Caring Gynae
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Pregnancy Care

Why do I need pregnancy care?

When a woman gets pregnant, chances are she has a number of questions regarding her health from the moment she finds out she has conceived. When a woman is pregnant it is important that she is taking care of her body to the best of her ability to create the best possible environment for her baby.

Pregnancy care can help keep you and your baby healthy. Babies of mothers who do not get pregnancy care are three times more likely to have a low birth weight and five times more likely to die than those born to mothers who do get care.

Doctors can spot health problems early when they see mothers regularly. This allows doctors to treat them early. Early treatment can cure many problems and prevent others. Doctors also can talk to pregnant women about things they can do to give their unborn babies a healthy start to life.

What is pregnancy care?

Pregnancy care is the care you receive from a health care provider, such as a doctor or midwife, during pregnancy. During pregnancy care visits, your health care provider will make sure you and the developing fetus are healthy and strong. These regular checkups are your chance to learn how to manage the discomforts of pregnancy, have any testing you may need, learn warning signs, and ask any questions you may have.

It's best to begin before you are pregnant - this is sometimes called pre-pregnancy health or preconception planning. But if that is not possible, begin pregnancy care as soon as you know you're pregnant.

What will happen during my first pregnancy care visit?

The first pregnancy care visit is usually the longest. The examination is very thorough. You will be asked questions about your medical history. You will also be asked about your partner's medical history and your family's medical history. You will have a complete physical exam. Your health care provider will measure your height, weight, blood pressure, breathing, and pulse.

Usually, you will be given a gynecological exam that will include:

You may be offered blood or skin tests to check for:

Some pregnancy care doctors will also do an overall physical health check involving listening to your heart and lungs, feeling the front of your throat to see if your thyroid gland is enlarged, checking your breasts for lumps and looking at your legs to check for varicose veins.

You may also be given urine tests to check for diabetes or other infections.

Tell your doctor or nurse if you traveled to a country with Zika or think your partner has Zika. They may test you for Zika and check to see if the baby has it, too.

Your health care provider may take this opportunity to discuss your lifestyle and habits and to suggest certain changes that may help make the pregnancy healthy. One of the most important things a woman can do is to take folic acid - a B vitamin - every day to prevent serious birth defects.

You may have an earlier ultrasound if you experienced bleeding during early pregnancy, or your pregnancy may need to be 'dated', if you are unsure about when your last period was (or you didn't have a last period to speak of). Sometimes an early ultrasound is done as a genetic test, known as a nuchal translucency scan. Some pregnancy care doctors purchase ultrasound machines to perform 'informal' ultrasounds at every pregnancy visit in their private rooms (however, this is not essential and you can decline having this done if you prefer). Generally, the ultrasound your pregnancy care doctor does can only provide a limited amount of information. You would need to have an ultrasound performed by a qualified technician and reported on by a qualified ultrasonographer, to definitely confirm your pregnancy care doctor's ultrasound findings.

Genetic testing may be offered to you (or you may request it) to screen for inherited abnormalities in your baby. There are many options to consider, with these tests usually being organised after a consultation with a genetic counsellor. This is covered in more detail in genetic testing and early ultrasound.

The main aims of the first pregnancy visit are for your pregnancy care doctor to obtain detailed information about your health, medical and pregnancy history as well as provide you with information about various aspects of the pregnancy and your care and perform (or order) some routine pregnancy tests.

How often will I have pregnancy care visits?

If you are 18 to 35 years old and healthy, you will probably have a "low-risk" pregnancy. If so, plan to have pregnancy care visits about

  • every four or six weeks, from the first to seventh month of pregnancy (the first 28 weeks)
  • every two or three weeks in the eighth month (from week 28 to 36)
  • every week in the ninth month (from week 36 until delivery)

If you have a high-risk pregnancy, your health care provider may ask you to come in for pregnancy care more often.

Specific factors that might contribute to a high-risk pregnancy include:

  • Advanced maternal age. Pregnancy risks are higher for mothers age 35 and older.
  • Lifestyle choices. Smoking cigarettes, drinking alcohol and using illegal drugs can put a pregnancy at risk.
  • Medical history. A prior C-section, low birth weight baby or preterm birth - birth before 37 weeks of pregnancy — might increase the risk in subsequent pregnancies. Other risk factors include a family history of genetic conditions, a history of pregnancy loss or the death of a baby shortly after birth.
  • Underlying conditions. Chronic conditions - such as diabetes, high blood pressure and epilepsy - increase pregnancy risks. A blood condition, such as anemia, an infection or an underlying mental health condition also can increase pregnancy risks.
  • Pregnancy complications. Various complications that develop during pregnancy pose risks, such as problems with the uterus, cervix or placenta. Other concerns might include too much amniotic fluid (polyhydramnios) or low amniotic fluid (oligohydramnios), restricted fetal growth, or Rh (rhesus) sensitization - a potentially serious condition that can occur when your blood group is Rh negative and your baby's blood group is Rh positive.
  • Multiple pregnancy. Pregnancy risks are higher for women carrying twins or higher order multiples.

What will happen during my follow-up pregnancy care visits?

Your health care provider will check that your pregnancy is progressing well. During pregnancy care visits your provider may

  • test your urine
  • check your blood pressure
  • check your weight
  • check for swelling in the face, hands, or feet
  • examine your abdomen to check the position of the fetus
  • measure the growth of your uterus
  • listen for the sounds of the fetal heartbeat
  • offer pregnancy testing

Each visit is also an opportunity to discuss any questions or concerns that have come up since your last visit.

What is pregnancy testing?

Your health care provider may offer you certain tests during your pregnancy. These tests are used to make sure that you are healthy and the fetus is doing well. Some tests identify possible birth defects.

The different tests are done at certain times. Your health care provider will let you know what tests you may want or need, and when you will need them.

Some common pregnancy tests for birth defects and other abnormalities include

Another common test is the biophysical profile (BPP). It is most commonly given during the third trimester. The BPP uses ultrasound combined with a fetal monitor to observe fetal heartbeat and movement. BPP allows your health care provider to evaluate the well-being of the fetus.

What is an ultrasound?

Ultrasound allows a health care provider to take pictures of the embryo or fetus as it develops. An ultrasound scan builds a picture of the embryo or fetus on a screen by bouncing sound waves into your uterus. Ultrasound is also called a sonogram. Depending on when it is done during pregnancy, it may

  • confirm your due date
  • find certain abnormalities
  • find multiple pregnancies
  • measure the length of your cervix
  • show the position and size of the fetus
  • show the position of the placenta

Ultrasound is a very safe procedure - no x-rays are involved.

Between 11 and 13 weeks of pregnancy, some providers combine a blood test with a special kind of ultrasound. Some providers refer to this as the combined test. It is used to screen for Down syndrome and other genetic birth defects.

How ultrasound is done?

There are two ways to do an ultrasound - through the abdomen or through the vagina. Ultrasounds may be performed by your health care provider or by a trained ultrasound technician.

During an abdominal ultrasound, your provider will place the ultrasound wand on your abdomen, using a small amount of gel to help lubricate the area. You may feel pressure during the exam, but it is not painful.

During a vaginal ultrasound, your provider will insert the ultrasound wand into the vagina. This may feel similar to a vaginal exam. You may feel pressure during the exam, but it is not painful.

What changes can I expect during pregnancy?

There are many changes that occur during pregnancy. Your body will go through a lot of hormonal changes. Your uterus will grow up to 18 times larger than it normally is. Your breasts and nipples will become larger. And you will gain weight.

You may have increased and decreased sexual desire. You may have changes in the texture of your hair and in the amount of body hair you have. And you may experience other discomforts and changes that are new to you. You can discuss these changes at your pregnancy care visits.

Common discomforts during pregnancy include

  • nausea or vomiting

    • Nosebleeds and nasal stuffiness are common during pregnancy. They are caused by the increased amount of blood in your body and hormones acting on the tissues of your nose. The hormones that seem to have the most to do with this process include the pregnancy hormone human chorionic gonadotropin (hCG), estrogen, and progesterone. Abnormal levels of thyroid hormones have also been reported in women with severe vomiting.
  • indigestion and heartburn

    • Hormones and the pressure of the growing uterus cause indigestion and heartburn. Pregnancy hormones slow down the muscles of the digestive tract. So food tends to move more slowly and digestion is sluggish. This causes many pregnant women to feel bloated. Hormones also relax the valve that separates the esophagus from the stomach. This allows food and acids to come back up from the stomach to the esophagus. The food and acid causes the burning feeling of heartburn. As your baby gets bigger, the uterus pushes on the stomach making heartburn more common in later pregnancy.

  • constipation

    • Many pregnant women complain of constipation. Signs of constipation include having hard, dry stools; fewer than three bowel movements per week; and painful bowel movements. Higher levels of hormones due to pregnancy slow down digestion and relax muscles in the bowels leaving many women constipated. Plus, the pressure of the expanding uterus on the bowels can contribute to constipation.
  • aches and pains in the abdomen and lower back

    • As your uterus expands, you may feel aches and pains in the back, abdomen, groin area, and thighs. Many women also have backaches and aching near the pelvic bone due the pressure of the baby's head, increased weight, and loosening joints. Some pregnant women complain of pain that runs from the lower back, down the back of one leg, to the knee or foot. This is called sciatica (SYE-AT-ick-uh). It is thought to occur when the uterus puts pressure on the sciatic nerve.
  • tiredness

    • During your pregnancy, you might feel tired even after you've had a lot of sleep. Many women find they're exhausted in the first trimester. Don't worry, this is normal! This is your body's way of telling you that you need more rest. In the second trimester, tiredness is usually replaced with a feeling of well being and energy. But in the third trimester, exhaustion often sets in again. As you get larger, sleeping may become more difficult. The baby's movements, bathroom runs, and an increase in the body's metabolism might interrupt or disturb your sleep. Leg cramping can also interfere with a good night's sleep.

Tips for avoiding nausea and vomiting

  • Eat a small portion of something before getting out of bed.
  • Drink small cups of ginger or peppermint tea.
  • Have several small meals throughout the day instead of fewer large ones.
  • Drink fluids between meals rather than with your meals.
  • Avoid strong spices and odors and greasy foods.

Tips for avoiding heartburn

  • Have several small meals throughout the day instead of fewer large ones
  • Chew your food slowly.
  • Don't lie down for at least an hour after eating.
  • Wear clothes that are loose around your waist.
  • Raise your head with several pillows while sleeping.

Tips for avoiding constipation

  • Increase the amount of liquids and fiber in your diet.
  • Eat more dried or raw fruits and vegetables.
  • Use whole-grain bread and cereals.
  • Get exercise.

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