You may think that taking a family history to understand health risks will soon be obviated by genomic testing or a shared electronic medical record. I believe that it will always have special value at the prebaby visit, whether that information is available or not. In eliciting a history of any potentially hereditary conditions, the key is to assure families that you will be on their team to provide the best medical care for any eventuality. But this is also the time to ask about each family member, their education, employment, and medical conditions, including mental health and substance use. In the process, you are likely to hear about any estrangements, abuse, divorces, dependent relatives, and just plain family stress that will impact on this newly forming family. The question, “Who will you have to help you with the baby?” will elicit social support, but also concerns about fears of intrusive relatives or demands of dependent family members. Parents will thank you later for suggesting a doula, inviting relatives to takes turns coming to help after the first 2 “settling in” weeks when the father has to go back to work, or arranging a sitter for older siblings even though mother is home! This is a good moment to discuss prebaby classes and strategies for supporting any siblings at this big transition with daily special time. It is a valuable service to have resource listings for child care as this may be a bigger stress than concerns about delivery!
Even if they already know the baby’s sex, I like to ask, “Were you hoping for a girl or a boy?” (and why) as a way to elicit gender bias, in addition to finding out about risk for genetic conditions. Such bias may later become relevant, especially for toddler discipline, which presents as the “prejudiced parent syndrome” of overly lax or overly strong punishment. Turning to the father and asking, “What are your ideas about circumcision?” is sure to engage his attention and show that you expect him to be an active participant in decisions in what may have seemed a female process so far. If they have not decided or are actively disagreeing, you may express curiosity about “how they usually decide things together.” Be sure to recommend local anesthesia for circumcision, if planned!
Parental bias about gender also may come from negative experiences when the parent was growing up, such as a whiny sister or hyperactive cousin. Verbalizing that “everyone has memories from how we were raised that we may or may not want to repeat” is a great opener for asking, “What was it like when you were growing up? What would you like to do the same way and what differently?” This is an appropriate time to ask about their marriage and whether this was “a good time to have a baby.” Although most pregnancies are unplanned, it is the norm for parents to have come to an acceptance and excitement about the pregnancy by the second trimester. If you detect marital discord or depression, making a referral now is very important, rather than waiting in hopes it will resolve when the baby comes. With all its joys, studies show that the arrival of a baby is a huge stress that tends to worsen the parental relationship. Plus, they have more time to get to help now than they will after delivery!
Having a baby is life’s biggest commitment, adventure, and joy. Showing parents in the prebaby visit that you care about them, their values, and questions, and not just the medical care of their child can quickly establish a deep understanding that will inform all future contacts – making communication easier, more effective, and more meaningful.
Dr. Howard is assistant professor of pediatrics at the Johns Hopkins University School of Medicine, Baltimore, and creator of CHADIS (www.CHADIS.com). She had no other relevant disclosures. Dr. Howard’s contribution to this publication is as a paid expert to Frontline Medical Communications. E-mail her at pdnews@frontlinemedcom.com.