Lisa Downton, APRN, CNM is an advanced practice registered nurse and Certified Nurse Midwife at St. Elizabeth Physicians. She sees patients at Women’s Health – Crittenden and Women’s Health – Edgewood.
Q: What are the components of a comprehensive preconception counseling session?
A: There’s a lot to consider when potential parents come in for preconception counseling. We try to gather as much information as possible during these comprehensive visits. Individuals should anticipate a complete discussion of their medical and surgical history, including any specific gynecological history. That includes abnormal Pap smears, previous gynecological surgeries or procedures, previous obstetrical history, births, miscarriages and any other significant events. In addition to this medical history review, I conduct a physical assessment and measure the patient’s height and weight. A complete thyroid, cardiac, breast and pelvic exam are also performed.
Q: Are any specific medical tests and screenings recommended during preconception counseling?
A: Preconception counseling is a great opportunity to conduct tests and screenings that show us if the patient has any risk factors that may affect their chances of becoming pregnant or impact their ability to carry a healthy pregnancy. We test patients for sexually transmitted infections because these diseases can cause pregnancy complications and potentially lead to serious health problems for a newborn. A Pap smear alerts us if the patient has cervical cancer or human papillomavirus (HPV), the virus that causes cervical cancer. In most cases, HPV doesn’t affect the developing fetus. But it can lead to pregnancy complications like miscarriage, pre-term birth and low birth weight. It’s important to also screen patients for anemia, a condition where the patient doesn’t produce enough red blood cells. Mild anemia is common in pregnancy, but severe anemia can cause complications for the patient and the baby. Lastly, we conduct a blood type and Rh factor screening. The Rh test shows us if the patient has a protein in their blood that makes their blood compatible with their baby’s. If they don’t have the protein, we can provide a medication that will protect their baby during pregnancy and birth.
Q: How do you assess and address pre-existing medical conditions that may affect pregnancy?
A: We review the patient’s medical record for any pre-existing medical conditions, particularly diabetes, hypertension, heart disease and clotting disorders. We also make sure they are screened for depression and anxiety. If they have any of these physical health or mental health conditions and need additional care, we refer them to the appropriate specialists. In cases where they are taking medication (or are prescribed new medications), we review those medicines to make sure they’re safe to take during pregnancy.
Q: What lifestyle changes do you recommend for those planning to conceive?
A: Practicing healthy lifestyle habits is always important. But it’s particularly critical during pregnancy. During our preconception counseling sessions, we talk with patients about quitting smoking or nicotine use and avoiding alcohol and illicit drugs. We also talk about healthy weight, either losing or gaining weight, exercising safely during pregnancy, following whole food nutrition and reducing exposure to environmental toxins and hazards. I also talk about the importance of taking a daily prenatal vitamin with 400 mg of folic acid to prevent brain and spine congenital disabilities. Ultimately, these conversations are about helping our patients be the healthiest versions of themselves.
Q: What advice do you have for genetic screening and counseling?
A: If prospective parents know they have a family history of any inherited conditions — or they are worried they might — genetic counseling and screening can be beneficial. Some health conditions are more common in certain racial or ethnic groups. For example, we typically recommend screening for cystic fibrosis in white patients, sickle cell anemia in Black patients, the blood disorder thalassemia in Mediterranean or Asian patients and Tay-Sachs disease in patients of Jewish descent.
Q: Who is eligible for preconception genetic counseling and screening?
A: We make preconception genetic counseling and screening available to many patients. As previously mentioned, we offer our services to potential parents who have a family history of various health conditions or who belong to certain racial or ethnic groups. But genetic counseling and screening are also available to patients over age 35, those who have been exposed to toxins or medications that can negatively affect a fetus, patients with abnormal test results and partners who are close blood relatives. In addition, we recommend counseling and screening for patients who have experienced three or more miscarriages.
Q: What can you expect with preconception genetic counseling and screening?
A: In addition to a comprehensive, straightforward discussion of their medical and family history, our patients can anticipate a conversation about any risk factors they have that could affect a potential pregnancy. We also go further in these sessions. We take a deep dive into explaining all available testing options and thoroughly explain their results. Most importantly, we are here as a guide to help our potential parents make the right preconception decisions for them.
Q: How do you support patients in managing stress and mental health during the preconception period?
A: Planning for and trying to get pregnant can be mentally and emotionally taxing. While we focus a great deal on giving potential parents the information and guidance they need about their physical health, we recognize they also need support in managing the stress that comes with this process. Our mental health counselors provide continuous care and talk with our patients about a wide variety of coping strategies, including meditation and yoga. Trying to get pregnant can also be expensive, especially if you use any fertility treatments. So, we help our patients by referring them to St. Elizabeth Physicians Behavioral Health offices as well as how to use any employee assistance programs they may have access to.
Find more information or make an appointment with our experts please visit www.stelizabeth.com/womenshealth or call a Women’s Health office near you.
