A Mom's "Proactive in Prenatal Care" Top 10 Checklist

The following "top 10" is provided for use as a check list to help women identify areas of concern with their pregnancy which could ultimately lead to a possible stillbirth. This list is not intended for self treatment use or diagnosis. It is to be utilized as a tool to help women know the specific areas to observe and then to use their findings in conjunction with their medical provider's care to help ensure the well being of their baby.

1) Notify your Physician of bleeding, fluid loss, or fever (>101)

2) Be aware of intrauterine movements of the baby; frequent hiccups, hyperactivity, and or no activity - all can be serious and need evaluation. It is important to document and chart baby's daily kick counts. This helps to provide a record of the increase or decrease of the various movements.

3) Learn your baby's sleep/wake patterns and report any change. Usually their patterns are obvious by 28 weeks. Get to know the "personality" of your baby!

4) Go to Labor and Delivery if your baby does not move at bedtime (9pm-10pm and later especially) and request monitoring. Research has shown that the majority of stillborn babies die at night while a mother is sleeping and she is at a resting heart rate, which means there is less blood flow to the baby. If there are any cord compression issues, then they become most vulnerable during the night while the mother sleeps. It is best to be monitored and have stress tests later in the night, and while lying down, this will provide a more accurate picture of what is really going on with the baby. If you are monitored by your Dr. during the day, and while sitting up, you are more likely to not show very strong signs of fetal distress- which could be misleading. Cord compression, cord knots, cord entanglement, Velamentous cords, and other cord issues can be seen on Ultrasound! If your Ultrasound shows any cord issue, you will most likely need to start bed rest and monitoring in order to get far enough along to have the baby viable outside the womb. You and your Dr. would then both be involved in close monitoring of the baby, and ultimately if the baby is showing a steady decline with continued stress, you could end up being induced or delivering in order to save the baby's life.

5) Be aware of uterine tightness, back- pressure, or pelvic pressure. Go to Labor and Delivery if persistent.

6) Be aware of your blood pressure and know if it is below 100/60 or above 140/80. Low blood pressure can be just as serious as high blood pressure!

7) Inform your physician of unusual fetal symptoms such as "quivering", "very strong kicking" or "localized pain".

8) Be aware of your fluid intake especially in the summer, and keep your urine clear (diluted) not yellow (concentrated).

9) Obvious uterine contractions less than 10 minutes apart for one hour, you need to be monitored. Continual Brackston-Hicks, or false labor, can be hard on the baby and can cause fetal stress.

10) Obvious labor, loss of your mucous plug, and frequent contractions (< 3min apart) need to be monitored at the hospital.

For more information go to www.preginst.com

Written by Dr. Jason H. Collins, MD, OB/GYN

Provided by Candy & Steve McVicar in memory of daughter Grace, who was stillborn on December 20, 2001. Grace's death was preventable. Had our Drs acted on the information in this top 10 she would be with us today, alive & well. If your Dr. does not take you seriously when you raise questions of concern, find one who will, & persist until a Dr. takes the time to listen & act on your requests to be monitored & examined. Stay Proactive in Your Prenatal Care. Pay attention to your baby, do your daily charting of baby's kick counts, & stay persistent with those providing your medical care!!

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