

Meeting this broad objective will require, among other things, more sophisticated measurement of unmet need in the areas served by these publicly financed clinics.

For private insurance , where coverage of prenatal care can be inadequate:

We recommend that Congress and state governments act to expand and strengthen private insurance coverage of maternity services .

This goal could be reached in various ways. For example, Congress could mandate that all employers covered by the Fair Labor Standards Act provide a defined package of maternity services to employees and their dependents. Congress could also repeal the exemption contained in the Pregnancy Discrimination Act allowing employers of fewer than 15 persons to provide no pregnancy coverage. Congress could also modify the Employee Retirement Income Security Act (ERISA) in order to permit states to require that self-funded employer health plans provide maternity benefits; more than half of employer-provided health insurance plans are self-funded and as such are exempt from state insurance regulation through ERISA.

We also urge purchasers of private insurance to press for improved coverage of prenatal care through labor union negotiations, switching to more comprehensive plans, and similar consumer-based actions. Private insurance companies themselves should take the initiative of offering comprehensive coverage of prenatal care as part of their basic insurance packages .

In all these actions, attention should be focused on eliminating such gaps in coverage as waiting periods for prenatal benefits to begin, dependent coverage that fails to include prenatal services, limited insurance for part-time or seasonally employed individuals, and burdensome copayments and deductibles for maternity services ( Chapter 2 ). 7

Inadequate System Capacity

Urging all pregnant women to begin prenatal care early is a hollow message if prenatal clinics are nonexistent—or so backed up as to be nonexistent in practical terms—or if private providers are lacking or unwilling to accept low-income patients. Yet the Committee uncovered considerable evidence that capacity is inadequate in various communities, particularly for poor women ( Chapter 2 ). Accordingly, as a companion initiative to reducing financial barriers:

• We recommend that public and private leaders designing policies to draw pregnant women into prenatal care make certain that prenatal services are plentiful enough in a community to enable all women to secure appointments within 2 weeks with providers close to their homes .

Methods for achieving this objective will vary across states and communities, but several approaches will probably be required simultaneously. We recommend:

— more careful assessment at the community level of existing service capacity and of the areas and groups for whom capacity is inadequate; state leadership in this area is particularly appropriate, as noted above ;
— more generous financing of clinic systems, in particular, to allow them to meet demand, also noted above ;
— resolution of the malpractice crisis in obstetrics ;
— increased Medicaid reimbursement for maternity care offered by private providers in order to increase the number of physicians who accept Medicaid patients ;
— restoration of the National Health Service Corps and equivalent state programs to help develop an adequate pool of providers for medically underserved areas ;
— expansion of the variety of settings in which prenatal care is offered; school-based health clinics in particular can help bring prenatal care to adolescents ;
— increased use of certified nurse-midwives (CNMs) and obstetrical nurse—practitioners; state laws and physicians themselves should support hospital privileges for CNMs and collaboration between physicians and nurse-midwives or nurse-practitioners; eventually, large interstate variations in the laws governing the use of such midlevel practitioners should be eliminated; and
— leadership by the professional societies of obstetric care providers to increase the involvement of private physicians in the care of indigent women. (For example, private sector leaders should work collaboratively with Medicaid officials and leaders of maternal and child health agencies to raise reimbursement levels for maternity care, to solve administrative problems in the Medicaid program, and to develop proposals for providing physicians with incentives to serve poor women. National professional organizations should urge local ones to focus on problems of underserved women) .

The last point is particularly important. Raising Medicaid fees and addressing the malpractice problem in obstetrics are undoubtedly necessary to enhance private sector involvement in indigent care, but leadership from the professional societies is also critical. The work of the Committee on Underserved Women of the American College of Obstetricians and Gynecologists is a useful step in this regard. Other national, state, and local organizations of obstetric care providers should establish similar groups.

With regard to the specific issue of malpractice, the Committee urges public and private groups with expertise in this area to develop without delay a range of possible solutions to the current situation, perhaps experimenting with various approaches in different states. One interesting proposal is to provide sufficient funds to public agencies for them to absorb the costs of malpractice insurance for providers (MDs, CNMs, and others) who care for significant numbers of indigent women.

Institutional Organization, Practices, and Atmosphere

However well-organized the maternity care system appears at the state or national level, a pregnant woman experiences and judges it in her individual community, in a specific clinic or office, and with a particular provider. In reviewing initiatives to increase the early use of prenatal care, the Committee has been repeatedly impressed by the success of programs that emphasize internal institutional modification as a means of drawing more women into care and sustaining their participation. Therefore, in addition to addressing financial barriers and problems of limited capacity:

• We recommend that those responsible for providing prenatal services periodically review and revise procedures to make certain that access is easy and prompt, bureaucratic requirements minimal, and the atmosphere welcoming. Equally important, services should be provided to encourage women to continue care; follow-up of missed appointments should be routine, and additional social supports should be available where needed .

In this context, the Medicaid program requires special emphasis. However generous the eligibility expansions described earlier, little is gained if the task of applying for and maintaining Medicaid coverage is so difficult, complicated, and time-consuming that prompt, continuous participation in prenatal care is virtually impossible for all but the most socially organized and determined women. Accordingly:

We recommend that states shorten and simplify the process of obtaining Medicaid coverage for prenatal services and that, once a woman is enrolled , her coverage be uninterrupted throughout pregnancy, labor and delivery, and a postpartum visit .

Adopting the presumptive eligibility option and eliminating the asset test (or using a much simplified, more generous one) can help in meeting these goals, as can wider implementation of various options now available to ensure uninterrupted coverage of prenatal services ( Chapter 2 ). Other useful steps include on-site determination of eligibility (by placing eligibility workers in maternity clinics serving low-income populations, for example), shortened application forms requiring minimum documentation, suspension of error rate sanctions in determining the eligibility of pregnant women, a single application form for several programs, and bilingual staff or interpreters.

Of course, such improvements are of little value if potential recipients know little about the Medicaid program or whether they might be eligible for coverage. Closing the gap between the number of pregnant women eligible for the program and the number enrolled requires explicit information, widely disseminated, about who is eligible and how to apply for coverage. Accordingly:

We also recommend that states and communities aggressively advertise the availability of the Medicaid program to finance prenatal care for low-income pregnant women. Materials developed for this purpose must be accurate, current, and directed to issues of pregnancy coverage and maternity services. The materials should present the information in a way that is not so complex as to intimidate potential applicants and should include clear directions about where and how to apply for the program .

Several other, more general attributes of prenatal services can also help to increase use of care and we recommend that they be widely adopted:

— services are easy to find in the telephone book, listed under several headings ;
— the telephone system in an individual setting is well organized and staffed so that callers do not constantly reach a busy signal;
— reasonable efforts are made through various channels of public information to inform women of service hours and location, to advertise new maternity programs, and to alert women to services that complement prenatal care, such as the Special Supplemental Food Program for Women, Infant, and Children (WIC) ;
— there is a gap of 2 weeks or less between an initial call for a prenatal care appointment and the appointment itself ;
— services are located near public transportation; where needed, transportation costs are subsidized or provided directly ;
— a woman sees as few different providers as possible in the course of a pregnancy ;
— clients spend minimal time in a waiting room (by using, for example, a staggered rather than a block appointment system) ;
— patients are treated courteously, not only by physicians and nurses, but also by receptionists, appointment clerks, and other gatekeepers, particularly at the first contact or visit ;
— staff training is frequent and supports a positive orientation toward clients ;
— careful consideration is given to women's cultural preferences, such as using female providers for women whose cultures do not accept medical examinations performed by men; similarly, health and nutrition education are consonant with cultural practices, including diet ;
— adequate time is allowed for talking with clients about unfamiliar procedures and treatments ;
— special efforts are made to coordinate the hours and the paperwork of prenatal services with other services needed by clients ;
— appointments are timed to accommodate women's schedules, particularly those who work or go to school ;
— bilingual staff or interpreters are present where common language barriers commonly exist; and
— child care services are provided or are easily accessible nearby .
Public Information and Education

Studies of women who received insufficient prenatal care reveal that an important contributing factor is a low value attached to this service ( Chapter 3 ). Some women state quite directly that they did not think prenatal care was important or useful, some seem to fear it, some contend that other matters were more pressing than seeking out prenatal services, and some say care is important only if you feel sick. These personal perspectives have led the Committee to conclude that drawing more women into prenatal care will require increased public information and education about the nature and value of this care. This fourth goal supplements the three already noted: eliminating financial barriers, ensuring basic system capacity, and improving the organization and ambiance of services themselves.

• We recommend that public and private groups—government, foundations, health services agencies, professional societies, and others—invest in a long-term, high-quality public information campaign to educate Americans about the importance of prenatal care for healthy mothers and infants and the need to begin such care early in pregnancy. The campaign should carry its message to schools, the media, family planning and other health care settings, social service networks, and places of employment. Additional campaigns should be aimed at the groups at highest risk for insufficient care. Whether directed at the entire population or a specific subgroup , public information campaigns should always include specific instructions on where to go or whom to call to arrange for prenatal services .

We urge a serious effort to avoid one-shot, short-lived campaigns. Sporadic media flurries around such issues as low birthweight have been frequent in recent years, but few have been long-term and many have already fizzled without, we suspect, much impact on attitudes or behavior.

We also underscore the importance of campaigns aimed at the groups that most often secure insufficient prenatal care, such as very young teenagers, low-income multiparous teenagers, uninsured women, women over 35 with several children, recent immigrants, certain high-risk minority groups, and very low-income women in both rural and dinner-city areas (Chapters 1 and 2 ). Those who plan and implement campaigns to reach these groups should study in advance where the targeted individuals live, work, study, and play, and what they read, watch, and listen to. They must address their messages not only to pregnant women, but also to their male partners and their families. They must be aware of linguistic barriers and cultural influences. Put another way, audience definition, market research, premarket testing, and other skills of the advertising and marketing fields need to be applied to public education about prenatal care.

In addition to general information about what prenatal care is and why it is important, public information campaigns should include three themes: first, prenatal care is important even if a pregnant woman feels well; second, although previous pregnancies have been uneventful, subsequent ones may not be, and health supervision is important from early pregnancy on. Third, the signs and symptoms of pregnancy should be clearly explained. In addition to these messages about prenatal care and pregnancy, public information and education should emphasize basic concepts of family planning, given the strong association between whether a pregnancy is planned and onset of prenatal care ( Chapter 2 ).

Schools especially should help in conveying such information. Although the topics of prenatal care and family planning are discussed in some health education programs, not all schools offer such education, and anecdotal information suggests that the quality of some health education is poor. Clearly, young people need to understand what prenatal care and family planning are and their importance in reproduction. Schools are in an excellent position to reach this population with high-quality education on these important topics.

Similarly, it is important that the health education offered as part of family planning services—both through groups and one-on-one counseling—include material on the importance of prenatal care. Because virtually all users of contraception are sexually active, it is highly appropriate that future pregnancies be discussed during visits to obtain contraception, even if avoidance of pregnancy is the main focus at the time. Such preconception counseling should cover the value of planning for pregnancy, the role of prenatal care in healthy birth outcomes, and how to obtain such care. When a woman enters the family planning system because she wishes a pregnancy test, additional opportunities for providing education about prenatal care arise. And, of course, if the test is positive and the woman elects to continue the pregnancy, she needs prompt referral for prenatal care and education to help her understand the importance of such care. This import referral opportunity—often missed—is discussed in more detail later.

Finally, we wish to underscore the simple notion that prenatal services must be advertised to prospective clients. New or existing services that no one knows about are not really accessible. Thus, public information campaigns about the importance of prenatal care—whether directed toward the general population or toward specific groups—should always explain how to arrange for care in a given community or through a specific program. This suggestion was made above in relation to the Medicaid program, but it applies equally to all programs that are attempting to serve women who are at risk for inadequate prenatal care.

The Role of Outreach: a General Framework

Available data suggest that the four-part comprehensive program just outlined would lead to major improvements in the use of prenatal care. It would not bring about universal participation in prenatal care, however. The data presented in Chapters 1 through 3 suggest clearly that a variety of women will remain outside the system, despite major improvements, because of extreme social isolation or youth; apathy, fear, or denial; drug addiction; homelessness; fear of deportation, arrest, or other sanction; culturally based avoidance; and other concerns.

Figure 5.1 illustrates this point. Group A is the set of women who—because of adequate insurance, a well-functioning health care system in their community, personal resourcefulness, or all three—secure sufficient care. Group B is the set of women who would be able to obtain more adequate care were the four basic system changes made. The precise size of group B, of course, is unknown; however, data and program experience presented throughout this report suggest that it is substantial. The European data and experience summarized by Miller (see his paper at the end of this volume) show that rates of participation in prenatal care are high when the maternity system includes few barriers to care.

Proportion of pregnant women obtaining sufficient prenatal care under various organizational and financial arrangements.

Group C is the residual, hard-to-reach population that would remain without prenatal care even after major system reforms had been made. As with group B, the precise size of group C is unknown; it is probably small. For these women, special services are needed to locate and enroll them in prenatal care and then to provide them with enough support, attention, and caring that they do not drop out along the way. These two functions—casefinding and social support—are the activities defined in this report as outreach. In the two sections that follow, we offer some suggestions about how these services can be used to increase use of prenatal care among those who are hardest to reach.

Before doing so, however, we must stress our view that, at present, outreach services are being unfairly saddled with the burden of removing obstacles to prenatal care. Time and again, the Committee learned of communities that have invested in outreach to overcome basic inadequacies in existing networks of prenatal services, rather than changing the system itself. Faced with significant financial barriers, limited service capacity, inhospitable institutional practices, and a basic lack of public understanding about prenatal care, the response is often to hire outreach workers, or organize brief campaigns of posters in buses touting the importance of prenatal services, or arrange for compensatory social support rather than take on the more challenging task of repairing fundamental flaws. Repeatedly, outreach is organized to help women over and around major obstacles to care, but the obstacles themselves remain. The Committee gradually came to the conclusion that organizations whose primary focus is casefinding and social support seem, in the words of one member, to be ''waging guerilla warfare'' against institutions that are turning away patients, either deliberately or as an inadvertent consequence of their financial and other policies. Given that outreach programs typically have neither the resources nor the authority to bring about significant improvements in access to care, it is not surprising that their impact, though sometimes positive, is often limited ( Chapter 4 ). Accordingly:

• We recommend that initiatives to increase use of prenatal care not rely on casefinding and social support to correct the major financial and institutional barriers that currently impede access. Rather, outreach should be only one component of a well-designed, well-functioning system and should be targeted toward women who remain unserved despite easily accessible services. Outreach should only be funded when it is linked to a highly accessible system of prenatal services, or, at a minimum, when it is part of a comprehensive plan to strengthen the system, emphasizing the four areas previously described .

To fund outreach in isolation and hope that, alone, it will lead to major improvements in the use of prenatal services is naive and wasteful.

Casefinding

Stressing again that outreach must be linked to improved—or improving—prenatal care systems, the Committee tried to learn which casefinding methods are most effective. Unfortunately, data assembled from the 31 programs studied were not sufficient to support clear recommendations about what techniques are indisputably the most useful. This weak science base is traceable primarily to difficulties in isolating the impact of a single casefinding method (usually, several are in place simultaneously) and the fact that data on casefinding efficacy are usually confounded by other aspects of the maternity care system. In addition, little research of any kind has been done in this area, probably because of the methodological problems just noted and because of its low status among health services researchers. What the Committee could distill about useful forms of casefinding is presented in Chapter 4 . Based on the experiences summarized there and in Appendix A :

• We recommend that in communities where financial and institutional barriers have been removed, or as part of a comprehensive plan to do so , at least five kinds of casefinding be considered for their compatibility with a program's goals and constraints :

telephone hotline and referral services that can make prenatal appointments during the initial call and can provide assistance to callers in arranging needed maternity, health and social services;

television and, in particular, radio spots to announce specific services, coordinated with posters displayed in the mass transit system ;

efforts to encourage current program participants to recruit additional participants from their friends, neighbors, and relatives ;

strong referral ties between the prenatal program and a variety of other systems in which pregnant women at risk for insufficient care may be found: family planning clinics, schools, housing programs, WIC agencies, welfare and unemployment offices, churches and community service groups, shelters for the homeless, the police and corrections systems, substance-abuse programs and treatment centers, and other health and social service networks; and

outreach workers who work in carefully defined target areas and seek clients among well-defined target populations .

Whatever the method used, casefinding should be directed toward high-risk groups and areas. This requires that program leaders pinpoint the sociodemographic characteristics and geographic locations of women who obtain insufficient prenatal care.

The materials in Chapter 1 can help to define target groups, although the data discussed there are primarily national—states and communities need more detailed information on their own populations. Chapter 2 also presents information that can help to define target groups. Data from both chapters suggest that several populations are likely candidates for targeted casefinding (as they are for focused campaigns of public information): very young teenagers, low-income multiparous teenagers, women over 35 with several children, substance-abusing women and homeless women, recent immigrants, certain high-risk minority groups, and very low-income women in both inner-city and rural areas.

The fifth method highlighted above, use of outreach workers, requires comment. Much of the program data assembled by the Committee suggest that the effectiveness of these workers is limited. We suspect, though, that when such workers are used only in a carefully targeted way—in very low-income housing projects, for example, or other areas with high concentrations of women at risk for inadequate prenatal care, their effectiveness may be greater than some of the program data suggest. The personal touch they offer to women whose lives are often in chaos may be just what is needed, and the poorest inner cities and rural areas of America may need more of them. We emphasize again, though, the importance of their work being focused on areas of greatest need only, given the expense, labor-intensity, and occasional dangers of the job.

A final note on outreach workers. It is not uncommon for communities to have outreach workers from several different agencies working in a single area. Representatives from child abuse and neglect services, pediatrics, social services, sanitation, housing, and rat and poison control can all be knocking on the same doors. The potential for fear, suspicion, and lack of efficiency that such a scenario suggests leads us to a simple suggestion:

We recommend that communities experiment with multipurpose outreach workers in an effort to increase efficiency, enhance the receptivity of neighborhood residents, and, perhaps, increase the effectiveness of such workers. Evaluation should accompany well-designed trials of this approach and, if they are found useful, results should be widely disseminated .

We recognize a historical cycle here. Over the years, single-purpose and multipurpose outreach move in and out of style. In the early days of the War on Poverty, for example, the multiservice model was ascendant; in the 1980s it is rare. Our sense is that the pendulum has swung too far in the single-purpose direction and that a change is in order.

The Committee also calls particular attention to casefinding through closer links between pregnancy testing and prenatal services. A major opportunity to enroll pregnant women in prenatal care promptly is missed each time a positive pregnancy test is not accompanied by an appointment for prenatal services, if appropriate. Similarly, a negative pregnancy test signals that referral to family planning or even infertility services may be in order.

We recommend that pregnancy-testing services and prenatal care programs develop stronger referral ties, including the ability to make appointments for prenatal care at the pregnancy testing site. Missed prenatal appointments require vigorous follow-up .

In this context, we also urge that, given teenagers' poor use of prenatal care (especially teenagers who already have one or more children), schools include the availability of pregnancy testing in their health services and make special efforts to help pregnant teenagers obtain prenatal care. Health clinics based in schools are increasingly common and provide a natural setting for this function.

Similarly, pediatricians, family practitioners, and others caring for families with young children can help in the task of casefinding. In Chapter 1 , the strong association between higher birth order and poor use of prenatal care was noted; young, poor, multiparous women in particular form an exceedingly high-risk group. This finding supports an additional suggestion:

We recommend that health care providers in touch with women who have young children—particularly low-income teenagers with young children—periodically raise the topics of family planning and child spacing. If additional children are planned or already on the way, the topic of prenatal care should be raised. Specific information on where and how to obtain prenatal care should be easily available in these settings .

We also urge that careful thought be given to the mechanics of linking prenatal services more directly to pregnancy testing and pediatric services. In particular, referral systems must ensure that patient confidentiality and sensitivity are respected. To help develop and disseminate information about this method of casefinding, it would be useful to describe and evaluate alternative approaches.

On a more general level, we also emphasize that casefinding—by whatever method—can be time-consuming, expensive, and difficult to conduct. For example, high-risk groups who remain outside the maternity care system may resist efforts to draw them into care and be difficult to engage; casefinding through outreach workers requires a significant investment in recruitment, training, support, and supervision; developing appealing placards for subways and buses often requires careful graphic design, market research and premarket-testing, and extensive negotiations with local transit authorities. Yet it is our impression that in planning and raising funds for prenatal care programs, the casefinding function is often shortchanged.

We recommend that those responsible for planning and funding prenatal programs recognize explicitly that casefinding is not simple and may be costly. Program planning and budgeting should provide adequate, realistic support for casefinding .

Social Support

Ample data show that with the care and attention of a single person or two (a patient advocate, a case manager, a granny, or whatever), high-risk women can be helped to obtain adequate prenatal care and to secure the many ancillary services they need (see Appendix A ).

Were the four recommendations for improving the maternity system implemented, the need for social support might decrease, because women would not need as much help arranging for care. Even in a well-functioning system of prenatal services, however, Group C (see Figure 5.1 ) would remain, requiring concentrated support and assistance. Accordingly:

• We recommend that programs providing prenatal services to high-risk, often low-income groups include social support services to help maintain participation in care and arrange for additional services as needed. Home visiting is an important form of social support and should be available in programs caring for high-risk women .

Sometimes the primary obstetric care provider fills this social support role; sometimes the task is delegated to others. Whatever the arrangement, this function needs to be adequately financed (and, in particular, reimbursed through public and private insurance), as it, like casefinding, can be time-consuming and therefore expensive.

However, having made this general point, we are reluctant to urge that "case management," as it is currently being used in the administration of the Medicaid program, be widely applied. As a recent survey of state Medicaid directors noted, "Case management lacks a precise conceptual or operational definition. In the absence of a definition, case management typically describes a range of activities that can vary from routine, minimally professional referral services, to primary nursing, to comprehensive care plan development, oversight, and monitoring." 8 This situation leads to an additional suggestion:

We recommend that the federal government, in partnership with states, providers, consumers, and public and private insurers, develop clear standards and performance criteria for the function of case management. These standards and criteria must be unequivocally oriented toward women's health and social needs. Once developed, they should be adopted in a wide range of prenatal settings, particularly those caring for significant numbers of high-risk women, and all payment systems should support such care .

In concluding these sections on casefinding and social support, the Committee again stresses that they do not substitute for the basic system repairs outlined earlier. Program leaders and policymakers concerned with increasing use of prenatal care should concentrate first and foremost on financial and institutional issues and should not be seduced into thinking that more limited measures such as hotlines or outreach workers will solve the problem. Instituting an outreach program may appear less difficult and expensive than fundamental system reform; it may also have considerable public relations value. But the Committee strongly suggests that outreach should be aimed only at carefully defined high-risk groups and that it should be an adjunct to a well-functioning system that is easily accessible to the vast majority of pregnant women.

Management and Evaluation

The Committee's study of programs yielded several observations about management and evaluation ( Chapter 4 ). On the basis of these findings:

• We recommend that programs to improve participation in prenatal care invest generously in planning and assessment of needs. Doing so will require a deeper appreciation, among funders in particular, of the time needed for responsible, intelligent program design and planning. Substantial improvements in the use of prenatal care (or in other measures of outcome such as low birthweight or infant mortality) should not be expected too soon .

Issues to be considered in basic planning and needs assessment include in-depth reviews of existing maternity services, provider practices, and attitudes; public and private health insurance coverage in the target state or community; the views of local women regarding existing maternity services; careful definition of the target populations, of local barriers to prenatal care, of existing community services, and of relevant historical and political realities; market research and premarket testing of materials (where applicable); design and testing of management information systems or other mechanisms for providing basic program data (who is being served, how staff and other resources are being used, program changes over time, and so on); and consideration of whether a formal evaluation should be included, and, if so, what type.

Far too many of the programs reviewed by the Committee were deficient in conducting these basic functions, even programs receiving public funds and in existence for many years. Many programs came into existence quite quickly—often because of the sudden availability of money or opportunity—and were in business before a number of important preliminary steps could be taken. Funders, policymakers, and particularly politicians need to understand that these programs—like human services generally—cannot be organized in a hurried, slipshod manner; information needed for planning takes time to gather and analyze.

The Committee noted a reluctance to view investments in prenatal care programs as long-term commitments whose impact should not be anticipated too soon. Developing new statewide networks of clinics, changing community views about the value of a service such as prenatal care, encouraging more private physicians to care for low-income patients, convincing a community that a certain care facility is now receptive to immigrant women, or developing trust in a particular community worker are all difficult tasks that take generous amounts of time. We were distressed by the number of programs that felt under pressure to show "results" (such as a dramatic increase in first-trimester enrollment in prenatal care or a marked decrease in low birthweight) in a year or so, sometimes less. Common sense alone suggests that many of the types of programs outlined in the Appendix take several years to develop into smoothly functioning services and sometimes longer to show results, if any. Moreover, no single approach (such as a media campaign or a modest expansion in Medicaid eligibility) should be under pressure to correct such complicated problems as infant mortality or low birthweight.

With regard to program evaluation:

• We recommend that early in a program's course its directors decide whether it is to be primarily a service program (with data collected mainly to help in program development and monitoring) or whether it is also to test an idea in the field. The latter type requires ample funding if the evaluation is to be sound; it also requires sophisticated systems for data collection and experts in program evaluation—resources that must be built into the program from the outset .

This recommendation carries the implicit message that although all programs should be carefully managed, not all should be evaluated. Meaningful evaluation is often expensive, drawing resources from other activities that may be more urgent; moreover, it requires control or comparison groups, which many operating programs cannot establish. It requires significant technical skill and expertise, as well as adequate investments in research design, computer software, and data entry and analysis.

For programs that choose to include a strong evaluation component, specific consideration should be given to qualitative versus quantitative approaches and to the possibility of randomized trials and alternative designs that attempt to overcome selection bias. We also note that a higher quality of effort is needed than that exhibited by most of the programs reviewed. Indeed, the Committee found that significant amounts of time and money are being wasted on evaluation studies that are so flawed methodologically as to be almost useless.

The Committee found a number of topics that merit research. Before listing them, however, we assert that no further research should be conducted to show the importance of financial and institutional barriers in the poor use of prenatal care. More than enough data documenting these relationships exist, even if public policy addressing these problems is inadequate. We do urge, however, that any community designing programs to increase early use of prenatal care carefully assess the extent of financial barriers, inadequate system capacity, and inhospitable institutional practices. For example, in many communities only anecdotal information exists regarding the availability of prenatal services: whether certain clinics are overloaded, and if so, to what extent; the fees at area clinics; and so forth. Obtaining such basic information should be the first order of business in designing prenatal programs..

We are reluctant to recommend extensive research on the relative effectiveness of various casefinding activities, i.e., assessing the client-yield of community workers versus hotlines or financial incentives. These activities are usually so intertwined with other variables in the system that methodologically sound studies of their impact would be virtually impossible to design. Moreover, given the major role that financial and institutional barriers play in determining use of prenatal care, it seems almost diversionary to study outreach techniques rather than to improve the basic prenatal care system. With this context in mind:

• We recommend that in communities where financial and institutional obstacles to care have been significantly lowered , research be undertaken on several topics :

Why do some pregnant women register late—or not at all—for prenatal care even when financial and institutional barriers are ostensibly absent? In particular, what are the emotional and attitudinal factors that limit participation in care ?

How can the content of prenatal care be revised to encourage women to seek such care early in pregnancy ?

What casefinding techniques are most helpful in identifying very high-risk groups (such as low-income multiparous teenagers) and linking them to prenatal services ?

What are the costs associated with various forms of casefinding and social support ?

What are the most effective ways to forge links between physicians in private practice and community agencies providing the ancillary health and social services that high-risk women often need ?

How is access to maternity services being affected by such recent developments as the decreased ability of hospitals to finance care for indigent patients through cost-shifting, the increase in corporate ownership of hospitals, the gradual expansion of the DRG (diagnosis-related groups) system beyond the Medicare program, and the increasing profit orientation of the health care sector generally ?

With regard to the first topic, it would be helpful if researchers could use similar theoretical frameworks and lists of barriers when interviewing women. As Chapter 3 shows, many questionnaires have been developed, but their diversity hampers efforts to synthesize findings. One particular issue that research of this type might probe is why some women who are clearly pleased to be pregnant seek pregnancy confirmation early but then do not arrange for prenatal care, even in areas where the maternity care system is functioning well.

The second topic suggests that early enrollment in prenatal services might increase if such care were more clearly directed to major issues in the first trimester of pregnancy. These include: the steps women can take to protect the health and development of the fetus (such as avoiding x-rays, alcohol and other drugs); the discomforts of early pregnancy (such as nausea, worries about "getting fat," and changing personal relationships occasioned by the pregnancy); and the ambivalence or negative feelings that some women experience when first learning they are pregnant. If prenatal care gave more emphasis to these first trimester issues, and if women better understood that prenatal care was helpful and important from conception onward, use of this health service might well increase.

The third topic should include such questions as: (1) What is the relative effectiveness of such casefinding techniques as community canvassing via outreach workers, telephone canvassing, hotlines, public service announcements, and/or provision of various incentives? Do some approaches work better in some settings and for some target groups? (2) How can referral links between prenatal care and other services in which high-risk women participate best be developed and maintained? (3) What institutional homes (health departments, social services agencies, free-standing institutions) are best suited to various outreach activities?

The fourth topic—costs—merits emphasis. With very few exceptions—the Central Harlem Outreach Program of New York City being the shining example—the programs reviewed by the Committee had little or no data linking program costs to client outcomes. To compete for future support and to provide more accountability, such data need to be collected.

The fifth topic addresses the problem of private practitioners being isolated from many community-based agencies that provide the supplementary services some of their patients need, such as WIC and substance abuse treatment. Research in this area should proceed with the full involvement of private practitioners so that conclusions will be acceptable to them and relevant to their practices.

Our sixth and final suggestion for research simply acknowledges that fact that current changes in the health care system may be decreasing access to prenatal care. If so, such influences need to be carefully described and quantified, and policymakers should be alerted to the findings of such investigations.

A Note to Funders

We conclude with some observations directed to those who fund prenatal services: public agencies, legislative bodies, and private foundations and voluntary groups. Many of these points have been covered elsewhere under various headings. We collect and reiterate them here for emphasis.

Over the years, private and public institutions have funded a variety of demonstration and research programs in the general area of prenatal care for low-income groups. The Committee has reviewed many of these programs and has concluded that at least three problems cloud the relationship between these programs and their sponsors.

First, the absence of reliable and consistent funding of prenatal care programs for low-income groups often forces program directors to ask foundations or government for research and demonstration funds that in fact are used—out of necessity—to subsidize basic program services. It is for this reason, perhaps, that the Committee found very little real innovation or research in the areas of delivery of prenatal care or outreach for low-income groups. In the Committee's view, fostering high-quality research on complicated issues of access to care will require government, foundations, and program directors to give up the fiction of subsidizing direct services through research grants.

Second, the Committee found that many research and demonstration programs are funded by foundations and government for 2 or 3 years. These short funding cycles have at least two negative consequences. First, they require program leaders to spend large amounts of time searching for funds, responding rapidly to competitive grant announcements, preparing numerous funding applications, lobbying state legislatures and other public groups for support, and so on. Coupled with often burdensome reporting requirements, the struggle to maintain funding has become debilitating and frustrating. Second, the short cycles carry the implicit message that programs must implement, evaluate, and show results within 2 or 3 years. Program directors are aware that their funding may depend upon their ability to provide these results quickly. Such a process suggests a lack of understanding of the basic facts of organizational sociology. To implement and institutionalize change in any organization or client population requires considerable time. The Committee suggests that genuine innovation and evaluation cannot be accomplished in much less than 5 years and that to expect valid results in less time is naive.

Third, although both government and foundations have regularly funded demonstration projects in the area of prenatal care for poor women, often with considerable public fanfare, support of successful programs over many years is less evident. The Committee suggests that foundations and government might more usefully serve this area of health care by working together, in a deliberate and planned fashion, to ensure that programs whose value and effectiveness have been proven are maintained ''when the grant runs out.'' A conscious plan for moving innovation into the mainstream would allow those responsible for health care to use their energies in more constructive and innovative ways. It would also enable useful programs to continue when the next social priority comes along claiming attention and funds.

In the long run, the best prospects for improving use of prenatal care—and reversing current declines—lie in reorganizing the nation's maternity care system. Although a new system may include some elements of the existing one, the Committee specifically recommends against the current practice of making incremental changes in programs already in place; instead it argues for fundamental reform. Several ways are available for designing the specific components of a new system, but no such work should proceed until the nation's leaders first make a commitment to enact substantial changes. A deeper commitment to family planning services and education should accompany improvements in the maternity care system.

In the short term, we urge strengthening existing systems through which women secure prenatal services. This includes simultaneous actions to remove financial barriers to care, make certain that basic system capacity is adequate for all women, improve the policies and practices that shape prenatal services at the delivery site, and increase public information and education about prenatal care. Federal leadership of this four-part program is essential, supplemented by state action to ensure the availability of prenatal services to all residents.

Even if all four system changes were implemented, there would still be some women without sufficient care because of extreme social isolation, youth, fear or denial, drug addiction, cultural factors, or other reasons. For these women, there is a clear need for casefinding and social support to locate and enroll them in prenatal services and to encourage continuation in care once it is begun. These outreach services, built onto a well-designed, highly accessible system of prenatal services, can help draw the most hard-to-reach women into care.

Unfortunately, though, outreach is often undertaken without first making certain that the basic maternity care system is accessible and responsive to women's needs. Too often, communities organize outreach to help women over and around major obstacles to care rather than removing the obstacles themselves. Thus, the Committee specifically urges that outreach be funded only when linked to a well-functioning system of prenatal services or, at a minimum, when it is part of a comprehensive plan that emphasizes four areas noted above. To fund outreach in isolation and hope that it alone will accomplish major improvements in the use of prenatal services is naive and wasteful.

In support of this general view, the Committee also makes a number of recommendations regarding program management, evaluation, and research. The Committee concludes that not all programs should have to muster the funds and expertise to conduct meaningful evaluation. For those that choose to do so, a higher quality of effort is needed than that exhibited by most of the programs reviewed. With regard to research, the Committee specifically urges that no more research be conducted to demonstrate the importance of financial and other institutional barriers to care. We do, however, suggest six specific research topics and recommend that the current practice of securing funds for services under the guise of research cease.

References and Notes

That is, the complicated network of publicly and privately financed services through which women obtain prenatal, labor and delivery, and postpartum care.

Throughout this chapter, major recommendations are bulleted (•) and in bold face; subsidiary recommendations and suggestions that develop a recommendation further are in italics.

This sequence was followed in the early 1980s when the Social Security system was threatened with financial difficulties. Both the President and the Congress recognized that corrective action needed to be taken and appointed the National Commission on Social Security Reform (the "Greenspan Commission") to develop a plan for solving the system's financial problems. The Commission recommended a series of measures in January 1983 and Congress adopted them later that year.

This is currently only an option for states ( Chapter 2 ).

Cite this Page Institute of Medicine (US) Committee to Study Outreach for Prenatal Care; Brown SS, editor. Prenatal Care: Reaching Mothers, Reaching Infants. Washington (DC): National Academies Press (US); 1988. Chapter 5, Conclusions and Recommendations.
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Prenatal Care
What happens at an appointment?
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What is prenatal care?

Prenatal care is when you get checkups from a doctor, nurse, or midwife throughout your pregnancy. It helps keep you and your future baby healthy.

Why is prenatal care important?

Prenatal care is an important part of staying healthy during pregnancy.

Your doctor, nurse, or midwife will monitor your future baby’s development and do routine testing to help find and prevent possible problems. These regular checkups are also a great time to learn how to ease any discomfort you may be having, and ask any other questions about your pregnancy and the birth of your future baby.

When do I need to start having prenatal care appointments?

You can start getting prenatal care as soon as you know you’re pregnant.

It’s actually best to see a doctor BEFORE you get pregnant — this is sometimes called pre-pregnancy care or preconception planning. But if that’s not possible, just begin prenatal visits as soon as you can.

How often will I have prenatal care visits?

How often you’ll get prenatal care depends on how far along your pregnancy is and how high your risk is for complications. The typical prenatal care schedule for someone who’s 18-35 years old and healthy is:

Every 4 or 6 weeks for the first 32 weeks

Every 2 or 3 weeks for the 32nd-37th weeks

Every week from the 37th week until giving birth

Your doctor might ask you to come in for check-ups more often if you have a high-risk pregnancy.

For free, personalized reminders for prenatal appointments and information about pregnancy and parenting, check out Text 4 Baby .

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Taking care of you and your baby while you’re pregnant.

Last Updated July 2022 | This article was created by familydoctor.org editorial staff and reviewed by Robert "Chuck" Rich, Jr., MD, FAAFP

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It’s important to take care of your baby, even before he or she is born. You can do this by living a healthy lifestyle and keeping doctor’s appointments while you’re pregnant. This is called prenatal care. You’re more likely to have a healthy birth if you maintain a healthy pregnancy.

Path to improved health

Schedule an appointment with your doctor as soon as you find out you’re pregnant. Your doctor will start by reviewing your medical history. He or she also will want to know about your symptoms. During this first appointment, urine and blood samples will be taken. Urine tests check for bacteria, high sugar levels (which can be a sign of diabetes), and high protein levels (which can be a sign for preeclampsia, a type of high blood pressure during pregnancy). Blood tests check for blood cell count, blood type, low iron levels (anemia) and infectious diseases (such as syphilis, HIV, and hepatitis).

The doctor also may do other tests at your first visit. These may vary based on your background and risk for problems. Tests can include:

A pelvic exam to check the size and shape of your uterus (womb)
A Pap smear to screen for cervical cancer
An ultrasound to view your baby’s growth and position (An ultrasound uses sound waves to create an image of your baby on a video screen.)

After your first visit, you will have a prenatal visit every 4 weeks. In months 7 and 8, you will have a visit every 2 weeks. In your last month of pregnancy, the visits will occur weekly until you deliver your baby. At each visit, the doctor will check your weight and blood pressure and test your urine. The doctor will listen to your baby’s heartbeat and measure the height of your uterus after the 20th week. You should always discuss any issues or concerns you have with your doctor.

Below are some other guidelines to follow during your pregnancy.

How much weight should I gain during pregnancy?

Talk to your doctor about this. It’s different for everyone, but most women should gain about 25 to 30 pounds. If you’re underweight when you get pregnant, you may need to gain more. If you are overweight, you may need to gain less.

What should I eat?

Eating a balanced diet is one of the best things you can do for yourself and your baby. Be careful of the following foods and drinks during pregnancy:

Raw meat, eggs, and fish . Food that isn’t fully cooked can put you at risk for food poisoning. Don’t eat more than 2 or 3 servings of fish per week (including canned fish). Don’t eat shark, swordfish, king mackerel, or tilefish. These fish have high levels of mercury, which can harm your baby. If you eat tuna, make sure it’s light tuna. Don’t eat more than 6 ounces of albacore tuna and tuna steaks per week. It’s safe to have 12 ounces of canned light tuna per week.
Fruits and vegetables . Wash all produce before eating it. Keep cutting boards and dishes clean.
Dairy . Eat 4 or more servings each day. This will give you enough calcium for you and your baby. Don’t drink unpasteurized milk or eat unpasteurized milk products. These may have bacteria that can cause infections. This includes soft cheeses such as Brie, feta, Camembert, and blue cheese, or Mexican-style cheeses, such as queso fresco.
Sugar substitutes . Some artificial sweeteners are okay in moderation. These include aspartame (brand names: Equal or NutraSweet) and sucralose (brand name: Splenda). However, if you have phenylketonuria (PKU), avoid aspartame.
Caffeine . Don’t drink more than 1 or 2 cups of coffee or other drinks with caffeine each day.

Can I take medicine?

Check with your doctor before taking any medicine. This includes prescriptions, pain relievers, and over-the-counter medicines. Some medicines can cause birth defects, especially if taken during the first 3 months of pregnancy.

Can I take vitamins?

Pregnant women should take at least 400 micrograms (mcg) of folic acid each day. It can help prevent problems with your baby’s brain and spine. Ask your doctor if you need more than 400 mcg.

It’s best to start taking folic acid before you get pregnant. You can get folic acid from taking a prenatal vitamin. You should take this every day. Don’t take other vitamins or supplements without your doctor’s approval.

How long can I keep working?

How late you work in pregnancy varies for each person. Your job and work environment play a big role. For instance, jobs that involve radiation, lead and other materials—such as copper and mercury—can be harmful to your baby. If your job is active, you may not be able to work as long. Desk jobs aren’t thought to cause harm to your baby. However, you should not rest a computer on your stomach or uterus.

Your overall health also plays a part in how long you work. If you’re at risk of certain issues or preterm labor, you may be on bed rest and not able to work.

What about exercise?

Unless you have issues during pregnancy, you should get regular exercise. Exercise promotes a healthy lifestyle and can help ease discomfort. Try to get at least 30 minutes of exercise each day. Talk to your doctor about any conditions that may prevent exercise.

Some women say exercising while pregnant makes labor and delivery easier. Walking and swimming are great choices. If you were active before pregnancy, it is probably safe to continue. If you weren’t active before pregnancy, start slowly. Listen to your body and don’t overdo it. Drink plenty of water to prevent overheating or dehydration, especially in the second trimester. It’s best to avoid exercises that may cause you to fall. This includes skiing and rock climbing. You also should avoid contact sports, such as soccer or basketball. Ask your doctor if you have any concerns.

Call your doctor if you have symptoms with exercise, such as:

Blurred vision
Stomach pain

Can I have sex?

It’s safe to have sex while you’re pregnant. However, talk to your doctor if you have concerns or are at risk for problems. Some women’s level of interest in sex changes when they’re pregnant. As you grow, you may need to try different positions, such as lying on your side or being on top.

What can I do to feel better?

Below are common side effects of pregnancy with tips on how to manage them:

Morning sickness . Nausea or vomiting may strike anytime during the day (or night). Try eating frequent, small meals. Avoid foods that are greasy, spicy, or acidic. Some women are more nauseous when their stomach is empty. Keep crackers nearby to prevent an empty stomach. Talk to your doctor if morning sickness causes you to lose weight or lasts past the first 3 months of pregnancy.
Tiredness. Fatigue is common when you’re pregnant. Try to get enough rest or take naps if possible. Talk to your doctor if you have symptoms with fatigue. You may have anemia.
Leg cramps. Being active can help reduce leg cramps. Stretch the calf of your leg by flexing your foot toward your knee. Also stay hydrated by drinking lots of water.
Constipation . Drink plenty of fluids. Eat foods with lots of fiber, such as fruits, vegetables, and bran cereal. Don’t take laxatives without talking to your doctor first. Stool softeners may be safer than laxatives.
Hemorrhoids . Try to avoid becoming constipated. Don’t strain during bowel movements. Clean yourself well after a bowel movement. Wet wipes may feel better than toilet paper. Take warm soaks (sitz baths) if necessary.
Urinating more often. You may need to urinate more often when you are pregnant. Changing hormones can be a factor. Also, as your baby grows, he or she will put pressure on your bladder.
Varicose veins . Avoid clothing that fits tightly around your waist or legs. Rest and put your feet up as much as you can. Avoid sitting or standing still for long periods. Ask your doctor about support or compression hose. These can help prevent or ease varicose veins.
Moodiness. Your hormones are on a roller coaster ride during pregnancy. Your whole life is changing. Don’t be too hard on yourself. Get help right away if you feel sad or think about suicide.
Heartburn . Eat frequent, small meals. Avoid spicy, greasy, or acidic foods. Don’t lie down right after eating. Ask your doctor about taking antacids.
Yeast infections . The amount of discharge from your vagina can increase during pregnancy. Yeast infections, which can cause discharge, are common as well. Talk to your doctor if you see any unusual discharge or if it has an odor.
Bleeding gums. Brush and floss regularly. See your dentist for cleanings. Don’t avoid dental visits because you’re pregnant. Just be sure to tell your dentist you’re pregnant.
Stuffy nose. Changes in the levels of the female hormone estrogen can cause a stuffy nose. You may also have nosebleeds .
Edema (retaining fluid). Rest with your legs up as much as you can. Lie on your left side while sleeping. This position helps blood flow from your legs back to your heart better. Don’t use diuretics (water pills).
Skin changes. Stretch marks appear as red marks on your skin. Lotion with shea butter can help keep your skin moist and reduce itchy, dry skin. Stretch marks can’t be avoided. They do often fade after pregnancy. You may have other skin changes. These can include darkening of the skin on your face or around your nipples. Some women get a dark line below their belly button. Try to stay out of the sun or use sunscreen to help lessen these marks. Most marks will fade after pregnancy.

Things to consider

There are several things you should avoid while you’re pregnant. Take notice to follow this list of warnings. Talk to your doctor if you need help.

Don’t smoke or be around people who do smoke . Smoking raises your risk for miscarriage, preterm birth, low birth weight, and other health problems.
Don’t use drugs . Cocaine, heroin, marijuana, and other drugs increase your risk of miscarriage, preterm birth, and birth defects. Your baby could be born addicted to the drug you’ve been abusing. This is called neonatal abstinence syndrome. It can cause severe health problems for your baby.
Don’t drink alcohol . Drinking alcohol is the major cause of preventable birth defects, including fetal alcohol disorder .
Don’t clean your cat’s litter box or eat raw or undercooked red meat . You could get toxoplasmosis , a disease that can cause birth defects.
Don’t douche . Your vagina doesn’t require cleansing in addition to normal bathing. Douching disrupts the helpful bacteria that keep your vagina clean.

When to see a doctor

Call your doctor if you have:

Blood or fluid coming from your vagina
Sudden or extreme swelling of your face or fingers
Headaches that are severe or won’t go away
Nausea and vomiting that won’t go away
Dim or blurry vision
Severe pain or cramps in your lower abdomen
Chills or fever
A change in your baby’s movements
Less urine or burning when you urinate
An illness or infection
Any other symptoms that bother you

Questions to ask your doctor

What medicines can I take during pregnancy?
When should I start taking a prenatal vitamin? What kind is best?
How much folic acid do I need to take each day?
How can I prevent or reduce swelling?
How much weight should I gain while pregnant?

National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development: What Is Prenatal Care and Why Is it Important?

U.S. Department of Health & Human Services, Office on Women’s Health: Prenatal Care

Last Updated: June 28, 2022

This article was contributed by familydoctor.org editorial staff.

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CreATE YOUR BIRTH SANCTUARY.

Midwives monitor the health and well-being of the mother and baby, but it is not as simple as only addressing physical health. Normal physiological birth works best when a woman’s space feels safe and protected. We want to create a haven for your peaceful birth; we know from experience that this results in the best outcomes for mothers and babies. We spend time developing and discussing a birth plan with you during your pregnancy, doing our best to tailor our care to your desires.

You will be in close contact with our midwives as labor begins. When the time comes, two of our midwives will meet and be with you throughout the labor process. Knowing everyone in your birth space really creates a sense of ease and allows the hormonal labor orchestra to flow.

An expecting mother may choose to labor and deliver in the comfort of her own home. Midwives honor your turf and bring all the necessary equipment, medications, herbs and supplies. One of our favorite moments is that time after the birth when we have cleaned everything, finished the newborn/mother exam, reviewed postpartum instructions, and tucked your family into bed.

Birth Center in Pullman

We have put a lot of intention into creating a comforting space for women to labor and deliver, full of vitality and love. Birth centers offer a great alternative to home birth when families live far away or feel more comfortable away from home to birth.

ViviAnne Fischer

Licensed midwife.

ViviAnne brings the deep wisdom of experience to her care for women through prenatal, labor & delivery, and postpartum care. She integrates the art of traditional midwifery and current knowledge. ViviAnne enjoys the relationships she develops with families and often creates lasting friendships. Women appreciate her compassionate, calm and patient nature.

Midwifery care is available at our Pullman, Moscow, and Lewiston offices!

Tina Gearhart

Certified nurse midwife.

As a certified nurse midwife, CNM, Tina is able to provide women’s health midwifery care from adolescence through menopause! She can provide care for Well Woman exams, labs, family planning, and gynecological concerns. Tina’s straightforward and deeply caring manner really helps women feel informed and empowered in their healthcare. M idwifery care is billable to insurance, Medicaid, or self-pay and is available at our Pullman, Moscow, and Lewiston offices! Book with any midwife for prenatal care, or book with Tina specifically for Well Woman care.

Naturopathic Doctor, Licensed Midwife

The Medicine Woman of The Nest, Dr. KO guides healing with a sense of patience, ease, and trust. As a midwife and doula, Dr. KO brings a tender reverence for the sacred transition of birthing. With a foundation of evidence-based care, she empowers the mother to trust her own body and intuition. Book with any midwife for prenatal care and Dr. KO will be on your team – the three midwives rotate each week.

Dr. KO is currently not accepting new naturopathic clients; but you are welcome to call us at email [email protected] to discuss options and be added to a wait list for intensive spiritual counseling.

Click below to work with Dr. KO in her weekly group offering, Meditation Circle at The Nest in Moscow Wednesdays at 6pm.

Jess Mallery

Student midwife, birth assistant.

Jess brings a steadying and supportive presence to births at home and the birth center. As the student midwife at The Nest, she attends office visits and births as an important part of earning her degree from the Midwives College of Utah. Her contributions to maternity care and delivery reflect her deep honor for the experiences of pregnancy, birth, and womanhood.

Jessica Smith

Lactation consultant, nurse.

As your lactation specialist my goal is to compassionately support you through your parenthood experience. I apply a holistic approach to my practice, combining ancient wisdom with evidenced based science to give you a full range of information. My goal is to create a safe space for you to feel connected, honored, and supported in the decisions that give you peace and joy. This is a very challenging, vulnerable, and intimate time in life and having someone to guide you through your journey can be immeasurable. I feel humbled and honored to work beside parents in this transformational time.

We accept Idaho Medicaid and Washington Apple Health (Molina or Amerigroup) plans. There may be some non-covered services we will discuss with you.
We accept most insurance plans and are preferred providers with many companies that operate in our area! Even if we aren’t listed as a preferred provider with your plan, check in with our biller because many times we are able to accept it. To learn about your insurance coverage out-of-pocket costs, fill out this link and our biller will do the work for you: https://www.islandbillingseattle.com/estimates
For families paying out-of-pocket, we offer a cash discount and affordable monthly payment plans.

If you are in need of financial assistance for any of your costs please reach out and ask to fill out our financial assistance form.

At your complimentary consultation, we will give you information about our fees that address your specific financial situation.

Where can I learn more?

Explore the Whole Health Compendium for more pregnancy related resources!

(509) 330-5539

[email protected]

Fax: (509) 795-0936

Mailing address: 425 S Grand Ave. Pullman, WA 99163

Our Offerings

Midwifery Care
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Pullman, Washington
Lewiston, Idaho
Moscow, Idaho
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My journey to midwifery started early. I was born at home with a midwife and grew up surrounded by women who used herbs, homeopathy and food to heal the body. I was always drawn to pregnancy and birth, however, I took a few detours along the way! My boys were born in 2002, 2005, and 2006. I earned my Masters Degree in Human Development shortly after the birth of my second son – with a focus on families and parenting. In 2007, I became a birth doula while also teaching at WSU. The calling to midwifery grew louder over time and I went back to school to earn my bachelors in midwifery and become a certified professional midwife in 2015. I love connecting with families and being a part of their journey. I am passionate about doing what I can as a midwife to facilitate and hold space for normal physiological birth, with the goal always that women will feel they were well cared for, heard and honored. I am also excited about advancing midwifery care in the U.S.! I serve as a committee member on the Midwifery Advisory Council in Washington and the Idaho Midwifery Council in Idaho.

I have been in health care my entire adult life. I started as a certified nursing assistant working in a nursing home, became a phlebotomist, and an EMT (though, I never worked as an EMT) until I discovered my passion for nursing. I found out I was pregnant with my first daughter the same time I was accepted into nursing school. As a typical first-time mom, I was nervous, excited, and wanted to feel as though I could connect with my OB. After 3 visits of having to explain to him I was there because I was pregnant, I had lost all confidence that he’d be of any use once in labor. A friend had suggested a CNM (certified nurse midwife), and this was life-changing. She deserves all the credit for where I am today.

I attended nursing school at the Colorado Mesa University in Grand Junction, Colorado and graduated with a Bachelor’s of Science in Nursing, in 2002. I started nursing school with a 3 month old, and my second daughter was 3 month old when I graduated… something I don’t necessarily recommend attempting. While working as a medical/surgical nurse, I attended graduate school at the University of Colorado in Denver and graduated in 2006 with a Master’s in Science specializing in nurse midwifery (Nurse Practitioner, Nurse Midwife). I would spend the majority of my career in Colorado working in the hospital and clinic setting, until crossing over to the home birth and birth center world. I finished 2021 by becoming an IBCLC (International Board Certified Lactation Consultant).

I am passionate about women’s health, pregnancy, and birth. I believe in empowering teens to learn and trust their bodies, guiding women and their partners through their low-risk pregnancies and birth, and guiding women through and beyond menopause. I treat women as a whole – mind-body-spirit – and believe optimal health can be achieved when all three are aligned. As a Certified Nurse Midwife (CNM), I am able to evaluate, diagnose, prescribe medications if needed, and support women throughout the life span. I provide evidenced-based education, resources and recommendations to allow for individuals to make informed decisions about their health in a non-judgemental manner. Types of visits include preconception counseling, birth control (IUDs, Nexplanon, Natural Family Planning, etc.), gynecological visits, annual physical exams, and blood work if needed, and of course prenatal and postpartum visits. As an IBCLC, I support the breastfeeding mama throughout the entire breastfeeding journey. I am also able to evaluate tongue/lip ties and revise them, if and when appropriate.

I was born in Moscow a few years ago, and grew up on the Palouse. My husband and I live on a lovely farm outside of Palouse that has been passed down by my great-great grandparents who settled here 1913. I have two grown daughters (22 & 19), one of which is a pharmacy tech, and the other is currently attending WSU – Go Cougs! I am also lucky enough to have two bonus boys (12 & 10); along with the true rulers of the farm, a 7yr old white golden retriever and a 6yr old German Shepard. We are looking forward to bringing more animals back to the farm in the near future. I love lifestyle photography and more recently have delved into birth photography. I enjoy running, reading and audible books, gardening, and might be a bit of a wine enthusiast; mostly though, I just enjoy being at home with my husband.

I was born and raised in a suburb of Minneapolis, Minnesota. I graduated from Bastyr University as a doctor of naturopathic medicine. I am also in the final stages of completing a Masters of Science in Midwifery from Bastyr. I was brought to midwifery and naturopathic medicine through the desire for a life dedicated to the pursuit of the overwhelming joy of loving service. I have been volunteering with several organizations to serve underprivileged children in various countries since the age of 16.

I attended Stanford University and graduated with a degree in neurological psychology and a minor in human biology. As I gained more focus on healthcare throughout my undergraduate career, I geared my service work towards sexual and women’s health. After graduation, my entrepreneurial spirit and search for a more holistic system of medicine brought me to a career in naturopathic medicine, and training as a craniosacral and visceral manipulation practitioner and massage therapist. I am very dedicated to the power of holistic healthcare, and I believe firmly in the ability of each individual to manifest their own health. I have begun my clinical education at Bastyr; while my skills continue to evolve, the clinical style I always attempt to embody is illustrated by the phrase, ‘listening in love.’

I came to midwifery through a desire to support health from conception. I ascribe to the belief that a child’s time in the womb and experience of birth are some of the most formative health experiences, and these experiences will continue to impact the health of the individual throughout the entirety of their life. In addition, I am drawn to the empowerment of women that pervades the field of midwifery, returning to women their dignity and power, and supporting the reclamation of birth by the women who are giving it.

I truly believe that giving birth is one of the most important events that will occur in the life of a woman; I cannot adequately express how excited, honored and grateful I am to have the opportunity to partner with women in this experience.

The foundation of my life, belief, and medical practice is this:

All illness would be eradicated if we could all remember the one essential truth-

Everything is love.

Student Midwife, DONA Birth Doula

When I was 11 years old, I attended the birth of my little sister. This experience laid the foundation for a lifelong fascination with all things pertaining to childbearing and women’s health. I received excellent midwifery care during my own pregnancies, which inspired me to become a midwife myself. I am currently in midwifery school and have been honored to learn from several local midwives, including the amazing midwives at The Nest. I’ve attended nearly 100 births and am grateful for each of these experiences.

I also work independently as a doula (find me at palousedoulacollective.org). My goal is to provide support that is suited to the needs of each woman and her family. Creating such support requires time, attentiveness, and honor for the unique needs of each client. Because of this, I place high value on prenatal visits in which we get to know each other, explore individual goals, preferences, concerns, and questions. I do my utmost to ensure my clients have access to evidence-based information, are honored in their decisions, and feel prepared to welcome their baby. I support labor and delivery through in-person emotional and physical care. And in the early postpartum days, I remain available to offer a listening ear, gentle advice if it is desired, and connection to additional community resources. It is my joy and privilege to support this sacred and ordinary process.

When I’m not busy with birth work, I enjoy cooking, making things with yarn and fabric, and exploring with my family. My husband and I live in Latah County, Idaho, and have five children.

Nurse, Lactation Consultant

Hi there, I’m Jessica Smith. I offer lactation consultation at The Nest for the greater Palouse community, whether you are a Nest midwifery patient or not. I’m a nurse, IBCLC (International Board Certified Lactation Consultant), Certified Birth and Postpartum Doula (find me at palousedoulacollective.org), and Certified Breastfeeding Educator. I’m also a rural, homeschool momma of four littles living on our regenerative farm with ALL the animals in Palouse, WA.

My interest in wellness, birth, babies and maternal health started from a young age. During high school and college I taught swim lessons and worked at a long term care facility as well as a special needs home. Upon graduation I worked as a school nurse, pediatric home-care nurse, and a minor-care/ready-care nurse. But, soon my passion for the healthcare, or rather dis-ease care system began to wane. I was constantly trying to get my patients outdoors to experience the world and nature around them. I wanted to help them live healthy, balanced lifestyles. My passion for getting back to nature and our roots continues throughout my own life and blends into my work. This is why I take a “holistic” approach.

When my own journey with motherhood began, I was awakened to the fact that in our culture there is a disconnect between birth and postpartum. Like many, I prepared for the birth but never really gave much thought to postpartum. While planning for birth is important, planning for the postpartum period is even more important. I found myself struggling with lack of resources and unable to ask for help. I struggled with breastfeeding, low supply, and ended up supplementing. Through help of doctors and lactation consultants we ended up saving my breastfeeding experience for two years and then was able to successfully tandem nurse when baby #2 arrived! I experienced birth trauma and postpartum anxiety & depression. I struggled to find balance and healing again after each baby. I came across Julia Jones Newborn Mother’s Collective, Ayurveda Postpartum care and found the missing link in my postpartum experience. Through the wisdom of ancient traditions and scientific role of Oxytocin, I learned what we have missed in our culture. While there’s much from ancient traditions and culture, we can’t apply to our modern lifestyle there are two culturally universal things we can do, help and support the new mother and offer nutrient dense, warm prepared meals.

Through my pediatric nursing experience, I cared for many previous NICU babies with unique challenges, in which I saw a vast difference in the ones who were fed breastmilk. This led me to dive deeper into the lactation world and fueled my love for working with families through difficult times. I furthered my education and became certified as a breastfeeding educator and birth doula. Birth work has caused me to look deeper at my own healing so I can show up for clients with positive energy. As your lactation consultant my goal is to support you through your experience. I love working and troubleshooting through challenges with clients to apply what feels right for you and your needs. I want to guide you where necessary with an open mind well as empower you and promote healthy lifestyle.

The best to you, Jessica

Special Trainings:

Midwife Assistant Training | 2009
Lewis-Clark State College, Nursing Graduate | 2011
Postpartum Doula Training, Newborn Mother’s Collective | 2015
Certified Birth Doula | 2015
Certified Lactation Educator, Evergreen Perinatal Education | 2016
Intuitive Birth for Birth-Workers | 2019
Perinatal Mood and Anxiety Workshop, Perinatal Support Washington | 2020
University of San Diego Extension, Lactation Consultant Didactic and Internship | 2021
Steamy Chick, Peri-Steam Facilitator | 2021
Tongue Tie, A Comprehensive Approach to Assessment and Care, Melissa Cole, MS, IBCLC | 2022
International Board Certified Lactation Consultant | 2022

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Vandal Health Education

Associate director of programs and wellbeing initiatives.

Emily Tuschhoff, MS, CHES

Physical Address: 1000 Paradise Creek St. Moscow, ID 83844

Mailing Address: 875 Perimeter Drive MS 1230 Moscow, Idaho 83844-1230

Phone: 208-885-4146

Email: [email protected]

Assistant Director, Health Promotion

Amanda Ferstead, MPH, MA, MS, CHES

Phone: 208-885-1539

Email: [email protected]

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Jeneba Hoene

Phone: 208-885-2039

Email: [email protected]

Student Recreation Center Room 102

Physical Address: 1000 Paradise Creek Street Moscow, Idaho 83844-1230

Mailing Address: 875 Perimeter Drive Moscow, Idaho 83844-1230

Phone: 208-885-4104

Email: [email protected]

Reach out to a medical provider to talk with someone about questions concerning pregnancy.

On Campus Options

Vandal Health Clinic | 208-885-6693
Counseling and Mental Health Center | 208-885-6716
Women's Center | 208-885-2777

Gynecological Information

For minor gynecological procedures such as Pap tests, you can visit the Vandal Health Clinic. You may also choose to visit an off-campus provider for your care.

Mobility Assistance

If your pregnancy limits your mobility, Vandal Access service may be able to help.

Pregnancy Tests

What are they.

Pregnancy tests are usually simple urine tests that screen for a hormone called human chorionic gonadotropin (hCG). HCG is released when a fertilized egg attaches to the lining of the uterus and is only found in the body if you are pregnant.

You can take a home pregnancy test or go to a medical provider to be tested. If you take a home test, it's important to follow all of the instructions carefully. The results will be either positive — meaning pregnant — or negative — meaning not pregnant. When used as directed, home tests have similar results to the urine pregnancy tests used by most medical providers. At-home tests usually cost between about $12-$15 and are available at most drug stores.

At-Home Test Accuracy

Home pregnancy tests (HPTs) can be quite accurate. But accuracy depends on:

How you use them — Be sure to check the expiration date and follow the instructions. Wait 10 minutes after taking the test to check the results window. Research suggests waiting 10 minutes to get the most accurate result.
When you use them — The amount of hCG or pregnancy hormone in your urine increases with time. So, the earlier you take the test, the harder it is to spot the hCG. Many HPTs claim to be 99 percent accurate on the first day of your missed period. But research suggests most HPTs don't always detect the low levels of hCG present that early in pregnancy. When they do, the results are often very faint. Most HPTs can accurately detect pregnancy one week after a missed period. Also, testing your urine first thing in the morning may boost accuracy.
Who uses them — Each woman ovulates at a different time in her menstrual cycle. Plus, the fertilized egg can implant in a woman’s uterus at different times. HCG only is produced once implantation occurs. In up to 10 percent of women, implantation does not occur until after the first day of a missed period. So, HPTs are accurate as soon as one day after a missed period for some women but not for others.

How to Read Results

A positive test result means you're likely pregnant. If you've taken a home pregnancy test, it's important to visit a medical provider for another test. Your medical provider can confirm the results, discuss what to do next and options for prenatal care.

A negative result from a home pregnancy test means you're unlikely to be pregnant. Sometimes, it means you've taken the pregnancy test too early to know for sure. If you still think you may be pregnant, wait until a day or two after your missed period and take another test.

Sometimes the results of pregnancy tests are hard to read. If it's unclear whether the home pregnancy test you've taken is positive or negative, visit a medical provider.

Where can I buy a test?

Pregnancy tests are available at the Vandal Health Clinic . At-home tests usually cost between about $12-$15 and are available at most drug stores.

Reach out to the Vandal Health Clinic or your primary care provider for next steps if you find out you are pregnant. You may also find support at the Counseling Mental Health Center and U of I Women’s Center .

Prenatal Care

See your medical provider frequently.

It is important to check in with your medical provider regularly. If your medical provider believes you have a low-risk pregnancy, you can expect to visit them at least once a month for the first seven months, every two or three weeks for the eighth month, and weekly during the ninth month until delivery. If you have a high-risk pregnancy, if this is your first baby, or if you have other health issues that need to be monitored, you can expect to see your medical provider more frequently.

Eat a healthy diet

A healthy diet is vital for a healthy pregnancy. It's the best thing you can do for your baby's mind and body. It will also make you strong and ready for labor, delivery and breastfeeding. Ask your medical provider about specific nutritional guidelines.

Walking and other aerobic and strength exercises can help strengthen your body for your pregnancy and delivery. Be sure to consult with your medical provider about your exercise plans to be sure you're not overdoing it.

Get plenty of rest

Be sure to get enough sleep and engage in strategies to manage your stress .

Avoid alcohol and other drugs

Prescription drugs, alcohol, illegal drugs, caffeine, cigarettes and even over-the-counter drugs can be harmful to the developing fetus. Check with your medical provider before you take any medications or substances, or if you're concerned about something you've already taken during your pregnancy. After a baby is born, you should talk to your medical provider about medications, including birth control options, and their potential impact on breastfeeding.

Try to avoid infections

Certain infections such as bacterial vaginosis and sexually transmitted infections can be more harmful during your pregnancy. Be sure to talk with your medical provider if you think you have an infection, or if you experience recurrent infections, so you can get treatments that are safe for you and your baby.

Embracing Life.

Promoting health., providing hope..

Palouse Care Network promotes a culture of life on the Palouse through a diverse network of services that empower healthy relationship decisions.

PCN is a faith-based 501(c)3 non-profit serving the Palouse region of Eastern Washington and Northern Idaho. We offer resources, education, life skills coaching, and a reproductive health medical clinic. We are a non-discriminatory, judgement-free organization promoting life, health, and hope.

How You Can Get Involved

Call (208) 882-2370 , Volunteer or Donate Now .

Palouse Care Network

Community donations ensure our ability to meet the needs of local women, men, and families in need of support for unplanned pregnancy decisions, reproductive health, material needs, and social support. All donations are tax-deductible. Our financial statements are available and our team is always happy to answer your questions.

Why Palouse Care Network

Supporting life and building families since 1982.

We believe that human life has invaluable worth and significance in all of its dimensions, including the unborn, the aged, the weak, the mentally impaired, the physically challenged, and every other condition in which humanness is expressed from conception to the grave.

Holistic Care

We believe in caring for the whole person, whatever brings them through the doors of our center. Our holistic model of care addresses the physical, intellectual, emotional, social, and spiritual needs of each individual, offering them hope for a healthy future. We offer many free services including pregnancy tests, early ultrasounds, pregnancy options consultation, female STI/STD testing, cancer screenings, life coaching, community referrals, parenting classes, and material assistance.

We invite you to join our mission, vision and work through prayer, financial support, or as a volunteer. Contact us to learn more.

Get in Touch

Call us or complete the form below to learn more about getting involved with Palouse Care Network in Moscow or Pullman.

1515 West A Street Moscow, ID 83843

Monday: 9:00-4:00

Wednesday: 9:00-4:00

Call Us: (208) 882-2370

Serving the palouse in two locations, 1540 ne stadium way pullman, wa 99163.

Tuesday: 9:00-4:00

Thursday: 9:00-4:00

IMAGES

Care Plans for Pregnancy
Importance of prenatal care Essay Example
Preconception Health & Prenatal Assignment Example
(PDF) Turning the Pyramid of Prenatal Care
Substandard Prenatal Care Essay Example
Prenatal Development Reflection Essay

VIDEO

My prenatal care
Unrealistic/Realistic Monday… || Self care + essay
Empowering Futures: The Vital Role of Prenatal Care in Maternal and Child Well-being
Interprofessional Collaboration to Reduce Health Disparities
Concept Analysis in Clinical Practice: Palliative Care
Importance of Prenatal Care

COMMENTS

What is prenatal care and why is it important?
Having a healthy pregnancy is one of the best ways to promote a healthy birth. Getting early and regular prenatal care improves the chances of a healthy pregnancy. This care can begin even before pregnancy with a pre-pregnancy care visit to a health care provider.
Essay on Prenatal Care
Essay on Prenatal Care. Prenatal care is medical care for pregnant woman and is important for a healthy pregnancy. Its key components include regular checkups and prenatal testing, eating healthfully, exercising, and beginning as soon as one knows she is pregnant. During her pregnancy, a woman should see her doctor about once each month for the ...
Prenatal Care Essay Examples
The Significance of Prenatal Care. Prenatal/ antenatal care is an essential aspect of healthcare that focuses on the health and well-being of pregnant women and their babies. It involves regular check-ups, some screenings, and education to ensure a healthy gestation and safe delivery. By monitoring the pregnancy, addressing pitfalls, and ...
Healthy Pregnancy: The Importance of Prenatal Care
Regular prenatal care throughout your pregnancy helps to catch potential concerns early and reduces the risk of pregnancy and birth complications. As soon as you suspect you are pregnant, make an appointment with your OB/Gyn. If you don't have one, call your health insurance to determine which obstetricians are covered by your insurance.
The Importance of Prenatal Care
Ideally, you want to get prenatal care early in the pregnancy and regular care throughout. Prenatal care is especially crucial for women with high-risk pregnancies. Pregnancies with a greater chance of complications are called high-risk. These factors may increase the risk of problems during pregnancy: Very young age or over age 35.
The Significance of Prenatal Care
View Sample. Order it today. Prenatal/ antenatal care is an essential aspect of healthcare that focuses on the health and well-being of pregnant women and their babies. It involves regular check-ups, some screenings, and education to ensure a healthy gestation and safe delivery. By monitoring the pregnancy, addressing pitfalls, and furnishing ...
Importance of Prenatal Care Essay [848 Words] GradeMiners
Conclusion. Prenatal care is widely recognized as an essential element in improving pregnancy outcomes. Some of the benefits of prenatal care include keeping the mother-to-be and the fetus healthy, preventing and minimizing difficulties throughout the pregnancy term and at the time of childbirth, and providing counseling and education to the mother on nutrition and lifestyle habits as labor ...
116 Pregnancy Essay Topic Ideas & Examples
We've compiled a list of 116 pregnancy essay topic ideas and examples to help inspire you: The physical changes of pregnancy: A look at how a woman's body changes during pregnancy. ... The barriers to accessing prenatal care and support in low-income communities. Pregnancy and childbirth in rural areas: The challenges faced by women in rural ...
Prenatal Care Essays (Examples)
Pages: 4 Words: 1317. Prenatal care is an important aspect of pregnancy and can result in positive outcomes for both mother and infant. Low-risk pregnancies have different recommendations for prenatal care than high-risk pregnancies. Low risk pregnancies begin with medical checkups that include screening tests.
Prenatal Development: The Incredible Journey Before Birth: [Essay
The Importance of Prenatal Care. Prenatal care plays a pivotal role in monitoring and promoting the health of both the expectant mother and the developing fetus. Regular prenatal check-ups allow healthcare providers to identify and address any potential issues, provide guidance on proper nutrition, and offer support for maternal mental health.
The Journey of Becoming a Mother
Contemporary prenatal care interferes with women's ability to accomplish the tasks of pregnancy and, combined with "intervention-intensive" care during labor and birth, has the potential to seriously disrupt women's transition to becoming a mother. Nature's plan—the gradual, hormonally encouraged "falling in love" that happens as a ...
Pregnancy Care: Overview, Prenatal & Postnatal Care
Overview. Pregnancy care consists of prenatal (before birth) and postpartum (after birth) healthcare for expectant mothers. It involves treatments and trainings to ensure a healthy prepregnancy ...
Why Prenatal Care is Important for Mom and Baby
Prenatal care is the foundation of a healthy pregnancy, labor and delivery. Early and regular prenatal care is very important to the health of your baby and to your own health during pregnancy. If problems do arise, regular visits to your OB/GYN can allow him or her to identify and treat complications as soon as possible.
Prenatal Care, Essay Example
Essays.io ️ Prenatal Care, Essay Example from students accepted to Harvard, Stanford, and other elite schools All papers examples Disciplines
Prenatal Care Essay Examples
Prenatal Care Essays. Results: 3 samples found . essays on this Topic. Importance of Prenatal Care 🔥 trending. Subject: 👪 Family. Pages: 4. Words: 848. Rating: 4,8. Prenatal care is extensively acknowledged as a type of preventative healthcare vital in enhancing pregnancy results. Prenatal care helps monitor the pregnancy development ...
Prenatal Care Essay Examples
A pregnant woman requires a lot of care to have a healthy pregnancy. One should follow a strict diet to ensure their child does not grow…. Pregnancy Prenatal Care. View full sample. Searching for Prenatal Care essay examples? ️ Check it in our sample's database. 📚 Find plenty of high-quality samples from professional writers.
Conclusions and Recommendations
Chapter 5. Conclusions and Recommendations. At the outset, the focus of this study was outreach for prenatal care. The Committee's charge was to determine which outreach techniques most effectively draw women into care early in pregnancy and maintain their participation until delivery. For this study, outreach was defined to include various ...
What Is Prenatal Care?
Prenatal care is an important part of staying healthy during pregnancy. Your doctor, nurse, or midwife will monitor your future baby's development and do routine testing to help find and prevent possible problems. These regular checkups are also a great time to learn how to ease any discomfort you may be having, and ask any other questions ...
Taking Care of You and Your Baby While You're Pregnant
Pregnant women should take at least 400 micrograms (mcg) of folic acid each day. It can help prevent problems with your baby's brain and spine. Ask your doctor if you need more than 400 mcg. It's best to start taking folic acid before you get pregnant. You can get folic acid from taking a prenatal vitamin.
Midwifery Care
Our care integrates the art of traditional midwifery with evidence-based practices. Our certified professional midwives and certified nurse midwife bring over 40 years of collective experience and have helped thousands of families safely welcome their babies into the world in a variety of settings. The midwifery model of care is rooted in the belief that pregnancy and birth are normal life ...
Sexual Health: Pregnancy
Prenatal Care. See your medical provider frequently. It is important to check in with your medical provider regularly. If your medical provider believes you have a low-risk pregnancy, you can expect to visit them at least once a month for the first seven months, every two or three weeks for the eighth month, and weekly during the ninth month ...
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Palouse Care Network promotes a culture of life on the Palouse through a diverse network of services that empower healthy relationship decisions. PCN is a faith-based 501(c)3 non-profit serving the Palouse region of Eastern Washington and Northern Idaho. We offer resources, education, life skills coaching, and a reproductive health medical clinic.
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Our caring and supportive team is here to help with your pregnancy needs along with education programs for a healthy pregnancy, labor and delivery, infant care and postpartum care and support. We're here to help! Please call for an appointment. (208) 384-9504. www.treasurevalleypath.org Address: 1327 W. Beacon Street, Boise, ID 83706.

What is prenatal care and why is it important?

Pre-Pregnancy Care

Prenatal Care

Healthy Pregnancy: The Importance of Prenatal Care

What is prenatal care?

What to expect at your prenatal visits

Each prenatal visit is important for a healthy pregnancy

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The Importance of Prenatal Care

Reduce the Risk of Complications

What Happens during Prenatal Visits

When Is the Right Time to Schedule a Prenatal Visit?

The Significance of Prenatal Care

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What is prenatal care?

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Performance

Intermittent Fasting

Pre-Exposure Prophylaxis (PrEP)

Path to improved health

How much weight should I gain during pregnancy?

What should I eat?

Can I take medicine?

Can I take vitamins?

How long can I keep working?

What about exercise?

Can I have sex?

What can I do to feel better?

Things to consider

When to see a doctor

Questions to ask your doctor

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