The beginnings of prenatal care

You are having your baby at a time when more is known than ever before about pregnancy, childbirth, and infant care. This increasing knowledge is changing some of our older ideas about prenatal care and proving the values of others.

Prenatal care, as we know it today, begins even before conception. All the good health habits you have learned while you were growing up have helped to prepare you for the experience of having a baby. Your good health, now, is insurance for you and your child.

It is wise to see your doctor for a general health examination before you become pregnant. This gives him information about you and your health that he can use to great advantage when your pregnancy begins. He will certainly want you to come to him as soon as you are reasonably sure that conception has taken place.

There is no way of telling exactly when conception does occur but there are some early signs of pregnancy. You will recognize these if you have had a baby before. The first of these is usually the absence of a regular menstrual period, although this is not always a sure sign. Menstruation can be delayed for other reasons. Some pregnant women even have a small flow at the regular time during the first three or four months.

When a baby has actually started to develop, he soon manages to make his presence known. You may be sleepier than usual. Your breasts may begin to enlarge and become tender. You may need to urinate more often. You may be slightly nauseated in the morning or even later in the day, especially if tired or upset.

If you have skipped a period and have any of these other symptoms, it is important for you to see a doctor. Whoever takes care of you will need as much time as he can have, before the baby comes, to get to know you, and to work out with you a plan for your care that will meet your own personal needs and your particular family situation.

There are special laboratory tests for pregnancy, as you may have heard. If your doctor thinks it is advisable for you to have one of them, he will make the arrangements for you. Most people do not bother with these unless there is an urgent reason for an early diagnosis.

Arranging for medical supervision

Once you are sure that you are pregnant, you will naturally begin to make plans. Wherever you live, however you live, whatever your income may be, there are things you can do, and services you can use to safeguard your health and your baby's.

Since prenatal medical supervision is the key to successful childbearing, your first step should be to arrange for this. It is given by private physicians, and by doctors in hospital clinics, public health centers, and private health organizations. If you have a tight budget, try to find out what maternity care is available in your community, at a price you can afford. You can get this information from your health department or from a local hospital.

If there is a public health nurse in your town or county, she may be your chief adviser, especially if you are getting your prenatal care through a public health clinic. She will be able to tell you about health and welfare services for which you may be eligible, and to make other suggestions that may help you solve any problems you may have.

If you have a family doctor, your prenatal care has already begun. Through the health care he has been giving you, he has already contributed a great deal to the success of your pregnancy. Physicians in general practice have included obstetrics (maternity care) in their training. Your regular doctor will decide whether to refer you to an obstetrician or look after you himself. Later, you may want him to take care of your baby. Or, he and your obstetrician may prefer to help you select a pediatrician. Whatever the arrangement, make it early, so that a physician can help you in planning for the care of the baby and will be ready to begin your child's medical supervision as soon as he is born.

Perhaps you are a newcomer in your community. Friends may be able to recommend a doctor, but it is wise to have professional advice about this, too. Call the office of your local medical society or ask at the nearest hospital, public health center, social service agency, or nursing organization for the names of two or three good family doctors in your neighborhood. At the same time, you might also ask about obstetricians.

Your first examinations

When you have chosen a doctor, go to him as soon as you can for your first examination as an expectant mother. It is highly desirable for your husband to go with you if he can. Whether you go to a private doctor or to a public clinic for this, you will need to make an appointment in advance. When you call for this, ask if the first visit will be long or short. It is always well to be prepared for a longer absence from home than you expect. One appointment may include a number of different examinations which may take, altogether, several hours. If you have small children try to leave them at home or with relatives or friends. When you have to take a little child with you, take along a storybook or one of his favorite small toys. Find out whether there is a snack bar or cafeteria where you can buy sandwiches, milk or juice. If not, bring some light refreshment with you. Children become irritable when they are hungry and tired, and so do their mothers.

Wherever your first examination takes place, about the same things will happen. Someone in the doctor's office will begin your record by making out a card with your name, address, telephone number, age and place of birth; the name, age, birthplace, occupation and business address of the baby's father; the names and ages of any other children you may have. When the doctor, himself, sees you for the first time, he will probably go more fully into your own history and your family history. He will be particularly interested in any previous pregnancies, including any miscarriages you may have had. He will ask about your menstruation: how old you were when it began, how regular it is, and whether or not it gives you any trouble. He will also want to know about previous illnesses, or serious accidents. If you have family problems, tell him about these. He needs all the information he can get about you in order to help you with real understanding.

After this history has been taken, you will be shown into a dressing room or into the doctor's examining room and left to undress. The nurse will give you a sheet or robe to wrap around you. You may have been told in advance to bring a sample of urine. If not, you will now be asked to urinate into a container which the nurse will give you. This specimen can give the doctor valuable information about your health and he will have it analyzed as soon as possible. This test will be repeated at regular intervals until after your baby is born.

Your first examination is likely to be very thorough. You will be weighed and your height will be measured. The doctor will take your blood pressure, test your reflexes, note the color and texture of your skin. He will check your eyes, ears, nose, throat, and teeth for any signs of conditions that may need attention. He will examine your breasts to see if they are tender, or if there is any secretion from the nipples. He will thump your chest, listen to your heart and lungs with a stethoscope, and examine your abdomen.

Next comes the internal or pelvic examination. Try to relax completely for this. Breathing through your mouth will help. The doctor places a tube-like instrument (speculum) in the vagina, the passageway to the uterus. This opens the vagina a little so that, with a light, the doctor can see the mouth of the uterus (cervix). During this examination, he may wipe off the lip of the cervix with a cotton-tipped swab. This will give him a few cells to have tested to rule out the possibility of cancer.

After removing the speculum, the doctor then puts two gloved fingers into the vagina and his other hand on top of your abdomen. In this way, he can feel the uterus and learn about its size, shape, and position. This and the other tests he makes will give him a good idea of how far along your pregnancy is.

While he is making this internal examination, your doctor may take certain measurements to determine the size of your birth canal. These measurements may be postponed until a later visit but they are always made sometime during a pregnancy. Later on, the doctor may want to use X-rays to make sure that the bony structure of the birth canal is large enough for a normal birth.

Doctors know that in the very early months of development, a baby is more sensitive to X-rays than he will be later. They, therefore, make it a general rule to X-ray the abdomen only when it is important to have information that can be obtained in no other way. This is why an abdominal X-ray is usually postponed until the latter part of pregnancy.

X-rays of the chest, head, legs or arms can do no harm to even an early pregnancy, when carefully carried out. From the time you first suspect that you are going to have a baby, be sure to tell any doctor who advises an X-ray for you that you are or may be pregnant. He can then decide whether or not to go ahead with the X-ray at that time.

Early in your pregnancy, perhaps during your first visit to your physician, a little blood will be taken from one of your arm veins with a needle. This blood will be used for several tests: one for anemia, one for syphilis, one to find out what your blood type is and to check for the Rh factor.

When these examinations are over, the doctor or the nurse will want to talk with you about the general care of your health during your pregnancy: your food, your rest and sleep, your weight, the care of your teeth, your clothing, your work, exercise and recreation. This will be a good time for you and your husband to bring up such questions as: Should we have marital relations during the pregnancy? When will the baby be born? Where? What will the charges be, and for what services?

Marital relations

Without much evidence to support it, there is a rather widespread belief that intercourse during the times when you would have had your second and third menstrual periods following conception may make a miscarriage more likely. Although this may not be true, it does no harm to be on the extra-safe side. Your doctor may, therefore, advise you not to have marital relations during those days. He may, also, recommend that, about two months before the baby is due, you stop having marital relations altogether. This is a wise precaution because there is a possibility that germs always present on the skin may be carried up to the uterus during intercourse.

The due date

When will your baby be born? In the human being, the average time from conception to birth is about 266 days. Since it is so nearly impossible to know when conception has occurred, doctors have had to find a way of estimating the due date that does not depend on this. Relying on the fact that most babies are born about 280 days after the beginning of the mother's last normal menstrual period, they usually count back 3 months from the first day of the last normal menstruation and add 7 days. For example, if your last period started on June 10, your baby will arrive about March 17, according to this formula. Only about 1 in 12 babies arrives exactly on the day indicated, so don't be alarmed if your labor begins one or two weeks earlier or later than you think it should.

Hospital arrangements

Where will your baby be born? At a first appointment, the doctor or the nurse may not have much time to tell you about hospital arrangements. If you are a patient at a hospital clinic, you will probably be having your baby in this hospital. A private physician may be able to give you a choice of several hospitals. Make an early selection, if you have a choice, so that you will have plenty of time to become familiar with the hospital where you will be, and its requirements. See page 58 for information about hospitals and the provisions they usually make for maternity care.

Medical fees for maternity care

You will want to ask your doctor not only what his total charge will be, but what this includes. Is he giving you a flat figure that covers everything, or will there be separate charges for laboratory tests, X-rays if these are needed, drugs, the services of an anesthetist?

Be frank with your physician. If you find you have come to a doctor you cannot afford, ask to be put in touch with services you can afford. This does not mean that your care will be inferior. It does mean that you will not be worrying about how your bills are going to be paid. Above all, don't stay away from a doctor you want just because you have heard that he is expensive. Many physicians adjust their fees to their patients' incomes.

Natural childbirth

Many women are interested in an approach to childbearing called natural childbirth. This is a name given to a special kind of maternity care which originated in England some time ago. You may be one of the mothers who has previously had a child by this plan. On the other hand, you may have heard just enough about it to want more information. Your doctor will be glad to tell you whatever you wish to know.

Briefly, it is a program of education, exercise, and training which prepares a woman, mentally and physically, for active and conscious cooperation with the processes of birth during labor and delivery. Under the supervision of doctors and nurses especially trained to help her do this, an expectant mother learns how to relax and work in harmony with the forces that bring her baby out of her body into the world. Because she receives little or no medication, there is little or no anesthesia in her system for her baby to absorb.

Every doctor who delivers a baby wants the birth to be as natural and satisfying an experience for the mother as possible. What is "natural" for one person, however, may not be for another. Your doctor will try to work out, with you, a way of handling your pregnancy, labor, and delivery that will seem right to both of you. If he wants you to take certain exercises, he will show you how to do them, or refer you to a class where they are taught by a nurse with special training for giving this instruction. He may also suggest that you join a group or class for expectant parents sponsored by your hospital, a public health agency, the American Red Cross, a nursing association or some other medically approved agency.

Other appointments

Arrangements will be made for later visits at the time of your first appointment with your doctor. Ordinarily, he will want to see you once a month through the first six months, and more often after that.

Make every effort to keep all of your appointments. Every one is important. Each time you see him, your doctor will want to check on your weight and your blood pressure, examine your abdomen to see how much the baby has grown and what his position is, listen for the fetal heart sounds and test your urine. From time to time, he may wish to have other tests made. The information he gets from these repeated examinations will be the basis for the decisions he makes with you and the guidance he gives you throughout your pregnancy.

Plan for your family

A new baby can be a happy event in a family. This is especially true if the baby is wanted and planned. Now that you are expecting a baby, you and your husband talk over how many other babies you want and when you want them.

When you plan your family, both you and your husband can be happier because you two won't be worrying about having another baby until you are ready.

There are many ways to be sure you will have your babies only when you want them. Your doctor will help you find a way that best suits both you and your husband.

Marcus Siegel

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