The president of the Association of Midwives of Madrid (AMM), Cristina González Fernández, has warned that 69.2 percent of women do not know that the preconception consultation exists, a "great paradox" considering that 90.2 percent consider it essential to prepare before getting pregnant.
"Women firmly believe that they need to prepare, but they do not know that there is a consultation specifically designed for this purpose," she pointed out based on the results of the study "Everything Starts Before: Pregnancy Begins in Preconception," promoted by the Federation of Associations of Midwives of Spain (FAME).
The work was conducted with a sample of 2,001 women aged 18 to 45 residing in Spain, to which 118 additional interviews with pregnant women and women who are already trying to become mothers are added. From this analysis, it is also inferred that 20.9 percent would arrive late or would not be clear about the ideal time to attend the preconception consultation.
"The optimal moment is the moment that crosses your mind: I am going to seek a pregnancy, before stopping contraception," González Fernández pointed out, who recalled that, although the consultation is "individualized," it is based on some "basic premises," such as "asking personal and partner history."
Only 13.7% take folic acid before conceiving
During this visit, it is reviewed whether the woman takes medication and "sometimes some type of test is performed, some blood analysis," although "not always." "Sometimes, a screening for cervical cancer prevention, the cytology, is done," she detailed, adding that "supplementation is also worked on," in which she emphasized the role of folic acid, which "is universal," despite the study revealing that only 13.7 percent of women seeking pregnancy consume it before achieving it.
"This supplementation is important because it prevents neural tube defects," as it contributes to its proper closure "avoiding serious problems that sometimes even lead to a voluntary interruption of pregnancy," she indicated, stressing that "it is recommended between one and three months before conception." However, 10.6 percent of the surveyed women do not know what it is.
The midwife has added that in the consultation, the obstetric history is also asked about and the menstrual cycle is analyzed, in addition to inquiring about the consumption of toxins by both the woman and her partner. In this sense, she has insisted on the convenience of both attending the appointment, since among women seeking pregnancy, 52.7 percent consume alcohol at some point and 22.3 percent smoke on some occasion.
Even so, she has emphasized that 31.4 percent of those trying to get pregnant have reduced alcohol intake by 31.4 percent and, in the case of pregnant women, it has been reduced by 45 percent. She has also reminded that physical state influences pregnancy: 22.9 percent present some relevant health problem, such as overweight, polycystic ovary, thyroid disorders, or other pathologies.
To this data, it is added that 9.8 percent do not know if they have any medical condition that should be evaluated, 32.3 percent take some prescribed medication, and 27.8 percent have used hormonal contraceptives in the last year.
González Fernández has reiterated the importance of preconception consultation, included in the service portfolio of all autonomous communities, but has acknowledged that there are "many barriers" to access it, the main one being "the waiting lists." She has considered "a delay of three weeks" acceptable, since "it does not have to be done the next day," although she has specified that the delay depends on the specific center and not so much on the autonomous community.
In any case, she has emphasized that "all women can go to their Primary Care centers, to their health centers," since it is a "free" service and does not require "private insurance." "We want primary prevention to be a reality" and include the consultation and preconception health, which "must be a public health priority" when one starts to think about having a baby.
The midwife, a key professional before pregnancy
In this line, and after reminding that "the midwife is the reference figure also before pregnancy," the survey reflects that 36.9 percent of pregnancies are unplanned and that "many others have been partially planned." Furthermore, among pregnant women or women seeking a pregnancy, 66.3 percent have not yet had contact with any healthcare professional.
In the group of 18 to 24 years, 40.1 percent first turn to a friend or family before the healthcare system, while 21.5 percent consult their specialist in Gynecology and 25.5 percent are aware of the existence of the preconception consultation. Only 5.9 percent go to their midwife.
The study also analyzes the educational level: among women with higher education, 52.2 percent started supplementation before pregnancy, a percentage that drops to 33 percent among those with basic education.
Regarding the demands in the consultation, 64.6 percent request an assessment of their prior health status and 59.9 percent ask for a review of the tests performed, while 58.3 percent raise doubts about emotional balance. In this area, 77.3 percent perceive that stress affects their well-being.
In light of this data, González Fernández has pointed out that "the level of trust in the midwife increases when they know her," as 62.2 percent of recent mothers trust this professional a lot, compared to 56 percent of those trying to get pregnant. For her part, the secretary of FAME, Asunción Obiol, has emphasized that the midwife accompanies "the entire vital stage of women."
There is "a gap from contraception to pregnancy," she indicated, emphasizing "all the information and health checks that a woman should be able to receive." "The preconception consultation improves the health of mothers and their children," she summarized, adding that "having healthy families shortens that process that many women have to achieve a pregnancy."
"We are a very accessible professional, very close and the link with all the needs," she continued, recalling that "we work in multidisciplinary teams" and defending "that mothers can request and know that this care exists and that they will find it in the midwives' consultation." "This ignorance is the main barrier that brings about improvable results," she concluded, before emphasizing that "a woman is a mother when she thinks it."