1. Prenatal Care and Advocacy Susanna R Magee MD MPH Brown MOMS

2. Goals  Discuss various components of prenatal care Medical history Vitamins Diet Timing of Visits Special Needs  WIC  NHP

3. Sue Magee  Jefferson Medical College  Brown Residency  Brown Maternal and Child Health Fellowship  Faculty Dept FM Brown Clinical Academic Director of Maternal and Child Health December 2006 Director of the Rocking Chair Project Co-Advisor Brown MOMS Program

4. MOMS  What I love most about the program and why I wanted to get involved The effect it can have on the new mother and her baby Clinical experience in the early years Practical knowledge Chance to get to know faculty and create mentor relationships Patient advocacy  Applicable to any field

5. Medical History  All previous history components can effect current prenatal care Anxiety/depression/other psychiatric disease Hypertension Diabetes Thyroid Disease Migraines/Headaches Family History of medical problems

6. Medical History  Past OB history Type of delivery ‘Gs and Ps’  Past surgical history Surgical scarring

7. Vitamins  Folic acid Dosing 0.4 mg vs. 4 mg  Iron  Vitamin B6

8. Diet  Foods to eat  Amount to eat Weight gain Expected ‘belly growth’  What to avoid Mercury, unpasteurized foods  Strange cravings pica

9. Timing of Visits  Number of visits  What happens at each visit Measuring with tape measure Fetal heart by Doppler Blood work Ultrasound Non-stress testing

10. Timing of Visits  First Trimester 2 visits, every 4 weeks Prenatal labs Dating confirmed PAP Common issues—constipation, bloating, decreased exercise tolerance  Second Trimester Every 4 weeks Glucose tolerance testing Rh status

11. Timing of Visits  Third Trimester Every 2 weeks 28-36 weeks Weekly after 36 weeks Group B strep  Non invasive  May prevent life threatening disease

12. WIC  Federally funded Department of Agriculture Pawtucket, Central Falls and Providence have separate offices  Require proof of pregnancy letter  Formula and food coverage prenatally and until child is 5 milk eggs cheese tuna  Anemia and lead testing moms and babies  Formula coverage

13. NHP-’Neighborhood’  Medicaid managed care program  Insures all pregnant women and children to the age of 18 need to meet income stipulations  Covers all medications that would be necessary in pregnancy, including over the counter medications  Case managers available  Smoking cessation programs available

14. Smoking Cessation  Behavioral component and Medical component  Case management programs work Combined with medication, quit rates as high as 37%  Wellbutrin safe in pregnancy  Stages of Change theory important

15. Rocking Chair Project  New component of MOMS?  Chair delivered to the mom’s home that you assemble with a faculty advisor  Complete the circle of care  Home visit learning