Prenatal Care - Increasing Access To Prenatal Care, Barriers To The Use Of Prenatal Care, The Relation Between Prenatal Care And Birth Outcomes

Prenatal care refers to medical care and other health-related services offered during pregnancy to ensure the well-being of the mother and her future offspring. Medical visits for prenatal care follow the pattern recommended by the American College of Obstetricians and Gynecologists (ACOG): an initial visit in the first trimester, one visit every four weeks through twenty-eight weeks of gestational age, then a visit every two weeks until thirty-six weeks, and then a visit every week through forty weeks (or until delivery). This pattern results in thirteen prenatal care visits for a normal length pregnancy. The emphasis on more visits at the end of pregnancy reflects the historical roots of prenatal care in the detection of preeclampsia/eclampsia, a systemic hypertensive-related disorder that traditionally was the leading cause of maternal mortality.

The initial prenatal care visit involves taking a thorough obstetric history; establishing the gestational age of the fetus and the expected due date; assessing the initial level of risk to ensure appropriate level of treatment; initiating serial surveillance of fetal and maternal biologic markers to ensure that the pregnancy is following a normal developmental trajectory (e.g., physical exams, laboratory tests); and providing general prenatal education and psychosocial support. Subsequent visits involve continued serial surveillance, psychosocial support, and childbirth and post-partum education. Women with high-risk conditions, such as diabetes, elevated blood pressure, sexually transmitted diseases, and twins, may be followed more closely or referred to high-risk prenatal care specialists.

While the timing of prenatal care visits is well established, the content of the visits continues to evolve. New tests and procedures—such as alpha-fetoprotein, amniocentesis, genetic testing, sexually transmitted disease detection, and ultrasound—have emerged and have increased the physician's capacity to monitor the health of the mother and the growing fetus.

Although prenatal care as a formal medical service began in the early 1900s as part of the newly emerging obstetric profession's efforts to reduce maternal mortality, more recently the primary focus of prenatal care has increasingly shifted toward improving the health of the newborn. This shift has been accompanied by an expansion of prenatal health care to address a broader, more comprehensive range of health and social services that affect infant health. In 1965, as part of the War on Poverty, the federal Maternal and Infant Care project provided funds, for the first time, for social workers, health educators, and nutritionists to augment traditional medical services at the then newly inaugurated community health centers. This broadening of prenatal care reflected recognition of the larger social health context of a pregnancy, the limits of medical care alone to improve birth outcomes, and the increased focus on infant outcome.