Planning
Your Pregnancy
Good care and a healthy lifestyle before and during
pregnancy increase the odds that you'll end your 40-week
journey (and begin a whole new one) with a healthy
baby in your arms. Also, if you are prepared, it will
help your body handle the stress of pregnancy, labor,
and delivery. If you're planning to become pregnant
and have already planned a pre-pregnancy checkup,
good for you-it's a smart move. As a part of this
visit, your doctor will ask about your medical and
family history, medications you take, any past pregnancies
you've had, and your diet and lifestyle. Your answers
will help your doctor decide whether you need special
care during pregnancy. Some women have medical conditions-such
as diabetes, high blood pressure, and seizure disorders-that
can cause problems during pregnancy. Be sure to let
your doctor know if a past pregnancy was complicated
by diabetes, high blood pressure, premature labor,
preterm birth, or birth defects. Folic acid, taken
before pregnancy and for the first 3 months of pregnancy,
can reduce the risk of neural tube defects. Three
types of providers offer medical care for pregnancy
and birth: obstetrician-gynecologists (ob-gyns), family
practitioners, and certified nurse-midwives (CNMs).
Labor and delivery nurses help care for women and
their babies during labor, delivery, and right after
birth.
Your
Ob-Gyn: Your Partner in Health Care
Your doctor takes care of your basic health needs
and treats problems. This includes telling you about
leading a healthy lifestyle and doing tests and exams
to look for disease. An ob-gyn is a doctor who specializes
in the care of women. Your ob-gyn offers preventive
health care, too. Preventive health care includes
exams and routine tests that look for problems before
you are sick. Your doctor can evaluate your health
and provide care for a range of medical problems,
not just those of the reproductive system. For many
women, the ob-gyn is their primary care physician-the
doctor they turn to first for health care. It supports
women's health care issues and offers a range of teaching
programs to help doctors keep up with the latest advances
in women's health care. The care provided by your
ob-gyn can range from a basic gynecologic exam to
complete health care of reproductive or other disorders.
Obstetrician-Gynecologist: A doctor with special skills,
training, and education in women's health care.
Choosing
Health Insurance
Women often must choose health care insurance for
themselves and their families. This pamphlet offers
suggestions to help make your choice of health care
insurance easier. Some plans require that you see
a primary care provider-either a physician or nurse
practitioner-before getting a referral to see other
types of care providers, including obstetrician-gynecologists.
Some health plans limit your choice of doctors. Another
thing to consider before choosing your plan is the
out-of-pocket costs-any money that you must pay for
health care including monthly premiums. A plan may
have a lifetime maximum dollar limit or an out-of-pocket
maximum on each person or family covered. Health care
plans differ on how the health care provider is paid
for his or her services. Managed care plans pay only
for care provided by doctors enrolled in the plan.
Deductible: The amount you must pay first for covered
benefits before your health care plan begins paying
for health care services. Managed Care Plans: Insurance
plans that prescribes which medical providers may
be used by patients.
Ultrasound
Exams
Ultrasound, which creates pictures of the internal
organs from sound waves, can be found today in every
major hospital and in many doctors' offices. Ultrasound
is energy in the form of sound waves produced by a
small crystal. They are changed into pictures of the
internal organs and-during pregnancy-the fetus. The
type of ultrasound that is most often used, called
real-time, combines still pictures one after another
to show movement, somewhat like the single frames
that make a motion picture. Ultrasound is not necessary
for every woman or in every pregnancy. Your doctor
will discuss with you whether ultrasound will be used.
Ultrasound is used in obstetrics to examine the growing
fetus inside the mother's uterus. Ultrasound is used
to measure the flow of blood within vessels of the
uterus, fetus, and umbilical cord, which connects
the fetus and the placenta. Ultrasound with a vaginal
probe is a painless exam that may feel like the exam
you have for a Pap test. Combined with other tests
and exams, ultrasound can help your doctor make an
accurate diagnosis and determine proper treatment
for certain problems.
Vaginal
Birth After Cesarean Delivery
A cesarean birth is the delivery of a baby through
an incision (cut) made in the motherís abdomen and
uterus. Today, many women who have had a cesarean
delivery can safely give birth through the vagina.
This is called vaginal birth after cesarean (VBAC)
delivery. VBAC is an option for many women. Of women
who try VBAC, about 60-80% succeed and are able to
deliver vaginally. Other women may try VBAC but need
to switch to a cesarean birth. There are some good
reasons to try VBAC. In deciding if you can try VBAC,
a key factor is the type of incision you had in your
uterus for your previous cesarean birth. Women with
high vertical (classical) scars on the uterus have
a higher risk of rupture. There is a higher risk for
infection in the mother and baby in women who try
VBAC and then give birth by cesarean.
Later
Childbearing
Most women over age 35 have healthy pregnancies and
healthy babies. Age need not be a barrier to a safe,
healthy pregnancy. Also, medical advances have opened
the door for women to have safer pregnancies in their
30s and 40s. They may have concerns about whether
their age will affect their ability to become pregnant,
their health, and the health of their baby. Because
pregnancy puts new demands on a woman's body, the
risk of complications during pregnancy is higher for
these women. Women with diabetes need special care
during pregnancy. Doctors rely on personal and family
medical histories, physical exams, and special procedures
and tests to help find those pregnant women who are
more likely to have problems. Older couples may have
special concerns about a healthy pregnancy. Early
and regular prenatal care-care before the baby is
born-may increase a woman's chances of having a healthy
baby. This procedure can help detect certain birth
defects in the fetus during pregnancy, such as Down
syndrome and many other genetic conditions.
