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Pre-conception counseling (also called pre-conceptual counseling) is based on the medical theory that all women of child-bearing years should be pre-screened for health and risk potentials before attempting to become pregnant. Physicians and baby experts recommend that a woman visit her physician as soon as the woman is contemplating having a child, and optimally around 3 to 6 months before actual attempts are made to conceive. This time frame allows a woman to better prepare her body for successful conception (fertilization) and pregnancy, and allows her to reduce any health risks which are within her control. Agencies such as the March of Dimes  have developed screening tools that physicians can use with their patients. In addition, obstetricians (see Obstetrics and General Practitioner) have developed comprehensive check-lists and assessments for the woman who is planning to become pregnant.
In one sense, Pre-Conception Counseling and Assessment can be compared to a well-baby visit in which a baby is screened for normal health, normal development, with the benefit of identifying emerging problems that may have gone unnoticed in an infant. For a woman, the Pre-Conception Counseling Assessment and Screening is intended to assess normal health of a child-bearing woman, while at the same time identifying:
- Existing or emerging illness or disease which may have gone undetected before, and
- Existing risks for the woman who may become pregnant, and
- Existing risks which may affect a fetus if the woman does become pregnant.
Obstacles to Pre-Conception Counseling
The most common obstacle to pre-conception counseling and assessment is that many pregnancies are still unplanned.[How to reference and link to summary or text] Globally, 38% of pregnancies are unintended. Many unintended pregnancies result from failure to use birth control or failure to use it correctly; if a birth control method fails, there is no opportunity for pre-screening and assessment.
In the United States, for instance, over half of pregnancies are unintended. Half of unintended pregnancies result from not using birth control, and 45% of them from using birth control inconsistently or incorrectly.
The second most common obstacle to pre-conception counseling and assessment is that most women do not know, realize, or understand the benefits of visiting their physician before trying to become pregnant.[How to reference and link to summary or text] Most women still take for granted the biological aspects of becoming pregnant, and do not consider the extreme value of pre-screening before becoming pregnant. Most women who want and anticipate having a baby are naturally prone to thinking in terms of having a well baby. In the majority of cases, women do not think about having a baby who has any kind of problem. Most women do not know how their own medical history could pose risks to a developing fetus. Likewise, they may not understand that pregnancy carries a certain number of risks as well. When family history risks and pregnancy risks are considered together, it may point to potential problems for that particular woman, or to her unborn baby once she becomes pregnant.
The third most common obstacle to pre-conception counseling and assessment may be the lack of health insurance. However, most insurances will cover this as a screening visit. Also, many physicians will do the pre-conception screening during a regular office visit or gynecological visit if the woman just informs the doctor of her desire to become pregnant. Most gynecologists will inquire about child-bearing intentions anyway.
What is involved in Pre-Conception Counseling?
Pre-screening covers many body-system areas (not just the reproductive organs), as well as aspects of the woman's lifestyle, and family history information. It begins with basic information and becomes more in-depth, especially if the woman has had previous illnesses, diseases, etc. Pre-screening assessments begin with a questionnaire which the woman fills out, generally before seeing the physician. Some offices have the woman go over parts of the questionnaire with a Nurse Practitioner, if available.
Certain blood work may be ordered. This often includes a CBC (Complete Blood Count) which can show anemia. A CBC includes WBC (White Blood Cell Count) which can show the presence of infection. Anemia and infection, indicating problems with the woman's overall health at that moment, can both affect a woman's ability to become pregnant at that time as well as affect the stability of the pregnancy and health of the fetus. Fortunately in the majority of cases both infection and anemia can be treated once the cause is identified. Anemia may require ongoing evaluation and iron supplement.
Urine sample or urinalysis can reveal the presence of proteinuria (protein in the urine), a possible indicator of infection or kidney disease, or the presence of blood which can indicate a urinary tract infection. Urinalysis might also show the presence of glucose (glycosuria), but women of child bearing age are unlikely to have undiagnosed diabetes (this is separate from gestational diabetes that may occasionally develop during the course of a subsequent pregnancy).
Using the assessment
The areas a physician will assess are too numerous to include here. When women have pre-existing illnesses / conditions / diseases, these may add to pre-natal risks and will need ongoing evaluation. Also any medications which are used to treat these conditions will need monitored and possibly reduced or increased.
The presence of Diabetes remains a huge risk for the unborn child, and a woman will be screened specifically for this condition. Known diabetics will need monitored closely. For more information, see this online article Diabetes and Diabetic risks http://journal.diabetes.org/clinicaldiabetes/V18N32000/pg122.htm
The woman's role
A woman may need to adjust certain aspects of her health and well-being which are in her control. These usually include aspects of lifestyle, drug and alcohol use, exercise, rest and stress reduction. In addition, she may need to discontinue certain herbs or over-the-counter medications as recommended by the physician. Many physicians will also recommend pre-natal vitamins before a woman actually conceives in order to boost her overall health.
Pre-Conception Counseling, Assessment and Screening can aide the woman and her unborn child if she conceives. Attention to areas which can be controlled, listed above, can improve a woman's chances to conceive as well as improve the in-utero environment of the fetus and improve the overall health of the fetus. Pre-Conception Counseling, Assessment and Screening also assists the Physician in being aware of pre-existing conditions and areas of potential problems so that he/she can better evaluate and guide the woman-patient. Women who are thinking of getting pregnant should see their physician first, before stopping their current birth control. Investment of time, energy and attention to potential problems during a pre-conception planning stage can greatly benefit both the woman and future pregnancy.
- J. Joseph Speidel, Cynthia C. Harper, and Wayne C. Shields (September 2008). The Potential of Long-acting Reversible Contraception to Decrease Unintended Pregnancy. Contraception.
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Family planning and reproductive health
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