First Trimester Prenatal Visits
One of the first calls you'll make when you suspect you're pregnant is to your family doctor or obstetrician.
If you had a positive pregnancy test shortly after a possible conception, some doctors may ask you to hold off on scheduling your first prenatal visit for a few weeks until your pregnancy is well established. Others may want to see you right away. Meanwhile, you can begin thinking of all the questions you want to ask -- write them down as you think of them and bring the list with you! Here's what your doctor will do during this visit.
Calculate your due date
If you know the day your last period started, your doctor can use this to calculate your due date. She'll probably also ask you if your cycles are regular, since this can affect the reliability of the calculations. Establishing your due date early in pregnancy allows your doctor or midwife to monitor your baby's growth as closely as possible and to interpret lab results accurately. If you're not clear about your dates or if your periods are irregular, then your provider will probably do a physical examination and perform an ultrasound to get a better idea of when you are due.
Take a detailed health history
Many aspects of your health and your family's health history can affect your pregnancy and may help determine the kind of care you need. Among other things, your doctor may ask you about:
- Your age and occupation at the time of the office visit
- Your height, weight, and BMI
- Gynecological history, including any problems you may have had
- Risk factors for sexually transmitted diseases (such as whether you or the father have had multiple partners or have had sexually transmitted diseases in the past)
- Prior pregnancies
- Chronic health conditions such as high blood pressure, diabetes, and asthma
- Your immunization history
- Past surgeries
- Drug allergies
- Mental health issues
- Alcohol consumption
- Tobacco use
- Use of cocaine or other illicit drugs
- All prescription and over-the-counter medications you use
- All herbs, dietary supplements, and vitamins you use
- Genetic or other birth defects in your extended family
- Race and ethnicity, both yours and the baby's father's, since this can be associated with certain genetic risks
- Problems your mother or other family members had during pregnancy or childbirth
- Exposure to toxic substances in your workplace or home
- Your level of stress
- Your level of physical activity
- The father's age and occupation
Your family's health history
It may surprise you that your doctor asks so many questions about your parents, partner, siblings, and other family members. This is because many health problems are hereditary.
If your mother had any difficulties during pregnancy or childbirth, knowing this helps your doctor or midwife be alert to problems you might face. Likewise, if there are any chronic diseases in your family or your partner's family, your practitioner can be on the lookout for them.
Your health provider will also ask you if anyone in either family has had a medical condition caused by a genetic abnormality. Knowing this will help her decide whether to refer you to a genetic counselor and whether to order certain tests, such as amniocentesis, which can detect certain genetic problems. Your doctor may also ask you about any religious beliefs (or other types of beliefs about pregnancy and medical care in general) that might influence your willingness to receive certain treatments.
Your first prenatal visit will usually include a thorough physical exam in which your doctor will check your weight, height, and vital signs such as blood pressure. (Sometimes doctors wait until the second visit to do the physical exam, since the first visit focuses so intensively on your medical history.) She'll do breast, abdomen, and thyroid exams; she will also do a pelvic exam to look for changes in your cervix and your uterus size, which help your practitioner tell how far along you are, and a pap smear to test for abnormal cells that can indicate a risk of cervical cancer.
Your doctor will also send you to the lab for a lot of blood tests to find out your blood type, Rh factor (to determine whether you are at risk for forming antibodies against your baby during the pregnancy), and blood count to make sure you're not anemic.
In addition, the practitioner will likely suggest tests for sexually transmitted diseases like HIV, syphilis, chlamydia, and gonorrhea (chlamydia and gonorrhea can be detected either with urine testing or with a cervical culture at the time of the pap smear). It's important to be checked for STDs so these conditions can be treated during pregnancy to prevent transmission to the baby at the time of delivery.
Your practitioner will also want to test for hepatitis B, because its transmission from mother to infant is preventable in about 90 percent of babies who receive immunization at birth. In addition, pregnant moms are routinely checked for immunity to German measles (rubella) and, in some cases, for exposure to varicella (chickenpox) and toxoplasmosis. Depending on your ethnic background and medical history, you may also be tested for sickle-cell anemia, Tay-Sachs disease, cystic fibrosis, thalassemia, or other inherited conditions.
A urine sample will be collected to test for signs of diabetes, urinary tract infection, and other problems. If you're significantly overweight, have a family history of diabetes, or previously gave birth to a large baby, your practitioner may order a more definitive test for diabetes during one of your first prenatal visits.
What to expect in future visits
From now on, you will probably see your practitioner every four weeks until the 28th week, after which you'll see each other more often. In addition, you'll want to talk about possible screening to make sure your baby is developing normally and to discuss which approach to take.
In the past, the most common prenatal test was the multiple marker screening, usually given between 15 and 20 weeks. But the American Congress of Obstetricians and Gynecologists (ACOG) has recommended a new first-trimester screening method that measures a different set of markers and can catch Down Syndrome and other birth defects as early as 10 weeks. This test is covered by many, but not all, insurance plans.
The key is to discuss screening as early as possible with your doctor -- talk over which test would be best for you and whether you are a candidate for early genetic screening. The results of the early screening can help you decide whether amniocentesis is indicated much earlier and whether it might be more accurate than the multiple marker tests.
The downside is that the tests are not perfect, and every amniocentesis carries a risk of miscarriage (between one in 200 and one in 400 procedures, according to the Centers for Disease Control and Prevention). However, if you feel that the test results would help you decide whether or not to proceed with the pregnancy or would help you prepare yourself emotionally, it's reasonable to get the tests you need.
You'll also probably schedule an ultrasound or sonogram sometime between 18 and 20 weeks.
Besides discussing tests and procedures, your doctor or midwife will offer advice about how to eat well and what kind of weight gain to expect. He or she will also usually recommend a multivitamin with folate and iron and suggest ways to assure that you get adequate calcium in your diet, possibly with the help of supplements. Your provider can also help you deal with morning sickness, if it's a problem for you, and the various other aches and pains of pregnancy such as sore breasts and swollen feet and legs. Finally, your prenatal visits will provide the opportunity to get the answers to the countless questions you're sure to have as your baby develops.
Your doctor's philosophy
At the first visit, it's crucial is to get a feel for your doctor's philosophy and approach: How will he or she work with you? How much say will you have over your birth plan? Where will the baby be delivered? Who's on call if your doctor's on vacation, and who will take care of you and the baby in an emergency? What sort of prenatal education and resources does she recommend?
If, for some reason, you lack confidence in your provider, talk it over. Depending on his or her response, you may want to find a different one. This relationship is going to play a key role in your life for the next nine months, so it's important to make sure you're on the same page.
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