‘One ingredient of a happy birth is good antenatal care, so that you are confident that you are healthy and the baby starts life under the best possible conditions. But the care you give yourself is probably more important than the care you receive from professionals.’
— Sheila Kitzinger
Prenatal care, as defined by Wikipedia, is preventive healthcare with the goal of providing regular check-ups that allow doctors to treat and prevent potential health problems in pregnancy while promoting a healthy lifestyle that benefits both mother and child.
Mommy Shares:
The amount of advice the world has for pregnant women, it’s unlimited and bizarre! Vegetable vendors have told me not to buy one vegetable and to buy another. In office, if I so much as ventured to the coffee machine to talk to a colleague, someone would remark that I stay off the beverage. Suddenly, neighbours, in-laws and acquaintances all have something to suggest. It can get so overwhelming.
Being informed cannot be much help unless one is informed correctly. It is here that organized prenatal care pitches in and comes as a lifesaver, especially for first-timers. Stay calm, for pregnancy is a natural biological process like any other, highly evolved to take care of itself. Out of love or courtesy, you can choose to listen to everyone but whatever you follow, there is no need to compromise on reason, comfort or instinct.
A closely monitored prenatal care regime improves the chances of a healthy pregnancy, smooth delivery and healthy baby. It effectively reduces many risks related to nutrition and the overall health and safety of the mother and child before and during childbirth.
The amount of care you need depends on many factors like your overall health, age, weight, blood pressure, blood glucose, family history, genetic risk factors, mental health and whether you are carrying one or more children. Certain factors, such as gestational diabetes, or being over the age of 35 call for a more closely monitored pregnancy.
The critical areas to consider in creating a healthy pregnancy experience for you and your baby are:
Relationship with Gynaecologist
Your gynaecologist is going to see you through the joys and discomforts of your pregnancy, and will oversee your delivery or make alternative arrangements. Your relationship with her/him shall have an unmistakable impact on your pregnancy experience. To get the most out of your visits, telephonic consultations and interactions, aim to have an open relationship with your doctor/s. Be professional and respect the doctor’s time. Plan your questions before the visit. It is also a good idea to keep your health insurance details handy, if you have any.
Timely detection of any issue that may occur during the course of the pregnancy is the next best thing to prevention, and regular prenatal appointments can help immensely. This is also the time to seek answers or medical advice for any questions that may be bothering you.
Although this can vary, if you’re healthy and there are no complicating risk factors, most health care providers schedule visits:
During these appointments, your health care provider will check your weight and blood pressure along with the growth and development of your baby (by feeling your abdomen, listening for the foetal heartbeat, checking your updated ultrasound, etc). During the span of your pregnancy, there will be blood and urine tests, a cervical examination at least a few times and at least two ultrasounds.
The First Visit
As soon as you discover that you’re pregnant, schedule your first prenatal appointment. Make a list of the items you want to discuss. It is important to take your spouse for the appointment as well.
The first examination and consultation is expected to be thorough. The health care provider might enquire about various aspects of your life like profession, family life, financial status, health insurance, lifestyle, smoking or drinking tendencies, etc. You will be asked questions about your and your partner’s medical history along with the family’s. If this is not the first pregnancy, details of the earlier instances are made note of. Your physical exam can include your height, weight, blood pressure, breathing, pulse, cervical exam, and/or an ultrasound.
Due Date
Most women do not give birth on their due dates. However, estimating a due date is important to ascertain if your pregnancy is progressing well.
The due date is usually counted by adding 40 weeks to the start of your last period. If your periods are irregular, your doctor may use an ultrasound to understand gestational age and arrive at a due date.
Lab Tests
At your first prenatal visit, blood tests might be done to check:
In addition, a urine test may also be done to:
Doctor Says:
While ultrasounds are fairly routine, some other prenatal tests done on the foetus are amniocentesis, quad screen, chorionic villus sampling, group B strep screening, etc.
Conditions like anaemia, Rh factor incompatibility, and certain infections like hepatitis B, HIV, syphilis, chlamydia and toxoplasmosis, may require advanced screening to work out a safe course of intervention for the mother and child.
— Dr Manju Subberwal, HOD at G.B. Pant Hospital, Maulana Azad Medical College, New Delhi
Healthy Weight Gain During Pregnancy
Many women are concerned about weight gain during pregnancy; some wonder if they will ever get back to their pre-pregnancy size and others feel that they may not have gained enough. During pregnancy, women gain about 15 to 20 pounds (approx. 7-9kg) in fluids alone, as a result of the extra water, blood and amniotic fluid carried by the body.
Gaining the necessary amount of weight in pregnancy is essential for the health of the mother and child. In many developing countries, most children are born at lower than average birth weight. Low birth weight implies low immunity and such babies need more support and intervention to live a healthy life.
If you are active and eating a well-balanced diet, this is the best time to let the body’s intrinsic intelligence take over and not be too finicky about the weight. A stricter monitoring of weight is warranted only if you are underweight or overweight prior to the pregnancy.
What is equally important is that women do have personal health goals for themselves even as they allow themselves and their bodies enough time to rest and recuperate and/or establish their breastfeeding patterns. One or more pregnancies are no reason to lose one’s fitness and shape forever, especially in today’s world that has much more awareness and enablers pertaining to health.
If you have gained more weight than recommended, do not try to lose the weight during pregnancy. It is not safe to lose weight during pregnancy as the demands of weight loss can put pressure on your or the baby’s health. However, you may aim for a slower rate of weight gain.
Prenatal Ultrasounds
An ultrasound, also called a sonogram, allows a health care provider to see a live image and take pictures of the embryo or foetus by projecting sound waves into your uterus. The picture is enough to give a fair idea of the physical body of the developing baby. Sound waves are safer compared to any other kind of radiation. Depending on when it is done during pregnancy, it may:
Ultrasounds are considered relatively safe, and have been used for over 35 years for monitoring pregnancies. Pregnant women are advised to stay clear of exposure to any kind of artificially projected radiation including X-rays.
How an Ultrasound Is Done
Ultrasounds may be performed by your doctor or by a trained technician or radiologist.
Prenatal ultrasounds of multiple pregnancies need to be done more regularly than that of a single foetus to assure the healthy development of all the children carried by the mother.
Doctor Says:
In an early pregnancy, a vaginal ultrasound is preferred for diagnosis as the baby is too small to be seen through the abdominal wall. It is also to confirm that the foetus is placed normally inside the uterus and not outside in the fallopian tubes which is an anomaly called ectopic pregnancy.
Ultrasounds are completely safe and are not to be seen as a risk even when done regularly for any reasons. The number of scans conducted varies from woman to woman. At least four scans are recommended as part of routine pregnancy care—first at 6 weeks to confirm an intra-uterine pregnancy, the second at 12 weeks to rule out Down’s syndrome, the third at 19 weeks which is basically an anomaly scan to see that the baby has formed normally and fourth before delivery to judge foetal weight, orientation and other parameters for delivery.
A 3-D ultrasound can show you the face of your baby and is very helpful to form an emotional connect with the parents. A 4-D ultrasound can show the baby yawning or sucking her/his thumb which makes for a lifelong precious memory for the parents. These interventions where the baby is seen for the first time in reality can make two individuals come together and become one unit—parents.
— Dr Geetanjali Nanda, Consultant Radiologist, Mahajan Imaging, New Delhi
Prenatal Sex Determination
An ultrasound allows for the determination of the sex of the unborn child in the second trimester and onwards. In many countries, the parents have a choice whether they would like to know the sex of the child so that they may prepare themselves and their environment to receive the child.
However, in India, to counter selective abortion of the girl foetuses, the law bans prenatal sex determination.
Lifestyle Do’s and Don’ts
When you’re pregnant, what you don’t put into your body (or expose your body to) is almost as important as what you do.
Some ideas to consider:
Research Suggests:
Travel During Pregnancy
Clothing in Pregnancy
As long as pregnant women are comfortable in their clothing and it’s not too restrictive or tight, it does not hamper the development of the baby.
Footwear in Pregnancy
Hair Treatments in Pregnancy
Prenatal Skin Care
Hormonal changes during pregnancy can cause various changes to a woman’s skin. Most women sail through pregnancy with good skin and minimal complaints. Your skincare regime should be continued through the pregnancy and afterwards. If you are experiencing specific skin concerns like oiliness, pigmentation or darkening, you can seek medication, but ensure that all medication, even topical (meant to be applied on the skin externally) is approved by your doctor for use.
Doctor Says:
Skin and hair cleaning – Clean your face with a mild cleanser twice a day. Pay close attention to cleaning along the hair and jaw lines where pores could be clogged.
Avoid sun and use sunblock –Try to avoid exposure during peak sunny hours and cover up the sun-exposed areas whenever you go out. Use a sunblock cream with at least SPF30+ and apply it about 30 minutes before sun exposure. You need to reapply every 3 to 4 hours if exposure continues.
Red, itchy skin – Product that contains chamomile and cucumber can make red, itchy skin cool and calm. Dip cotton in milk and apply it on the itchy regions of the body.
Acne – Clean face twice daily with a mild, fragrance-free cleanser. Avoid exfoliates and scrubs. Use oil-free or non-comedogenic cosmetics. Avoid salicylic acid, retinoids and benzoyl peroxide containing products. You can try products with AHA and Azelaic Acid.
— Dr (Mrs) Sudhanshu Gauri, Sr. Consultant, Dermatologist at Kaya Skin Clinic
Women also develop a dark vertical line down the middle of their abdomen, called ‘linea nigra’. It is caused naturally by the hormones made by the placenta. It lightens and disappears slowly after giving birth.
The skin of the abdomen sustains an enormous amount of growth or stretching, making it prone to itching in the later stages of pregnancy and stretch marks after delivery. A daily moisturizing regime can reduce itching and soothe marks. Use natural oils like sesame, cocoa butter or aloe vera gel, or a prescribed ointment.
Prenatal Dental Care
If there is a pending procedure related to the teeth, and you have the opportunity to plan your pregnancy, it is advised to finish it before you get pregnant.
Sometimes, hormonal changes caused by pregnancy can make a woman more susceptible to gum-related diseases. Hence, any dental problems developed during pregnancy should be consulted for.
Doctor Says:
Comprehensive prenatal healthcare should include an assessment of oral health. Common oro-dental problems during pregnancy are acid erosion of dental enamel, dental caries, pregnancy gingivitis and pregnancy oral tumour.
Most of these problems are treated by reducing oral acid exposure through dietary and lifestyle changes, good oral hygiene including tooth brushing and flossing and the use of antiemetic, antacids, or both.
— Dr Major Meenaxe Bansal Kamat, Founder at Me Panacea Dental Clinic, Gurgaon
Environmental Do’s and Don’ts
Summing Up: