You should begin receiving prenatal care the moment you suspect you are pregnant. All of your baby’s vital organs will have already begun forming by this time. The person you choose as your caregiver will be the one providing you prenatal care. (For a discussion of selecting a doctor or midwife, see How To Choose Your Caregiver in [Section 1]). He or she will chart your progress during your pregnancy and will watch for any signs that indicate a potential problem.
When you visit your caregiver’s office for your first prenatal examination you will have a complete medical history taken and a physical examination done. If applicable, you will be told to stop smoking, to stop the use of alcohol and drugs, and to improve your nutritional habits. You may be advised the benefits of exercise and counseled about sex, hygiene, and any other relevant topics. Expect this first exam to take about an hour, and feel free to break up any areas of concern that do not come up in the normal course of the exam.
The physical examination you receive will include:
» A breast examination.
» A pelvic, or vaginal, examination to:
• confirm the pregnancy.
• take a pap smear.
• take a smear for gonorrhea and chlamydia.
• take a vaginal culture.
• estimate the size and shape of your pelvis.
A pelvic exam usually will not be done again until the last month of pregnancy.
» Blood tests for:
• blood type and Rh factor.
• complete blood count.
• rubella titer to determine if you are immune to German measles.
• syphilis and hepatitis B.
Some clinics and offices also provide other blood chemistry checks for a more complete analysis of the woman’s health. Additional blood tests that may be offered after counseling include those for human immunodeficiency virus (HIV), toxoplasmosis, and alpha-fetoprotein. If your racial or genetic background dictates, you may be tested for sickle cell anemia, Tay-Sachs disease, or thalassemia.
» Urine tests for:
• a complete urinalysis.
• a culture to check for infection, if indicated.
After the first examination, you will probably be given checkups on a monthly basis. Starting in the seventh calendar month, the checkups will be biweekly. In the ninth calendar month, they will become weekly. All these checkups will probably include:
» Checking your weight.
» Checking your blood pressure.
» Checking your urine for:
• protein, high levels of which may indicate pregnancy-induced hypertension.
• sugar, high levels of which may indicate diabetes.
» Checking your abdomen for:
• Growth of the uterus to estimate the progress of the pregnancy.
• size and position of the fetus.
Some caregivers encourage women to participate in their prenatal care by checking their own weight and urine during their office visits.
Other screening tests that may be performed, beginning at 28 weeks, are:
» Blood tests, including:
• 1-hour glucose tolerance test (GTT). About 1 hour after drinking a liquid high in sugar, blood is drawn for a glucose level to check for development of gestational diabetes. This test may be performed earlier, at around 16 weeks, if there is a family history of diabetes, previous large babies, or a history of gestational diabetes. If the test result is high, a 3-hour glucose tolerance test is given to confirm the diagnosis.
• antibody screening. In Rh-negative women, blood is drawn to check for antibodies, and within the next week, a shot of RhoGAM, an Rh-immune globulin, is given intramuscularly.
» Culture of the vaginal and rectal area to check for the presence of group B streptococcal infection. In some practices, this test is not done until 36 weeks and may also be done when the woman is admitted in labor.
» Vaginal exam to check the status of the cervix and the position of the baby. This may be done weekly, starting at 36 weeks.
Your caregiver will probably discuss with you the symptoms he will want you to report. These symptoms, or warning signs, may or may not indicate a serious complication. If you experience any of the warning signs, notify your caregiver immediately. Do not worry about bothering him. It is his job to answer your questions about your physical well-being.
- Vaginal bleeding. It is never normal to bleed during pregnancy
- Sharp abdominal pain or severe cramping.
- Loss of fluid from the vagina.
- Any signs of labor before the thirty-seventh week of pregnancy.
- Persistent nausea or vomiting.
- Frequent dizzy spells or fainting.
- Visual disturbances such as dimness, blurring, flashes of light, or dots in front of the eyes.
- Sudden and excessive swelling of the face, hands, or feet.
- Severe and persistent headache.
- Pain or burning upon urination.
- Marked decrease in the frequency of urination.
- Persistent dull or sharp pains, anywhere.
- Fever higher than 100°F orally, or chills and fever.
- Vaginal discharge that is irritating.
- Noticeable decrease in fetal movement.
- Any other problem that you feel is unusual.
A warning sign should be taken as an indication of possible illness, infection, or threatened miscarriage. However, it is just as important that you remain calm as it is that you recognize the sign and act on it, since nothing may be wrong. Just speaking with your caregiver can be reassuring. Genital sores, vaginal discharge, and other genital discomforts are warnings of venereal or sexually transmitted diseases. Your baby will be at risk if you contract a venereal disease while pregnant. Not only gonorrhea and syphilis are serious, but the herpesvirus and chlamydia can also cause serious problems if the baby becomes infected. Inform your caregiver of any current or previous problems or venereal diseases so that he can test you and treat you if necessary during your pregnancy. In addition, recent studies indicate that pregnant women who have been exposed to HIV, the virus that causes acquired immune deficiency syndrome (AIDS), are at risk for passing the virus on to their unborn children. It is important that you be tested for HIV early in your pregnancy because early treatment may decrease the risk of transmission to the fetus.
Another condition that you should be aware of is toxoplasmosis, a disease that is contracted by eating raw or rare meat or by coming in contact with infected cat, particularly the feces of such a cat. Toxoplasmosis can cause brain damage, malformation, blindness, or death in an unborn child. Therefore, while you are pregnant, you should avoid changing a cat’s litter box and eating meat that is not well cooked.
A food item that could cause serious problems for pregnant women is soft cheese. Any soft cheese—including feta, mozzarella, goat, brie, Camembert, blue-veined, and Mexican—could contain a bacteria called listeria that causes miscarriages and stillbirths. These lethal bacteria may also be found in raw and undercooked meat, poultry, and seafood, as well as on raw vegetables. Tow other foods in which listeria has been found are hummus dip and taboule salad. Listeria can be killed only by heating to the boiling point. Cold or freezing temperatures do not destroy it.
The symptoms of listeria infection include fever, chills, and other flu-like symptoms, plus headache, nausea, and vomiting. They can occur 2 to 30 days after ingestion.
Although information on this bacteria is not widely available, listeria is very dangerous, so products that could be contaminated with it should be carefully avoided during pregnancy. Dr. Boris Petrikovsky, chief of maternal-fetal medicine at North Shore University Hospital on Long Island stated that listeria is “the No. 1 food-borne infection that kills fetuses.”
The following guidelines can help reduce your chances of ingesting this harmful bacteria:
- Avoid all soft cheeses.
- Use only pasteurized diary products.
- Eat only thoroughly cooked meat, poultry, and seafood.
- Reheat any ready-to-eat grocery store or deli items.
- Thoroughly wash raw vegetables.
- Wash hands, countertops, and all utensils after handling uncooked foods.
Listeria is not harmful to healthy adults, but it is very dangerous to the elderly and to people with weakened immune systems, as well as to pregnant women and their fetuses.
The precautions used to avoid listeria infection will also help prevent food poisoning from E. coli and salmonella bacteria. Always cook meat, especially hamburger, until there is no pink and the thermometer registers 170°F. Poultry should be cooked to an internal temperature of 185°F.
Several other situations have been cited as possibly being hazardous during early pregnancy. For example, one investigation showed that the employees in a semiconductor plant who worked in the room where computer chips were etched with acids and gases had a miscarriage rate of 39 percent, which is nearly twice the national average.
Some concern also exists about a possible correlation between exposure to electromagnetic radiation and miscarriage. Sources of this radiation include computer monitors and video display terminals, electric blankets, waterbed heaters, electric cable ceiling heat, and power lines and substations. There is no conclusive evidence to support this concern.
Other possible risks are to women who handle the chemicals used in dry cleaning and in hair dyes and permanents. In addition, the use of hot tubs and saunas by pregnant women has been associated with birth defects and fetal death. Further studies are needed to determine whether any danger actually exists in these cases. Until then, you may want to avoid these situations.