Intervention includes providing the means to meet the needs identified during the health and risk assess- ment and providing counseling specific to precon- ception care. During the course of this assessment and counseling, the potential for education of the woman and couple is immense. Information about
Expecting the Best: A Preconception Class TABLE 5-7
1. Assessing psychological readiness a. the choice to bear children b. alternatives to pregnancy c. the timing of pregnancy d. assessing and coping with psy-
chosocial risks
2. Assessing physical readiness a. achieving/maintaining ideal
weight
b. initiating/continuing regular ex- ercise
c. evaluation of medical problems d. routine screening for all women
(1)hemoglobin or hematocrit (2)Rh factor
(3)rubella titer
(4)urine dipstick for protein and sugar
(5)Pap smear (6)gonococcal culture (7)syphilis
(8)hepatitis B (9)HIV (offer)
(10)illicit drug screen (offer)
e. additional screening for some women
(1)tuberculosis skin test (2)chlamydia culture or rapid
screen (3)toxoplasmosis (4)CMV
(5)herpes simplex (6)varicella
(7)hemoglobinopathies (8)Tay-Sachs
(9)parental karyotype (10)mammography f. dental exam
3. Examination/concerns of the father 4. Creating a positive environment for
conception a. nutrition
b. substance avoidance (1) cigarettes (2) alcohol (3) caffeine
(4) drugs: over-the-counter, recreational, prescribed
c. environmental pollutants, occu- pational hazards
5. Discontinuing family planning methods and timing conception a. menstrual history, menstrual
charting, and maximizing fertil- ity
b. discontinuing oral contraceptive pills and spermicides
c. safer sex d. infertility 6. Special concerns
a. genetic counseling b. prenatal diagnosis c. DES exposure
d. chronic medical problems 7. Choosing a care provider and birth
place
8. Before preconception clinic visit a. medical history form
b. nutritional history form (7-day diet recall)
c. stress evaluation scale d. lab tests
Source:From Summers, L., and Price, R. A. Preconception care: an opportunity to maximize health in pregnancy. J. Nurse-Midwifery38(4):198, 1993. Reprinted by permission.
the woman’s body and how to care for it for best health and the correction of misconceptions are basic components of preconception care education. The midwife can also provide the woman or couple with recommendations for positive health behaviors and suggest lifestyle changes if indicated. The midwife needs to be knowledgeable about and have estab- lished contacts with a variety of treatment and coun- seling resources (primary care providers, mental health centers, genetic counseling centers, drug treat- ment centers, smoking cessation programs, outreach programs, support groups, fitness and exercise cen- ters, nutritional counseling services, women’s shel- ters, to name a few) and be ready to make the necessary referrals. The provision of preconception care is a natural bridge between the well-woman gy- necologic care encompassed in the primary care of women and midwifery care during pregnancy.
Information about the course of pregnancy from the preconception preparations the couple makes to birth represents the ultimate in “early childbearing education.”
References
1.Public Health Service Expert Panel on the Content of Prenatal Care. Caring for Our Future: The Content of Prenatal Care.
Washington, DC: U.S. Public Health Service, 1989, p. 25.
2.Healthy People 2000: National Health Promotion and Disease Prevention Objectives.
Washington, DC: U.S. Public Health Service, 1991.
3.Healthy People 2010: National Health Promotion and Disease Prevention Objectives.
Washington, DC: U.S. Public Health Service, 1999.
4.Centers for Disease Control and Prevention/
National Center for Chronic Disease Prevention and Health Promotion. Safe Motherhood:
Promoting Health for Women Before, During, and After Pregnancy, 2002.
5.Beck, L. F., Morrow, B., and Lipscomb, L. E.
Prevalence of selected maternal behaviors and experiences, Pregnancy Risk Assessment Monitoring System (PRAMS), 1999. MMWR 51(SS02):1–26 (April 26) 2002.
6.Klima, C. S. Unintended pregnancy: conse- quences and solutions for a worldwide problem.
J. Nurse-Midwifery43(6):483–491 (November/
December) 1998.
7.Jack, B. W., Culpepper, L., Babcock, J., et al.
Addressing preconception risks identified at the time of a negative pregnancy test: a randomized trial.J. Fam. Pract. 47(1):33–38 (July) 1998.
8.Hellerstedt, W. L., Pirie, P. L., Lando, H. A., et al. Differences in preconceptional and prenatal behaviors in women with intended and unin- tended pregnancies. Am. J. Public Health 88(4):663–666 (April) 1998.
9.Martin, S. L., Mackie, L., Kupper, L. L., et al.
Physical abuse of women before, during and after pregnancy. JAMA 285(12):1581–1584 (March 28) 2001.
10.Centers for Disease Control and Prevention.
Recommendations for the use of folic acid to reduce the number of cases of spina bifida and other neural tube defects. MMWR 41 (RR- 14):1–5, 1992.
11.Iqbal, M. M. Prevention of neural tube defects by periconceptual use of folic acid. Pediatr.
Rev. 21:58–66, 2000.
12.Jeffcoat, M. K., Geurs, N. C., Reddy, M. S., et al. Periodontal infection and preterm birth: re- sults of a prospective study. J. Am. Dent. Assoc.
132(7):875–880 (July) 2000.
13.Reynolds, H. D. Preconception care: an integral part of primary care for women. J. Nurse- Midwifery43(6):445–453 (November/December) 1998.
14.Brent, R. L. Addressing environmentally caused human birth defects. Pediatr. Rev. 22(5):153–165 (May) 2001.
15.Einarson, A., Selby, P., and Koren, G.
Discontinuing antidepressants and benzodi- azepines upon becoming pregnant: beware of the risks of abrupt discontinuation. Can. Fam.
Physician47:489–490 (March) 2001.
16.Brundage, S. C. Preconceptional health care.
Am. Fam. Physician 65(12):2507–2514 (June 15) 2002.
17.Cefalo, Robert C. Preconception care and the risk of congenital anomalies in the offspring of women with diabetes mellitus: a meta-analysis.
Obstet. Gynecol. Survey57(2):71–72 (February) 2002.
18.American Diabetes Association. Preconception care of women with diabetes. Diabetes Care 25(S1):S82–S84 (January) 2002.
19.Gei, A. F., and Hankins, G. D. Cardiac disease and pregnancy. Obstet. Gynecol. Clin. North Am. 28(3):465–512 (September 1) 2001.
20.American College of Obstetricians and Gynecologists. Seizure disorders in pregnancy.
ACOG Educational Bulletin No. 231.
(December) 1996.
21.Jack, B. W., and Culpepper, L. Preconception care.J. Fam. Pract. 32(3):309, 1991.
22.Anderson, A. M. M., Wohlfahrt, J., Christens, P., et al. Maternal age and fetal loss: popula- tion-based register linkage study. BMJ 320:1708–1712, 2000.
23.Summers, L., and Price, R. A. Preconception care: an opportunity to maximize health in pregnancy. J. Nurse-Midwifery 38(4):188–198 (July/August) 1993.
24.Centers for Disease Control and Prevention/
National Institute for Occupational Safety and Health. The Effects of Workplace Hazards on Female Reproductive Health. Pub. No. 99-104.
February 1999.
25.Frey, Keith A. Preconception care by the nonobstetrical provider. Mayo Clin. Proc.
77(5):469–473 (May) 2002.
26.Haug, K., Irgens, L. M., Skaerven, R., et al.
Maternal smoking and birthweight: effect mod- ification of period, maternal age, and paternal smoking. Acta Obstet. Gynecol. Scand.
79:485–489, 2000.
27.Centers for Disease Control and Prevention/
National Institute for Occupational Safety and Health. The Effects of Workplace Hazards on Male Reproductive Health. Pub. No. 96-132.
January, 1997.
28.Summers, L., and Gegor, C. Preconception care and counseling. Postgrad. Obstet. Gynecol.
15(4):1–8 (February) 1995.
Proper nutrition is essential to human growth, de- velopment, and well-being. It is in fact impossible to separate health and nutrition. Four of the ten top leading causes of death among American women—
coronary heart disease, certain types of cancer, stroke, and diabetes—have dietary factors associ- ated with them [1]. Furthermore, the prevalence of osteoporosis and extremes in body weight contin- ues to increase and have reached epidemic propor- tions. It is projected that overweight and obesity will soon replace smoking as the leading contribu- tors to morbidity and mortality in the United States [2]. Measures to reduce this disease burden are rel- atively simple and well researched: maintaining a healthy weight; eating a well-balanced, nutritious diet; not smoking; and exercising regularly.
However, survey data from the American Dietetic Association (ADA) reveal that while women seem to recognize the relationship between diet and health, only about one-third of them actually im- plement dietary strategies to reduce their risk of nu- tritionally related progressive chronic disease [3].
It is essential that midwives incorporate the promotion of healthy nutrition into their clinical and preventive health visits as well as their treat- ment plans for diseases that have dietary factors as- sociated with them. This must be done in a clear manner that avoids conflicting messages and that provides clients with specific steps that can realisti- cally be incorporated into their everyday lives. In order to do this, midwives must have an under- standing of basic nutrition principles and of nutri- tional concerns specific to their client population.
Midwives must then be able to translate this knowl- edge into effective educational messages and nutri- tional recommendations and interventions.