Two articles in the September issue of the American Journal of Obstetrics and Gynecology (AJOG) decry the flaws in our prenatal care system that cause women, especially primiparas, or those with medical or lifestyle issues, to delay the first prenatal visit until “after many organs have formed or interventions that could minimize risk to the fetus should have been initiated.”  This opportunity to ask the patient about general well-being, medication use, hypertension, diabetes, history of pregnancy complications, smoking, or alcohol use, is lost forever along with the opportunity for early evaluation and treatment.

For the first article, a research assistant called all obstetrical clinics in a state.  Posing as a pregnant, fully insured woman, the research assistant asked each clinic when she should come in for her first prenatal visit.  The recommended appointment times ranged from immediately (4 weeks of gestation) to 10.6 weeks, with 25 percent of the clinics recommending a first appointment at 8 weeks or later.  Scheduling calls were not a source of prenatal advices.  Dr. Nettleman and her colleagues concluded that, “Office-based delays in scheduling the first prenatal visit occur in a substantial proportion of clinics, even for fully insured women. There is a need for a standard source of advice in early pregnancy.”

The second article, an editorial by Dr. Arnold W. Cohen, points out that the first encounter with pregnant patients is often handled as a “non-event,” when, in fact, it “should be used as an effective educational and triaging opportunity.”  Dr. Cohen provides a list of eight simple questions that take approximately 60 seconds to ask, to effectively triage patients who need to be seen right away.  This would allow the physician to provide better care and with fewer traditional prenatal care visits.  Dr. Cohen says, “By instituting individualized prenatal care first appointments and using reduced scheduled appointments or group prenatal care for low-risk patients, obstetrics care providers could use their time and efforts more effectively to improve prenatal care, rather than just provide prenatal care. . . To do this though, we each must ask ourselves what the barriers are in my practice to the implementation of this type of care and find ways to overcome them.”

The citations for the two articles are:

·         Nettleman MD, Brewer J, Stafford M. Scheduling the first prenatal visit: office-based delays. Am J Obstet Gynecol 2010;203:207.e1-3.

·         Cohen, AW.  Scheduling the first prenatal visit:  a missed opportunity.  Am J Obstet Gynecol 2010;203:192.