Prenatal Visits
What to Expect
For most of the women reading this, as soon as the test stick turned colors or showed the smiley face, you started to think about anything you might have done or should and shouldn't do now that you are pregnant.
Looking for advice and guidance at this time includes finding good prenatal care. In this case, what does "good" mean? What are you really looking for? You want to make sure you do what's best for baby, but will some care be better than others?
First, prenatal care in the United States is fairly standardized, so not to worry. I'd like to list what you will be offered, in terms of recommended screening tests and optional testing, as well as some of the extras that are involved depending on age, genetics, and risk factors.
The first prenatal visit is made during the first trimester (before 12 weeks) in order to discuss your personal history, concerns, and risks that could impact the pregnancy. While you are bursting with questions, often the provider will be better equipped to answer you once they have completed a physical exam-including a pelvic with a speculum exam, pap and cervical cultures, and taken a complete history that includes questions about your medical, surgical, gynecological, family, and social history. Once that is done, and he or she has covered medical concerns brought to light by the history and physical, there will be some time for questions. If your list is long, you may be invited back for the second visit sooner to discuss them and often are given reading material and websites that can answer them.
Standard blood tests will be ordered. These are blood type, complete blood count, syphyllis, hepatitis, rubella (German measles). Toxoplasmosis, cystic fibrosis, a variety of anemias, and thyroid screening will be done if indicated. Sometimes an ultrasound is done or ordered, though it's important to realize that this is not a routine in this country.
Also, other screenings will be discussed. A First Look Test, or Early Risk Assessment, as it is also called, is a test between 11-13 weeks done with mom's blood work and a sonogram to assess risk of Down's Syndrome. Women over 35 will also be discussing amniocentesis, usually done at 16 week and older women may be speaking about CVS, a different early form of screening for Down's.
It's a lot to do, and while you are barely settling into the idea of pregnancy and (for some of you) still worrying about possible miscarriage, you are discussing what could go wrong, now and later. It can be overwhelming, but don't worry. It gets easier.
While the first visit can take up to an hour, return visits are between 5-20 minutes depending on the practice and are every 4 weeks at the beginning. The physical parts of the visits only take 5 minutes. They will include a urine dip for glucose (sugar) and protein, a blood pressure reading, your weight, and a uterine measurement done with hands, and later at times, a tape measure, and the good part—listening to the fetal heartbeat. The rest of the visit may be used for review of upcoming testing, or developmental milestones and what to expect, or to answer questions you might have. Please write your questions down, as it is very easy to forget them as soon as you sit down in the office. Also, if you know you have a long list or a number of concerns it's to everyone's benefit if you call the office to see if they can give you a little more time.
Other standards include a comprehensive ultrasound between 18-20 weeks called a fetal survey, done to look at the fetal anatomy and development. Sometimes the gender can be seen, but it is not an official part of the survey. Be sure to let your sonographer know at the start of your ultrasound if you have a preference to know the gender. When you leave, it will not be written down anywhere, so the opportunity will be lost.
At the beginning of the third trimester (26-28 weeks) you will be asked to drink sugar syrup and then have your blood drawn an hour later for a diabetes of pregnancy screening, and at that time another complete blood count to check for anemia. Helpful tip: pack a snack because some women feel lightheaded by the end of the hour so as soon as they draw your blood, have something (preferably with protein) to eat. This is when prenatal visits change to every two weeks.
Finally, in the last 4 weeks, your visits are weekly. You will be discussing testing recommendations for postdates (overdue), and depending on your personal pregnancy may be offered or advised tests called NST's (non-stress tests = non-invasive monitoring) and BPP's (ultrasounds). At 36 weeks, there will also be a vaginal culture taken for GBS (group b strep), a normally harmless vaginal microbe that can cause infections in labor.
With prenatal care being fairly standardized, what makes the difference in prenatal visits for each woman is finding an office she feels comfortable with and providers, whether midwives or doctors, that she feels she can trust. Enjoy this special time in good health!
