prenatal care in the united states prenatal care in the united states prenatal care in the united states is a health care preventive care protocol recommended to women with the goal to provide regular check-ups that allow obstetricians-gynecologists or midwives to detect, treat and prevent potential health problems throughout the course of pregnancy while promoting healthy lifestyles that benefit both mother and child. patients are encouraged to attend monthly checkups during the first two trimesters and in the third trimester gradually increasing to weekly visits. women who suspect they are pregnant can schedule pregnancy tests prior to 9 weeks gestation. once pregnancy is confirmed an initial appointment is scheduled after 8 weeks gestation. subsequent appointments consist of various tests ranging from blood pressure to glucose levels to check on the health of the mother and fetus. if not, appropriate treatment will then be provided to hinder any further complications. main article: prenatal care prenatal care in the united states started as a preventive measure against preeclampsia, which included program visits during which medical professionals conducted physical, history, and risk evaluations. over the last century, prenatal care has shifted focus to low birth weight and other preventive conditions in order to decrease the rate of infant mortality. increased use of prenatal care was found to decrease the rates of birth-weight-related mortality and other preventable medical ailments such as post-partum depression and infant injuries. the united states has socioeconomic disparities that prevent the equal adoption of prenatal care throughout the country. various levels of prenatal care accessibility can be observed in both developing and developed countries such as the u.s. although women can benefit from taking advantage of prenatal care, there exists varying degrees of health care accessibility between different demographics, by ethnicity, race, and income-level, throughout the united states. education level can also influence the utilization and accessibility of prenatal care. nearly one-fifth of women in the united states do not access prenatal care during the first trimester of pregnancy. the prenatal health care system, along with personal attitudes all contribute to the utilization and accessibility of prenatal care. suggested steps to improve prenatal care in the united states include the implementation of community-based health care programs, and the increase in number of those insured. background main article: prenatal care prenatal care is health care provided to pregnant women as a type of preventive care with the goal of providing regular check-ups that allow obstetricians-gynecologists or midwives to detect, treat and prevent potential health problems throughout the course of the pregnancy while promoting healthy lifestyles that benefit both mother and child. health professionals instruct mothers on prenatal nutrition, the benefits of breastfeeding, life style changes, injury and illness prevention, and methods to monitor potentially dangerous health conditions. medical professionals also inform the mother on the birthing process and basic skills for taking care of a new born. during visits physicians determine the due date, family and medical history, conduct a physical exam and pelvic exam, and run various blood work. physicians also conduct ultrasounds to monitor the baby's health periodically throughout the pregnancy. ultrasounds are used to measure fetus growth, heartbeats, movement, and the identification of physically identifiable abnormalities. regular check-ups allow physicians to assess changes to the mothers' blood pressure, weight, uterus size, protein supplies from urine samples, and various diseases such as diabetes through screen tests. prenatal care serves as a tool to inform mothers on common concerns, and on methods to take care of themselves (amount of rest needed, the proper nutritional diet, etc.). schedule a prenatal care schedule is recommended to consist of: monthly visits to a health care professional for weeks 1 through 28 -(up to month 7) visits twice a month from 28 to 36 weeks of pregnancy -(the 7th and 8th month) weekly after week 36 (delivery at week 38–40)-(after the 8th month) more frequent visits are warranted for women older than 35 or in case of a high risk pregnancy, with the number and types of extra controls depending on individual risk factors. on the other hand, it has been suggested that 8 to 11 visits in total can be sufficient for women considered at low risk of adverse perinatal outcomes. example of prenatal care schedule in the united states for low-risk pregnancies screening and monitoringeducation and interventionvaccination and other prophylaxis pre-conception check up height and weight to calculate bmi blood pressure medical history abdominal and pelvic examination rubella testing varicella testing domestic violence depression blood lipids (cholesterol and hdl) pap test preterm labor education and prevention substance use weight and nutrition and pregnancy domestic violence and pregnancy list of medications, dietary supplements, herbal supplements accurate recording of menstrual dates counseling in case of potential vaginal birth after caesarean tdap or tetanus booster if needed rubella and/or varicella vaccination if needed hepatitis b vaccine folic acid supplementation visit 1, 3–6 weeks height and weight to calculate bmi blood pressure medical history abdominal and pelvic examination rubella testing varicella testing domestic violence depression complete blood count abo/rh blood typing syphilis test gonorrhea and chlamydia for women at high risk for stds urine culture hiv testing lead poisoning test if necessary hepatitis b hepatitis c if high risk preterm labor education and prevention exercise in pregnancy nutrition follow-up of modifiable risk factors in pregnancy nausea and vomiting in pregnancy warning signs course of care physiology of pregnancy counseling in case of potential vaginal birth after caesarean discussion of diagnosis of fetal aneuploidy tdap or tetanus booster if needed nutritional supplements if needed influenza vaccination if necessary varicella vaccination if necessary tetanus and pertussis vaccination if necessary visit 2, 10–13 weeks weight blood pressure fetal heart monitoring diagnosis of fetal aneuploidy if warranted preterm labor education and prevention fetal growth review of labs from visit 1 breastfeeding nausea and vomiting in pregnancy physiology of pregnancy follow-up of modifiable risk factors in pregnancy visit 3, 16 weeks weight blood pressure fetal heart monitoring fundal height depression diagnosis of fetal aneuploidy if warranted obstetric ultrasonography (optional) preterm labor education and prevention follow-up of modifiable risk factors physiology of pregnancy second-trimester growth quickening progesterone for prevention of preterm birth if necessary visit 4, 18–21 weeks weight blood pressure fetal heart monitoring fundal height preterm labor education and prevention follow-up of modifiable risk factors parent education program family issues length of stay gestational diabetes rho(d) immune globulin visit 5, 24–28 weeks weight blood pressure fetal heart monitoring fundal height preterm labor risk depression gestational diabetes screening domestic abuse rh antibody status if needed hepatitis b surface antigen if needed gonorrhea and chlamydia for women at high risk for stds preterm labor education and prevention psychosocial risk factors in pregnancy follow-up modifiable risk factors work physiology of pregnancy preregistration fetal growth awareness of fetal movement rho(d) immune globulin if necessary visit 6, 29–32 weeks weight blood pressure fetal heart monitoring fundal height preterm labor education and prevention follow-up of modifiable risk factors travel contraception sexuality pediatric care episiotomy labor & delivery issues pregnancy-induced hypertension counseling in case of potential vaginal birth after caesarean visit 7, 36 weeks weight blood pressure fetal heart monitoring fundal height cervix exam confirming fetal position culture for group b streptococcus follow-up of modifiable risk factors postpartum care management of late pregnancy symptoms contraception when to call provider discussion of postpartum depression visit 8-11, 38–41 weeks weight blood pressure fetal heart monitoring fundal height cervix exam follow-up of modifiable risk factors postpartum vaccinations infant cpr post-term management labor and delivery update pre-conception counseling pre-conception counseling in the united states is recommended to include: height and weight to calculate bmi blood pressure medical history abdominal and pelvic examination rubella screening varicella screening domestic violence screening depression screening testing for gonorrhea and chlamydia for women at high risk for stds vaccination vaccinetyperecommendation by cdc hepatitis a vaccine inactivatedyes, if indicated hepatitis b vaccine inactivatedyes, if indicated hpv vaccine inactivatedno (under study) influenza vaccine inactivatedyes live attenuatedno mmr vaccine live attenuatedno meningococcal vaccine polysaccharide or conjugateyes, if indicated tdap toxoid or inactivatedyes, during each pregnancy between 27 and 36 weeks of gestation td vaccine toxoidyes, if indicated (tdap preferred) varicella vaccine live attenuatedno anthrax vaccine subunitno, unless risk of exposure is significant bcg vaccine live attenuatedno japanese encephalitis vaccine inactivatedinsufficient data for recommendation rabies vaccine inactivatedno, unless post-exposure typhoid vaccine live attenuatedinsufficient data for recommendation smallpox vaccine live attenuatedno, unless post-exposure yellow fever vaccine live attenuatedno, unless risk of exposure is significant influenza vaccination it is recommended that all pregnant women receive influenza vaccination during flu season. increased infectious susceptibility in pregnancy may increase the likelihood of influenza complications such as pneumonia, particularly in the third trimester. in addition, the fever, tachycardia and hypoxemia caused by influenza may be harmful to the developing fetus. vaccination with inactivated trivalent influenza vaccine is cost saving relative to providing supportive care alone in the pregnant population, but a 2009 review concluded that there was insufficient evidence to recommend routine use of it during the first trimester of pregnancy. inactivated vaccines for influenza are considered safe at any gestational age. on the other hand, live attenuated influenza vaccines such as the nasal spray vaccine is not recommended in pregnancy. preservative-free vaccines are available in case of hypersensitivity to eggs or to vaccine components. rubella rubella is contagious viral disease, with symptoms like mild measles. screening for rubella susceptibility by history of vaccination or by serology is recommended in the us for all women of childbearing age at their first preconception counseling visit to reduce incidence of congenital rubella syndrome (crs). due to concerns about possible teratogenicity, use of mmr vaccine or measles vaccine is not recommended during pregnancy. susceptible pregnant women should be vaccinated as soon as possible in the postpartum period. varicella varicella is a herpes virus that causes chicken pox and shingles. administration of the varicella vaccine during pregnancy is contraindicated. immunity status to varicella should be elicited during the preconception counseling visit. tetanus and pertussis if an urgent need for tetanus protection occurs during pregnancy, td vaccine should be administered. if no urgent need arises and the woman has previously received tetanus vaccine, td vaccination should be delayed until the postpartum period. all postpartum women who have not received td or tdap vaccine in the last two years are recommended to receive tdap prior to discharge after delivery. it is recommended for pregnant women who have never received tetanus vaccine (i.e., have never received dtp, dtap or dt as child or td or tt as adult) to receive a series of three td vaccinations starting during pregnancy to ensure protection against maternal and neonatal tetanus. in such cases, administration of tdap is recommended after 20 weeks' gestation, and in earlier pregnancy a single dose of tdap can be substituted for one dose of td, and then the series completed with td. attitudes towards prenatal care studies have found no differences between the attitudes of women from different ethnic or social backgrounds regarding prenatal care. browner and press found no significant differences between various demographics in women's attitude toward their personal prenatal care practices. women, regardless of demographics, are similarly affected by certain health behaviors, stressful events, environmental stress, social support, mental health, and prior obstetric history. there was no influence of ethnicity, marital status, transportation availability, rural vs. urban residence, distance of residence from clinic, or prior prenatal care on the timing of women's first access to prenatal care. a woman's first prenatal visit was associated with self-referral to care, more prenatal care advocates, and fewer children. the greater number of children means that mothers have lower means, and a higher time and physical burden preventing them from attending prenatal care appointments regularly. positive influences social networks of family, friends, and surrounding persons play a significant role in influencing an individual's utilization of prenatal services. networks of those underutilizing prenatal care and acting against medical recommendations tend to be larger and of higher density in comparison to women who utilize care appropriately. this suggests that populations affected by underutilizing prenatal care are larger than populations utilizing care appropriately. social network share opinions, reach a consensus, and act to communicate and reinforce their suggestions and expectations; all of which are valued higher than that of health care professionals. first-time mothers, and a supporting number of family members and friends, their