The Parent.Guide’s Guide to Prenatal Care

Published by 
Jess Miller
Last updated: 
July 30, 2018
The Parent.Guide's Guide to Prenatal Care

Finding out you're pregnant can be a joyous occasion, but it can also be very intimidating. After getting over your initial excitement and shock, prenatal care will be the next thing on your mind. You are going to have to find a doctor and apply for insurance if you do not have it. Then you have to come up with a birth plan, submit yourself to tests and physical examinations. You may even start panicking a little bit when you think about everything that needs to be figured out. That's completely normal.

The good news is, it is truly not as scary as it seems. Sure, there will be paperwork, doctor appointments, and tests, but it is controlled chaos. Your doctor will have the prenatal care routine all mapped out, and you won't have to worry about a thing. Better yet, you don't have to walk into it without any knowledge of what to expect. Almost every woman who has a baby in the United States goes through the same process, and it may seem like a lot, but it's not.

What is Prenatal Care?

Prenatal care is an essential part of staying healthy during pregnancy. It is when a doctor (OB/GYN), midwife, or nurse monitors your baby's development during the gestation period.

Why are Prenatal Visits Important?

Prenatal care can help reduce the risk of complications during the pregnancy and delivery. Your physician will also let you know what kind of diet you should eat to maintain your health and the health of your fetus. They will explain what substances you should stay away from while pregnant.

The doctor will tell you what medications & vitamins are safe for you to take during the pregnancy. Additionally, your doctor will help you control things like high blood pressure and diabetes. They may even refer you to other specialists to monitor those conditions through-out the pregnancy.

What Can You Expect at Your Appointments?

Don't worry about your appointments if you are stressing out. Nothing crazy usually happens at the OB/GYN. At every visit, your doctor will test your urine, take your weight, check your vitals and check for the fetus's heartbeat. As you get farther along, the doctor will also start measuring your belly to see roughly how big the baby is.

OB/GYN meeting pregnant woman

Near the end of the third trimester, when you are going to the doctor more frequently, your physician will check your cervix for dilation and check to see if it is shorter and thinner.

How Often Will You Visit the OB / GYN?

You are going to visit your doctor a lot. You will visit them so much that it will begin to feel as if you live there. If there are no complications involved in your pregnancy, your schedule will look something like this:

  • 4 to 28 weeks: One visit per month
  • 28 to 36 weeks: Two visits per month
  • 36-40 weeks: One visit per week

If you have complications, you will probably have to go more often. But don't worry, women who see their OB/GYN often while pregnant, generally have healthier pregnancies and infants.

Accessing and Affording Prenatal Care

According to the Kaiser Family Foundation, the average cost of prenatal care for a pregnant woman, who has no complications, is approximately $2,000. That includes an average of 12 doctors' appointments ranging from $100 to $200 each. These visits will also include lab tests such as blood and urine tests, and at least one ultrasound. That price range does not cover the cost of the delivery itself, which can range from $3,000 for an uncomplicated vaginal birth to over $70,​​​​000 for a c-section.

dollars

Luckily, health insurance can offset most of those costs. The Affordable Care Act (ACA) has ensured that all health insurance policies cover maternity care. So, if you have private insurance, the out of pocket cost of your prenatal care will depend on your co-pays. You could also qualify for Medicaid or a policy under the Children's Health Insurance Program (CHIP).

Maternity Care Under the ACA

Before the ACA went into effect by the Obama Administration, in 2014, women were often left without maternity care when they became pregnant. In fact, only 12 percent of insurance policies offered included maternity care. Not only did insurance companies refuse to cover prenatal care or only provided it through expensive riders, but they also denied women policies a lot.

uninsured rate

The insurance companies refused to cover women in many states because they claimed many had pre-existing conditions. For instance, women who had previously been received medical treatment for sexual assault, cervical cancer survivors, or mothers who had a c-section did not qualify for coverage.

Before the ACA, women were also charged at least 30 percent more for insurance policies than men. Even on policies that excluded maternity coverage. And if you were pregnant before you purchased insurance, that pregnancy was considered a pre-existing in 45 states, and you would not have qualified for coverage.

medicaid coverage

All of that changed when the ACA went into effect. Maternity care was named one of the ten essential health benefits. The ACA ensured that all small group and individual plans covered it. Insurance companies also are no longer able to charge women more than men for the same policies. Finally, insurance companies were no longer allowed to deny insurance to people based on pre-existing conditions.

Private Health Care Plans

Although every insurance plan now offers maternity care, that does not mean you qualify for it all year around. You cannot opt out of buying health insurance during the open enrollment period, great pregnant months later and then buy a plan in the marketplace. In fact, the only state that allows year-round purchasing is Nevada.

The other 49 states only enable people to purchase plans from on- and off-exchange companies during open-enrollment. If you have no insurance and become pregnant, the only other way to buy a private insurance policy is during a special enrollment period because you've met the requirements for a qualifying event.

The qualifying events that allow you to buy insurance during closed enrollment periods are as​​​​ follows: Changes in the household, changes in residence, loss of health insurance, and miscellaneous changes.

Changes in Household

The first of the qualifying events that could make you eligible for a special enrollment period is a change in your household in the last 60 days. For instance, if you get married, and you pick a plan by the end of the month, you'll have insurance coverage the first day of the following month.

On the flip side, if you were legally separated or divorced and lost your health insurance, you would qualify. However, you must have lost your health insurance during the divorce or separation as a result of the divorce or separation. If while you were married you didn't have health insurance, getting separated or divorced wouldn't qualify you for a special enrollment period.

Another household change is death. If you had a marketplace plan with someone else and they died, resulting in your no longer being eligible for your place you qualify for special enrollment. Finally, if you had a baby, placed a child for foster care or adopted a child, you could get insurance that starts the day of the event even if you apply 60 days later.

Changes in Residence

Another way to buy insurance during a special enrollment period is a change in residence. For instance, if you moved to the U.S. from a foreign country or U.S. territory that would qualify. Also, if you are a seasonal worker moving to or from the place you live and work that would open a special enrollment period for you. If you are a student moving to or from the place you attend school, you may qualify.

If you moved to a new zip code or county and finally if you moved to or from transitional housing or a shelter you could buy insurance during special enrollment. There is a catch to this, though, you only qualify for the special enrollment period based on residency changes if you had qualifying health insurance for at least one day during the 60 days before your move. The only time that is moot is if you are moving from a foreign country or U.S. territory.

Loss of Health Insurance

Losing your health insurance is another way to buy insurance during a special enrollment period. If you have lost your health insurance for the following reasons in the last 60 days or expect to lose it in the next 60 days you may qualify:

  • Lost individual coverage for a policy you bought yourself
  • No longer eligible for Medicaid or CHIP
  • Losing job-based coverage
  • Lost coverage you received through a family member
  • No longer eligible for Medicare

You can visit Healthcare.gov and apply for a special enrollment period to be sure.

Miscellaneous Changes

Finally, various changes in your life may make you eligible for a special enrollment period. For example, if you recently got out of jail or prison. You became an American citizen. Also, if you or starting or ending service with VISTA, NCCC, and AmeriCorps State and National.

Finally, if you gained status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder or membership in a federally recognized tribe, you may qualify to buy insurance outside of open enrollment.

Medicaid & CHIP

If you do not qualify for a special enrollment period or cannot afford a private insurance plan, you could apply for a Medicaid or Children’s Health Insurance Program (CHIP) policy.

Medicaid

Medicaid is a service that allows low-income families to access healthcare for free. All states offer Medicaid to help pregnant women access prenatal care. That means that unlike a private insurance policy, you will have no co-pays or deductibles. The Department of Human Services in each state handles Medicaid approval, and eligibility standards may vary.

However, there are some things that you will most definitely need to provide such as proof of pregnancy, income, and citizenship. After you apply for Medicaid either at your local health department or online, a caseworker will tell you exactly what they need from you.

CHIP

If you do not qualify for Medicaid because your income is too high, you may be eligible for CHIP. The program the offers low-cost health insurance for children and pregnant women who earn too much to receive Medicaid. Unfortunately, while all states cover children, only 18 states and the District of Columbia cover pregnant woman, and that coverage varies widely.

Medicaid Chip coverage

The following states cover pregnant women to some degree:

Only 16 of those states cover women for 60 days post-partum. Louisiana, Nebraska, and Oklahoma do not offer women care after their babies are born through the CHIP program.

  • Arkansas
  • California
  • Colorado
  • Illinois
  • Louisiana
  • Massachusetts
  • Michigan
  • Minnesota
  • Nebraska
  • New Jersey
  • Oklahoma
  • Oregon
  • Rhode Island
  • Tennessee
  • Texas
  • Virginia
  • Washington
  • Wisconsin

How a Potential ACA Repeal Would Affect Maternity Care

If Congress were to repeal the ACA, millions of women would suffer as a result. The government would no longer consider maternity care an essential health benefit. If that happened, insurance companies could once again discriminate against women without any repercussions. They can charge the women more money for healthcare policies. Insurance companies would no longer have to offer plans that cover maternity care.

Even more disturbing, if Congress repeals the ACA, there would no longer be protections for people with pre-existing conditions. That means, if a sexual assault survivor received medical care for their assault and became pregnant twenty years later, the insurance company can deny them insurance. The same goes for women who have had c-sections in the past. It would devastate women and their access to fair and affordable health care.

How to Find an OB/GYN

Finding a good OB/GYN (or midwife) can be the most stressful part of pregnancy outside of finding insurance if you have none. Every woman wants to make sure that the doctor who is going to be caring for her and delivering her baby is a fantastic physician. A competent physician can mean the difference between life and death for you and your child. That's not hyperbole either.

How to Find an OB/GYN

You can find an OB/GYN using various methods. The first is by asking your insurance company for a list of providers in your network. Then research every doctor on the list. Another way is by asking your friends and family for recommendations. Finally, you can study the doctors you've narrowed your choice down to by checking both online reviews and the Federation of State Medical Boards. There are other factors to consider when you are choosing an OB/GYN, though.

Level of Care

One thing to consider when you are looking for an OB/GYN is the level of care you will need during the pregnancy. If you have a healthy, or normal pregnancy with no complications, you should be fine with any good OB or midwife. However, if wind up in the "high-risk" category, you will want to find someone with experience dealing with those types of pregnancies.

"High-risk" may seem like a scary term, but it just means that you had a pre-existing condition before the pregnancy, or have developed a condition, that could complicate the pregnancy. Although most "high-risk" pregnancies cause no problems, some doctors will not take on patients in that category. So, make sure you ask a lot of questions to ensure they have experience dealing with whatever condition you have.

Birthing Options

Another thing to consider when you are searching for a physician or midwife during your pregnancy is how you want to give birth. For example, if you want to give birth in a pool in your living room, you are going to need a doctor or midwife who will come to your house. Or, more commonly, if you want to have a vaginal birth after having a c-section during a previous delivery, you will need to find a doctor who performs VBACs.

A lot of doctors will not perform VBACs because of the risks involved even though four out of five women who have one give birth successfully. If you want to have a vaginal birth, speak to all of your OB/GYN candidates and see if they are comfortable with your birthing plan. Also, make sure you ask your doctor about the risks involved so that you can make an informed decision.

Hospital Privileges

hospital room

If you want to give birth at a particular hospital or birthing center, you will need to make sure the OB/GYN you choose has privileges there. Not all doctors will have privileges at all of the hospitals in your area, so this is extremely important.

Availability

Finally, you will need to ask your potential OB/GYN about their availability. Do they allow their patients to text or email them via a patient portal after hours? If not, do they have an answering service to call if you are experiencing an emergency? You are going to want an OB/GYN or midwife that is easy to reach.

What to Expect: the First Trimester

Now that you know how to find health insurance and a doctor, we are sure you would like to know exactly what to expect at your doctor appointments. Your pregnancy will be broken up into three-month parts called trimesters. The first trimester is the first three months of your pregnancy. Your first prenatal appointment will take place as early as possible in the first trimester, and it will include a lot of testing.

First Prenatal Appointment

At you first prenatal visit you will have to fill out a lot of paperwork, and it will probably be the longest appointment. The doctor will take a medical history during the visit. One of the things the nurses and doctor will ask you is when the first day of your last period was. They use that information to determine your due date.

They will also ask if you have any gynecological problems, if your periods were regular, and if this is your first pregnancy. If it isn't your first pregnancy, the doctor will want to know about the previous one(s) and if they resulted in healthy deliveries

doctor supplies

In addition to your gynecological history, they'll ask you about your overall history. Do you have any chronic conditions, drug allergies, past surgeries or take any medications regularly? The doctor will also want to know your family's medical history. This will let them know if there are any hereditary issues that they need to be aware of. After they run down your history with you will be made aware of genetic testing that is available to you.

If you decide to take the tests, they will happen later in the pregnancy. Finally, after all of the information is out of the way, you will have a physical exam. Your first physical exam will be just like a routine pap smear, but the doctor will also check to see if they can feel the fetus. They will screen for sexually transmitted infections and cancer,  and give you a urine test, take your blood pressure and your weight.

After the exam, the doctor will likely send you for routine blood-work that will tell the doctor what your hCG levels (the pregnancy hormone) are, what your blood and Rh types are, as well as measure your hemoglobin, and check for any other infections or diseases.

Other First Trimester Appointments

The rest of the appointments during the first trimester won't be nearly as long. At every appointment, the doctor will ask if you are experiencing any problems. Nausea is a common issue during the first three months, and the doctor may prescribe you something for that. You will also have to give a urine sample at every appointment and have your weight and blood pressure taken

doctors office

During this time your doctor may send you to have your first ultrasound to see exactly how far along you are. Finally, toward the end of the first trimester, between nine and twelve weeks, you may be able to hear the baby's heartbeat. Your doctor will use a small device called a fetal Doppler to listen to it.

Second Trimester

During the second trimester, your doctor will focus on tracking your baby's growth primarily. At every doctor's appointment, you will have your weight and blood pressure taken. The doctor will then check to see how much your baby has grown. To do this, they will measure the distance between the top of your uterus and your pubic bone. The measurement in centimeters usually equals the number of weeks you are pregnant.

The doctor will also listen to the baby's heartbeat at each appointment. When you are around 20 weeks pregnant, they will check to see how much the baby is moving. If this is not your first pregnancy, you may feel the baby moving around earlier than 20 weeks. You can also find out the sex of the baby (if the baby cooperates) in your second trimester, usually at about 16 to 20 weeks. Your doctor will also test your iron levels, blood count, and screen for gestational diabetes.

Genetic Testing

During the second trimester, the doctor can also begin testing for genetic disorders. The doctor may do a maternal serum alpha-fetoprotein (MSAFP) and multiple marker screening during this time. The MSAFP test measures the level of a protein produced by the baby called alpha-fetoprotein. If the levels of this protein are abnormal, it may indicate Down syndrome or spina bifida.

If there are any abnormalities detected, you may want to get an amniocentesis. An amniocentesis is a very invasive test and does carry a small risk of miscarriage though, so be sure to speak to your doctor so you can make an informed decision.

Every prenatal vitamin contains folic acid, which has been proven to prevent birth defects. What most women don’t realize is that 80% of the population has a mutation on a gene that metabolizes folic acid. Depending on the mutation you may lose up to 70% of your ability to absorb folic acid. This gene is called MTHFR (MethyleneTetraHydroFolate Reductase).

If you are in the 15% to 20% of the population that has the worse mutation you will only absorb 30% of the folic acid you are taking and the worse part is that unmetabolized folic acid has been linked to Autism. If you have an MTHFR mutation you should replace folic acid for Methylfolate which is the active form of folic acid. The MTHFR test is not covered by insurance but it is a non-invasive cheek swab test and can be ordered online without a prescription by anyone.

Third Trimester

The third trimester is the busiest trimester of your pregnancy. Your appointments will start out the same way as the other appointments in the second trimester. The doctor will check your urine, blood pressure and weight. They will ask how often the baby is moving, check the fetal heartbeat and growth.

3rd trimester

At 36 weeks, you will start going to the doctor once a week, and they will begin checking the baby's position. Your baby will drop during this time, and it should be headfirst in your uterus waiting to be welcomed into the world. You may have another ultrasound during this time to be sure of the baby's position and check the level of amniotic fluid in your womb. The doctor will also give you pelvic exams to check for cervical changes.

As you get closer to the date of birth, your cervix will begin to get softer. It will also dilate and efface. Your doctor will let you know the progress in centimeters and percentages. For instance, you may be four centimeters dilated and fifty percent effaced. When you are 100 percent effaced and 10 centimeters dilated, the baby will be ready to come into this world.

Tests at the End

During the third trimester, you will also be tested for group B strep. This is a critical test and will determine if there is group B streptococcus (GBS) present. GBS is a bacteria carried in the lower genital tract and the intestines. It is usually harmless for adults but can make the baby seriously ill if they are exposed during a vaginal delivery.

The doctor will swab your vagina and anal area, send it to the lab and have it tested. If it is positive for GBS, you will be given IV antibiotics during the delivery. Don't worry too much about this, however. The condition only affects about one in every 2,000 babies.

Don't Stress the Prenatal Care

The most important thing you need to remember while you are pregnant is to take care of yourself. It is true that you are going to be at your doctor's office a lot. Sometimes, you will wake up in the morning and groan at the thought of going to the doctor's that day. It's totally normal.

Making an entire human being, or multiple human beings is hard work. All you have to do, though, is listen to your doctor, go to your appointments, eat right and try to stay calm. That last one will probably be the most difficult.

swaddle baby

Your doctor will have all of this under control. You will pick an experienced OB/GYN or midwife, and by the time you meet with them, they will have perfected the prenatal care schedule. And even if there is a complication with your pregnancy, your doctor will almost certainly have it under control.

You will have nine months of annoying and, sometimes, incredibly exciting appointments but remember, every appointment is closer to a baby. Also, every appointment is meant to ensure that you and your baby are healthy and happy.

Good luck on your baby journey!

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