Prenatal Check-up

Prenatal care is a program of care for a pregnant woman before she gives birth to her
baby. Most women begin their prenatal care in the first trimester of pregnancy. Visits to the
doctor occur about once a month during the first six months. The frequency of visits
increases to every two or three weeks for the remainder of the pregnancy.

Where do I go for prenatal check-ups?

Who you choose to care for your pregnancy affects where you will go for your check-
ups. You may have yours at a community clinic, a local health center, or a lying-in clinic. Most
doctors and midwives carry out all their check-ups at a clinic. Some doctors or midwives also
offer home visits. In many areas, you'll only have to visit the hospital for your ultrasound
scans and special tests.

Will I see the same caregivers all the way through?

If you're under an obstetrician's private care, you will be seeing her every single time
you come in for a check-up. She will also be the one to care for you when you give birth.

If you are giving birth in a government hospital or in a lying in clinic, the doctor or
nurse on duty will take care of your check-ups. Sometimes, you can expect to see the same
caregiver for several visits, although it is more likely that you will be seeing a number of
obstetrician residents (obstetricians-in-training). When it comes to the birth itself, there are no
guarantees you'll have a doctor you know.

Why is it Important?

Prenatal care consists of much more than just monitoring the mother's diet and weight.
Keep in mind that during pregnancy it is not just the health of the pregnant woman that must
be watched, but also the health of the unborn baby. Maternal difficulties such as diabetes
(which can develop as a result of being pregnant even if diabetes was not present before),
insufficient weight gain, and high blood pressure, if gone untreated, can be harmful to the
fetus. A doctor can also monitor the baby's well being directly by listening to the fetal
heartbeat, checking the size and positioning of the uterus and fetus, and testing for various
abnormalities. Some conditions, if detected prenatally, can be treated in-utero (i.e., before the
baby is born). In other instances, early detection can allow the proper medical facilities to be
present at the time of birth to allow the baby full access to the help it needs. It is very
important to receive proper prenatal care in order to ensure the health of both you and your
baby.

What Happens at a Prenatal Check-up?

Several tests are performed during these visits.

1. At your first prenatal visit, your doctor will ask about your medical history and your
lifestyle. She will take your blood pressure and measure and weigh you so that she can work
out your body mass index (BMI).
 2. Your urine will also be checked for protein, which could indicate the pregnancy-
related condition pre-eclampsia.

3. Your doctor will also take some blood samples and may arrange for you to have a
dating scan to establish how many weeks' gestation you are. She may feel your womb to get
a rough idea of whether your baby is growing at the expected rate.

4. Measuring your baby

You won't be given internal examinations at your check-ups unless your doctor
thinks it's necessary. Your doctor may feel, or 'palpate', your abdomen once your pregnancy
is at around 36 weeks to see what position your baby is in.

Once you get to about 24 weeks, she will also start measuring the size of your
bump with a tape measure (from the pubic bone to the top of your bump). She will measure in
centimetre and the reading should be same as the number of weeks you are pregnant -- give
or take 2-3cm. This will give your doctor a rough idea of how your baby is progressing. If she
has any concerns about your baby's growth, she may refer you to have an ultrasound scan.

5. Blood tests - These involve taking a small sample of your blood, which is then
tested for your blood group; whether your blood is rhesus negative or positive; whether you
are anaemic whether you are immune to rubella; for syphilis; and for hepatitis B. You may
also be offered a test for, if you agree, HIV.

6. Ultrasound scans - It is now recommended that all women have a dating scan early
on in pregnancy to establish their baby's gestational age and detect multiple pregnancies.
You'll also be offered another scan at 18-20 weeks to check that your baby is developing
properly, and that your placenta is positioned in a way which won't cause problems with the
birth.

7. Screening tests - The nuchal ultrasound scan at around 11 to 14 weeks screens for
Down's syndrome. These tests can't tell you for certain whether or not your baby is affected -
they can only give you an approximate risk

8. Pap test may be done to detect changes in the cervix that could be forerunners to
cancer.

9. The doctor can also perform various tests to check the fetus for birth defects.

10. Your first prenatal visit is a good opportunity to ask questions, and it's not too
early to ask about where you might give birth -- most areas have various options. If you prefer
to have a home birth, keep in mind that a midwife or a hilot (traditional birth attendant), and
not a doctor, will probably be the one delivering your baby.

What about listening to my baby's heartbeat?

If you want to hear your baby's heartbeat, your doctor or midwife can let you listen to it
from about 16 weeks onwards (sometimes earlier). While hearing your baby's heartbeat does
not indicate how healthy your baby is, the experience is usually reassuring and exciting to
expectant parents.

Some doctors and midwives use an old-fashioned stethoscope, the same

stethoscope used to listen to your chest. However, most doctors/midwives now use a
handheld fetal heart monitor that amplifies your baby's heartbeat so you get to hear it, too.
Some doctors have ultrasound machines in their clinics can also show the baby's heartbeat.

If you do get to hear the heartbeat, don't be surprised at the speed -- your baby's
heart rate is 120-160 beats per minute (BPM) compared to your 60-100.

How often will I have prenatal checks?

Prenatal Visit Period of Pregnancy

st
1 visit As early in pregnancy as possible before four months
or during the first trimester
2nd visit During the 2nd trimester
3rd visit During the 3rd trimester
Every 2 weeks After 8th month of pregnancy till delivery

.
What if I'm worried about something between prenatal visits?

If you're concerned about something, don't wait until your next check-up: either phone
to make an earlier appointment, or visit your midwife or doctor. In many areas, doctors or
midwives also operate a telephone helpline so you can call with a minor query without having
to make a visit. If you have a serious concern, your doctor or midwife may need to see you to
give a proper diagnosis or prescribe medication if needed.

What if I've got special problems?

If you've got special problems such as a pre-existing medical condition, or if you

develop a problem during your pregnancy, you'll probably need the care of an obstetrician.
You'll then see your doctor at most of your antenatal visits, and may need to go for more
regular check-ups than other mothers-to-be.

If you have a problem in late pregnancy -- particularly a rise in blood pressure, or a

concern that your baby isn't moving around a lot -- you may find yourself referred to the
hospital Delivery Room or Intensive Maternal Unit. These areas of the hospital are open 24
hours a day, seven days a week.

References:
http://www.estronaut.com
http://www.babycenter.com.ph
Public Health Nursing in the Philippines’ Book, Edition 10