Prenatal Care

Routine visits in early United States practice

A 2021 review of United States prenatal care guidelines describes relatively unstructured beginnings in the nineteenth century, when most medical care was given by laypeople and childbirth was largely part of domestic life. The authors trace the case for routine visits to early research on toxemia, which led to urine and blood pressure screening and, in turn, to a need for regular contact during pregnancy.

The review states that the first codified prenatal visit schedule came in 1930 from the United States Children's Bureau, at a time when high infant and maternal mortality had increased attention to prenatal care. That schedule called for monthly visits until 28 weeks of gestation, bimonthly visits until 36 weeks and weekly visits until delivery. The authors report that these recommendations were essentially unchanged after a 1989 call by a National Institutes of Health task force for changes in how prenatal care was delivered.

Later schedules and the WHO trial

ACOG describes its standard prenatal schedule as unchanged for many years, with monthly office visits until the seventh month and more frequent visits from the eighth month to delivery. ACOG notes that the COVID-19 pandemic prompted interest in telehealth and in tailored prenatal care, a plan based on a person's risk of complications that may combine remote counseling with in-person testing.

In 2001 WHO published a multicenter randomized trial comparing standard antenatal care with a new model that the authors described as emphasizing actions known to be effective, with fewer clinic visits. Hofmeyr and Hodnett state that routine visits, introduced without evidence of effectiveness, became entrenched over the last century. The history on this page rests on a small number of sources and is mainly North American and British in scope.

Antenatal and prenatal

Antenatal care and prenatal care are used for the same routine care during pregnancy. WHO and NICE guidance use the term antenatal, ACOG uses prenatal, and the Cochrane review abstract writes antenatal (prenatal) care. The sources reviewed do not treat the two terms as naming different services; the difference is mainly one of national usage.

Tailored and group care

ACOG uses the term tailored prenatal care for a plan geared to an individual's risk, which can include telehealth visits for general counseling and in-person visits for specific tests. It also describes group prenatal care, in which pregnant people learn about pregnancy together. These are terms used by one professional body. The other guidance reviewed for this page does not define them, and this page does not assess their evidence base.

Providers and content

ACOG lists the content of prenatal care as medical care, screening tests, answers to questions, and help finding social support and community resources. It names obstetrician-gynecologists as the professionals who provide most prenatal care, maternal-fetal medicine specialists for higher-risk pregnancies, and family medicine doctors and midwives for average-risk pregnancies. Midwives may also work with average-risk pregnancies in collaboration with obstetrician-gynecologists as part of a care team.

NICE recommends planning 10 routine antenatal appointments for nulliparous women, those who have not given birth before, and 7 for parous women, those who have. Extra appointments are offered when medical, social or emotional needs require them. At the booking appointment the clinician discusses the schedule, the planned number of visits and the professionals involved. NICE also recommends measuring symphysis fundal height at appointments after 24 weeks for singleton pregnancies, unless regular growth scans are being done.

Scope in international guidance

The WHO guideline on routine antenatal care covers recommendations on nutrition, maternal and fetal assessment, preventive measures, common physiological symptoms, and interventions to improve the use and quality of antenatal care. It is written for pregnant women and adolescent girls receiving antenatal care in any healthcare or community setting, and it gives weight to person-centered well-being as well as the prevention of death and illness. Later WHO updates address micronutrient supplements, zinc, vitamin D and ultrasound before 24 weeks.

Practices used alongside routine care

Several practices described on this site, including Birth Charting, Prenatal Yoga, Doula Therapies and Natural Childbirth, are sometimes used alongside routine prenatal care. The guidance reviewed here describes routine care and does not evaluate these practices, so their roles and evidence are covered on their own pages rather than on this one.

Purposes stated in guidance

ACOG states that early and regular prenatal care can help an ob-gyn find problems sooner and take steps to manage them, and that it may increase the chances of a healthy baby. These are the professional body's statements of purpose; they do not report the size of any effect. ACOG adds that people with a preexisting medical condition, or one that develops in pregnancy, may need to be seen more often, and that people aged 35 or older may need extra visits.

The WHO trial measured outcomes that routine care is intended to influence, including low birthweight, pre-eclampsia and eclampsia, severe postpartum anemia and treated urinary tract infection. The trial's authors concluded that the reduced-visit model seemed not to affect these maternal and perinatal outcomes.

Where the sources do not show benefit

The Cochrane review found no clear difference between reduced-visit and standard schedules for maternal death, hypertensive disorders of pregnancy, preterm birth or small-for-gestational-age babies. The review therefore does not show that additional routine visits improve those outcomes. Its evidence concerns visit numbers and visit content, so it does not establish the value of every component of routine care.

The sources reviewed for this page do not address claims that prenatal care delivers benefits beyond the outcomes listed above, and this section does not repeat them. Claims of that kind would need a source that measures the outcome in a defined population before they could be stated here.

Randomized trials of reduced-visit schedules

The WHO trial randomized clinics rather than individuals. It included 27 clinics offering the new model and 26 offering standard care, in Argentina, Cuba, Saudi Arabia and Thailand, with women enrolled over an average of 18 months. Women in the new-model clinics had a median of five visits, compared with eight in the standard model. Rates of low birthweight, pre-eclampsia and eclampsia, anemia and urinary tract infection were similar between groups, and women and providers were generally satisfied, although some women were concerned about the timing of visits.

A Cochrane review updated in 2015 pooled seven trials of more than 60,000 women, four in high-income countries and three cluster-randomized trials in low- and middle-income countries. It found that reduced-visit programs were associated with higher perinatal mortality (risk ratio 1.14, 95% confidence interval 1.00 to 1.31, five trials, moderate-quality evidence), with the difference larger in low- and middle-income countries. The authors report that women were less satisfied with reduced visits, and that these programs may lower costs.

Reanalysis and its interpretation

A secondary analysis by Hofmeyr and Hodnett reanalyzed the WHO trial and reported that the increased perinatal mortality in the reduced-visit package persisted after adjustment for potential confounding factors. The same paper argues that routine visits for healthy pregnant women do make a difference. That interpretation goes beyond the trial's own conclusion, which was that the reduced-visit package seemed not to affect outcomes. The paper is a single reanalysis of one trial, and it is not a replication.

The reviews show limits on how far these findings apply. The trials compared schedules in settings with different baseline visit numbers. Dowswell and colleagues note that where the standard number of visits is already low, visits should not be reduced without close monitoring of fetal and neonatal outcomes. The high-income subgroup had only 32 perinatal deaths in 5,108 babies, so its estimate is imprecise.

Labor support as a related area

Continuous support during labor is a separate intrapartum topic, but it is related to doula care. A 2017 Cochrane review of 27 randomized trials, with 26 providing usable outcome data for 15,858 women, found that continuous one-to-one support was associated with more spontaneous vaginal births and fewer cesarean births, with low-quality evidence. Subgroup analyses suggested the largest reduction in cesarean birth when the support was provided in a doula role, and the authors call these subgroup findings exploratory. The review reports no evidence of harms.

These findings concern labor support and do not show how doula care would change prenatal visit schedules. The sources reviewed do not test doula care as an addition to routine prenatal visits.

Prenatal care is a medical service

Prenatal care is a medical service. ACOG advises bringing a full list of medications, vitamins and supplements, along with personal and family medical history, to the first appointment. Complementary approaches should therefore be discussed with the clinician providing care, including any supplements, bodywork, breathing practices or other activities a person plans to use alongside routine visits. The sentence reflects the conventional care boundary in the guidance and is not a finding about any specific practice.

When to contact the care team

NICE advises that people be told they can contact the maternity service at any time of day or night if they have concerns about the baby's movements after 24 weeks, and that urgent concerns such as pain and bleeding be reported to the maternity service. Symptoms like these should be reported to the care team and should not be delayed while another approach is tried.

Limits of this page

This page describes prenatal care itself and is not a replacement for medical guidance. The sources reviewed do not establish that complementary practices change the outcomes listed above, and nothing here is advice to change visit numbers. If a clinician or service is considering a reduced schedule, the Cochrane review's caution that visits should not be reduced without close monitoring of outcomes applies.