Prenatal Care

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What is preconception care?

While about half of pregnancies in the U.S. are unplanned, this does not make preconception care any less important. Ideally, women thinking about getting pregnant should meet with a health professional at least three months prior to conception to discuss their current health and to gain a better understanding of what to expect from the pregnancy. Topics for discussion should include:

• Family planning and birth control
• Nutrition and exercise
• Vaccines and disease screenings
• Management of any existing health problems
• Medication
• Personal and family health history

What if I don’t have insurance?

There are several state and federal programs to help with the financial strain of a pregnancy. If you don’t have insurance, visit your local Department of Human Services to learn about the Medicaid options in your state. This comprehensive program covers women from prenatal care through delivery. The Affordable Care Act has added benefits for women who are pregnant, so check the federal health coverage website, Healthcare.gov, to learn about your eligibility.

Contact your local health department to learn about Title X Family Planning Programs in your area. These offices offer preconception health and reproductive life planning services to uninsured families. Planned Parenthood is also an excellent resource for pre-pregnancy counseling. They offer sliding scale payment options for uninsured patients, based on family size and household income.

Who are the prenatal care professionals I should turn to?

We’ve identified three types of primary care professionals who can help you plan for an upcoming pregnancy and guide you through the delivery process.

Obstetrician/Gynecologist: Trained to manage pregnancies, from planning to puerperium, OB/GYNs serve as primary physician for most pregnant women. They provide expectant mothers with the necessary prenatal care (blood tests, vitamins, ultrasounds) to ensure a healthy gestation and delivery. They screen a mother-to-be for possible complications with herself and her child, and they provide women with delivery options based on the health of the mother and child. They also remain in contact with new mothers directly after birth to ensure everyone is well.

Family Practice Doctor: Planning for a baby or preparing for a healthy birth can be stressful. Having a doctor you trust there to guide you through pre-pregnancy to pediatric care can ease these fears. Your family practice doctor can:

• Counsel you on the best nutrition for you and the baby
• Explain what to expect during each stage of pregnancy
• Help you plan when and where you will deliver
• Be there with you in the delivery room
• Advise you on caring for your infant once he or she is born.

Midwife (CNM, CPM, LM): Mothers-to-be who wish to take a more natural approach to their pregnancy often seek out CNMs. These professionals are trained to oversee low-risk births, using minimally invasive medical techniques during pregnancy and delivery. They take a “watchful waiting” approach, allowing pregnancies and births to progress without the use or aid of drugs, unless they foresee potential health problems. They work closely with mothers-to-be to determine the best course of action for delivery, and they ensure those needs are met, regardless of whether the birth takes place in the home, a birthing center, or a hospital.

Certified Nurse-Midwives receive their certification through the American College of Nurse-Midwives (ACNM), Certified Professional Midwives are certified through the North American Registry of Midwives (NARM). The title of Licensed Midwife is awarded by each state in which a midwife practices; it is a license to practice, not a certificate of education. CPMs differ from CNMs in that they did not attend nursing school prior to becoming a nurse, where CNMs begin as nurses and are then trained as midwives.

What should I ask my doctor?

There are a number of environmental and physical factors that can influence your pregnancy. When you visit a primary care professional, make sure to ask them about the effects of health variables like:

• Your family’s medical history
• Previous reproductive complications
• Previous surgeries

Substances that enter your body can significantly affect the health of you and your child, so ask your doctor about:

• Medication safety
• Substance abuse quitting programs
• Prenatal nutrition

You should also learn about potential risk factors in your environment, such as harmful toxins to avoid at home and work. Womenshealth.gov provides a list of questions to ask your doctor during your pre-conception checkup.