Pregnancy care: Clinical guidance and practice resources
Pregnancy is a complex, high-impact period that influences health beyond birth.
Evidence-based, patient-centered resources are essential to foster optimal health through pregnancy, labor and postpartum. Specifically, the perinatal period can affect future health, making this time period important in a woman's life.
Guidelines and recommendations
Clinical practice guidelines
(Developed by the American Academy of Family Physicians (AAFP), May 2014) (Reaffirmed 2019)
The guideline, Labor After Cesarean/Planned Vaginal Birth After Cesarean, was developed by the AAFP. It was approved by the Board of Directors in 2014 and an executive summary was published in the Annals of Family Medicine on January 12, 2015.
Key recommendations
Counseling, encouragement and facilitation for a planned vaginal birth after cesarean (PVBAC) should be provided so that women can make informed decisions. If PVBAC is not locally available, then women desiring it should be offered referral to a facility or clinician who can offer the service.
Indications for and circumstances surrounding the prior cesarean birth(s) should be discussed.
Induction of labor after cesarean is appropriate for women who have a medical indication for induction of labor and who are planning a LAC/VBAC. Misoprostol should not be used for cervical preparation or induction of labor in the third trimester of pregnancy for women with a prior cesarean birth.
At time of labor and presentation to the hospital, the plan for labor and vaginal birth should be reassessed with consideration of factors on admission that may affect the risks of labor and likelihood of vaginal birth. Any changes in status during labor should be discussed.
Patients should be informed of the specific short-term and long-term benefits and harms of planned LAC/VBAC for the patient, her fetus/infant and future pregnancies.
All women desiring planned LAC/VBAC should be counseled about the capabilities of their specific delivery setting and women at high risk for complications should be referred as necessary to facilities with capabilities to effectively treat problems as they develop.
Hospitals should have guidelines to promote access to LAC/VBAC and actively monitor and improve quality of care for women who choose labor after cesarean.
Clinical preventive service recommendations
Screening for unhealthy alcohol use is recommended for adults aged 18 or older, including pregnant women, in primary care settings, with brief behavioral counseling provided when risky or hazardous drinking is identified. Evidence shows a moderate net benefit for adults, while evidence is insufficient to assess benefits and harms for adolescents aged 12 to 17.
Daily low-dose aspirin (81 mg) after 12 weeks of gestation is recommended for pregnant persons at high risk for preeclampsia. Evidence shows a substantial net benefit in reducing the risk of preeclampsia, preterm birth, small for gestational age infants and perinatal mortality.
Screening for asymptomatic bacteriuria is recommended for pregnant persons using urine culture, based on evidence showing reduced risk of pyelonephritis and perinatal complications. Screening is not recommended for nonpregnant adults, as treatment provides no net benefit and carries potential harms.
Screening for asymptomatic bacterial vaginosis is not recommended for pregnant persons who are not at increased risk for preterm delivery, as evidence shows no net benefit. For those at increased risk, current evidence is insufficient to determine whether screening and treatment prevent preterm birth.
Screening for hepatitis B virus infection at the first prenatal visit identifies pregnant persons whose infants are at risk for perinatal transmission. Evidence shows that early identification and case management substantially reduce transmission and long-term liver-related complications in children.
Screening for gestational diabetes at 24 weeks of gestation or later improves maternal and fetal outcomes by identifying individuals who benefit from treatment. Evidence is insufficient to determine the benefits and harms of screening earlier in pregnancy.
Screening adults aged 35 to 70 with overweight or obesity identifies prediabetes and type 2 diabetes at an earlier stage, when intervention can reduce progression and long-term complications. Evidence shows a moderate net benefit when screening is paired with effective preventive interventions.
Preventing gonococcal ophthalmia neonatorum remains a critical newborn safety measure. Evidence continues to show that routine ocular prophylaxis at birth effectively prevents serious eye infection, including corneal damage and blindness, with substantial net benefit and no associated serious harms.
Adequate folate levels before and during early pregnancy play a critical role in preventing neural tube defects. Strong evidence supports daily folic acid supplementation for all persons who are planning to or could become pregnant, with substantial net benefit.
Perinatal depression is common and can affect both maternal and infant health. Evidence shows that counseling interventions for pregnant and postpartum persons at increased risk reduce the likelihood of developing perinatal depression and provide a moderate net benefit.
Depression is common in adults and can significantly affect health and daily functioning if left untreated. Evidence supports routine screening for depression in adults, including pregnant and postpartum persons and older adults, while evidence remains insufficient to determine the benefits and harms of screening for suicide risk.
Rh(D) blood typing and antibody screening during pregnancy help prevent maternal sensitization and reduce the risk of hemolytic disease in newborns. Evidence supports testing all pregnant patients at the first prenatal visit, with repeat antibody screening at 24 to 28 weeks’ gestation for unsensitized Rh(D)–negative patients, and use of Rh(D) immunoglobulin when indicated, with substantial benefit and minimal harms.
Behavioral counseling and support during pregnancy and after birth improve breastfeeding initiation and duration. Evidence shows a moderate net benefit from providing or referring patients to breastfeeding support interventions in primary care settings.
Hypertensive disorders are a leading cause of maternal morbidity and mortality. Regular blood pressure measurement throughout pregnancy helps identify these conditions early and provides substantial net benefit in preventing adverse outcomes.
Early identification of HIV infection supports timely treatment and reduces morbidity, mortality and transmission. Screening adolescents and adults, as well as all pregnant persons, provides substantial net benefit, including prevention of perinatal transmission.
Evidence is currently insufficient to determine whether routine screening or supplementation for iron deficiency or iron deficiency anemia during pregnancy improves maternal or infant health outcomes in asymptomatic patients.
Early screening for syphilis during pregnancy provides substantial benefit by preventing congenital infection and serious adverse outcomes for infants.
Addressing tobacco use in primary care improves health outcomes for adults and pregnancy outcomes for infants. Behavioral interventions are effective for all adults, including pregnant persons, while pharmacotherapy is recommended for nonpregnant adults.
Advanced Life Support in Obstetrics (ALSO)
This evidence-based training program equips maternity care teams with skills to manage obstetric emergencies. This course encourages a standardized team-based approach to improve patient safety and maternal outcomes. Learn more.
Basic Life Support in Obstetrics (BLSO)
Improve the management of normal deliveries as well as obstetric emergencies by standardizing the skills of first responders, emergency personnel and maternity care providers. Learn more.
Fourth trimester model of care
Support patients through the critical postpartum period with planning, tools, mental health resources and clear guidance for recovery and safety.
Tools to support postpartum planning and mental health
Postpartum care plan template (PDF)
Perinatal mood and anxiety disorders resource for family physicians (PDF)
Pregnant and postpartum women—Hear Her Campaign
Save your life: Post-birth warning signs (English PDF),(Spanish PDF)
Build skills and connect to support
U.S. Breastfeeding Committee
ALSO
BLSO
Addressing prenatal substance abuse
Inside Family medicine podcast
Thinking about postpartum care as a continuum, it begins with prenatal anticipatory guidance and continues with postpartum visits. An ongoing strategy may reduce maternal mortality and morbidity, and improve health for birthing people.
AAFP’s Inside Family Medicine offers a two-podcast series focusing on approaches and resources for treating perinatal mood and anxiety disorders (PMADs), supported by grants from Sage Therapeutics and Biogen.
Breastfeeding
Breastfeeding is a personal decision for pregnant women and new mothers. You play an important role in educating these patients on breastfeeding benefits, removing breastfeeding barriers and identifying resources to support them. Studies show a physician’s recommendation increases breastfeeding initiation and duration rates.
The AAFP recommends all babies, with rare exceptions, be breastfed and/or receive expressed human milk exclusively for the first six months of life. According to the AAFP breastfeeding policy, breastfeeding should continue with the addition of complementary foods throughout the second half of the first year. Breastfeeding beyond the first year offers considerable benefits to both mother and child and should continue as long as mutually desired.
Breastfeeding benefits and clinical support tools
For mothers, breastfeeding supports postpartum weight loss and combats depression, type 2 diabetes, breast cancer, ovarian cancer, hypertension, cardiovascular disease and other conditions. For children, breastfeeding lowers the risk of acute otitis media, gastroenteritis, atopic dermatitis and life-threatening conditions such as severe lower respiratory infections, necrotizing enterocolitis and sudden infant death syndrome. Older children who were previously breastfed experience fewer occurrences of hypertension, type 1 and 2 diabetes, obesity, asthma and childhood leukemia.
Create a positive breastfeeding environment for your patients. The AAFP’s breastfeeding position paper offers recommendations on how you can promote breastfeeding in your practice.
Resources from the HHS offer breastfeeding support for employers, health care professionals and employees.
Established in 1991 within HHS, the Office on Women’s Health coordinates women’s health efforts across the agency. OWH advances policies, educates health care professionals and consumers, and supports innovative programs that address critical women’s health issues.
OWH offers tips to support nursing moms, partner resources and materials to spread the word about the Supporting Nursing Moms at Work: Employer Solutions, an online resource. These materials include sample social media posts, info cards and web badges for easy sharing with managers, human resource directors, coworkers and employees.
The USBC is a nonprofit coalition of more than 40 nationally influential organizations working to improve the nation’s health by working collaboratively to protect and promote breastfeeding. The coalition’s core competencies are a guideline to integrate evidence-based breastfeeding into practice and are endorsed by the AAFP.
AAFP policy affirms breastfeeding as the physiologic norm and outlines the medical and psychosocial benefits for infants and parents. It provides guidance on exclusive breastfeeding for the first six months, continued breastfeeding with complementary foods and the family physician’s role in supporting breastfeeding across diverse family structures using inclusive, patient-centered language.
Learn more about AAFP breastfeeding policy.
In addition to its breastfeeding policy, the Academy also recommends medical schools, residency and fellowship programs and health care institutions establish policies and practices that support breastfeeding and lactation for medical trainees. This guidance outlines the facilities, protected time and cultural supports needed to help trainees meet their breastfeeding goals while continuing their education and patient care responsibilities.
Learn more about AAFP's support for breastfeeding accommodations for medical trainees
The AAFP compiled a reference list of commonly used ICD-10 codes related to breastfeeding care for both the lactating parent and infant. This resource supports accurate documentation and billing for conditions encountered during pregnancy, the postpartum period and lactation, including mastitis, nipple conditions, feeding difficulties, jaundice and growth concerns.
When you are supporting patients who are breastfeeding, these trusted resources offer clear, evidence-based guidance and peer support. They can help patients prepare for breastfeeding, troubleshoot common challenges and build confidence during the early weeks and beyond.
Resource center
Access evidence-based tools data and partner resources that support family physicians across pregnancy labor and postpartum care.
Pregnancy
Support pregnancy care with tools, resources and partnerships focused on maternal outcomes, workforce capacity and clinical decision-making.
Maternal health tools and partner resources
Alliance for Innovation on Maternal Health Community Care Initiative
Family physicians provide maternity care to hundreds of thousands of women (PDF)
Support for maternal mental health and substance use
National Maternal Mental Health Hotline
Addressing alcohol and other substance use (PDF)
Health equity
Advance equitable pregnancy care by addressing systemic barriers, bias and structural factors that contribute to disparities in maternal outcomes.
Pregnancy-related health equity resources
Striving for birth equity
Family medicine's role in overcoming disparities in maternal morbidity and mortality
Black Mamas Matter Alliance (BBMA) tool kits
Vaccines
Use evidence-based vaccine guidance to protect pregnant patients and their infants before, during and after pregnancy.
AAFP vaccine guidance for pregnancy care
Maternal Immunization Task Force for Pregnant Women: A call to action (PDF)
Talking about vaccines during pregnancy (PDF)
Vaccines in pregnancy: What patients need to know (PDF)
Vaccines in pregnancy: What family physicians need to know (PDF)
Sexually transmitted infections
Use timely screening and evidence-based treatment to reduce sexually transmitted infection-related pregnancy complications.
Treatment of congenital syphilis
Patient education
The AAFP patient education website FamilyDoctor.org provides many patient-facing resources.