7. You Should Also Know
Prenatal tests are of two types—screening and diagnostic. Screening tests
assess your risk of having a baby with a certain birth defect. These
tests can provide basic information to determine if more testing is
necessary. Diagnostic testing can provide nearly definite
results. Unfortunately, some prenatal diagnostic tests carry a very
small risk of miscarriage. These various tests are described in some of
the following weeks.
Healthcare Professionals Who May Care for You
Certified Nurse-Midwives. Many doctors in the United States have certified nurse-midwives on staff. A certified nurse-midwife
(CNM) is a registered nurse (RN) who has received additional training
delivering babies and providing prenatal and postpartum care to women.
In a normal, uncomplicated pregnancy, many
or most of your prenatal visits may be with a CNM, not the healthcare
provider. This may include labor and delivery. Most women find this is a
good thing—often these healthcare providers have more time to spend
with you answering questions and addressing your concerns.
A CNM will consult with a physician about
specifics of a particular pregnancy and about the labor and delivery of a
woman. Most midwives can help you explore birthing methods, including
natural childbirth, and pain-relief methods for labor and delivery,
including the use of epidurals.
If it’s important to you, a midwife may be
able to help you make your baby’s birth one the entire family can
participate in or experience. A certified nurse-midwife can also address
issues of family planning and birth-control counseling and other
gynecological care, including breast exams, Pap smears and other
screenings. CNMs can prescribe medications; each state has specific
A word of warning—Not all people who call themselves midwives
are certified nurse-midwives. Some are not even registered nurses. Be
sure to check the credentials of any nurse-midwife you are considering
for your care.
In the United States, the profession of
nurse-midwifery was established in the early 1920s. Before then,
midwives had attended births; however, often they were not trained
medical professionals. Nurse-midwifery in this country grew out of the
Frontier Nursing Service, which provided family health services to rural
The first school for nurse-midwifery
graduated its first class in 1933. Today there are over 7000 certified
nurse-midwives practicing in all 50 states; they attend nearly 10% of
all births, mostly in hospitals. Certified nurse-midwives work in
private practice (usually associated with a physician), hospitals,
birthing centers and clinics.
certification, a person must hold a bachelor’s degree and be a
registered nurse. He or she must complete a master’s degree or doctorate
program from an accredited institution, which usually takes 1 to 4
years. CNMs can be men or women—about 2% of all certified nurse-midwives
Advance-Practice Nurses. An advance-practice nurse, also called a nurse practitioner (NP),
has received postgraduate education in a medical specialty and holds
either a master’s degree or a doctorate. To be licensed to practice, an
NP must be nationally certified in an area of specialty, such as women’s
health, family health, pediatrics or some other specialty. An NP is
licensed through a state nursing board.
Nurse practitioners focus on
individualized care, a person’s condition and the effects a condition or
illness may have on one’s life. In a normal, uncomplicated pregnancy,
many or most of your prenatal visits may be with a nurse practitioner,
not the doctor. This may include labor and delivery. Most women find
this is a good thing—often these healthcare providers have more time to
spend with you answering questions and addressing your concerns.
Priorities of nurse practitioners include prevention, wellness and education. NPs may also be involved in research.
To be a nurse practitioner in obstetrics
and gynecology, a person must be nationally certified and educated to
care and treat women’s health issues (WHNP). Nurses may also be
certified as certified registered nurse anesthetists (CRNAs) and
administer anesthetics for various procedures, including pain relief for
labor and delivery.
In the United States, state regulations
determine whether NPs work independently of doctors or must work with
them. Some of the areas in which nurse practitioners work include
providing prenatal care and family-planning services, diagnosing and
treating illness and disease, doing physical exams, ordering and
interpreting medical tests and prescribing medications.
A nurse practitioner may work in various
institutions. Some places you may find them include private medical
practices, clinics, health centers, urgent-care centers, health maintenance organizations (HMOs) and walk-in clinics.
Physician Assistants. A physician assistant or physician associate (PA)
is a qualified healthcare professional who may take care of you during
pregnancy. He or she is licensed to practice medicine in association
with a licensed doctor. In a normal, uncomplicated pregnancy, many or
most of your prenatal visits may be with a PA, not the doctor. This may
include labor and delivery. Most women find this is a good thing—often
these healthcare providers have more time to spend with you answering
questions and addressing your concerns.
A PA’s focus is to provide many
health-care services traditionally done by a doctor. Most PAs work in
doctors’ offices, clinics, urgent care facilities and/or hospitals.
Physician assistants care for people who
have conditions (pregnancy is a condition they see women for), diagnose
and treat illnesses, order and interpret tests, counsel on preventive
health care, perform some procedures, assist in surgery, write
prescriptions and do physical exams. A PA is not a medical assistant, who performs administrative or simple clinical tasks.
The PA profession was created by a
physician at Duke University Medical Center in the mid-1960s because of a
shortage of doctors in some areas of the United States. Today, there
are over 140 accredited physician-assistant programs in our country.
Physician-assistant training lasts 2 to 3
years after receiving an undergraduate degree. Many schools do not
differentiate between the first-year PA students and first-year medical
students; they all take classes together.
A graduate of a physician-assistant
program receives a master’s degree. Some programs also offer a clinical
doctorate degree (Doctor of Science Physician Assistant or DScPA). There
are also specialty programs or residencies some PAs choose to take to
specialize in a certain area. They usually last an additional year.
A PA is licensed by the medical board of each state. After graduating from
an accredited program, a PA must pass a qualifying exam-administered
Physician Assistant National Certifying Exam (PANCE) before being
8. Weekly Exercises
Each weekly discussion contains an
exercise description and an illustration, if one applies, for safe
exercises to do during pregnancy. If you’re healthy and have no
pregnancy problems, experts agree you can probably exercise moderately
for at least 30 minutes three to five times a week. Studies show active
pregnant women often have fewer problems during pregnancy and don’t increase their baby’s risk for problems.
If you exercised before pregnancy,
continue exercising during pregnancy, at least at moderate intensity.
You’ll get the same benefits you did before you became pregnant.
Discuss exercising at your first prenatal
appointment. Your healthcare provider may have suggestions for your
Do these exercises to condition,
strengthen and tone various muscle groups, many of which you’ll want to
strengthen for your comfort during pregnancy. In addition, some of the
exercises strengthen muscles you use during labor and delivery. It’s
never too early to get started!
You may decide to set up a routine of
exercises to do, adding and deleting some as you get bigger. Some of the
exercises are done standing, some sitting, some kneeling and some lying
down. We suggest you leaf through each week and choose the exercises
that appeal to you.
We advise every pregnant woman to read and
practice the Kegel exercise (Week 14) to help strengthen pelvic-floor
muscles. Practicing throughout pregnancy can help in lots of ways,
especially with incontinence during and after pregnancy. Actually, it’s
an exercise every woman, no matter what her age, should practice every day.