So You Want to Have a Baby

March 4, 2004

By David Janeway, MD

Perspectives on prenatal care

One of the most rewarding parts of medicine is the celebration of childbirth and helping families prepare for pregnancy and childbirth. To steal a line from the armed forces: Parenthood: “ The Toughest Job You’ll Ever Love”

Every delivery is a miracle; an egg and sperm are able to change from something much smaller than the period at the end of this sentence, to a living, breathing, interacting (and often crying) newborn. In family practice we help mothers who are trying to conceive. We help bring those babies into the world and care for them until they too become mothers and fathers.

When to visit an obstetrical provider

It is never too early to visit your obstetrical provider. There are things you need to know and do to prepare for pregnancy. A healthy lifestyle when trying to conceive is very important. During the first two to eight weeks major organs such as the heart and skeletal structures are developing. When your menstrual period is due the fetus is already two weeks old.

Talking to your provider before you get pregnant

You need to discuss what medications, herbs, or other substances to avoid when you are trying to get pregnant and during pregnancy. If you have a chronic medical condition such as diabetes, thyroid disorders, or HIV there are medications that may help your pregnancy. Lab tests may be ordered to see if you need to be vaccinated against rubella prior to conception. Also, if there is a family history of genetic disease (such as sickle cell anemia) counseling may be offered.

When to start pre-natal vitamins

It is beneficial to take prenatal vitamins (PNV) when trying to conceive, or as directed by your obstetrical provider. The main difference between PNVs and a multi vitamin is the quantity of folic acid. Folic acid (0.4-1.0 mg per day) is especially important in the first four weeks after conception for brain and spinal cord development. Also, many women become iron deficient during pregnancy. Eating iron rich foods or taking vitamins containing iron may avoid this.

What to avoid when pregnant or trying to get pregnant

Alcohol use can cause fetal alcohol syndrome, which has been associated with defects of the face and head, mental slowing, poor growth, and behavior problems.
Smoking can cause a miscarriage, premature delivery, and sudden death (SIDS) in a newborn. Children of smokers may also not do as well on IQ tests, and their growth may be slower.
Street drugs can increase the risks of miscarriage, premature birth, and birth defects. Some drugs can also cause addiction at birth, and withdrawals for newborns.
Excess heat from sitting in a hot tub and or very hot bath may cause birth defects in the first three months of pregnancy.
Kitty litter boxes and kittens should be avoided in pregnancy because of a disease called Toxoplasmosis. This can cause birth defects including brain damage and blindness.
Unpasturized milk or milk products may cause listeriosis, which can cause spontaneous abortion or infections.

Physical activities to avoid

Generally you can enjoy the same physical activities during the first 12 weeks of pregnancy as you did prior to becoming pregnant. Heavy lifting, contact sports or sports that put you at risk of falls should usually be avoided in the last two trimesters. Sexual activity is fine throughout most normal pregnancies.

What is done at prenatal visits?

At the start of pregnancy you will generally be seen once a month, and at the end of pregnancy once a week. During the first visit, providers generally gather a complete medical history, and do a physical exam including a pap smear and blood tests. They may also go over information similar to what is presented in this article.

At most visits the provider will check your weight gain, blood pressure, and the baby’s heart rate. Urine is checked for protein and sugar, which may indicate diabetes or toxemia. Other tests include, a blood test for Down’s Syndrome and Spina Bifida (16 wks), a blood test for anemia and glucose tolerance (28wks), and a test for group B strep (36wks).

Often, an ultrasound is ordered to make sure the baby is doing well, or to confirm its due date.

Who are the providers of pregnancy care?

You may encounter many different medical titles. Here are a few definitions to help you understand their differences.

Perinatologists (M.D. or D.O.) specialize in high-risk pregnancies such as multiple births greater than twins, birth defects, blood abnormalities, and early pre-term labor and deliveries.
Obstetricians (M.D. or D.O.) generally specialize in pregnancy care and delivery, as well as pelvic conditions, and pelvic and breast surgery (hysterectomies, pelvic floor repair, mastectomies, etc.)
Family Practitioners (M.D. or D.O.) specialize in caring for patients throughout their life. This means they take care of the majority of common medical conditions, often including pregnancy and newborn care.
Midwives generally care for lower-risk obstetrical patients.

How to choose a provider

It is important to meet your provider, and others in their call group, to make sure you are comfortable with those who may be responsible during your delivery. You might get a recommendation from your primary care provider, or call the OB department at the hospital where you would like to have your baby.

How to pick a hospital

The care you will receive in the hospital is under the direction of your provider. If you are comfortable with your provider you should do well where they practice.

Locally, Cascade Valley Hospital, in Arlington, offers excellent care, a skilled Obstetrical nursing staff, a friendly atmosphere, and convenient location. If you deliver before week 34, or have a complex medical condition, you may need to be transferred to a regional medical center.

To find a local Obstetrical provider or learn more about Cascade Valley Family Birthing Center, you can call Linda at the HealthMatch referral line, 360-435-0514. You also might want to talk to the OB nurses in the Family Birthing Center. You can reach them at 360-435-0520.