What is the approach to counseling a patient about prenatal and postnatal care?

From the Guidelines

Counseling a patient about perinatal care should prioritize a comprehensive and continuous approach, focusing on accurate, evidence-based information and shared decision-making, as emphasized in the Society for Maternal-Fetal Medicine consult series #55 1.

Key Components of Counseling

• Before pregnancy, women should be informed about maternal and fetal health risks and strategies to prevent or reduce these risks, including discussions on optimal nutrition, physical activity, and health behaviors 1.
• During pregnancy, counseling should cover the potential risks and benefits of pregnancy continuation and termination, as well as postpartum health, contraception, and future pregnancy risks 1.
• The counseling process should be nondirective, patient-centered, and aimed at empowering patients to make informed reproductive health choices, considering their values and preferences 1.

Strategies for Access to Care

• Expanding healthcare practitioner education on counseling for high-risk women and facilitating referrals to obstetrician-gynecologist specialists and MFM subspecialists can improve access to care 1.
• Utilizing telemedicine and community resources, such as doulas and social services, can help address logistical barriers and support women during prenatal care and labor and delivery 1.

Postpartum Care and Counseling

• Counseling should address a woman’s physical and mental health after pregnancy, including signs and symptoms of life-threatening conditions and common postpartum changes, as well as risks and prevention of subsequent pregnancies 1.
• Contraception counseling should be initiated during pregnancy and continued throughout the interpregnancy period, focusing on the safety, effectiveness, accessibility, affordability, and acceptability of various options 1.

From the Research

Counseling Approach

To counsel a patient about perinatal care, the following steps can be taken:

• Begin by asking the patient if they plan to become pregnant in the next year, as this can help identify the need for prepregnancy counseling 2.
• Assess the patient's health status and risk factors, including chronic medical conditions such as diabetes, hypertension, and psychiatric illness, and provide guidance on optimal management before pregnancy 2.
• Discuss the importance of folic acid supplementation to reduce the risk of neural tube defects 2, 3.
• Screen for intimate partner violence, sexually transmitted infections, and genetic conditions, and provide education on healthy pregnancy habits 2.

Nutrition and Supplementation

• Recommend prenatal supplementation with essential vitamins and minerals, including calcium, iron, and folic acid, to reduce the risk of pregnancy complications and infant health problems 4, 5, 6.
• Encourage a balanced diet that meets the recommended dietary allowance for essential nutrients, and consider supplementation if necessary 4, 5.
• Discuss the importance of avoiding harmful substances, such as alcohol, nicotine, and illicit drugs, during pregnancy 2.

Prenatal Care

• Emphasize the importance of well-coordinated prenatal care, initiated at 10 weeks or earlier, to improve outcomes and reduce pregnancy-associated morbidity and mortality 3.
• Discuss the need for regular screenings, including blood pressure checks, urine tests, and ultrasounds, to monitor fetal development and detect potential complications 3.
• Provide education on the importance of maintaining a healthy weight, managing chronic conditions, and avoiding harmful substances during pregnancy 3.