Health care practices today are increasingly following the team model. An obstetrician will often work, for example, with a midwife, a physician assistant, and a nurse practitioner. A physician assistant (PA) is specially trained to provide some components of medical care and work directly under the supervision of a physician. A nurse practitioner (NP), also called an advanced practice nurse, provides primary health care. In a maternity care service, the NP might be an adult nurse practitioner (ANP), a woman’s health nurse practitioner (WHNP), an obstetrical and gynecological nurse practitioner , or a family nurse practitioner (FNP). PAs and NPs generally provide in-office care, bur usually do not attend births.In group practices such as these, you mayor may not have a choice of provider. Sometimes prenatal care is rotated among the many different types of practitioners and either a physician or midwife will attend your birth, depending on who is on-call when you go into labor. In other such practices you can choose your birth attendant the midwives and physicians see separate groups of women. This is based on you preference, your health, and whether your pregnancy is complicated by problems. Of course, in any of these cases, an obstetrician is always available for emergency care should the need arise.

Many women feel that collaborative practices offer the best of all possible worlds. In many of these practices, other health care personnel also are available to provide components of care. These may include, for example, a nutritionist, a childbirth educator, a massage therapist.

Doulas

A doula is an old concept and a new profession. A doula is somebody who provides support to the laboring woman and the new mother. Labor doulas are sometimes called labor coaches or monitrices. They are often on-call, like obstetricians, midwives, and other birth attendants, and will be with you for labor and birth. The advantage of a doula is that she (generally she) is especially trained or experienced in attending births and can provide excellent psychological and physical support. She can be great at massage, assisting with breathing techniques, helping with relaxation. She can often act as an advocate for you, intervening when hospital policies and your wishes seem incompatible.

The disadvantage of a doula, for some women, is that she is another professional. She is not a loved one and can interfere with the bonding that can occur during childbirth between a woman and somebody she loves. In well-staffed hospitals, nurses can provide the type of care that doulas provide. As midwifery, by definition, means “with woman,” many midwives provide the same type of support that doulas provide, as well as managing the labor and birth.

In some cultures men are prohibited from being present during child­birth, or are not allowed to touch the woman in labor. In such cultures, a female doula may provide invaluable support. Some partners travel or may be otherwise unavailable for birth and again, in this situation, a doula may be a big help. Well-conducted, controlled studies in a variety of countries and settings consistently have shown that a trained support person in childbirth has definite benefits in labor, including reduced use of pain medication, lowered incidence of vacuum or forceps delivery, and fewer cases of a 5-minute Apgar score below 7.

Support has been shown to shorten labor. Many doulas also provide care for mother at her home after the birth. Unlike a baby nurse, doulas focus on the physical and emotional needs of the mother. Some doulas provide only postpartum care.

A pregnant woman is a ready target for a wide range of well-meant but unasked-for instruction. Even in today’s very medically oriented society, superstitions about pregnancy abound. Few pregnant women have escaped the warnings of well-wishers who caution them against going swimming, reaching up to high shelves, wearing high heels, indulging in intercourse, eating certain foods, and so on. The list is apparently end­less. Many claim to be able to predict the sex of the fetus by gazing into the eyes of the mother to be or by looking at the shape of the bulge, or through a variety of other mysterious ways. Pregnancy is a very public state and even strangers do not hesitate to communicate their prediction the mother. Of course they are correct about 50 percent of the time.The best way to handle advice that you readily recognize as pure superstition is to listen to it politely and then follow the dictates of your own common sense. Remember that there is no truth to the old tale that port wine stains or strawberry marks, which are actually diffuse collections of blood vessels within the skin, are produced by experiences of the mother during pregnancy. But it has been scientifically proven that the baby does experience events in the world outside the uterus and after birth can remember sights and especially sounds experienced in the late months before birth. A baby may be born knowing the rhythm of his or her mother’s voice through hearing it repeatedly while in utero. Sensitive fetuses can even learn a melody this way. Evidence exists that the higher centers of the fetal brain are working in the last trimester, or last three months, of pregnancy. There is no evidence, however, that visual, auditory, or other sensory stimuli received by the mother during pregnancy can cause any physical changes in the fetus.

Women also love to tell pregnant women their own birth stories. Unfortunately, too many women whose births are normal feel that their stories are too boring to tell or that once the baby came, nobody was interested in their experience anymore. This means that often we don’t hear birth stories until we are pregnant and that most birth stories we do hear are the ones in which something went terribly wrong. A pregnant woman today could easily get the feeling that birth is a very scary and dangerous event, when in fact most births are totally normal. Ask women who do not volunteer their birth stories to tell them to you. Most often they will be reassuring and medically uneventful, but there will be something to learn in them. Do not try to plan your birth, however, on any­one else’s. Each birth is different-even for the same women.

Not all pregnancies can be planned. Both human and technological errors occur with all methods of family planning. Planning, however, has definite benefits, healthy pregnancies are most likely to occur in healthy women. Effective methods of contraception should be used until you know you want to get pregnant.Once you make the decision that you are ready for children, or more children, the best advice is to continue using birth control until you have had a pre pregnancy health care visit.Although many forward-thinking doctors and midwives have informally provided preconception care to women for decades, the concept that at this is a distinct type of care visit has only recently gained wide acceptance. In 1989, an Expert Panel on the Content of Prenatal Care,convened by the Public Health Service of the United States Department of Health and Human Services, advocated that pregnancy care begin in preconception period.

If you are planning to become pregnant within a year, or are actively trying to get pregnant, and have not discussed your plans with your gynecologist, midwife or nurse practitioner, you should call for an appointment. Screening tests that can pick up potential problems for a pregnancy were probably not conducted at your routine annual gynecologic visit, nor were you likely to have been given information regarding self-help measures and practices to aid in preventing birth defects and other problems that can occur in pregnancy. These measures can be most important even before you know you are pregnant.

A few birth control methods, such as Norplant or the IUD, require a health care visit for removal. This would be a good time to have preconception care. If you use Depo-Provera, you can combine a preconception visit with your last shot.

Nutrition

Women who are either overweight or underweight should use this planing time to try to achieve a healthful weight. Women who are underweight at the start of pregnancy tend to have smaller babies, even if they gain as much weight during pregnancy as somebody who starts her pregnancy at a normal weight for height. Optimal weight should be achieved :through a well-balanced diet. . If you have ill eating disorder, such as anorexia, bulimia, or pica (eating nonfood substances), this is the time to seek help from therapists and care providers skilled in these areas and to consider joining a support group.

Little is known about whether the father’s nutrition can affect the developing fetus. It is known, however, that four nutrients are essential in making sperm: vitamins A and E, linoleic acid (a type of fatty acid), and zinc. In general, a well-balanced diet will supply these nutrients.

A Final Word

Remember, becoming pregnant should be pleasurable. With a little advance planning, it also can be a time for you and your partner optimize your health and health care. A simple preconceptionist combined with good nutrition, vitamin supplementation, and common-sense avoidance of exposures will provide an excellent start to a healthful pregnancy.