Your Pregnancy After 35 : Your Health and Medical History (part 1) - Choosing a Healthcare Provider

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1. Prenatal Care

Prenatal care is the care you receive throughout your pregnancy. Special care from professionals during pregnancy can help identify pregnancy problems or conditions before they become serious. Always feel free to ask questions about your pregnancy at your prenatal appointments.

If you have confidence in your healthcare provider, you’ll be able to relax and enjoy your pregnancy. Pregnancy is a special time in your life; good prenatal care helps ensure you do everything possible to make it the best 9 months possible for you and your growing baby.

2. Your First Prenatal Visit

Your first prenatal visit may be one of the longest. Your healthcare provider will ask questions, order lab tests and give you a physical examination.

If this is a new healthcare provider, you may be asked for a complete medical history. This can include questions about your menstrual periods, recent birth-control methods, previous pregnancies and other details. Tell your healthcare provider about any miscarriages or abortions you have had. Include information about hospital stays or surgical procedures.

Discuss any medications you take or those you are allergic to. Your family’s medical history may be important, as in the case of diabetes or other chronic illnesses. Discuss any chronic medical problems you have. If you have medical records, bring them with you.

On your first visit, you will probably have a pelvic exam, which helps determine if your uterus is the appropriate size for how far along you believe you are in your pregnancy. You’ll have a Pap smear if you haven’t had one in the last year, and other tests may be necessary.

In most cases, you will visit your healthcare provider every 4 weeks for the first 7 months, then every 2 weeks until the last month, then once a week. You may be scheduled for visits more frequently if necessary. On every visit, your weight and blood pressure will be checked; they provide valuable information about how your pregnancy is progressing.

3. Taking Others to Your Office Visits

If you want to bring your partner with you to your prenatal visits, do so. These visits can help him understand what is happening to you and feel he’s a part of your pregnancy. And it’s nice for your partner and your healthcare provider to meet before labor begins.

It’s all right to take your mother or mother-in-law. If you want to bring anyone else, discuss it with your healthcare provider first.

Many offices don’t mind if you bring your children with you; other offices ask you not to bring children to office visits. Talking with your healthcare provider about a problem can be difficult if you’re trying to take care of a young child at the same time. If you do bring children, observe the following rules of etiquette.

Ask about office policy ahead of time.

Bring only one child to a visit.

Don’t bring a child on your first visit, when you will probably have a pelvic exam.

If you want your child to hear the baby’s heartbeat, wait to bring him until after you have heard it.

Bring something to entertain your child in case you have to wait. Not all offices have toys or books for kids.

Be considerate of other patients; if your child has a cold or is sick, don’t bring her.

4. Choosing a Healthcare Provider

You have many choices among healthcare providers to care for you during pregnancy. You can choose an obstetrician, a family practitioner, a certified nurse-midwife or a nurse practitioner to oversee your prenatal care.

An obstetrician is a medical doctor or an osteopathic physician who specializes in the care of pregnant women, including delivering babies. He or she has completed additional training in obstetrics and gynecology after medical school.

A perinatologist is an obstetrician who specializes in high-risk pregnancies. Only about 10% of all pregnant women need to see a perinatologist; your healthcare provider will refer you. If you see a perinatologist, you may still be able to deliver your baby with your regular healthcare provider. Or you may have to deliver at a hospital other than the one you had chosen because of its specialized facilities or the availability of specialized tests for you or your baby.

A family practitioner is a physician who provides care for the entire family. Many family practitioners have experience delivering babies. If problems arise, your family practitioner may refer you to an obstetrician or perinatologist for prenatal care.

A certified nurse-midwife is a trained professional who cares for women with low-risk, uncomplicated pregnancies and delivers their babies. These professionals are registered nurses who have additional training and certification in nurse-midwifery. Supervised by a physician, they will call him or her if care or delivery complications occur.

A nurse practitioner may also serve as your healthcare provider at office visits, if your pregnancy is normal. Nurse practitioners are registered nurses with advanced degrees in a specialty area. They are certified by national organizations in their specialty and practice under the rules and regulations of your state, under the supervision of a physician. They can provide prenatal care and family-planning services. At delivery, a nurse-midwife, obstetrician or family practitioner delivers the baby.

If you have a healthcare provider you like, you may be all set. If you don’t, call your local medical society for a referral. Ask friends who recently had a baby about their healthcare providers. Sometimes another healthcare provider can refer you to someone to care for you during your pregnancy.

Ellie didn’t fill out all of the forms at her first office visit; she left the family-history portion blank. She said she didn’t realize it mattered. We discussed how her family history could affect her and her pregnancy. The next month, she told me she had spoken to her mother, and there was a family history of diabetes and twins, both important pieces of information for her pregnancy.

Make an effort to communicate with your healthcare provider so you can comfortably ask him or her questions about your condition. Read articles and books such as this one and our other books. They will help you prepare questions to ask your healthcare provider. However, never substitute information you receive from other sources for information, instructions or advice you receive from your own healthcare provider. Your healthcare provider knows you, your history and what has occurred during your pregnancy.

Don’t be afraid to ask any question. Your healthcare provider has probably already heard it, so there is no need to be embarrassed. Check out even the smallest details. Your healthcare provider will be the first to tell you it’s better to ask a thousand “silly” questions than risk overlooking a single important one.

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