Elissa Hellman, MD Obstetrics/Gynecology

January 05, 2012

Congratulations on your pregnancy! If you're having your first baby this can feel like an exciting, overwhelming and unfamiliar time. You will have lots of questions, but also many opportunities to talk through things with your OB. Even if you feel like not much will change between your visits, it is important to go to all of your prenatal appointments. Your physician will want to make sure both you and your baby are making healthy progressions.

Scheduling your First Prenatal Visit:

Your first appointment at your OB will occur about six to eight weeks into your pregnancy. If you have a healthy pregnancy, your first prenatal visit will be the longest. A complete medical history is taken including obstetrical and gynecologic history, past surgeries or hospitalizations, current medical conditions or habits, medications and allergies.

Your physician will ask you about your last menstrual period and perform a transvaginal ultrasound to determine the size of the embryo and assign a due date. At this time a physical exam including a pap smear and routine blood and urine test is also performed. The blood draw includes a complete blood count, thyroid function exam and blood type identification, as well as HIV, Hepatitis B, Rubella and Syphilis to ensure identification of any infection that may affect the mother or fetus during pregnancy.

Your physician will also discuss proper nutrition and exercise along with allowable medications during pregnancy. Bring a list of supplements or over-the-counter medications you're taking to have your practitioner verify they are safe to use during pregnancy. Assuming the initial visit is between six and eight weeks, a woman can expect to have about 12-15 visits during her pregnancy. More visits may be necessary if you have had previous medical problems that make you more prone to having a high-risk pregnancy.

High Risk Pregnancy:

A high-risk pregnancy is classified as any condition where complications that arise could compromise the health of the mother or fetus. The most common maternal reasons include high blood pressure, diabetes and diseases prone to blood clotting. High-risk pregnancies can also include multiple gestations, such as twins or multiples, abnormal placentas or having a history of preterm labor, which puts the mother at risk for another early delivery. Be sure to disclose all pertinent family history to your physician as well, as it may be a predictor for any high-risk developments in your pregnancy.

Appointments and Testing along the way:

To get the most out of your prenatal appointments keep a notepad with you at all times to jot down questions to discuss during appointments. If possible, have your spouse come with you to your appointments. They may have their own questions or can help you remember details about changes to expect in the coming weeks. If there is anything you may have forgotten or are concerned about, don't hesitate to call between visits.

After your first exam each appointment begins with a nurse taking your blood pressure, weight and urine sample. Too much protein in your urine along with high blood pressure is an indicator for preeclampsia, which can be life threatening. Your practitioner will also measure the size of your uterus and listen to the baby's heartbeat using a handheld ultrasound called a Doppler. Bring along your partner or a family member to share this exciting moment.

There are several other routine and optional tests you will receive during pregnancy to ensure you and your baby are healthfully progressing. At 20 weeks, a comprehensive ultrasound is done to look at the developing anatomy, placental position and identify any abnormalities. It is often possible to verify the baby's gender at this time as well. At 26-28 weeks your blood count will be tested again to look for anemia and gestational diabetes. Around 35-36 weeks, a vaginal culture is performed to check for the presence of Group B Strep, a bacteria that is present in 25% of women. Group B Strep can be found in your intestines or lower genital tract. It is usually harmless to adults, but can cause serious illness in newborns. If the bacterium is found, antibiotics are given during labor to decrease exposure to the baby and avoid neonatal infections.

During the last month of pregnancy, the visit will also include cervical exams to monitor your body's preparation for labor. If you haven't already, this would also be the time to choose a doctor for your baby.

Optional Testing:

If you are of advanced maternal age or merely want some peace of mind, there are several genetic tests you can also take to assess the health of your baby. Consider taking these tests if you are 35 and older, as the chance of your baby being born with genetic abnormalities increases as you age. Genetic tests may identify a carrier status of an inherited or genetic disease such as cystic fibrosis, muscular dystrophy and other genetic conditions related to the parents ethnic background.

At 11-12 weeks, a blood test combined with an early ultra sound can be performed to screen for abnormalities. At 12-15 weeks, an amniocentiesis can be performed. During this procedure amniotic fluid is removed and the genetic material from the fetal cells are analyzed. At 16-20 weeks, a Quad Screen can be performed by testing the mother's blood. All of these tests done by obstetricians may identify chromosomal abnormalities in the fetus. If the mother is identified as a carrier for a disease, the father is then tested. If only one parent is a carrier, the fetus is usually not at risk for the disease. When both parents are a carrier, the fetus is at risk of having the condition. A genetic counselor will be able to discuss the risk with you and your partner.

Follow-up Appointment:

If you had a vaginal delivery, a follow-up visit occurs six weeks post partum. At this appointment an exam is performed to ensure you have healed well and a pap smear is also performed. If you had a cesarean section, there will be an appointment two weeks after you had your baby to check the healing of the incision. The standard post partum appointment will occur four weeks after that. If you have any questions regarding breastfeeding or post partum depression, be sure to ask them during this time or sooner to get the help you need. Contraception methods may also be discussed and prescribed at this appointment.

You go through many physical and emotional changes before, during and after becoming a new mom. Just like during your pregnancy, keep notes of anything that is of concern and bring it up with your physician. For example, you may want to know more about diet and how to ease back into exercise after birth. Your physician should be able to answer any questions you have or give you resources to help.