Few human experiences are more exciting, more daunting, or more intimidating than pregnancy. The joys of giving birth are accompanied by the reality of the potential for serious threats to the health of the mother and her baby. Most maternal deaths can be prevented, yet according to research conducted by the World Health Organization (WHO), the rate of maternal mortality has been increasing in the U.S. since 2000, making the U.S. one of only two countries, along with the Dominican Republic, reporting such a rise.
The most important factor in preventing complications during pregnancy and after the baby arrives is receiving quality prenatal and postnatal care. The steps entailed in maintaining the health of mother and baby before and after delivery include care services and support tailored to each woman’s individual needs.
- Prenatal care should begin as early in the pregnancy as possible to protect the health of the baby and the mother. According to the CDC, babies born to mothers who have not received prenatal care are three times more likely to have a low birth weight and five times more likely to die.
- Postnatal care, also called postpartum care, helps new mothers adjust to the physical, social, and psychological changes that result from giving birth.
Effective health care for expecting and new mothers is based on a continuing process that begins early in the pregnancy and extends to months of postpartum care tailored to the needs of the mother and baby. The resources in this guide cover all aspects of pregnancy and new motherhood. It includes tips and advice for new mothers intended to help them and their newborns stay healthy during the pregnancy and through the postpartum period.
What Is Prenatal Care?
Prenatal care helps keep the mother and her baby healthy throughout the pregnancy. Before and during pregnancy, a woman should eat nutritious foods, live a healthy lifestyle, and have regular health care checkups. As soon as a woman learns that she is pregnant, prenatal care begins in earnest to monitor her health and the baby’s progress. These are among the questions that expecting mothers have about pregnancy.
- What’s the best diet? The healthiest diet during pregnancy is based on whole foods that are high in protein, vitamins and minerals, and healthy fats (monounsaturated and polyunsaturated).
- What’s the best exercise? The physical changes a woman experiences during pregnancy can cause backaches, swollen ankles, insomnia, and many other painful and unhealthy conditions. Exercising during pregnancy provides many benefits to mothers and babies in decreasing symptoms, easing pain, and lifting the mood of women while they are pregnant.
- What prenatal tests are recommended? Tests are performed routinely at all stages of a woman’s pregnancy to detect diseases such as rubella, hepatitis B and C, and sexually transmitted infections. Testing is also done to detect birth defects.
Performing Physical Checkups and Monitoring
These checkups typically occur once a month early in the pregnancy and more often as the pregnancy progresses. Care providers ask about the woman’s health history and determine whether any complications are likely.
Providing Nutrition Consulting
A woman’s health care provider may recommend that she take prenatal vitamins to ensure that she and the baby receive the nutrients they need. The vitamins may include folic acid, iron, calcium, vitamin D, and iodine, but women should always check with their health care provider about any vitamins or other dietary supplements they take during pregnancy.
Recording Weight and Blood Pressure
As part of the physical exam, the woman’s weight is recorded for tracking her weight increase during the pregnancy. Her glucose levels are checked regularly, and her blood pressure is monitored to detect any dangerous increases. Tests are conducted for urinary tract infections (UTIs), which are common during pregnancy and increase the risk of preterm birth.
Conducting Ultrasound Tests
Women typically receive an ultrasound examination in the second trimester of their pregnancy, at 18 to 20 weeks. Ultrasound tests allow women to “see” the baby via digital pictures created using sound waves. The tests are used to check the baby’s age, growth, and position, and to screen for birth defects.
Measuring the Fundal Height
Part of checkups later in the pregnancy include measuring the fundal height of the woman’s abdomen. The fundal height indicates the gestational age, or how far the pregnancy has progressed. It also determines how well the baby is growing and how big the baby is.
Monitoring Changes to a Mother’s Uterus
During pregnancy, a woman’s uterus grows tremendously. Before pregnancy, it is about the size of an orange, and by the second trimester it expands and moves from the pelvis to an area between the navel and breasts. By the third trimester the uterus extends from the pubic area to the bottom of the rib cage.
Prenatal Care Information Resources
- Pregnancy Week by Week, Mayo Clinic—What to expect in the first trimester, second trimester, and third trimester of a pregnancy, including physical and emotional changes and how to choose a prenatal care provider
- Staying Healthy and Safe, Office on Women’s Health—Healthy eating, weight gain, calorie needs, food safety, the importance of fluids, cravings, medicine and herbs, travel, environmental risks, and when to call a health care provider
What Is Postnatal Care?
The postpartum period is six to 12 weeks after the baby’s birth, a time when the mother experiences physical and emotional changes as she turns her attention to caring for her newborn. Immediately after the birth, women typically spend one or two days in the hospital after a vaginal delivery or two to three days after a cesarean section.
- During their hospital stay, women receive instruction on breastfeeding. It can take two to three weeks for a woman to learn how to nurse her baby, including how to care for her breasts, position the baby for breastfeeding, pump and store breast milk, and overcome breastfeeding problems.
- Vaginal care is an important part of postnatal care. Women may have vaginal soreness, especially if tearing occurred during delivery. They may also experience contractions in the days immediately after delivering, as well as painful or frequent urination and some discharge.
- Another vital aspect of postpartum care is getting enough rest. Women need to recoup their strength after giving birth while expending energy to care for their newborn. To avoid tiredness, women can try to sleep when the baby sleeps, keep the baby’s crib near their bed for easy night feedings, and let someone else bottle-feed the baby while they sleep.
What Happens During Postnatal Care Visits?
The first postnatal care visit with the mother’s gynecologist or other obstetric health care provider should occur within three weeks of giving birth. At the initial postpartum assessment, care providers develop a plan for ongoing postnatal care, which culminates in a comprehensive examination no later than 12 weeks after the birth.
Performing Physical Checkups and Monitoring
The woman’s health care provider fully assesses the new mother’s physical, social, and psychological well-being, including her moods and emotions. The examinations cover the infant’s care and feeding, contraception and birth spacing, the physical recovery from birth, rest and fatigue, and any chronic health conditions.
Providing Nutrition Consulting
Women will be reminded to drink plenty of fluids, and some care providers may suggest that they drink beverages with electrolytes to help recover from giving birth. Nutritional advice may include eating high-protein foods as well as foods that help fight inflammation, such as those containing vitamin A, vitamin C, B vitamins, and zinc.
Consulting on Breastfeeding
To help overcome problems with breastfeeding, women may be referred to a lactation consultant, such as a postpartum doula who is trained in providing breastfeeding support or a breastfeeding counselor employed by their health care provider who offers initial breastfeeding training and information.
Advising on Care for Newborns
Women often feel unprepared after giving birth to their first child. Postnatal care visits provide them with an opportunity to learn how to safely handle newborns, such as always supporting the neck, as well as how to change a baby’s diapers and give a newborn a bath. Care providers also offer advice on feeding and burping, cleaning the umbilical cord, and soothing the baby.
Administering Postnatal Testing
Postnatal testing for the mother focuses on screening tests to detect postpartum depression, while screening for the baby looks for potential metabolic disorders caused by some enzymes missing or not working, problems related to too many or too few hormones, hemoglobin problems, hearing issues, and rare disorders such as congenital heart disease.
In addition, postnatal genetic testing on newborns identifies potential diseases or disorders caused by chromosomal abnormalities. For example, molecular karyotyping can detect neurological disorders and genetic defects that cause autism, epilepsy, and cognitive disorders.
Postnatal Care Information Resources
- Postpartum Care: An Approach to the Fourth Trimester, American Family Physician—Recommendations for care providers and new mothers to reduce maternal mortality in the postnatal period and address postpartum medical complications
- Access to and Quality of Healthcare for Pregnant and Postpartum Women During the COVID-19 Pandemic, Frontiers in Global Women’s Health—Strategies for reducing the disruptions to care that pregnant and postpartum women have experienced during the pandemic
- Maternal Mortality in the United States: A Primer, The Commonwealth Fund—Causes of pregnancy-related deaths in the U.S. tied to race and ethnicity
5 Prenatal and Postnatal Care Tips
Prenatal and postnatal care providers recommend that women have 13 to 14 prenatal visits with an obstetrician, midwife, or other maternity care professional, as well as several checkups in the postnatal period. However, many women face barriers to the care they need when they become pregnant:
- Young women who lack health insurance
- People of color
- Poor people
- Linguistic minorities
- Other marginalized groups
Efforts are underway to address health care disparities for pregnant women and new mothers by improving access to high-quality prenatal care, social support, and support for families. Staying healthy during and after pregnancy requires a concerted effort by women, their families, their employers, and others in their lives. These tips help ensure a complication-free pregnancy, delivery, and postpartum experience.
1. Get Enough Rest
Pregnancy and giving birth disrupt all aspects of a woman’s sleep cycle, but lack of sleep increases the likelihood of complications, according to a specialist in sleep disruptions.
- In the first trimester, a woman will likely crave sleep more than usual as the placenta grows, including wanting naps and earlier bedtimes.
- In the second trimester, the growing baby may cause the mother to wake up more often at night, and to use the bathroom more often.
- In the third trimester, sleep can be disrupted by back pain, baby kicks, leg cramps, and congestion.
These tips help encourage a good night’s sleep:
- Establish a regular bedtime and wake time.
- Participate in stress-reducing activities such as meditation and yoga.
- Sleep on one side and use a maternity pillow to support the back and knees.
- Elevate the head to reduce breathing problems.
- Drink plenty of fluids to prevent leg cramps.
2. Eat a Healthy, Nutritious Diet
Healthy eating during pregnancy promotes healthy mothers and healthy babies. Pregnant women require more protein, iron, folic acid, and iodine in their diets, among other nutrients. The advice of diet and nutrition experts for pregnant women includes the following:
- Emphasize whole grain, low-fat, low-sugar, and low-sodium foods.
- Avoid saturated fats, starch, and refined grains.
- When feeling nauseous, eat whole-grain crackers or a piece of whole-grain toast.
Beginning in the second trimester, a woman needs to increase her calorie intake by about 340 calories per day. In the third trimester she will need an extra 450 calories each day. Healthy snacks during pregnancy include low-fat or fat-free yogurt, fruit, low-fat cheese, and carrots with hummus. Pregnant women should avoid eating raw and undercooked fish and shellfish, unpasteurized soft cheeses, unpasteurized milk and juices, processed lunch meats, and raw sprouts.
3. Get Plenty of Exercise
One of the questions a woman should ask at her first prenatal checkup is whether she can exercise during her pregnancy. Pregnant women who do not have chronic health problems are generally advised to get at least 150 minutes of aerobic exercise each week. Walking, swimming, and other physical activities help alleviate many of the aches and pains associated with pregnancy. Exercise also reduces the risk of complications.
- Suitable forms of exercise during pregnancy include riding a stationary bike, yoga and pilates classes, low-impact aerobics, and strength training.
- Certain conditions during pregnancy may make exercise unsafe. These include preterm labor (occurring sooner than 37 weeks of pregnancy), being pregnant with multiples (twins, triplets, etc.), cervical insufficiency, gestational hypertension (high blood pressure), and placenta previa.
4. Listen to the Body’s Wisdom
Each woman experiences pregnancy in her own unique way, but it can be difficult to avoid trying to out-think the body during this time of tremendous physical change. Women need to learn how to let their bodies take the lead and to trust and act on the sensations and emotions they feel.
- Throughout the day, a pregnant woman can stop to take an inventory of how they feel at various locations, with different people, and doing different activities. They should try to identify the source of the sensations and emotions they experience at different times and places.
- They can find a quiet spot to lie down and mentally scan their body from head to toe, noting what characteristics and feelings they associate with different parts of the body, including what feels tense or stressed. Then they can breathe into those parts of the body to relax them, and when they finish, write down their sensations and note areas that felt blocked.
- The woman can then share these perceptions about what their body is telling them with their health care provider and pregnancy support team and ask for help in devising strategies for reducing pain, stress, and anxiety.
5. Check in Regularly with a Health Care Provider
Women have many questions during and after their pregnancy as they go through physical changes and experience new emotions. While many of these questions can be covered during a prenatal or postnatal visits, others may come up unexpectedly and need a more immediate answer. A woman should contact her health care provider right away if she experiences any of these symptoms:
- Unusual or severe cramping or abdominal pains
- Changes in the baby’s movement after 28 weeks
- Difficulty breathing or shortness of breath that appears to be worsening
- Indications of premature labor, such as pain in the lower abdomen or back, bleeding in the second or third trimester, or unusual vaginal discharge
Pregnant women who have a fever over 100 degrees Fahrenheit, severe or persistent vomiting, fainting or dizziness, problems urinating, blurred vision, swelling of the hands or face, or severe headaches should seek the advice of their health care provider as soon as possible.
Resources: Prenatal and Postnatal Care Tips
- Staying Healthy During Pregnancy, Nemours KidsHealth—Nutrition and supplements, exercise, sleep, activities to avoid, and the use of over-the-counter and prescription medications
- Protecting Your Birth: A Guide for Black Mothers, New York Times — A guide for pregnant Black women and their care providers to counter the devastating effects of racism in prenatal and postnatal care that cause a much higher mortality rate for Black women than the rest of the population
- Commit to Healthy Choices to Help Prevent Birth Defects, Centers for Disease Control and Prevention—Advice includes eating a diet rich in folic acid, scheduling regular prenatal visits, avoiding harmful substances, and adopting a healthy lifestyle
Prenatal and Postnatal Care Providers
The maternal mortality rate in the U.S. is more than double that of every other industrialized country. According to the Commonwealth Fund, in 2018 there were 17.4 maternal deaths per 100,000 live births in the U.S., compared to 1.7 per 100,000 births in New Zealand, 3.2 in Germany, 6.5 in the United Kingdom, and 8.6 in Canada.
- Approximately one-third of maternal deaths in the U.S. occur during pregnancy.
- About 17% of maternal deaths happen on the day of delivery.
- More than half of all maternal deaths in the U.S. occur during the postpartum period: 19% between one and six days postpartum, 21% between one and six weeks postpartum, and 12% in the remaining portion of the year after birth.
To combat the high maternal mortality rate and to improve outcomes for all pregnancies, health care professionals are adopting community-based models that combine the efforts of many different maternity health professionals. The medical professionals chosen by women to care for them through their pregnancy, delivery, and postpartum period include obstetricians/gynecologists (OB/GYN), family physicians, family nurse practitioners (FNP), certified midwives, and perinatologists.
Most pregnant women choose an OB/GYN to provide their care and to deliver their baby in a hospital. In the U.S., more than 98% of births occur in hospitals under the care of an OB/GYN, according to research reported in Frontiers in Sociology. The American College of Obstetricians and Gynecologists (ACOG) points out that hospitals and accredited birth centers are the safest places to give birth. The choice of maternity care provider has been complicated by concerns about COVID-19, and much effort has been made to ensure that labor and delivery remain safe for mothers and their babies.
Even before the COVID-19 pandemic, however, a growing number of women expressed an interest in nonhospital deliveries and community care, particularly for natural childbirth and more person-centered care. More women stated a preference for community births after COVID-19 (5.4%) than before the pandemic (1.6%), according to research compiled by Frontiers in Sociology.
A growing number of Black women are choosing to give birth at birth centers, which the New York Times describes as “halfway points between hospital births and home births.” The women choose birth centers due to concerns about COVID-19 and because of racial inequalities in health care.
In recent years, the number of family physicians who offer maternity care has declined, in part because family medicine residency programs find it difficult to meet the requirements of accrediting agencies. However, family physicians play critical roles in serving the maternity needs of women and families in rural and underserved communities.
In particular, reproductive health is the primary entry point for women into primary health care services, which includes pregnancy diagnosis and prenatal care. Family physicians perform all the medical services women need during pregnancy and after they deliver, but not the actual delivery. One proposal is to expand maternity care fellowships as an alternative to making maternity care a part of all residencies.
Family Nurse Practitioners
Family nurse practitioners (FNP) and women’s health nurse practitioners (WHNP) provide comprehensive health care that includes family planning, pregnancy counseling and care, and prenatal and postnatal care visits.
- They take patient histories, conduct physical examinations, order diagnostic tests, and interpret test results.
- They diagnose medical conditions and make advanced clinical decisions.
- They work with patients to create maternity health plans, prescribe medications and treatments, and make referrals.
Certified Nurse Midwives
A certified nurse midwife (CNM) has completed an accredited graduate-level program and passed a certification exam conducted by the American Midwifery Certification Board. CNMs are licensed by the American College of Nurse Midwives and can practice throughout the U.S. They typically care for women who have low-risk pregnancies and provide all primary care needs for their patients, including newborn care and preconception advice.
The focus of most CNMs is on natural childbirth that relies on breathing techniques, hydrotherapy, and other alternative approaches to labor and delivery. They often work in hospitals and birthing centers but may also perform home births; they are qualified to prescribe epidurals and labor-inducing medications.
A perinatologist is an OB/GYN doctor who specializes in treating high-risk pregnancies. Perinatologists are also referred to as maternal-fetal medicine (MFM) specialists. They have completed their OB/GYN residency as well as a three-year fellowship emphasizing medical, fetal, genetic, and other types of pregnancy complications. They often work with OB/GYNs, midwives, and other maternity care professionals, and they are often called when a pregnant woman has suffered an accident or other emergency.
Some women are referred to perinatologists before they become pregnant because they have a preexisting condition, such as diabetes or lupus, or because they have miscarried in the past. Perinatologists also see patients who have had a previous high-risk pregnancy. They offer advice on the effect of medications on the baby, review nutrition and weight plans, and screen for genetic risk factors, such as sickle cell disease and Tay-Sachs disease.
Taking Care of a New Mother’s Physical and Mental Health
Positive maternity outcomes start by keeping the mother and her baby healthy throughout the pregnancy, birth, and postpartum period. A woman’s care during and after pregnancy treats her physical and mental symptoms, prepares her to care for and feed her newborn, and anticipates and treats any complications that may arise during or after the pregnancy. Maintaining a comprehensive health plan that includes regular prenatal and postnatal care visits, a healthy diet, exercise, and preparation is the first and most important step in ensuring a happy, healthy outcome for mother and baby.