What to expect at your prenatal visits:
Starting Point: By convention, your 'pregnancy' begins the first day of your last period and not at conception. Of course you don't conceive until 2 weeks after your period begins (for a typical 28 day cycle) so you actually have only been pregnant for four weeks when you are "six weeks" pregnant. I know this is confusing, but it's always been that way since we started recording such things.
Pregnancies are measured in weeks in the medical world. Your due date is exactly 40 weeks from the first day of your last menstrual period. The reason we don't use months is because using months is too vague. Does a month mean 4 weeks (28 days) or 31 days (like January)? A 'nine month' pregnancy is based on months of the calendar like January, February, March… So if you tell someone you're 'eight months' do you mean you only have one more month to go (36 weeks) or are you talking about 32 weeks? See how months can be confusing? To avoid that confusion, we'll use weeks here.
4-6 weeks:
Your pregnancy test is positive and you should come in for your first visit around this stage in pregnancy.
What to expect at your visit: Your first visit is the most involved. We go over my practice, take a full medical history, do a full physical exam (including a pap smear), and then perform an ultrasound. Since the embryo is very tiny, the ultrasound is usually done vaginally. This allows us to check many things, such as the number of embryos, the position of the embryo (should be in the uterus and not in the tubes or elsewhere), and sometimes see a heart beat. The heart beat is the most reassuring sign that you're not going to have a miscarriage, better than blood tests. We give you some literature on pregnancy and samples of prenatal vitamins at this visit also. Before you leave, we draw some blood- it's a lot so let me apologize in advance.
Normal symptoms at this stage of pregnancy: The most common complaint in early pregnancy is fatigue. It is very common to sleep long hours and have no energy at this stage. Breast tenderness and some early nausea are also common. Although most bleeding is benign in early pregnancy, if you have any bleeding you should call immediately.
6-11 weeks
What to expect at your visit:: Every visit the baby's growth and heartbeat are assessed. At this point in the pregnancy, the baby is very small and these two tasks are difficult. The best way to evaluate the baby early in pregnancy is with ultrasound. We perform an ultrasound and measure the size of the baby and the baby's heartbeat. You can usually hear the heartbeat at this visit. A baby's heartbeat is about twice as fast as an adult (normally 110 to 160 beats per minute) and at this visit can be even faster.
Normal symptoms: The biggest hurdle at this point in pregnancy is nausea. Usually called morning sickness, this is a bad name since the nausea can happen at any time (or even all the time). You may feel some mild menstrual type cramps as the uterus begins to stretch and grow.
11-14 weeks
What to expect at your visit: Again we perform an ultrasound to measure the size of the baby and listen to the heartbeat. We also do a measurement that screens for some birth defects (such as Down Syndrome). This measurement is done with ultrasound and measures a small pocket of fluid underneath the skin on the back of the baby's neck ("nuchal translucency"). We're not sure why, but some babies with Down Syndrome have an increased thickness of this layer. There is also a blood test done as part of the nuchal transluceny at this visit.
Normal symptoms: As your uterus stretches you may occasionally feel some menstrual type cramps. This is normal. If you have bleeding or the cramps become regular, you need to call the doctor immediately.
14-18 weeks
What to expect at your visit: At this point in your pregnancy, we should be able to hear the baby's heartbeat by placing a small listening device (called a Doppler) on your abdomen. We also measure your abdomen to make sure the uterus is growing appropriately. There is also a blood test done (to check for Down Syndrome and spina bifida) at this point in the pregnancy (16-19 weeks). This test has been around for many years and checks 4 different chemicals in your blood. These results and other information (such as age, weight, and race) are fed into the lab's computer and a risk for Down Syndrome (DS) and neural tube defects (also known as spina bifida) is given. We consider a risk for DS > 1 in 270 to be positive. The only sure way to rule out DS is with amniocentesis and this may be recommended as the next step. If you will be 35 or older when the baby is born, we may discuss skipping this blood test and proceeding directly with amniocentesis.
Normal symptoms: You usually begin to feel movement at this point in the pregnancy. The old name for feeling the first movements was 'the quickening.' People used to think this was when the baby's soul entered its body and it sprang to life. We know now that babies are moving as early as 8 weeks (they're just too small to feel).
19-21 weeks
What to expect at your visit: At this point in the pregnancy we do a full ultrasound on the baby to look at all the baby's anatomy and check for growth. We can find out the sex of the baby at this visit also. Many, but not all, birth defects can be seen using ultrasound. The smaller the problem, the harder it is to see and some things can't be seen at all. Of course things that are genetic or metabolic (like Down Syndrome or Sickle cell anemia) can't be seen at all. Please bring a video tape (a regular VHS tape) and we can video tape the ultrasound.
Normal symptoms: Headaches are very common at this point in pregnancy and are very similar to migraine headaches. Unfortunately, most medicines used to treat migraines are not safe in pregnancy. Luckily, Tylenol is usually enough for the majority of them.
22-25 weeks
What to expect at your visit: At this point in your pregnancy, the baby is growing quickly. As with every other visit, we will check a urine specimen for protein, ketones, and glucose. We will also weigh you, check your blood pressure, measure your uterus, and listen to the baby's heart with a Doppler. When measuring the baby's growth we measure from the pubic sympysis to the top (fundus) of the uterus. This roughly should be the same number of centimeters as weeks in your pregnancy (e.g. at 24 weeks your fundal height should be 24cm). At this visit we will give you your packet from the hospital for registration. Inside the packet you will find all the information you need for signing up for classes on everything from baby CPR to childbirth to breast feeding.
Normal symptoms: A very common symptom during this point of the pregnancy is 'round ligament pain.' The round ligaments are two very small ligaments that go from each side of the uterus to the pelvis floor. They're about the size and length of your little finger and as the uterus grows, they get pretty stretched. This usually presents itself as a sharp pain on one side or the other that gets worse with moving (such as walking or rolling over in bed). Near the end of this time frame you may also experience 'Braxton -Hicks' contractions.
26-28 weeks
What to expect at your visit: During this stage of your pregnancy we perform a test for gestational diabetes. Diabetes is when your blood sugar is high and there is a special kind of diabetes found only in pregnancy. The test involves drinking a very sugary drink (usually given at the previous visit) and then drawing blood one hour later. If this value is above 140, you need to do an additional test that will tell us for sure if you have gestational diabetes. After this visit, the time between visits goes from one month to two weeks. We also perform an ultrasound at this visit to check the growth of your baby and make sure the baby is head down (vertex). Our ultrasound machine takes 4-D pictures, so bring a video tape.
Normal symptoms: Uterine cramping or "Braxton-Hicks" contractions are very common at this stage in pregnancy. The more times you have been pregnant, the earlier they begin and the stronger they can feel. Most women have just a few of these contractions in a day. If you ever have more than six in an hour, this could be signs of preterm labor and you should call the doctor.
29-34 weeks
What to expect at your visit: During this time your visits will be every two weeks unless there is a complication with your pregnancy. At every visit, the doctor will check the growth of your uterus (and indirectly, your baby) and listen to the baby's heartbeat. There are no routine labs or tests done during this period. This is also the time you should be signing up for birthing classes and a tour of the hospital.
Normal symptoms: Back pain is very common at this point in pregnancy. As the baby grows, their weight puts a lot of strain on your lower back. Massages and heat (on your back, NOT on your abdomen) work the best. Heartburn is also common as the baby starts to push up on your stomach. We have a list of safe medicines for this and other common problems available if you have not already received one.
35-40 weeks
What to expect at your visit: : You're getting very close now! During the final stages of your pregnancy your visits will be every week. Around 36 weeks we perform a test for the Group B Strep (GBS) bacteria on all women. This bacteria usually doesn't cause infections in adults, but can cause serious infections in newborns. The test involves a quick vaginal swab and takes about a week to get the results. If you have this bacteria (about 1 in 4 women do) your receive antibiotics in labor to protect the baby. The antibiotics are given in your IV, cross the placenta, and end up in the baby's circulation so that they are protected during birth. During the final weeks, we start performing checks to see if your cervix (the opening of the uterus/womb where the baby comes out) is dilating.
Normal symptoms: Labor is the big thing to look for at this point in your pregnancy. If you have contractions every five minutes for an hour, any vaginal bleeding, a sudden gush of fluid, or your baby is not moving, call your doctor immediately. |
