Prenatal

For years doctors have been stressing that all pregnant women should have intensive prenatal care. But last week the U.S. Public Health Service issued a report from a federal panel of experts that urged less prenatal care -- at least for some women. About 1.6 million of the nearly 4 million women who give birth annually have no evident health problems that could jeopardize them or their babies. The panel recommended that physicians cut back -- from 13, to seven or eight -- the number of office visits typically scheduled. The group also suggested curbing some routine procedures, including blood-pressure readings, pelvic examinations and screening for protein in the urine. In addition, women do not need a Pap smear if they have had one within the past year.

"Healthy pregnant women waste a lot of time and money going to the doctor," declares the panel's chairman, Dr. Mortimer Rosen of Columbia University's College of Physicians and Surgeons in New York City.

At the same time, the experts called for increased prenatal care for poor women and for drug and alcohol abusers. These women have a much greater chance of giving birth prematurely, and their infants often suffer from low birth weight and other difficulties. The shift in emphasis is "an attempt to use scarce health dollars more efficiently," says Rosen. The report could influence private insurers and government programs to alter reimbursement policies for pre-natal care.

Obstetricians agree that care for high-risk patients needs to be expanded, but many object to the "less is enough" approach for healthy pregnant women. They stress the need for frequent visits. "These women have a zillion questions on their mind," explains Dr. George Malkasian, president of the American College of Obstetricians and Gynecologists. "The earlier you answer those questions, the earlier you catch any problems."