Few events in a woman’s life are as anticipated as the birth of a child. With the availability of birth control options, women today have the ability to control their fertility choices as never before. Women can continue to have choice and control when it comes to decisions made during the course of the pregnancy, even if the pregnancy is unplanned. These choices form the basis for modern prenatal care.
The first choice a woman makes is whether to seek preconception care. There is a recent emphasis on preconception counseling because a woman’s medical condition, medications, occupational exposures, or social practices may have consequences in the earliest weeks of pregnancy, well before awareness of pregnancy or the traditional initiation of prenatal care. Optimizing health, controlling chronic illness, altering medications, updating vaccinations, and giving advice to supplement the diet with folic acid before conception can have a positive effect on a subsequent pregnancy. Family history should be reviewed to identify any genetic risks and a social and lifestyle history should be elicited. Preconception health care is an important opportunity to practice preventive medicine.
Most women seek care early in a pregnancy. In 1993, 79 percent of American women initiated prenatal care in the first trimester, with less than 5 percent waiting until the third trimester or receiving no prenatal care at all. It is the goal of the United States Public Health Service (USPHS) that at least 90 percent of American women initiate prenatal care in the first trimester.