Will you get paid for conducting a prebaby visit in your practice? Probably not in income, but certainly in long-term benefits to your care of the incoming child and family.
While parents are coached by websites to determine such things as your fees, what insurance you take, your credentials, age, gender, practice structure, hours, and availability, all these questions can be handled by your front desk or nursing staff or a handout. The really valuable conversations are the ones that you have that help the imminent parents begin to understand the sometimes subtle factors influencing the parenting they will undertake.
Dr. Barbara J. Howard
Pregnancy brings mental and emotional changes in a predicable pattern that is useful to understand. In the first trimester, the prospective parents become aware of their gender and sexuality in a new way, usually with pride and confirmation. For teenagers, this may not be welcomed by the family and may even place them at risk for being put out of the house. The fetus, however, is not very real to the parents at this point, except through the morning sickness that mothers – and even some empathetic fathers – experience. You are not likely to see the family in the first trimester unless an early ultrasound or genetic test raises concerns that require decisions.
In the second trimester, the gender is often revealed, making the child seem much more real. Men may spend a lot of time thinking about finances and how to support the upcoming demands. Some men deal with the impending departure of their freedom by taking up a new hobby, making the mother nervous about their commitment to helping with the baby in the future. In these months, prospective parents often have dreams of a deformed infant or other scary imaginings about forgetting or harming the baby. Older parents or those with a history of miscarriage or infertility may be particularly worried about possible abnormalities, but these fears are quite common among all parents. You can reassure parents that these dreams may be a way of helping them “be ready for anything.” The responsibility of parenting already has begun in needing to avoid medications, alcohol, and smoking – at least for the mother. While the father also may be abstaining in support, he may be oblivious, and the mother may be suffering alone and concerned about his future support in parenting.
The third trimester is the time parents come up with names, prep the bedroom, pack the suitcase, and make concrete plans for the delivery but also face the reality that delivering a baby has huge potential dangers as well as joys.
The third trimester is the most common time for a visit to interview pediatricians, and these issues are not far from the surface – if you ask. The goal of a prebaby visit – of forming a supportive relationship with the parents without a baby yet present – is multifactorial. It is best approached by:
• Asking about the history of previous pregnancies and the course of the current pregnancy so far.
• Asking whether flu and Tdap vaccines were given.
• Asking whether there have there been any complications or exposures to infections, medications, smoke, alcohol, or drugs.
• Congratulating abstinence and acknowledging all the ways that the parents have been “taking good care of this baby already.”
More parents are questioning the use of vaccines and antibiotics these days, and they may want to discuss your views or policies on these. Having handouts available on these plus ones on car seats, smoke exposure, supine sleeping position, safe crib accessories, and the expected newborn tests is important for all parents because these standards keep changing. While most practices want to attract new patients, be honest because sometimes parents are not a good fit!
Delivery method is not completely a choice, but put in a word about avoiding general anesthesia for the sake of the baby, which is not likely to have been on the parents’ minds. This is the chance to get them excited about the unique alertness their newborn will have in the first hour after birth under the influence of labor stress, giving them the chance to lock gaze in a moment they will never forget!
Asking “How do you plan to feed the baby?” rather than just “breast or bottle” gives you a chance to inform them of your team’s expertise and your support for their choice, but may also reveal ambivalences worth exploring. The prospect of breastfeeding often brings out fears of failure from the mother, but surprisingly, some fathers are possessive about their partner’s breasts and not willing to share. Some mothers are so modest that breastfeeding is taboo. A motivational interviewing style “pros and cons” discussion of nursing is in order, but may not budge those beliefs. In this age of safe formula, you need not strain your relationship to convince them. Such extremes in the family are quite likely to reemerge as issues later in the need to “surrender” to the requirements of childrearing, however.