Question 1—Preconception Counseling
Preconception care has been around since the 1980s, however, a recent push across many nationally recognized professional practices, including the American Academy of Family Physicians (AAFP), has been occurring (AAFP, 2015). This is largely due to the high rate of infant mortality, premature births, birth defects, and maternal deaths in the United States (AAFP, 2015). Preconception care refers is defined as: “individualized care for men and women that is focused on reducing maternal and fetal morbidity and mortality, increasing the chances of conception when pregnancy is desired, and providing contraceptive counseling to help prevent unintended pregnancies” (AAFP, 2015, para. 1). The AAFP is pushing for family practice health care providers to play a larger role in preconception care to help improve the current statistics.
As a future family nurse practitioner, I do not anticipate seeing a large population of women seeking maternity care; however, as the AAFP points out, family practice providers are the most frequent providers of ambulatory primary care services to women aged 18 to 44 (AAFP, 2015). This puts family care providers in a prime position to do the majority of the preconception interventions. Preconception interventions can occur during routine well-woman examinations and should include identifying childbearing goals, screening for risks that can impact pregnancies, and assisting women in making healthy changes before becoming pregnant.
There are a number of important topics to discuss during preconception counseling. I will utilize the most current, evidence-based guidelines available when providing preconception counseling to a woman who is planning a pregnancy. At this time, I would plan to discuss the following: reproductive and pregnancy goals; nutrition (especially folic acid); contraception; weight concerns; family and genetic history; management of chronic diseases; medication use; smoking cessation; avoiding alcohol; avoiding other drugs; eliminating toxin exposures; updating immunizations if needed; screening for sexually transmitted infections; and screening for abuse (Fowler & Jack, 2018). These are all important topics to discuss, because they have an impact on fetal and maternal health. For women in the interconception phase, it is important that they be counseled on healthy pregnancy intervals (Fowler & Jack, 2018). For instance, short interval pregnancies of less than 18 months are associated with high rates of preterm births, premature rupture of membranes, maternal morbidity and mortality, third trimester bleeding, anemia, and myometritis (Fowler & Jack, 2018).
American Academy of Family Physicians. (2015). Preconception care. Retrieved from https://www.aafp.org/about/policies/all/preconception-care.html
Fowler, J., & Jack, B. (2018). Preconception counseling. Treasure Island, FL: StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK441880/