Prenatal Care

You should schedule your first prenatal visit soon after you learn that you are pregnant. Your doctor or midwife will:

• Draw your blood
• Perform a full pelvic exam
• Do a Pap smear and cultures to look for infections or problems

Your doctor or midwife will listen for your baby’s heartbeat, but may not be able to hear it. Most often, the heartbeat cannot be heard or seen on ultrasound until at least 6 to 7 weeks.

During this first visit, your doctor or midwife will ask you questions about:

• Your overall health
• Any health problems you have
• Past pregnancies
• Medicines, herbs, or vitamins you take
• Whether or not you exercise
• Whether you smoke, use tobacco, drink alcohol or take drugs
• Whether you or your partner have genetic disorders or health problems that run in your family

You will have many visits to talk about a birthing plan. You can also discuss it with your doctor or midwife at your first visit.

The first visit will also be a good time to talk about:

• Eating healthy, exercising, getting adequate sleep, and making lifestyle changes while you are pregnant
• Common symptoms during pregnancy such as fatigue, heartburn, and varicose veins
• How to manage morning sickness
• What to do about vaginal bleeding during early pregnancy
• What to expect at each visit

You will also be given prenatal vitamins with iron if you are not already taking them.

In your first trimester, you will have a prenatal visit every month. The visits may be quick, but they are still important. It is OK to bring your partner or labor coach with you.

During your visits, your doctor or midwife will:

• Weigh you.
• Check your blood pressure.
• Check for fetal heart sounds.
• Take a urine sample to test for sugar or protein in your urine. If either of these is found, it could mean that you have gestational diabetes or high blood pressure caused by pregnancy.

At the end of each visit, your doctor or midwife will tell you what changes to expect before your next visit. Tell your doctor or midwife if you have any problems or concerns. It is OK to talk about them even if you do not feel that they are important or related to your pregnancy.

At your first visit, your doctor or midwife will draw blood for a group of tests known as the prenatal panel. These tests are done to find problems or infections early in the pregnancy.

This panel of tests includes, but is not limited to:

• A complete blood count (CBC)
• Blood typing (including Rh screen)
• Rubella viral antigen screen (this shows how immune you are to the disease Rubella)
• Hepatitis panel (this shows if you are positive for hepatitis A, B, or C)
• Syphilis test
• HIV test (this test shows if you are positive for the virus that causes AIDS)
• Cystic fibrosis screen (this test shows if you are a carrier for cystic fibrosis)
• A urine analysis and culture

An ultrasound is a simple, painless procedure. A wand that uses sound waves will be placed on your belly. The sound waves will let your doctor or midwife see the baby.

You should have an ultrasound done in the first trimester to get an idea of your due date. The first trimester ultrasound will usually be a vaginal ultrasound.

All women are offered genetic testing to screen for birth defects and genetic problems, such as Down syndrome or brain and spinal column defects.

• If your doctor or midwife thinks that you need any of these tests, talk about which ones will be best for you.
• Be sure to ask what the results could mean for you and your baby.
• A genetic counselor can help you understand your risks and test results.
• There are many options now for genetic testing. Some of these tests carry some risks to your baby, while others do not.

Women who may be at higher risk for these genetic problems include:

• Women who have had a fetus with genetic problems in earlier pregnancies
• Women, age 35 years or older
• Women with a strong family history of inherited birth defects

In one test, your doctor or midwife can use an ultrasound to measure the back of the baby’s neck. This is called nuchal translucency.

• A blood test is also done.
• Together, these 2 measures will tell if the baby is at risk for having Down syndrome.
• If a test called a quadruple screen is done in the second trimester, the results of both tests are more accurate than doing either test alone. This is called integrated screening. If the test is positive, an amniocentesis or cell-free DNA test may be recommended.

Another test, called chorionic villus sampling (CVS), can detect Down syndrome and other genetic disorders as early as 10 weeks into a pregnancy.

A newer test, called cell free DNA testing, looks for small pieces of your baby’s genes in a sample of blood from the mother. This test is newer, but offers a lot of promise for accuracy without risks of miscarriage. It may reduce the need for an amniocentesis, and so is safer for the baby.

There are other tests that may be done in the second trimester.

Contact your doctor or midwife if:

• You have a significant amount of nausea and vomiting.
• You have bleeding or cramping.
• You have increased discharge or a discharge with odor.
• You have a fever, chills, or pain when passing urine.
• You have any questions or concerns about your health or your pregnancy.

In your second trimester, you will have a prenatal visit every month. The visits may be quick, but they are still important. It is OK to bring your partner or labor coach with you.

Visits during this trimester will be a good time to talk about:

• Common symptoms during pregnancy, such as fatigue, heartburn, varicose veins, and other common problems
• Dealing with back pain and other aches and pains during pregnancy

During your visits, your doctor or midwife will:

• Weigh you.
• Measure your abdomen to see if your baby is growing as expected.
• Check your blood pressure.
• Sometimes take a urine sample to test for sugar or protein in your urine. If either of these is found, it could mean you have gestational diabetes or high blood pressure caused by pregnancy.
• Ensure that certain vaccinations are done.

At the end of each visit, your doctor or midwife will tell you what changes to expect before your next visit. Tell your doctor or midwife if you have any problems or concerns. It is OK to talk about any problems or concerns, even if you do not feel that they are important or related to your pregnancy.

Hemoglobin testing. Measures the amount of red blood cells in your blood. Too few red blood cells can mean that you have anemia. This is a common problem in pregnancy, although easy to fix.

Glucose tolerance testing. Checks for signs of diabetes which can begin during pregnancy. In this test, your doctor or midwife will give you a sweet liquid. An hour later, your blood will be drawn to check your blood sugar levels. If your results are not normal, you will have a longer glucose tolerance test.

Antibody screening. Is done if the mother is Rh-negative. If you are Rh-negative, you may need an injection called RhoGAM around 28 weeks of gestation.

You should have an ultrasound around 20 weeks into your pregnancy. An ultrasound is a simple, painless procedure. A wand that uses sound waves will be placed on your belly. The sound waves will let your doctor or midwife see the baby.

This ultrasound is typically used to assess the baby’s anatomy. The heart, kidneys, limbs, and other structures will be visualized.

Ultrasound can detect fetal abnormalities or birth defects about half the time. It is also used to determine the sex of the baby. Before this procedure, consider whether or not you want to know this information, and tell your doctor or midwife and your ultrasound provider your wishes ahead of time.

All women are offered genetic testing to screen for birth defects and genetic problems, such as Down syndrome or brain and spinal column defects.

• If your doctor or midwife thinks that you need one of these tests, talk about which ones will be best for you.
• Be sure to ask about what the results could mean for you and your baby.
• A genetic counselor can help you understand your risks and tests results.
• There are many options for genetic testing. Some of these tests carry some risk, while others do not.

Women who may be at a higher risk for these problems include:

• Women who have had a fetus with genetic abnormalities in earlier pregnancies
• Women age 35 or older
• Women with a strong family history of inherited birth defects

Most genetic testing is offered and discussed in the first trimester. However, some tests can be performed in the second trimester or are done partly in the first and second trimester.

For the quadruple screen test, blood is drawn from the mother and sent to a lab.

• The test is done between the 15th and 22nd week of pregnancy. It is most accurate when done between the 16th and 18th weeks.
• The results do not diagnose a problem or disease. Instead, they will help the doctor or midwife decide if more testing is needed.

Amniocentesis is a test that is done between 14 and 20 weeks.

• Your doctor or midwife will insert a needle through your belly and into the amniotic sac (bag of fluid surrounding the baby).
• A small amount of fluid will be drawn out and sent to a lab.

Cell-free DNA testing can sometimes be done instead of amniocentesis. Blood drawn from the mother is the only requirement. Cell-free DNA testing is also called “noninvasive prenatal screening”.

Contact your doctor or midwife if:

• You have any signs or symptoms that are not normal.
• You are thinking of taking any new medicines, vitamins, or herbs.
• You have any bleeding.
• You have increased vaginal discharge or a discharge with odor.
• You have a fever, chills, or pain when passing urine.
• You have moderate or severe cramping or low abdominal pain.
• You have any questions or concerns about your health or your pregnancy.

Expect increasing fatigue during this time. A lot of your body’s energy is directed toward supporting a rapidly growing fetus. It’s common to feel the need to reduce your activities and your work load, and to get some rest during the day.

Heartburn and low back pain are also common complaints at this time in pregnancy. When you’re pregnant, your digestive system slows down. This can cause heartburn as well as constipation. Also, the extra weight you are carrying puts stress on your muscles and joints.

It is important that you continue to:

• Eat well — including protein rich foods and vegetables frequently and in small amounts
• Rest as needed
• Get exercise or get a walk in on most days

In your third trimester, you will have a prenatal visit every 2 weeks until week 36. After that, you will see your doctor or midwife every week.

The visits may be quick, but they are still important. It is OK to bring your partner or labor coach with you.

During your visits, the provider will:

• Weigh you
• Measure your abdomen to see if your baby is growing as expected
• Check your blood pressure
• Take a urine sample to test for protein in your urine, if you have high blood pressure

Your doctor or midwife may also perform a pelvic exam to see if your cervix is dilating.

At the end of each visit, your doctor or midwife will tell you what changes to expect before your next visit. Tell your doctor or midwife if you have any problems or concerns. It is OK to talk about them even if you do not feel they are important or related to your pregnancy.

A few weeks before your due date, your doctor or midwife will perform the test that checks for group B strep infection on your perineum (groin area). There are no other routine lab tests or ultrasounds for every pregnant woman in the third trimester. Certain lab tests and tests to monitor your baby may be done for women who:

• Have a high-risk pregnancy, such as when your baby is not growing
• Have a health problem, such as diabetes or high blood pressure
• Have had problems in a prior pregnancy
• Are overdue (pregnant for more than 40 weeks)

In between your appointments, you will need to pay attention to how much your baby is moving. As you get closer to your due date, and your baby grows bigger, you should notice a different pattern of movement than earlier in your pregnancy.

• You will notice periods of activity and periods of inactivity.
• The active periods will be mostly rolling and squirming movements, and a few very hard and strong kicks.
• You should still feel the baby move frequently during the day.

Watch for patterns in your baby’s movement. If your baby suddenly seems to be moving less, eat a snack, then lie down for a few minutes. If you still don’t feel much movement, call your doctor or midwife.

Call your doctor or midwife any time you have any concerns or questions. Even if you think you are worrying over nothing, it is better to be on the safe side and call.

Contact your doctor or midwife if:

• You have any signs or symptoms that are not normal.
• You are thinking of taking any new medicines, vitamins, or herbs.
• You have any bleeding.
• You have increased vaginal discharge with odor.
• You have a fever, chills, or pain when passing urine.
• You have headaches.
• You have changes or blind spots in your eyesight.
• Your water breaks.
• You start having regular, painful contractions.
• You notice a decrease in your baby’s movement.
• You have significant swelling and weight gain.
• You have chest pain or difficulty breathing.