Explanation of Care/Prenatal Visits

The physician and others providing antepartum care should discuss with each patient the type of care that is provided in the office necessary laboratory studies, the expected course of the pregnancy, signs and symptoms to be reported to the physician (such as rupture of membranes), the timing of subsequent visits, health maintenance, education programs available, and the options for intrapartum care.

At some time during the prenatal period, communication between the prospective parents and a pediatrician may be helpful. The roles of the various members of the health care team, office policies (including emergency coverage), and alternate physician coverage should also be explained. Specific information regarding costs should be provided. Early in the third trimester, plans for hospital admission, labor, and delivery should be reviewed and information provided on what to do when labor begins, when membranes rupture, or if bleeding occurs.

Analgesic and anesthetic options should be discussed and an attempt made to identify risk factors (see "Analgesia and Anesthesia," this chapter). Because a general anesthetic may be required for emergencies associated with delivery, the patient should be advised of the hazards of ingesting food or fluid after the onset of labor. Aspects of newborn care, including the pros and cons of circumcision of male neonates, should be discussed.

Patients should be provided information about balanced nutrition, as well as ideal caloric intake and weight gain. Patients should be made aware of the benefits of exercise and daily activity and cautioned that a sensation of fatigue suggests that activity has been excessive. Pregnancy is not the time for competitive or dangerous sports or the acquisition of new athletic skills.

Smoking and alcohol consumption should be strongly discouraged. Information regarding cessation programs, where available, should be provided. Patients should be cautioned on the use of drugs, particularly illicit drugs that can have a significantly detrimental effect on the fetus.

A woman with an uncomplicated pregnancy and a normal fetus may continue to work until the onset of labor if her job presents no greater potential hazards than those encountered in normal daily life in the community or home. Most women may return to work several weeks after an uncomplicated delivery. A period of six weeks is generally required for a woman's physiologic condition to return to normal, but recommendations regarding the resumption of full activity should be based on the patient's individual circumstances.

The patient should be referred to appropriate educational literature and urged to attend childbirth education classes. Childbirth education classes provide ane excellent opportunity for women to obtain specific information about labor, delivery, and postpartum adjustment. Families should be encouraged to participate in childbirth education programs as well. Adequate preparation of family member can have a favorable and lasting effect on the mother, the neonate, and, ultimately, the family unit. Hospitals or community agencies or groups may offer such educational programs. The participation of physicians and hospital obstetric nurses in educational programs is desirable to ensure continuity of care and consistency of instruction.