PRENATAL CARE

What to expect

  • At your midwife check up
  • At your doctor’s visit
  • Prenatal testing
  • High risk pregnancy

After you have discovered you are pregnant you will need to make an appointment to see a doctor/obstetrician for your first sonar. This sonar is usually done between 10 – 12 weeks of gestation and will determine that all is well with baby, how many babies you are pregnant with and how far along in your pregnancy you are.

The estimated due date (EDD) you are given around this time is the more accurate date according to sonars If you know your 1st day of last menstrual period this would also be an accurate determination of due date.

Bear in mind that the emphasis is on ESTIMATED date, not DUE date. Only 3% of babies arrive on the given date!

It is necessary to have regular check-ups throughout your pregnancy. Early detection and treatment of potentially dangerous complications in pregnancy can greatly increase your chances of a happy and healthy pregnancy, birth and baby.

Regular check-ups are usually done as follows:

  • 10 to 12 weeks with doctor for initial check-up and sonar
  • 16 weeks with midwife
  • 20 to 22 weeks with the doctor for anomaly sonar to check all is well with baby and to see the sex of baby if it is your desire
  • 26, 30, 32, 34, 36, 37, 38, 39, 40, 41 weeks with the midwife
  • We usually request you return to the back-up doctor for a last check-up around 36-37 weeks just to touch base before the birth.

WHAT TO EXPECT AT YOUR MIDWIFE CHECK-UP

Your appointment will last anything between 30 and 45 minutes.

We spend a lot of time getting to know one another and building up a comfortable trust relationship.

Physical check-up:

  • Measure uterus (fundal height)
  • Palpating position of the baby
  • Listening to foetal heart
  • Taking blood pressure and pulse
  • Testing urine (for signs of infection, glucose or protein indicating possible complications)
  • Checking for odema and weighing
  • Discussing any pregnancy related problems
  • Education is ongoing and at each consultation you will learn something new and exciting
  • Birth planning

Q&A – we are always happy to answer any questions that have been on your mind, so jot them down and bring them with.

Doing it the old fashioned way – palpating to see the position of baby. Your midwife will encourage you and your partner to feel how baby is lying.

Your midwife will use a tape measure to measure the height of our uterus. This is placed on a graph and gives us an accurate way of determining that baby is growing as he or she should be growing. This graph is used all over the world by Obstetricians and Mdiwives. If the measurement is smaller or larger than normal, you will be referred for an ultrasound to check on the wellbeing of your baby.

We listen to your baby’s heart with a foetal dopler. The normal heart rate for a baby in uterus is between 110 and 160 beats per minute. We will be using this same dopler to listen to the wellbeing of your baby when you are in labour.

Family participation is important in your pregnancy, so involve your children with the prenatal visits.

WHAT TO EXPECT AT YOUR 1st DOCTOR / OBSTETRICIAN CHECK-UP

This appointment is usually between 15 20 minutes.

  • You will have a full physical check-up, including an internal examination where the uterus is felt and a pap smear is done
  • Sonar to determine size and wellbeing of baby, due date and whether or not you are expecting twins
  • Blood pressure, pulse, urine test
  • You will be asked for a full detailed history including lifestyle, relationships and health habits.

You will also be sent for various blood tests:

  • Blood group and Rh
  • Antibodies
  • HIV (+ counseling will be done)
  • Sexually transmitted diseases
  • Rubella (to see if you have had any previous exposure to German measles)
  • Hep B
  • Haemoglobin (to check for anaemia)

Depending on your age, family history or results, you may be requested to go for other tests such as Downes Screening for Dones Syndrome, diabetes, or genetic testing, etc.

It is necessary to know if there are any underlying conditions early in pregnancy so adequate antenatal care can be given to you and your growing baby to ensure a positive outcome.

Discuss your birth wishes/plans with your doctor as early as possible in your pregnancy. If you have decided on a midwife birth, communicate this with your doctor so he/she understands what their role is as back up gynae. Find out who the back up doctor is for the midwife practice and ideally start seeing them from the beginning.

PRENATAL TESTING

The following chart from www..womenshealth.gov describes some of the prenatal tests that you may be required to have during your pregnancy.

 

Test What it is

How it is done

Amniocentesis (AM-nee-oh-sen-TEE-suhss This test van diagnose certain birth defects, including”

–       Down syndrome

–       Cystic fibrosis

–       Spina bifida

It is performed at 14 to 20 weeks.

It may be suggested for couples at higher risk for genetic disorders. It also provides DNA for paternity testing.

A thin needle is used to draw out a small amount of amniotic fluid and cells from the sac surrounding the fetus. The sample is sent to a lab for testing.
Chorionic villus (KOR-ee-ON-ihk-VIL-uhss) sampling (CVS)

 

 

 

 

 

 

 

 

 

 

 

 

 

First trimester screen

A test done at 10 to 13 weeks to diagnose certain birth defects, including:

–       Chromosomal disorders, including Down Syndrome

–       Genetic disorders, such as cystic fibrosis

CVS may be suggested for couples at higher risk for genetic disorders. I also provides DNA for paternity testing.

 

A screening test done at 11 to 14 weeks to detect higher risk of:

–       Chromosomal disorders, including Down syndrome and trisomy 18

–       Other problems, such as heart defects

It also can reveal multiple births. Based on test results, your doctor may suggest other tests to diagnose a disorder.

A needle removes a small sample of cells from the placenta to be tested.

 

 

 

 

 

 

 

 

 

 

 

 

 

This test involves both a blood test and an ultrasound exam called nuchal translucency (NOO-kuhl trans-LOO-sent-see) screening. The blood test measures the levels of certain substances in the mother’s blood. The ultrasound exam measures the thickness at the back of the baby’s neck. This information, combined with the mother’s age, help doctors determine risk to the fetus.

Glucose challenge screening A screening test done at 26 to 28 weeks to determine the mother’s risk of gestational diabetes.

Based on test results, your doctor may suggest a glucose tolerance test.

First, you consume a special sugary drink from your doctor. A blood sample is taken one hour later to look for high blood sugar levels.
Glucose tolerance test This test is done at 26 to 28 weeks to diagnose gestational diabetes. Your doctor will tell you what to eat a few days before the test. Then, you cannot eat or drink anything but sips of water for 14 hours before the test. Your blood is drawn to test your ‘fasting blood glucose level’. Then, you will consume a sugary drink. Your blood will be tested every hour for three hours to see how well your body processes sugar.
Group B streptococcus (STREP-tuh-KOK-uhss) infection.

 

 

 

Maternal serum screen (also called quad screen, triple test, triple screen, multiple marker screen, or AFP).

 

 

 

 

 

 

 

Nonstress test (NST)

 

This test is done at 36 to 37 weeks to look for bacteria that can cause pneumonia or serious infection in newborns.

 

A screening test done at 15 to 20 weeks to detect higher risk of:

–       Chromosomal disorders, including Down syndrome and trisomy 18

–       Neural tube defects, such as spina bifida

 

Based on test results, your doctor may suggest other tests to diagnose a disorder.

 

This test is performed after 28 weeks to monitor your baby’s health. It can show signs of fetal distress, such as your baby not getting enough oxygen.

A swab is used to take cells from your vagina and rectum to be tested.

 

 

 

Blood is drawn to measure the levels of certain substances in the mother’s blood.

 

 

 

 

 

 

 

 

 

 

 

 

 

A belt is placed around the mother’s belly to measure the baby’s heart rate in response to its own movements.

Ultrasound exam An ultrasound exam can be performed at any point during the pregnancy. Ultrasound exams are not routine. But it is not uncommon for women to have a standard ultrasound exam between 18 and 20 weeks to look for signs of problems with the baby’s organs and body systems and confirm the age of the fetus and proper growth. It also might be able to tell you rhe sex of your baby.

 

Ultrasound exam is also used as part of the first trimester screen and biophysical profile (BPP).

 

Based on exam results, your doctor may suggest other tests or other types of ultrasound to help detect a problem.

Ultrasound uses sound waves to create a ‘picture’ of your baby on a monitor. With a standard ultrasound, a gel is spread on your abdomen. A special tool is moved over your abdomen, which allows your doctor and you to view the baby on a monitor.
Urine test A urine sample can look for signs of health problems, such as:

–       Urinary tract infection

–       Diabetes

–       Preeclampsia

If your doctor suspects a problem, the sample might be sent to a lab for more in-depth testing.

You will collect a small sample of clean, midstream urine in a sterile plastic cup. Testing strips that look for certain substances in your urine are dipped in the sample. The sample also can be looked at under a microscope.

UNDERSTANDING PRENATAL TESTS AND TEST RESULTS

If your doctor suggests certain prenatal tests, don’t be afraid to ask lots of questions. Learning about the test why your doctor is suggesting it for you, and what the test results could mean can help you cope with any worries of fears you might have. Keep in mind that screening tests do not diagnose problems. They evaluate risk. So if a screening test comes back abnormal, this doesn’t mean there is a problem with your baby. More information is needed. Your doctor can explain what test results mean and possible next steps.

HIGH RISK PREGNANCIES

Pregnancies with a greater chance of complications are called ‘high-risk’. This doesn’t necessarily mean there will be problems. The following factors may increase the risk of problems during pregnancy:

  • Very young or very old (under 18 or older than 40)
  • Over or underweight
  • Previous pregnancy complications
  • Multiple pregnancy – twins, triplets, etc
  • Existing health problems, such as cardiac problems, epilepsy, diabetes, cancer, HIV, high blood pressure, etc.

Health problems can also develop in pregnancy which could then place you as a ‘high’ risk pregnancy. This is why routine antenatal care is so important.

Women with ‘high-risk’ pregnancies are referred to an Obstetrician who will continue with their care until they are no longer considered ‘high-risk’, or until the baby is born. (A midwife specializes in low risk, healthy pregnancies only).

If your pregnancy is considered high risk, it will be understandable that you would be worried about your baby and not enjoy your pregnancy as much as you should. Share your concerns with your caregiver. Your doctor will explain the risks and chances of real problems to you. Follow your doctor’s advice. Get family members’ support and allow them to help you where possible.