KnowYourself

Self-Assessment
Pregnancy and Childbirth

Are You Ready for a Healthy Pregnancy?

Directions

Indicate which behaviors match your own or your female partner’s behaviors:
 
Done  Will Do  Won’t Do  
1.  Get a physical exam 
2.  Reduce your use of tobacco, alcohol, caffeine, and non-prescription drugs. 
3.  Get to an optimal weight. 
4.  Establish a well balanced, nutritious diet that includes plenty of folic acid. 
5.  Maintain a regular exercise routine. 
6.  Talk to your health care professional  about any chronic medical conditions you might have. 
7.  Get any necessary vaccinations. 
8.  If you are using a hormonal contraceptive method, change to another method. 
9.  If you are a cat owner, make arrangements for someone else to deal with the kitty litter. 
10.  Avoid any exposure to X-rays. 

11.  Avoid extremes in body temperature (e.g., hot tubs). 
TOTAL 

Scoring

Add up the number of boxes checked in each column.  A total of 11 for the “Done” column indicates that you (or your female partner) are doing many of the tasks necessary to prepare for a healthy pregnancy.  Points in the “Will Do” column total indicate that you are contemplating steps to take to ensure a healthy pregnancy.  Any points in the “Won’t Do” column total indicate that you are failing to take precautions necessary for a healthy pregnancy.

Source

This self-assessment instrument was developed from information provided in Chapters 13-15 of From Data to Action CDC's Public Health Survelliance for Women, Infants and Children available at: http://www.cdc.gov/nccdphp/drh/datoact/pdf/birout3.pdf

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Copyright 1999.
Judith A. Baker
All Rights Reserved.