Pregnancy and Your Healthcare Provider

If you think your relationship with your healthcare provider begins when you learn you are pregnant, take a giant step back. Developing a relationship with your provider should begin before you are pregnant. Scheduling a preconception visit before you are pregnant helps you get ready both mentally and physically for a healthy pregnancy. Your provider may perform a physical exam, review your medical history and discuss your social habits, reminding you to stop smoking and limit alcoholic beverages right away. In the first few weeks after conception, the baby's vital organs are developing -- so your behavior in the early weeks of pregnancy can affect your baby's health.

Your provider will also check your weight and eating habits. If you are underweight, he or she may suggest gaining weight before you try to conceive. An underweight woman has an increased risk of delivering a baby with low birth weight. Low birth weight has been linked to numerous health problems for infants, such as respiratory problems, learning disabilities, blindness and even death. If you are overweight, your provider may suggest losing weight. Overweight pregnant women are at risk for developing hypertension and diabetes during pregnancy.

Some women choose to take a prenatal vitamin while they are trying to conceive. Experts recommend taking 400 micrograms of folic acid beginning at least three months before becoming pregnant.  This has been shown to reduce or prevent specific birth defects known as neural tube defects, the most common of which is spina bifida. It is available in over-the-counter vitamins.

Once you discover you are pregnant, you embark on a partnership with your provider that is probably unlike anything you have experienced. Because you must have thoughtful communication with your provider throughout the nine months of pregnancy, be sure to establish a rapport with him or her. Your provider should be open to questions, easy to reach in an emergency and respectful of your wishes for pregnancy and delivery. You, in turn, should be clear in expressing your wants, honest about your health habits (such as whether you have continued to smoke) and considerate of your provider's time.

Visits become more frequent as your pregnancy progresses. The traditional pattern of care is:

• Prenatal visits once a month for the first six months.

• Prenatal visits every two weeks for months seven and eight.

• Prenatal visits every week in the ninth month up until delivery.

This schedule may differ depending on your provider and your specific health needs.

At your visits, your provider is looking for signs that you and your baby are healthy and that your baby is developing at a normal rate. He or she will check your weight gain, blood pressure and the amount of protein in your urine. High blood pressure and high amounts of protein in your urine are warning signs of preeclampsia, which can be fatal for your baby. Your provider will also measure your belly as an indicator of your baby's growth and listen to your baby's heartbeat.

Your prenatal visits can be learning experiences for you. At home, jot down any questions you have or issues you want to discuss. Having a list with you is the best way to be sure you won't forget anything.

As you get closer to your due date, your provider will begin discussing what to expect during delivery and what special thoughts you have about delivery.

Some women choose to write a birthing plan they share with their provider well in advance of their due date. A birthing plan is a guide that describes what is important to you about your delivery. You may write that you want a natural childbirth and that you want to breast-feed your baby immediately after birth. You may write that you want your husband and mother with you and involved. The best birthing plan describes your ideal delivery while acknowledging that things may change during this critical time. You may also find a birthing plan is not for you. Many women choose to have conversations with their provider at their prenatal visits and express their plans there. Some women feel comfortable asking their provider  to let them make decisions as they are needed during delivery. Choose the plan that is right for you and your baby.

After delivery, your provider will visit you before you leave the hospital or birthing center. You should have a follow-up visit six weeks after delivery. Your provider will perform a physical exam and talk to you about contraception options at your follow-up visit. This is a great time to talk about your experience both during your prenatal care and at delivery. You can both learn what went well and what didn't, and then make a note of that -- in case there is a next time.