An illustration of the concept of prenatal care

Prenatal care (also often referred to as pregnancy care in clinical practice) refers to a full-cycle care service that covers the four dimensions of maternal physical health, fetal growth monitoring, maternal psychological adjustment, and social support adaptation from the confirmation of pregnancy to the onset of labor. The core goal is to reduce the risk of pregnancy complications and birth defects, and ultimately obtain good maternal and infant outcomes. It is by no means as simple as "just regular prenatal check-ups" as commonly believed by the public.

I have been working in community maternal and child health care for almost five years, and I have met too many pregnant mothers who have misunderstandings about prenatal care. Last week, she was 32 weeks old. Every prenatal checkup report was green. She continued to do maternity exercises and felt that she was in great condition during pregnancy. However, when I came for a regular visit, I found that her ankles were so swollen that they couldn't bounce back after being pressed for a long time. She was also wearing tight jeans that tightened her belly. When I asked, I found out that she had stayed up until 1 o'clock every day for the past two months to watch short parenting videos. She thought the swollen legs were normal and ignored them at all - this is a typical "prenatal checkup" and no "prenatal care".

If you ask what prenatal care specifically includes, it really can’t be explained clearly by listing a list of rules. Different gestational weeks have completely different priorities, and even pregnant mothers with different physical conditions have far different care plans. For example, for pregnant mothers who have just been pregnant for about 6 weeks, many people think that as long as they have a B-ultrasound to confirm that it is intrauterine pregnancy and there is fetal heartbeat and fetal bud, everything will be fine. At most, they can take folic acid. But in fact, standard prenatal care requires baseline risk screening at this time: whether you have had a history of spontaneous abortion before, whether you have underlying diseases such as hyperthyroidism and hypothyroidism, whether your home has been exposed to formaldehyde during recent renovations, whether your cat has been dewormed for Toxoplasma gondii, and you may even be asked whether you have cried frequently recently or are always worried about your child's problems. If your anxiety is obvious, you need to receive psychological counseling in advance. Oh, by the way, when it comes to early pregnancy check-ups, there are now different voices in the industry: one group believes that pregnant mothers with no adverse pregnancy history do not need to do too many tests too early. If there is no bleeding and abdominal pain, they can just wait until 12 weeks to establish a file to avoid excessive anxiety. ； Another group of supporters of evidence-based medicine recommends doing folic acid metabolism gene testing in early pregnancy. If the risk is high, active folic acid supplementation can be better absorbed than ordinary folic acid. I met a pregnant mother who had had two miscarriages before. She was found to have a high risk of folic acid metabolism in the early pregnancy. She followed the doctor's advice to supplement active folic acid throughout the pregnancy. In the end, the baby was born healthy. In fact, there is no absolute right or wrong between the two views. It mainly depends on the situation and needs of the pregnant mother.

At the 13-27th week of pregnancy, everyone is most familiar with the two important prenatal examinations of major ovarian abnormalities and glucose tolerance, but there is much more to prenatal care than examinations. Last month, a 25-week pregnant mother was found to have one-hour glucose tolerance of 11.2mmol/L, which was 1 unit higher than the standard value. At that time, she took the report and sat on a chair in the corridor and shed tears, thinking that she would need to take insulin and her child would be born with hypoglycemia. In fact, the follow-up of prenatal care caught up at this time: we first contacted the nutrition department to customize a meal menu for her, and replaced the white rice she ate every day with 1/3 cereals, and replaced the high-sugar fruits such as grapes and watermelon she ate every day with cherry tomatoes and guava. We also asked her to take a 20-minute walk with her husband after meals every day, and she did not need to diet or starve. After half a month, her glucose tolerance was completely back to the normal range, and her subsequent weight gain was also well controlled. It’s also interesting to mention this. Many old people always think that “one person should eat and two people take supplements when pregnant.” They stuff pregnant mothers with bird’s nests and stew old hen soup every day. They also say that “eating more will make the baby stronger.” But now standard prenatal care actually requires pregnant mothers to control their weight. For pregnant mothers with a normal BMI, it is best to control the weight gain during pregnancy to 11.5 Between -16kg, thin pregnant mothers can increase their weight appropriately, while pregnant mothers whose BMI exceeds the standard should increase their weight less. The two concepts often clash. Last week, I met a mother-in-law who secretly gave pregnant mothers sugar water to drink, saying that "children need sugar to be smart." However, the next time I checked my blood sugar, it was directly over the standard. It took a lot of effort to explain to the elderly.

After 28 weeks of pregnancy, especially after 36 weeks, many pregnant mothers know that they need to do fetal heart rate monitoring every week for fear that the baby will be hypoxic. But prenatal care requires a lot of unexpected preparations at this time: for example, giving pregnant mothers a delivery rehearsal, explaining clearly the layout of the delivery room, how far the fingers can be opened to achieve painless delivery, how to use the Lamaze breathing method, and even teaching you to recognize the signs of labor: when your water breaks, you should lie down immediately and call 120, do not walk to the hospital by yourself, if you see redness and there are no regular contractions, you can take a shower at home before going. There are also many pregnant mothers who will suffer from severe prenatal anxiety in the third trimester of pregnancy. They can't sleep every day, fearing pain, being afraid of antenatal surgery, and fearing that there will be something wrong with the baby. I once met a 38-week pregnant mother who only slept 2 hours a day for a week. She had dozens of short videos of difficult labor on her phone. The more she watched, the more scared she became, and she cried at the thought of giving birth. We made an appointment with a mother who just had a natural birth in our community hospital last month and chatted for half an hour. We also showed her a live video of the delivery room and told her that her family members could accompany her during the entire delivery. After the painless injection, there was basically no pain. She slept for a full 6 hours that night. The final natural delivery went very smoothly. Even the midwife praised her for her good cooperation.

In fact, after all, prenatal care is never a cold medical procedure. It is more like setting up a flexible safety net for pregnant mothers and babies in the belly. It covers everything from what to eat today to how to relieve swollen legs, to screening for risky diseases, choosing a delivery plan, and even finding someone to complain about when you are in a bad mood. There is no one-size-fits-all standard. The best prenatal care is the one that suits you and allows you to spend your pregnancy safely and comfortably.