Believe it or not, prenatal care begins long before pregnancy, when the expectant mother herself is still a child! Ideally, to reduce the risk of complications during pregnancy, a woman needs to maintain good health and nutrition throughout her life. For example, adequate calcium and vitamin D intake during the woman’s infancy and childhood helps to prevent rickets, which can distort pelvic size, resulting in difficulties during birth. Maintaining immunizations protects her from viral diseases such as rubella. In addition, such healthy lifestyle practices as eating a nutritious diet, having positive attitudes about sexuality, practicing safer sex, having regular pelvic examinations, and receiving prompt treatment for sexually transmitted diseases (STDs) also contribute to the patient’s health status throughout pregnancy.

Prenatal care after the patient has conceived consists of a thorough assessment, including a health history and physical examination, prenatal testing, nutritional care, and reduction of discomfort. Each of these factors should be addressed at the first prenatal visit.

The first prenatal visit is also the time when the pregnant woman and her family can receive information on and counseling about what to expect during pregnancy, including necessary care. This promotes the development of healthy behaviors and helps to prevent complications. Keep in mind that the patient education you provide during pregnancy should vary depending on the age and parity of the woman as well as her cultural background. Warn the patient ahead of time that her first visit may be a long one.

Remember to keep the patient informed about assessment findings. Sharing this information with her may help her to comply with health care recommendations and encourage her to seek additional information about any problems or questions that she has later in the pregnancy.

Information obtained from the patient’s health history helps establish baseline data, which can be used to plan health-promotion strategies for every subsequent visit and identify potential complications. (See Formidable findings, page 153.)

The health history you conduct should be extensive. Be sure to include biographic data, information on the patient’s nutritional status, a medical history, a family history, a gynecologic history, and an obstetric history.

Physical assessment should occur throughout pregnancy, starting with the mother’s first prenatal visit and continuing throughout labor, delivery, and the postpartum period. Physical assessment includes evaluation of maternal and fetal well-being. At each assessment stage, keep in mind the interdependence of the mother and fetus. Changes in the mother’s health may affect fetal health, and changes in fetal health may affect the mother’s physical and emotional health.

At the first prenatal visit, measurements of height and weight establish baselines for the patient and allow comparison with expected values throughout the pregnancy. Vital signs, including blood pressure, respiratory rate, and pulse rate, are also measured for baseline assessment. (See Monitoring vital signs, page 162.)

Prenatal care visits are usually scheduled every 4 weeks for the first 28 weeks of pregnancy, every 2 weeks until the 36th week, and then weekly until delivery, which usually occurs between weeks 38 and 42. Women who have known risk factors for complications and those who develop complications during the pregnancy require more frequent visits.

Regular prenatal visits usually consist of weight measurements, vital sign checks, palpation of the abdomen, and fundal height checks. You should also assess the patient for preterm labor symptoms, fetal heart tones, and edema. Also, be sure to ask her if she has felt her baby move. (See Assessing pregnancy by weeks.)

At the start of the first prenatal visit, the woman should undress, put on a gown, and empty her bladder. Emptying the bladder makes the pelvic examination more comfortable for her, allows for easier identification of pelvic organs, and provides a urine specimen for laboratory testing.