Prenatal Care

The care you receive from a midwife or physician during your pregnancy is called prenatal care. The focus of good prenatal care is early detection of problems, health and nutritional education, parenting education, and establishment of a relationship with your health care system.

Prenatal Care evolved over the last 50 years in a somewhat haphazard way. However, in the late1980’s the U.S. Department of Health and Human Services (DHHS) convened a panel of maternal/child health experts and reviewed all the scientific literature regarding prenatal care. From this review, they published new recommendations for provision of prenatal care to LOW-RISK pregnant women. Many, if not most, clinicians adopted these recommendations.

The beauty of the new recommendations was the evaluation of routine procedures (many of which probably were not necessary) and the realignment of prenatal clinic visits with pregnancy “milestones”. A criticism of the new recommendations is that it authorized fewer visits. Now, remember, these recommendations are for low-risk women only. Any woman with significant high-risk factors should have a personalized care plan which addresses her needs. However, by eliminating some prenatal visits, there is a temptation in times of tight health care dollars to skimp on the most important aspects of prenatal care for those women who truly remain low-risk…..and those are usually the educational, nutritional, and psychosocial aspects of care.

The Panel addressed this concern in the report. It is full of recommendations about health education, nutrition, parenting, and psychosocial evaluation. However, the reality of the health care industry in the late 1990’s is such that all the rationale which some health care managers needed to cut appointments was an official proclamation that they may do so. Unfortunately, for the majority of low-risk mothers, after screening for pregnancy health complications, it is health education and psychosocial evaluation that are most valuable……..and unfortunately, very time-consuming.

For you, the pregnant woman, it is important that you find a clinician and a health care system which will give you adequate TIME to assess and prepare you for the near future. If you have a clinician who is always racing through your visits and overloading you with educational pamphlets because s/he has little TIME to spend with you, re-evaluate your choice. If you are stuck with that system, request additional appointments for discussion and education, and let your clinician know you are dissatisfied.

The Old System 
The New System
Initial visit (6-12 weeks) Initial visit (6-12 weeks)
16 week visit 16 week visit
20 week visit  22 week visit
24 week visit  28 week visit 
32 week visit  32 week visit
34 week visit  36 week visit
36 week visit 38 week visit
37 week visit  40 week visit
38 week visit  41 week visit (if necessary)
39 week visit
40 week visit
41 week visit (if necessary)

Is more better? Is it an issue of quality vs. quantity? The New System is perfectly adequate for most, low-risk women if your clinician is not rushed and has an appreciation for the educational and psychosocial aspects of pregnancy and parenthood. But the “medical model” of care has been justifiably accused of shortchanging the public on these aspects of health care. It’s really not a malicious or even premeditated effort. The reason is that, traditionally, physicians have not had the time to provide such comprehensive care…..their time was simply too valuable. It was nurses, midwives and the pregnant women themselves who have demanded that these services be provided and ranked in importance with the “medical aspects” of prenatal care.

It is the truly gifted clinician who can provide you with all the aspects of prenatal care which you deserve. No one should have to sacrifice one aspect for the other. “Comprehensive” prenatal care is the goal…..preparation for childbirth and parenting AND competent assessment and management of the physical aspects of care.

Your Prenatal Care experience should assess your physical condition and provide you with the preparation you need to assure that you achieve an optimal outcome for you and your baby. This experience should include:

  • A complete personal and family health history
  • An assessment of your psychosocial resources
  • A complete physical examination
  • Routine laboratory tests
  • Periodic visits as outlined above
  • Nutritional education
  • Preterm Labor education
  • Childbirth education
  • Preparation for Parenthood education
  • A guide of your health care system

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