labor nurse has been reborn and shares her experiences as a new nurse-midwife, woman, and blogger

Sunday, April 12, 2009

Why You Should Be Prepared

I don't remember who put out those commercials (I think maybe the March of Dimes) that shows this stork walking around an office and all the reactions of the various women that are there. The message is a good one: be prepared for pregnancy because you never know. Almost 50% of all pregnancies are unintended, and means that the women has unlikely been preparing her body for a healthy pregnancy. So, I am going to make a case for all women to be prepared.

I had mentioned in the previous post that most women do not make preconception visits with their women's health provider. For those of you who do want to become pregnant in the coming months or even year- please make an appointment with your midwife, nurse practitioner, or gynecologist. I, of course, am biased when it comes to nurse midwives and nurse practitioners for obvious reasons but I would put money on the fact that those specific providers would spend more time with you in answering questions and teaching important aspects of preconception readiness. (Not saying doc's aren't doing that well, but... nursing backgrounds seem to lend those providers with a better approach).

Here are some of the things that are discussed at a preconception visit: (this is not all inclusive- give or take some of this stuff)

  • Current method of birth control
  • Review of your menstrual history
  • Review of previous pregnancy history, if any
  • Review of your medical & mental health history and discussion of ways to improve your health to decrease pregnancy risks if applicable
  • Nutrition and exercise, and recommendations to improve on these things (because we know we all can!)
  • Smoking & recreational drug use and cessation
  • Immunization status
  • Folic acid intake (400mcg/day supplementation ideally up to 3 months before conception)
  • Genetic risks
  • Family history of birth defects, stillbirths, or miscarriages
  • Partner's health

Based on this information, the provider will make recommendations to improve whatever may pose a risk on a pregnancy. High risk issues, such as a family history of a genetic disease, may lead to an appointment with a genetic counselor. Specific discussion about the timing of conception is important, too, as well as learning about the menstrual cycle and how to "read" your own cycle is discussed. I've also found that distinguishing how infertility and fertility can help, too, because so many women worry that if they aren't pregnant within two months of trying they are infertile. This also ties in the importance of understanding the menstrual cycle and even mapping your own cycle to know what are you best days for conception.

The ultimate goal of of preconception counseling is for healthy moms and babies. There are things some women just don't want to hear (like weight loss, or adding exercise into your life) but are really important factors so when that stork shows up you are prepared whether you planned for it now or not.


Dana said...

Prior to conceiving our first baby, I made an appointment with my family doctor. He made me feel like I was an idiot to come see him "just because I was thinking of conceiving". He just told me to come back when I was pregnant.


Meggan said...

Thank you for this! These questions are great. I've been thinking about talking to my doctor about this but wasn't sure what I'd need to bring up.

TVille said...

Something that I think is worth noting is that I've never seen an insurance company pay for pre-conception check up (there's no DX for it, and it's not something that *requires* a visit to a health-care provider). If patients can tie any pre-conception questions to any annual exams they have, they won't be subjected to any unexpected out of pocket expenses.

Megan said...

I had a chat like this with my NP a couple of years before I started trying to conceive. This was at a university student health center. She actually brought it up! She did freak me out a little because she talked about how to access fertility services if I didn't succeed after a year of trying, but overall it was a good talk. Yes, good talk. And I didn't need those fertility services after all.

Labor Nurse said...

TVille, your bring up a valid point, but there is a billing code for this. (Its a V code, sorry can't remember what it is!). One of my clinical sites even had it on their "frequently used" code sheet.

Anonymous said...

I think checking on your rubella status is really critical. I insisted that my doc do a titer before I started trying to get pregnant and lo and behold, I was unprotected! This after receiving all of my childhood shots and boosters right on time, including one in my 20's when I went to college. You can't get that vaccination while pregnant because it's a live vaccine that carries risks similar to infection with rubella so I put off my plans for trying to get pregnant for three months, got the shot, got a follow up titer and was able to get pregnant knowing that my baby and I were protected. But I'll never get over how hard it was to convince my GP to do that first titer - seemed like a no brainer to me.

Joy said...

This is the #1 thing I tell women when they have been trying or don't know where to start in order t conceive (newlywed, know nothing about conception/pregnancy, etc.). GO SEE YOUR DOC!

Charting my fertility was the best thing I could've ever done for my reproductive health. After the birth of my 2nd daughter I noticed things were very different. Made an appointment and found out I had very early PCOS. I've been able to treat it (without developing the diabetic issues associated with it) and get pregnant again (due in Oct).