Wednesday, June 5, 2013

The Importance of the First Prenatal Visit

You just found out you're pregnant! You rush to call your husband, then your mother, email your Aunt Annie and text your BFF. Excitement, celebration, hugging and kissing!

But before the excitement cools, there's still one more person that wants to hear your good news... your OB/GYN.

Don't delay. Here's why.

The purpose of prenatal care is to optimize the chances of a healthy baby while ensuring the physical and emotional health of the mother. In order to best accomplish this, it is essential that there is early initiation of the first prenatal visit. Reports from Center for Disease Control have shown that delayed or no entry into prenatal care can result in a higher rate of complications with resultant severe maternal morbidity and or mortality. In addition, for the baby, studies have shown a direct association between early comprehensive prenatal care and increased birth weights.

What are some of the important reasons for having an early prenatal visit?

  • Establish more accurate dating

  • Counsel and educate patients about diet and exercise

  • Obtain a detailed medical history and physical so medical conditions both current and from previous pregnancies can be detected and managed early in the pregnancy

  • Discussions about avoidance of dangerous medications and harmful habits such as smoking, drinking, and the use of drugs

  • Detect early signs and symptoms of miscarriage or possible ectopic pregnancy

Unfortunately, recent studies have shown a trend that women are delaying the scheduling of their first prenatal appointments.

Several reasons why pregnant women delay early care:

Mothers sometimes avoid scheduling early appointments due to non-recognition of the pregnancy

Over the counter pregnancy tests are extremely accurate so make sure you know the signs of early pregnancy. It's very easy to ignore these signs but it's very important that you are seen before the fetus begins developing.

Difficult work schedules

Inform your employer that you are pregnant. Perhaps they can help rearrange your work schedule to find time for your very important prenatal visits.

Financial considerations

Ask the physician's billing department if the practice offers terms for newly pregnant families. Make sure you understand your insurance policy and if not, call your carrier and have them go over your options in detail.

Difficulty in the doctor's office accommodating the new pregnant mother

If the receptionist can not accommodate an early appointment, make sure the doctor knows you believe you are pregnant. Your doctor may have some slots available for a newly pregnant woman. If you can't get an appointment with the doctor, ask if they have a physician's assistance, midwife or a nurse practitioner to initiate your prenatal care. Alternatively, some practices now have Group Prenatal Care for low risk patients and multiple people can be seen together for the preliminary visit. This can be fun, a great way to meet other pregnant women and you can obtain the early, very important information and advice you need.

It has been found that over one quarter of all first prenatal visits are occurring after 8 weeks gestation when all the organ systems have already developed in the fetus and toxins or certain medical conditions have already taken their toll.

If you're not yet convinced:

In a recent article, Sept 2010 in the American Journal of Obstetrics and Gynecology by Arnold Cohen, a suggestion was made to have a mini-triage system established for all pregnant patients who called the office for a first prenatal appointment by a competent and skilled health care provider. By asking certain key questions that pertain to dating the pregnancy, and known risk factors such as medical illness, medications, and previous pregnancy complications, it can be decided which patients take precedence and require very early initial prenatal appointments and which patients are more routine and can be delayed. In this way, more time and effort can be expended to improve prenatal care to those who most need it. Too often the questions currently being asked revolve solely around patient insurance issues and hospital coverage.


In a country that spends 35% of all US infant spending on prematurity and also ranks at the bottom of the developed countries in the world on infant mortality, I think it is very reasonable to try and identify high risk pregnancies very early in the game in the hopes of preventing adverse outcomes through education and careful, frequent monitoring by a qualified health professional right at the very beginning of the pregnancy. In this way, we might be able to see an improvement in prematurity, adverse maternal outcomes, congenital anomalies, and low birth weight infants in the future.

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