Prenatal care
Encyclopedia
Pregnancy
Pregnancy refers to the fertilization and development of one or more offspring, known as a fetus or embryo, in a woman's uterus. In a pregnancy, there can be multiple gestations, as in the case of twins or triplets...
. The aim of good prenatal care is to detect any potential problems early, to prevent them if possible (through recommendations on adequate nutrition, exercise, vitamin intake etc.), and to direct the woman to appropriate specialists, hospitals, etc. if necessary. The availability of routine prenatal care has played a part in reducing maternal death
Maternal death
Maternal death, or maternal mortality, also "obstetrical death" is the death of a woman during or shortly after a pregnancy. In 2010, researchers from the University of Washington and the University of Queensland in Brisbane, Australia, estimated global maternal mortality in 2008 at 342,900 , of...
rates and miscarriage
Miscarriage
Miscarriage or spontaneous abortion is the spontaneous end of a pregnancy at a stage where the embryo or fetus is incapable of surviving independently, generally defined in humans at prior to 20 weeks of gestation...
s as well as birth defects, low birth weight
Low birth weight
Low birth weight is defined as a birth weight of a liveborn infant of less than 2,500 g. regardless of gestational age-Causes:LBW is either the result of preterm birth or of the infant being small for gestational age , or a combination of...
, and other preventable infant problems. Animal studies indicate that mothers' (and possibly fathers') diet, vitamin intake, and glucose levels prior to ovulation and conception have long-term effects on fetal growth and adolescent and adult disease.
While availability of prenatal care has considerable personal health and social benefits, socioeconomic problems prevent its universal adoption in many developed as well as developing nations.
One prenatal practice is for the expecting mother to consume vitamins
Prenatal vitamins
Prenatal vitamins are vitamin supplements intended to be taken before and during pregnancy and during postnatal lactation. Although not intended to replace a healthy diet, prenatal vitamins provide women of child bearing age with nutrients recognized by the various health organizations including...
with at least 400 mcg of folic acid
Folic acid
Folic acid and folate , as well as pteroyl-L-glutamic acid, pteroyl-L-glutamate, and pteroylmonoglutamic acid are forms of the water-soluble vitamin B9...
to help prevent neural tube defects.
Prenatal care generally consists of:
- monthly visits during the first two trimesters (from week 1–28)
- biweekly from 28 to week 36 of pregnancy
- weekly after week 36 (delivery at week 38–40)
- Assessment of parental needs and family dynamic
Physical examination
Physical examinations generally consist of:- Collection of (mother's) medical historyMedical historyThe medical history or anamnesis of a patient is information gained by a physician by asking specific questions, either of the patient or of other people who know the person and can give suitable information , with the aim of obtaining information useful in formulating a diagnosis and providing...
- Checking (mother's) blood pressureBlood pressureBlood pressure is the pressure exerted by circulating blood upon the walls of blood vessels, and is one of the principal vital signs. When used without further specification, "blood pressure" usually refers to the arterial pressure of the systemic circulation. During each heartbeat, BP varies...
- (Mother's) height and weight
- Pelvic exam
- Doppler fetal heart rate monitoring
- (Mother's) bloodBlood testA blood test is a laboratory analysis performed on a blood sample that is usually extracted from a vein in the arm using a needle, or via fingerprick....
and urine tests - Discussion with caregiver
Ultrasound
Obstetric ultrasoundObstetric ultrasonography
Obstetric sonography is the application of medical ultrasonography to obstetrics, in which sonography is used to visualize the embryo or foetus in its mother's uterus...
s are most commonly performed during the second trimester at approximately week 20. Ultrasounds are considered relatively safe and have been used for over 35 years for monitoring pregnancy.
Among other things, ultrasounds are used to:
- Diagnose pregnancy (uncommon)
- Check for multiple fetuses
- Assess possible risks to the mother (e.g., miscarriageMiscarriageMiscarriage or spontaneous abortion is the spontaneous end of a pregnancy at a stage where the embryo or fetus is incapable of surviving independently, generally defined in humans at prior to 20 weeks of gestation...
, blighted ovum, ectopic pregnancyEctopic pregnancyAn ectopic pregnancy, or eccysis , is a complication of pregnancy in which the embryo implants outside the uterine cavity. With rare exceptions, ectopic pregnancies are not viable. Furthermore, they are dangerous for the parent, since internal haemorrhage is a life threatening complication...
, or a molar pregnancy condition) - Check for fetal malformation (e.g., club footClub footA club foot, or congenital talipes equinovarus , is a congenital deformity involving one foot or both. The affected foot appears rotated internally at the ankle. TEV is classified into 2 groups: Postural TEV or Structural TEV....
, spina bifidaSpina bifidaSpina bifida is a developmental congenital disorder caused by the incomplete closing of the embryonic neural tube. Some vertebrae overlying the spinal cord are not fully formed and remain unfused and open. If the opening is large enough, this allows a portion of the spinal cord to protrude through...
, cleft palate, clenched fists) - Determine if an intrauterine growth retardation condition exists
- Note the development of fetal body parts (e.g., heartHeartThe heart is a myogenic muscular organ found in all animals with a circulatory system , that is responsible for pumping blood throughout the blood vessels by repeated, rhythmic contractions...
, brainBrainThe brain is the center of the nervous system in all vertebrate and most invertebrate animals—only a few primitive invertebrates such as sponges, jellyfish, sea squirts and starfishes do not have one. It is located in the head, usually close to primary sensory apparatus such as vision, hearing,...
, liverLiverThe liver is a vital organ present in vertebrates and some other animals. It has a wide range of functions, including detoxification, protein synthesis, and production of biochemicals necessary for digestion...
, stomachStomachThe stomach is a muscular, hollow, dilated part of the alimentary canal which functions as an important organ of the digestive tract in some animals, including vertebrates, echinoderms, insects , and molluscs. It is involved in the second phase of digestion, following mastication .The stomach is...
, skullHuman skullThe human skull is a bony structure, skeleton, that is in the human head and which supports the structures of the face and forms a cavity for the brain.In humans, the adult skull is normally made up of 22 bones...
, other boneBoneBones are rigid organs that constitute part of the endoskeleton of vertebrates. They support, and protect the various organs of the body, produce red and white blood cells and store minerals. Bone tissue is a type of dense connective tissue...
s) - Check the amniotic fluidAmniotic fluidAmniotic fluid or liquor amnii is the nourishing and protecting liquid contained by the amniotic sac of a pregnant woman.- Development of amniotic fluid :...
and umbilical cordUmbilical cordIn placental mammals, the umbilical cord is the connecting cord from the developing embryo or fetus to the placenta...
for possible problems - Determine due date (based on measurements and relative developmental progress)
Generally an ultrasound is ordered whenever an abnormality is suspected or along a schedule similar to the following:
- 7 weeks — confirm pregnancy, ensure that it's neither molar or ectopic, determine due date
- 13–14 weeks (some areas) — evaluate the possibility of Down SyndromeDown syndromeDown syndrome, or Down's syndrome, trisomy 21, is a chromosomal condition caused by the presence of all or part of an extra 21st chromosome. It is named after John Langdon Down, the British physician who described the syndrome in 1866. The condition was clinically described earlier in the 19th...
- 18–20 weeks — see the expanded list above
- 34 weeks (some areas) — evaluate size, verify placental position
Prenatal Care and Race in the USA
Many health professionals consider prenatal care a nearly essential practice for pregnant women; however, there are wide gaps in the American population regarding who has access to these services and who actually utilizes these services. For example, African-American expectant mothers are 2.8 times as likely as non-Hispanic white mothers to begin their prenatal care in the third trimester, or to receive no prenatal care during the entirety of the pregnancy. Similarly, Hispanic expectant mothers are 2.5 times as likely as non-Hispanic white mothers to begin their prenatal care in the third trimester, or to receive no prenatal care at all. The following factors impact a woman’s likelihood of acquiring prenatal care:- Health InsuranceHealth insuranceHealth insurance is insurance against the risk of incurring medical expenses among individuals. By estimating the overall risk of health care expenses among a targeted group, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to ensure that money is...
: 13% of women who become pregnant every year in the United States are uninsured, resulting in severely limited access to prenatal care. According to Children’s Defense Fund’s website, “Almost one in every four pregnant Black women and more than one in three pregnant Latina women is uninsured, compared with one in nearly seven pregnant White women. Without coverage, Black and Latina mothers are less likely to access or afford prenatal care.” Currently, pregnancy is considered a “pre-existing conditionPre-existing conditionA pre-existing condition is a risk with extant causes that is not readily compensated by standard, affordable insurance premiums. Pre-existing condition exclusions by the insurance industry are meant to cope with adverse selection by potential customers. Such exclusions have become a topic in the...
,” making it much harder for uninsured pregnant women to actually be able to afford private health insurance.
- Formal Education: Oftentimes, Black and Hispanic pregnant women have fewer years of formal education, which sparks a large domino effect of consequences related to prenatal care. A lack of formal education results in less knowledge about pregnancy appropriate prenatal healthcare as a whole, fewer job opportunities, and a lower level of income throughout their adult life.
- Trust & Comfort with Healthcare Industry: Many minority women have limited experience with the healthcare industry on a whole, as compared to their Caucasian counterparts. Consequently, there is a lower level of trust with physicians, nurses, and the entire care regimen. Many women who are distrustful of biomedicine will decline certain prenatal tests, citing their own bodily knowledge as more trustworthy than their doctor’s high-tech interpretations. Even worse, some minority women may opt to avoid the distress and discomfort of the medical industry and refuse prenatal care entirely.
- Understanding of Prenatal Testing: Many ethnic/racial minority mothers are referred to genetic counseling and prenatal testing centers after being declared “at-risk” for birth defects after initial screenings. However, few testing centers effectively communicate what occurs during the various tests, what the test is looking for, or what the various results could mean for the remainder of the pregnancy. Therefore, some mothers are quite uncomfortable with this lack of clearly communicated information and are consequently hesitant to pursue prenatal testing and counseling that health professionals would consider recommendable.
Consequences of Minorities’ Limited Access to Prenatal Care
Without timely, thorough, and appropriate prenatal care, the racial minorities of the United States continue to face severe consequences for the birth outcome of both infant and mother.- Delivery Complications: In one study, researchers found that all minority races experienced higher rates of complications such as: intrauterine growth restrictionIntrauterine growth restrictionIntrauterine growth restriction refers to poor growth of a baby while in the mother's womb during pregnancy. The causes can be many, but most often involve poor maternal nutrition or lack of adequate oxygen supply to the fetus....
, preeclampsia, preterm premature rupture of membranes, gestational diabetesGestational diabetesGestational diabetes is a condition in which women without previously diagnosed diabetes exhibit high blood glucose levels during pregnancy . It is widely accepted as a disease only in the United States, there is some question whether the condition is natural during pregnancy...
, placenta previa, and preterm birth.
- Low Birth WeightLow Birth WeightLow Birth Weight is the third album by Piano Magic.- Track listing :# Snowfall Soon 5:01# Crown Estate 4:33# Bad Patient 4:59# The Fun of the Century 5:01# Birdymachine 1:25# Not Fair 4:12...
: Black infants are almost twice as likely to be born at a low birth weight as White babies. This birth complication is ranked as the most prevalent cause of death among African American infants, claiming 1780 lives in 2005.
- Congenital Malformations: Any genetic factor or prenatal event that adversely affects the development of the fetus in utero can result in a congenital malformation. Some commonly known congenital malformations are cleft palate, heart defects, and Down syndromeDown syndromeDown syndrome, or Down's syndrome, trisomy 21, is a chromosomal condition caused by the presence of all or part of an extra 21st chromosome. It is named after John Langdon Down, the British physician who described the syndrome in 1866. The condition was clinically described earlier in the 19th...
. As of 2005, congenital malformations are the leading cause of death among Hispanic infants, claiming 1373 lives.
- Infant MortalityInfant mortalityInfant mortality is defined as the number of infant deaths per 1000 live births. Traditionally, the most common cause worldwide was dehydration from diarrhea. However, the spreading information about Oral Re-hydration Solution to mothers around the world has decreased the rate of children dying...
: In the United States, the non-Hispanic white population experiences an infant mortality rate of 5.8 deaths per every 1000 live births. The African-American population’s infant mortality rate is 2.3 times greater (13.6 deaths per 1000 live births).
- Impact of Prenatal Care on Birth Outcomes: When women utilize prenatal care appropriately, many of them increase their chances of having a successful birth outcome. For example, prenatal care includes discussions with physicians about what lifestyle changes should be made during pregnancy (such as tobacco or alcohol cessation); if these changes do not occur, the pregnancy is more likely to be problematic or result in an infant with a defect or prone to early mortality. Additionally, doctors can provide prescriptions for specific prenatal vitaminsPrenatal vitaminsPrenatal vitamins are vitamin supplements intended to be taken before and during pregnancy and during postnatal lactation. Although not intended to replace a healthy diet, prenatal vitamins provide women of child bearing age with nutrients recognized by the various health organizations including...
and supplements to ensure a healthy mother and infant. Finally, specific prenatal tests screen for genetic abnormalities, and expectant mothers can learn if their fetuses have any significant defects prior to delivery; in these situations, physicians and genetic counselors can help advise mothers about their options for continuing the pregnancy. While some poor birth outcomes cannot be entirely avoided through prenatal care, the pregnant woman can receive important information, advice, and guidance about her own individual situation, rather than being surprised in the delivery room with some unexpected news.
- Pregnancy and Exercise: Updated recommendations by the American College of Sports Medicine suggest at least 2-1/2 hours of moderate-intensity aerobic activity spread throughout the week for pregnant and postpartum women. Women who regularly engage in high-intensity or higher amounts of activity may continue under the counsel of their health care professional provided their condition remains unchanged. For more information on the exercise recommendations and the survey of health professionals, go to http://www.acsm.org.
Prenatal Care Improvements for Minorities
Although minorities continue to face decreased access to high-quality prenatal care, there are specific improvements the biomedical field can make to fix this disparity.- Connect physicians and patients on a cultural level: For many minority patients, it is difficult to develop a long-standing and trusting relationship with healthcare providers of different cultural backgrounds, as each culture has its own priorities, values, and goals. In traditionally underserved communities with sizeable minority populations, healthcare providers should strive to offer physicians and nurses who match the racial background of the patients they are working to serve.
- Improve all providers’ cultural awareness and sensitivity: If patients cannot be matched with healthcare providers culturally, then they should at least be able to visit a physician who is trained specifically to deal with cultural differences. This awareness and sensitivity can come in many forms, such as a familiarity with a foreign language, an understanding of how a specific ethnicity views mothers, or knowing how family networks play into the mothers’ decision-making process. All of these options have the potential to improve doctor-patient relationships, and this sort of education can be implemented in medical training programs both in medical school settings and on-site training programs.
- Community Outreach Programs: Because hospitals and doctors’ offices are unfamiliar and unwelcoming places for some individuals, the healthcare industry should establish a multifaceted community outreach program in large cities. These programs would train members of the minority population in basic health education; then these community health workers would help to facilitate connections between expectant mothers and local healthcare establishments. The community health workers could even continue their relationship throughout the duration of the pregnancy, serving as a patient liaison during the various tests, appointments, and conversations.