Prenatal care issues

The core contradiction in the current field of prenatal care is the mismatch between highly standardized general guidelines and the vastly different physical and psychological conditions of pregnant women. More than 90% of adverse events related to prenatal care are not essentially "failure to do the right thing", but excessive care and wrong care caused by rigidly applying unified standards.

Last week I met a woman in the outpatient clinic who had her first baby at the age of 32. Her pre-pregnancy weight was only 42 kilograms. She was underweight. I saw a maternal and child blogger who said, "The weight gain during the entire pregnancy should not exceed 25 kilograms. Any extra kilogram will easily lead to gestational diabetes and difficulty in giving birth." Shengsheng suppressed her daily food intake to 1,200 calories, and did not even dare to eat more meat. She wobbled when walking when she was tested for glucose tolerance. When her urine ketone body was found to be 3+, she was ordered to give her fluids by the doctor. She felt aggrieved and said that I had followed the guide, so why was it wrong?

In fact, there is no absolute "right answer" regarding the standards of prenatal care, and the medical and nursing opinions of different factions are quite different. Take for example whether to exercise in early pregnancy. Many obstetricians who have been practicing medicine for 20 or 30 years will repeatedly advise that if the fetus is unstable in the first three months, lie down as much as possible, do not lift heavy objects, and do not run around. Especially pregnant mothers who have had a history of miscarriage should move less. ； But now many teachers who provide evidence-based fertility education will say that as long as there are no clear high-risk indicators such as cervical insufficiency, persistent bleeding, and abdominal pain, it is completely possible to maintain the low-intensity exercise habits before pregnancy, such as walking, low-intensity yoga, and even swimming. Both sides are supported by data: the experience of veteran doctors comes from clinical statistics of large samples in the early years. In the past, medical conditions were limited, and many pregnant women had poor nutritional conditions. There were indeed many cases of miscarriage caused by uterine contractions caused by exercise. ； The evidence-based school is based on large-sample follow-up data in the past ten years. Pregnant women without high-risk factors maintain moderate exercise, and the probability of gestational diabetes, macrosomia, and slow postpartum recovery can be reduced by about 30%. No one can say that the other person is wrong. The core still depends on your own physical condition.

What many people don’t know is that at least half of the weight of prenatal care should be on the psychological level, which is ignored by the vast majority of families. Two months ago, I gave birth to a pregnant mother with her second child. The first child was born by caesarean section. The physical condition of this baby fully met the indications for vaginal trial delivery. She also wanted to have a natural birth. However, everyone in the family, from her husband to her mother-in-law, was against it. They kept saying in her ears every day, "If the uterus ruptures, neither the adults nor the child can survive." She continued for more than half a month. She cried until early in the morning every day. When she came for a routine prenatal check-up, the fetal heart rate soared to 170, and she had to be monitored three times before she could pass. Later, we did two science education sessions for her family, and contacted the psychological clinic for counseling. After her emotions stabilized, she finally gave birth to a little girl weighing 6 and a half pounds. Nothing happened. You said that if no one cares about her emotions and she really suffers from prenatal depression, or long-term emotional stress leads to premature birth, then it will be really troublesome. At present, less than 20% of domestic tertiary hospitals have opened prenatal psychological outpatient clinics. Most families still think that "pregnant mothers are just hypocritical." The gap in this area is really huge.

As for the most frequently asked questions such as "should I supplement DHA?" and "should I buy a fetal heart rate monitor for use?", there is no unified answer. Let’s just talk about DHA. If you live in a coastal city and can eat deep-sea fish two or three times a week, and if you eat 100g each time, you don’t need to supplement at all. Taking too much will increase the metabolic burden. ； But if you live inland and don’t have access to fresh deep-sea fish a few times, then following your doctor’s advice and supplementing it is indeed beneficial to the development of the fetus’s optic nerve and brain. Not to mention home fetal heart rate monitors. If you are a low-risk pregnant mother and every prenatal check-up goes smoothly, there is really no need to buy one. I have seen too many pregnant mothers listen to the fetal heart rate at home. If there is a slight fluctuation, they go to the emergency room in the middle of the night. After checking for a long time, they find that the baby is sleeping or playing with the umbilical cord. Not only is it useless, but the more the test is done, the more anxious they become. ； But if you have high-risk factors such as gestational hypertension and intrauterine growth restriction, renting a home tester for daily testing can indeed detect problems early and reduce the risk of adverse pregnancy.

I have been in the obstetrics department for almost 8 years, and I have seen too many pregnant mothers who have engraved online strategies into their DNA. One day, I will compare the size of my belly with the pregnant mother next door, tomorrow I will compare my weight gain with my colleagues, and I will get extremely nervous if the pregnancy does not meet the standards even a little bit. To be honest, those guides and strategies are just a safety bottom line drawn for you, not KPIs for you to follow to figure out the details. There are so many standard answers to prenatal care. If you eat comfortably, sleep well, and the doctor doesn’t say there is anything wrong every time you have a prenatal check-up, that’s better than anything else. Don't live your life as a "standard pregnant mother" model. You are yourself first, and the pregnant mother second. This is more important than any nursing rules.