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Tuesday, 11 October 2011

Prenatal care

Prenatal car, refers to the medical and nursing care recommended for women before and during pregnancy. The aim of good prenatal care is to detect any potential problems early, to prevent them if possible (through recommendations on adequate nutrition, exercise, vitamin intake etc), and to direct the woman to appropriate specialists, hospitals, etc. if necessary. The availability of routine prenatal care has played a part in reducing maternal death rates and miscarriages as well as birth defects, low birth weight, and other preventable infant problems in the Fiscella 1995. Animal studies indicate that mothers' (and possibly fathers') diet, vitamin intake, and glucose levels prior to ovulation and conception have long-term effects on fetal growth and adolescent and adult disease.
While availability of prenatal care has considerable personal health and social benefits, socioeconomic problems prevent its universal adoption in many developed as well as developing nations.
One prenatal practice is for the expecting mother to consume vitamins with at least 400 mcg of folic acid to help prevent neural tube defects.
Prenatal care generally consists of:
monthly visits during the first two trimesters (from week 1–28)
biweekly from 28 to week 36 of pregnancy
weekly after week 36 (delivery at week 38–40)
Assessment of parental needs and family dynamic




Physical examination


Physical examinations generally consist of:
Collection of (mother's) medical history
Checking (mother's) blood pressure
(Mother's) height and weight
Pelvic exam
Doppler fetal heart rate monitoring
(Mother's) blood and urine tests
Discussion with caregiver




Ultrasound
Analysis and Ultrasound Program during pregnancy


Obstetric ultrasounds are most commonly performed during the second trimester at approximately week 20. Ultrasounds are considered relatively safe and have been used for over 35 years for monitoring pregnancy.
Among other things, ultrasounds are used to:
Diagnose pregnancy (uncommon)
Check for multiple fetuses
Determine the sex of the fetus
Assess possible risks to the mother (e.g., miscarriage, blighted ovum, ectopic pregnancy, or a molar pregnancy condition)
Check for fetal malformation (e.g., club foot, spina bifida, cleft palate, clenched fists)
Determine if an intrauterine growth retardation condition exists
Note the development of fetal body parts (e.g., heart, brain, liver, stomach, skull, other bones)
Check the amniotic fluid and umbilical cord for possible problems
Determine due date (based on measurements and relative developmental progress)
Generally an ultrasound is ordered whenever an abnormality is suspected or along a schedule similar to the following:
7 weeks — confirm pregnancy, ensure that it's neither molar or ectopic, determine due date
13–14 weeks (some areas) — evaluate the possibility of Down Syndrome
18–20 weeks — see the expanded list above
34 weeks (some areas) — evaluate size, verify placental position






Prenatal Care and Race


Many health professionals consider prenatal care a nearly essential practice for pregnant women; however, there are wide gaps in the American population regarding who has access to these services and who actually utilizes these services. For example, African-American expectant mothers are 2.8 times as likely as non-Hispanic white mothers to begin their prenatal care in the third trimester, or to receive no prenatal care during the entirety of the pregnancy. Similarly, Hispanic expectant mothers are 2.5 times as likely as non-Hispanic white mothers to begin their prenatal care in the third trimester, or to receive no prenatal care at all. The following factors impact a woman’s likelihood of acquiring prenatal care:


Health Insurance: 13% of women who become pregnant every year in the United States are uninsured, resulting in severely limited access to prenatal care. According to Children’s Defense Fund’s website, “Almost one in every four pregnant Black women and more than one in three pregnant Latina women is uninsured, compared with one in nearly seven pregnant White women. Without coverage, Black and Latina mothers are less likely to access or afford prenatal care.” Currently, pregnancy is considered a “pre-existing condition,” making it much harder for uninsured pregnant women to actually be able to afford private health insurance.
Formal Education: Oftentimes, Black and Hispanic pregnant women have fewer years of formal education, which sparks a large domino effect of consequences related to prenatal care. A lack of formal education results in less knowledge about pregnancy appropriate prenatal healthcare as a whole, fewer job opportunities, and a lower level of income throughout their adult life.
Trust & Comfort with Healthcare Industry: Many minority women have limited experience with the healthcare industry on a whole, as compared to their Caucasian counterparts. Consequently, there is a lower level of trust with physicians, nurses, and the entire care regimen. Many women who are distrustful of biomedicine will decline certain prenatal tests, citing their own bodily knowledge as more trustworthy than their doctor’s high-tech interpretations. Even worse, some minority women may opt to avoid the distress and discomfort of the medical industry and refuse prenatal care entirely.


Understanding of Prenatal Testing: Many ethnic/racial minority mothers are referred to genetic counseling and prenatal testing centers after being declared “at-risk” for birth defects after initial screenings. However, few testing centers effectively communicate what occurs during the various tests, what the test is looking for, or what the various results could mean for the remainder of the pregnancy. Therefore, some mothers are quite uncomfortable with this lack of clearly-communicated information and are consequently hesitant to pursue prenatal testing and counseling that health professionals would consider recommendable.
Consequences of Minorities’ Limited Access to Prenatal Care
Without timely, thorough, and appropriate prenatal care, the racial minorities of the United States continue to face severe consequences for the birth outcome of both infant and mother.


Delivery Complications: In one study, researchers found that all minority races experienced higher rates of complications such as: intrauterine growth restriction, preeclampsia, preterm premature rupture of membranes, gestational diabetes, placenta previa, and preterm birth.
Low Birth Weight: Black infants are almost twice as likely to be born at a low birth weight as White babies. This birth complication is ranked as the most prevalent cause of death among African American infants, claiming 1780 lives in 2005.
Congenital Malformations: Any genetic factor or prenatal event that adversely affects the development of the fetus in utero can result in a congenital malformation. Some commonly known congenital malformations are cleft palate, heart defects, and Down syndrome. As of 2005, congenital malformations are the leading cause of death among Hispanic infants, claiming 1373 lives.


Infant Mortality: In the United States, the non-Hispanic white population experiences an infant mortality rate of 5.8 deaths per every 1000 live births. The African-American population’s infant mortality rate is 2.3 times greater (13.6 deaths per 1000 live births).
Impact of Prenatal Care on Birth Outcomes: When women utilize prenatal care appropriately, many of them increase their chances of having a successful birth outcome. For example, prenatal care includes discussions with physicians about what lifestyle changes should be made during pregnancy (such as tobacco or alcohol cessation); if these changes do not occur, the pregnancy is more likely to be problematic or result in an infant with a defect or prone to early mortality. Additionally, doctors can provide prescriptions for specific prenatal vitamins and supplements to ensure a healthy mother and infant. Finally, specific prenatal tests screen for genetic abnormalities, and expectant mothers can learn if their fetuses have any significant defects prior to delivery; in these situations, physicians and genetic counselors can help advise mothers about their options for continuing the pregnancy. While some poor birth outcomes cannot be entirely avoided through prenatal care, the pregnant woman can receive important information, advice, and guidance about her own individual situation, rather than being surprised in the delivery room with some unexpected news.


Pregnancy and Exercise: Updated recommendations by the American College of Sports Medicine suggest at least 2-1/2 hours of moderate-intensity aerobic activity spread throughout the week for pregnant and postpartum women. Women who regularly engage in high-intensity or higher amounts of activity may continue under the counsel of their health care professional provided their condition remains unchanged. For more information on the exercise recommendations and the survey of health professionals, go to http://www.acsm.org.




Prenatal Care Improvements for Minorities


http://maapatashala.com/index.htm Although minorities continue to face decreased access to high-quality prenatal care, there are specific improvements the biomedical field can make to fix this disparity.


Connect physicians and patients on a cultural level: For many minority patients, it is difficult to develop a long-standing and trusting relationship with healthcare providers of different cultural backgrounds, as each culture has its own priorities, values, and goals. In traditionally underserved communities with sizeable minority populations, healthcare providers should strive to offer physicians and nurses who match the racial background of the patients they are working to serve.
Improve all providers’ cultural awareness and sensitivity: If patients cannot be matched with healthcare providers culturally, then they should at least be able to visit a physician who is trained specifically to deal with cultural differences. This awareness and sensitivity can come in many forms, such as a familiarity with a foreign language, an understanding of how a specific ethnicity views mothers, or knowing how family networks play into the mothers’ decision-making process. All of these options have the potential to improve doctor-patient relationships, and this sort of education can be implemented in medical training programs both in medical school settings and on-site training programs.
Community Outreach Programs: Because hospitals and doctors’ offices are unfamiliar and unwelcoming places for some individuals, the healthcare industry should establish a multifaceted community outreach program in large cities. These programs would train members of the minority population in basic health education; then these community health workers would help to facilitate connections between expectant mothers and local healthcare establishments. The community health workers could even continue their relationship throughout the duration of the pregnancy, serving as a patient liaison during the various tests, appointments, and conversations.



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