What Every Health Care Provider Should Know About The Preconception Visit

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What Every Health Care Provider Should Know About
The Preconception Visit

• Margaret Malnory, MSN, RN
• Wisconsin Association for Perinatal Care

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Preconception History

• Around 1983 a movement began to rethink
  traditional efforts used to impact the outcome of
  pregnancy

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WAPC History

• 35 years old
• Largest perinatal association in the country
• Multidisciplinary membership
• Began preconception work in 1985
• 1987 Becoming a Parent Initiative formulated

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WAPC Preconception Goals

• All pregnancies should be intended at the time of
  conception
• All babies will be born healthy and into a family
  that is prepared to offer nurturing, love, and
  support

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• In an ideal world a positive pregnancy test
  evokes emotions of joy excitement and the
  satisfaction of a dream come true

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• According to Caring for our Future The Context
  of Prenatal Care
• The preconception visit may be the single most
  important health care visit viewed in the context
  of its effect on pregnancy.

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WAPC Focus

• WAPC advocated for a single "preconception visit"
  for 15 years. 

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Barriers to a single preconception visit

• Knowledge
• Time
• Payment
• Current system. 

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Preconception

• Preconception Care usually focuses on
  pre-pregnancy wellness or womens wellness
• WAPC has focused on all persons of childbearing
  age for the last 17 years

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Becoming A Parent

• Video clip

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Consequences of Unintended Pregnancy

• Later initiation into prenatal care
• Increased socioeconomic burdens
• Relationships end
• Forfeiture of professional dreams
• Forfeiture of education
• Maternal depression
• Maternal physical abuse

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Consequences of Unintended Pregnancy

• Increased exposure of the fetus to harmful
  substances
• Low birth weight infants
• Infant mortality
• Child Abuse

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Infant Mortality in Wisconsin

• Most did not feel as if they had control over the
  timing and spacing of their pregnancies
• 71 of pregnancies were unintended
• Either no contraception was used or contraception
  failed
• 43 of women whose infant died were pregnant with
  that baby within twelve months of their
  previous pregnancy

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How Can Preconception Care Improve Outcomes?

• Assist in decision making about
  becoming a parent
• Maintain optimal general health
• Protect fertility / reproductive health
• Reduce risks to future pregnancies
• Prepare for healthy pregnancy

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How Can Preconception Care Improve Outcomes?

• Early confirmation of pregnancy
• Early entry into prenatal care
• Decrease infant mortality
• Decrease LBW infants

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Preconception Care

• Needs to be rethought of as care provided at
  every interaction a provider has with persons of
  childbearing age

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• What Can You Do?
• Find ways around or through the barriers

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Opportunities

• Reach other providers
• WAPC has developed information sheets for
  specific chronic conditions
• For example epilepsy
• Mailed to all the neurologists in Wisconsin to
  encourage them to discuss possible pregnancies
  with their patients

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Opportunities

• Use every possible opportunity to reach all
  persons who are of reproductive age
• general health exams for school, athletics or
  employment
• annual examinations
• family planning or STD visits
• postpartum examination
• well child appointments

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Opportunities

• AODA appointments
• emergency room visits
• community education programs
• womens centers
• school nurse visits
• health resource centers

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Opportunities

• school curricula
• career days
• public health programs, such as WIC, immunization
  clinics, well child services
• media spots
• screening clinics

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Opportunities

• Political action to move for reimbursement for
  preventive services
• preconception visits
• contraception

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The challenge to care providers is to be aware of
the value and benefit of preconceptional care and
to take advantage of every opportunity to
incorporate it into health care encounters
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Having a baby must be an informed decisionnot
a chance event
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For more information or to purchase materials

• Contact WAPC , 1010 Mound Street, Madison, WI
  53715
• 608-267-6060
• 608-267-6089 (fax)
• http//www.perinatalweb.org

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