Prenatal Care

Care During Pregnancy

First Trimester Screening

As soon as you know you’re pregnant, it’s time to enter into prenatal care. Pregnancy is an incredible experience but it’s also a time to take extra care of yourself and spend a little extra time with us.

What is a First Trimester Screening?
- A first trimester screening, performed roughly between 11-13 weeks of pregnancy, is used to detect chromosomal abnormalities such as Down’s Syndrome, Edwards’ Syndrome and Patau’s Syndrome. It involves two parts, a blood test and an ultrasound screening referred to as a ‘Nuchal Scan’ or ‘Nuchal Translucency Screening.’ The screening helps your OB/GYN determine the fetus’ risk of these abnormalities.
How is a Nuchal Scan Performed?
- A nuchal scan is done by ultrasound. The ultrasound technician will measure the amount of fluid in the back of the baby’s neck. While all babies have some fluid in the back of their necks, the presence of excess fluid in the back of a baby’s neck can be a symptom of an abnormality.
When Is a Nuchal Scan Performed?
- Nuchal scans are generally performed between 11 and 14 weeks gestation. Tests completed before or after this range are not as accurate.
How Accurate are Nuchal Scans?
- Nuchal scans are screening tests – not diagnostic tests. This means that they can be used to assess the risk or likelihood that your baby has an abnormality, but they cannot be used to diagnose a condition. If your nuchal scan does detect an abnormality, you will then have the option to pursue further diagnostic testing.
  
  First trimester combined screenings typically detect Down Syndrome 85 percent of the time. However, they also give a false positive 5 percent of the time, meaning that they indicate an abnormality that doesn’t exist.
What Should I Do If My Nuchal Scan Comes Back Positive?
- If your nuchal scan indicates that there might be an abnormality, the first thing you need to do is try to relax. Just because the scan says something could be wrong with your baby’s chromosomes does not necessarily mean that something is.
  
  At this point, you will likely have the option to pursue diagnostic testing such as chorionic villus sampling or amniocentesis for a better understanding of what is going on. These tests do come with increased risks, however, so you will want to talk to your provider to find out which course of action is best for you.
What Risks are Associated with Nuchal Scans?
- Nuchal scans themselves present no known risks. However, receiving a false positive can lead to undue anxiety, more testing and even terminating a pregnancy needlessly.
  
  Nuchal scans are routine and relatively risk-free, so if your provider recommends one, do not be alarmed. He or she is likely just checking to be sure.

Ultrasound Examination

Prenatal ultrasounds are common part of a new mother’s prenatal testing. Using high-frequency sound waves, ultrasounds produce images of a fetus and the mother’s reproductive organs. These sessions, which are usually performed in a doctor’s office, track fetal growth and development and monitor for any ongoing problems.

Standard ultrasounds are two-dimensional. A water-based gel is applied directly to the mother’s abdomen, and a wand, also called a transducer, will be maneuvered around the area. Transvaginal ultrasounds may also be used, in which a smaller transducer is placed inside the vaginal canal.

The images being captured will then be shown on a screen in black-and-white. These are used from the very beginning of pregnancy to confirm the gestational age and size of the fetus, monitor the fetal heartbeat, examine the mother’s reproductive system, and diagnose any abnormalities. Doctors may also use ultrasounds to guide them as they perform other tests, such as an amniocentesis (an analysis of the amniotic fluid).

Ultrasounds are usually performed as part of screening or medically recommended testing, and should not be performed solely to reveal the sex of the fetus. Doctors also do not recommend ‘souvenir’ ultrasounds, as these might pose as-yet unknown risks for the fetus.

Childbirth Setting & Environment

While most people immediately think of giving birth in a hospital, you may be surprised to hear that you do have other options, including home births and birth centers. Read on to find out which birthing option is best for you!

Hospital

Pros: Hospitals have plenty of emergency personnel on hand, so if anything goes wrong, you are in good hands. If you or your baby have any complications, a fully stocked and staffed OR and NICU are generally just an elevator ride away. Hospitals are the only option for patients who require a C-section, and are recommended for patients who have a high-risk pregnancy. Hospitals also offer round-the-clock help.

Cons: Hospitals often have many strict guidelines, policies, rules and red tape that can interfere with a mother’s birth plan. Mother and baby are also often separated following the birth.

Home Birth

Pros: The mother is allowed to give birth in a familiar, relaxing environment. She has much more control over the birth process, and can move around, eat, drink, shower and dress as she pleases. Children are welcome to attend. The cost of home birth is typically lower than the cost of a hospital birth. A trained midwife is generally still present to make sure everything goes well.

Cons: Home birth may not be an option for women who are having twins or who have health conditions or complications, including diabetes, hypertension or preeclampsia. It is not an option for women who need a C-section. If something goes wrong, the mother and baby will still need to be transferred to the hospital. There are also no at-home options for pain relief.

Birth Center

Pros: A middle ground between a hospital and a home birth, birth centers take a natural, family centered approach to birth, while still offering low-tech medical interventions. Mothers have more freedom to give birth as they want than in a hospital setting. Pain relief options are often available. Certified nurse-midwives will typically care for the mother during birth. Childbirth is viewed as a normal, safe, and healthy process, but precautions are taken just in case. Many birth centers are now located inside hospitals, meaning that transfer to the hospital proper in case of an emergency would be faster.

Cons: Dedicated birth centers have rigid requirements and usually only accept low-risk pregnancies. Mothers must still be transported to the hospital in case of a serious emergency, and while birth centers are more comfortable and relaxed than a hospital, they still aren’t home.

Hospitals, home births and dedicated birth centers are all excellent choices for different women. Speak to your doctor about your risk level and birthing requirements to see which option is best for you.