Routine content of prenatal care

The core of routine prenatal care is essentially "safety for mother and child" care covering the entire pregnancy cycle (from diagnosis of pregnancy to the onset of labor). The core is divided into four major modules: health monitoring, lifestyle adjustment, risk warning and intervention, and psychological support. There is no universal unified template. All content will be dynamically adjusted according to the underlying disease, gestational age, and fetal development of the pregnant mother.

Not long ago, I met a little girl who was just 12 weeks pregnant in the clinic. She grabbed the "100 Prenatal Care Tips" searched on a social platform and asked me one by one whether she had to lie on her left side all the time, whether she couldn't eat hot pot, and whether she needed to have B-ultrasound every week. In fact, the answers to these questions are almost always question marks - at least they are not applicable to everyone.

Let’s first talk about the prenatal check-up that everyone is most familiar with. This is the core requirement in prenatal care. Documentation, thyroid function, infectious disease screening, and NT ultrasound in early pregnancy (before 13+6 weeks) are standard for checking basic risks. If you have basic diseases such as systemic lupus erythematosus and hypothyroidism, additional items will be required. For example, for pregnant mothers with hypothyroidism, we generally require TSH to be checked every 2 weeks and the dosage of Euthyrox to be dynamically adjusted. This part is individualized content beyond the routine, and there is nothing to compare with.

Oh, by the way, here’s a point that has been controversial for many years: Should I do diabetes tolerance? A pregnant mother said before that she usually doesn't eat sugar, and her blood sugar must be normal, so there is no need to suffer the consequences of drinking sweet sugar water. There are indeed two views in the industry: the older generation of obstetricians will make judgments based on family history of diabetes, pre-pregnancy weight, and weight gain rate during pregnancy, and low-risk people may not do so at their discretion. ； But now the unified requirement of evidence-based obstetrics is that all pregnant mothers with no contraindications should be screened. After all, gestational diabetes is very hidden, and many people have no symptoms at all. However, long-term high blood sugar will not only affect fetal lung development, but may also cause macrosomia, shoulder dystocia and other risks. In this regard, it is recommended to follow the requirements of the local prenatal hospital, and there is no need to bear it.

After having major ovarian abnormalities and glucose intolerance in the second trimester, many pregnant mothers begin to relax, thinking that as long as they pass the prenatal check-up, everything will be fine. In fact, lifestyle adjustment is a soft requirement throughout the entire pregnancy. There is really no need to take bird's nest and sea cucumber supplements every day. As long as you ensure that you have enough protein, fresh vegetables, and carbohydrates of mixed thickness every day, and your weight gain is within a reasonable range, I have met pregnant mothers who only ate whole grains during the entire pregnancy. In the end, the baby was a week smaller, which was not worth the gain. It's totally okay to eat milk tea and hot pot once in a while. As long as you don't feel gastrointestinal discomfort after eating it and your blood sugar is normal, you don't have to feel guilty.

Speaking of exercise, it’s even more interesting. Many pregnant mothers go to the stairs to assist in delivery during the third trimester of pregnancy. In fact, this is also a controversial point. The traditional view is that moderate climbing of stairs by low-risk pregnant mothers can help the fetal head descend and shorten the labor process. ； But now more obstetricians will advise not to climb deliberately. After all, the center of gravity is unstable in the third trimester. Climbing stairs can easily lead to falls if you cannot see the steps clearly, and it will also increase the burden on the knee joints. If you want to move, walking briskly on the ground, doing pregnancy yoga, and swimming are safer than climbing stairs. If you live on a low floor, you can usually walk up slowly. There is no need to bother yourself by climbing ten or eight floors to assist in delivery.

There is another question that people ask a lot: Should I buy anti-stretch mark oil? To be honest, no product has been proven to prevent stretch marks 100%. 70% of this depends on genetics, and the rest depends on how fast you gain weight. If you gain more than one pound a week, no oil will help. But if you feel your skin is not tight or itchy after applying oil, then you can just use some ordinary olive oil or body lotion. You don’t need to feel like you are paying an IQ tax. Your comfort is the most important thing.

What many people don’t know is that psychological support has now been included in the routine prenatal care of most tertiary hospitals. This is really not hypocritical. Hormones fluctuate greatly in the third trimester, and many pregnant mothers will cry for no reason. They feel that everyone only cares about the child in their belly, and no one cares about whether they sleep well or whether they feel uncomfortable. They are also always worried about the pain of giving birth and the problem of the child. These are all very normal reactions. If you feel that your mood is not right, you can talk to the psychological clinic of the prenatal care hospital, or chat with pregnant mothers of the same gestational age. Don’t hold it in yourself. We have encountered pregnant mothers who were severely anxious at 38 weeks of pregnancy. They could not sleep all night, and their blood pressure soared to the critical value. It took two weeks to adjust their mood before it calmed down. The impact of psychological state on the outcome of pregnancy is really greater than you think.

The most common thing I say to the pregnant mothers I supervise is, don’t regard prenatal care as a KPI that must be completed. You don’t need to set three alarm clocks every day to count fetal movements. You only need to fix a time every day, such as touching your belly while lying on the sofa and watching TV. The frequency of the baby’s movements is about the same as usual. If the frequency of the baby’s movements suddenly doubles or decreases by half, come to the hospital quickly. It is much more efficient than rigidly counting one hour. In the final analysis, the core of prenatal care is never to complete tasks according to the script, but to make you and the baby in your belly comfortable. If you are unsure about something, ask your prenatal doctor directly, which is much more reliable than searching online for half an hour.