What to Expect at Your First Prenatal Appointment
Your first appointment normally occurs between weeks six and eight of pregnancy. However, it can sometimes be scheduled at ten weeks. The timing of this appointment will determine what types of tests will occur and how long the appointment takes, but plan for it to last at least an hour.
1. An Initial Health Assessment
The doctor will usually begin the appointment by establishing a baseline of your vitals. They will take your blood pressure, determine your weight, and check your oxygen levels. If your appointment is after the six week mark, then they will also take the time to listen to your baby’s heartbeat. This will become a regular occurrence throughout your many prenatal checkups in the coming months.
2. Blood & Urine Tests
Next, you will provide your doctor with a urine sample and have blood tests done. These will give your OB-GYN an overall view of your health and indicate if you have certain health conditions, such as anemia, clotting disorders, diabetes, or a urinary tract infection, that may require treatment. They will also determine your blood type as well as you and your baby’s rH factors. This refers to a protein that is or is not present on the surface of your red blood cells. It is signified by the plus or minus sign attached to your blood type. This is an important piece of information because if you are rH negative and your baby is rH positive, your body will begin to reject the fetus, unless medical interventions are taken during early pregnancy. Finally, they will check for sexually transmitted infections since many of these conditions can impact your developing baby in utero. Thankfully, bacterial infections like syphilis, chlamydia, and gonorrhea can be treated with antibiotics. Conversely, if you have a viral STI such as hepatitis B, HIV, or genital herpes, these conditions cannot be cured. Instead, your doctor can prescribe antivirals to help prevent the spread of these infections to your baby.
3. Due Date Determination
Your doctor will determine your due date at your first prenatal appointment using the first day of your last period as the start of your gestational window. This will give you a general idea of when to plan for your little one’s arrival, but it is also crucial for your physician as well, because it allows them to properly monitor your baby’s growth and ensure that they are reaching the proper milestones throughout your 40 weeks of pregnancy. It is important to remember that this is an estimated time of arrival, not a guarantee. In fact, most first time moms tend to deliver at 41 weeks or later if they are given the chance to progress naturally. In contrast, if you are expecting multiples or if you used in vitro fertilization to conceive, this time frame will actually be shortened.
4. A Possible Ultrasound
Some doctors will choose to do an ultrasound during this visit. First trimester ultrasounds will simply confirm the pregnancy, determine that the implantation occurred correctly (the fertilized egg implants incorrectly in the case of an ectopic pregnancy), and show the number of fetuses present. Conversely, if you know the exact date of your last period and you don’t have a history of ectopic pregnancy, your doctor may choose to forgo this diagnostic procedure until the second trimester.
5. Prenatal Testing
For the ladies who pushed their appointment until their tenth week or later, you may have the opportunity to partake in a genetic screening test called cell-free DNA testing. According to The American College of Obstetricians and Gynecologists (ACOG), “the cell-free DNA in a sample of a woman’s blood can be screened for Down syndrome, Patau syndrome (trisomy 13), Edwards syndrome, and problems with the number of sex chromosomes.” This simple blood test can be performed as early as 10 weeks of pregnancy and it can even let you know the sex of your baby. However, if you are having multiples and they are not identical, you may still have to wait until your ultrasound in order to determine the sex of all of the babies. This test looks for a Y chromosome. A positive test result indicates a male chromosome is present. Thus, if it is absent, then you are only having girls. In contrast, if it is present, then you could be having all boys or a mix of both genders.
6. Pelvic Exam
Finally, depending on when you had your last pap smear and your family medical history, your healthcare provider may decide to do a pelvic exam. This allows them to check for abnormal tissue and infections that could impact the pregnancy. Not all physicians will deem this physical exam necessary though, so don’t be surprised if they skip this procedure.
Topics You Should Discuss
1. Health History
During your visit, your doctor will want to get a comprehensive rundown of you and your partner’s family medical history in order to determine if you have any health problems that could impact your pregnancy. These can include conditions such as diabetes, hypertension, thyroid disease, autoimmune disorders, and genetic disorders that you could pass onto your unborn child (e.g. Down syndrome, Cystic fibrosis, or Tay-Sachs disease). Additionally, they will inquire about any allergies, previous surgeries, and if you have a history of miscarriages or ectopic pregnancies. These risk factors can help your physician determine if you are prone to having a high risk pregnancy and how to best care for you throughout the next nine months. Remember that you want to provide your doctor with as many details of your overall health information as possible. This will allow them to better care for you and your baby.
2. Weight Gain
The recommended amount of weight that a woman should gain throughout her pregnancy is dependent on what pre-pregnancy weight category she falls under — underweight, normal, overweight, or obese. For those ladies who are in the normal category, you should be gaining a total of 25 to 35 pounds. Underweight women should put on as much as 40 pounds and obese women should only aim to put on a maximum of 20 pounds. These guidelines are important because gaining too much weight puts you at a higher risk of developing conditions like gestational diabetes and preeclampsia as well as having complications during delivery. You can lessen your risk of these conditions by simply eating well, exercising, taking a prenatal vitamin with at least 400 micrograms of folic acid daily, and drinking plenty of water.
3. Medications
As mentioned, a proper diet and low to moderate activity are important throughout pregnancy. However, there are a lot of things that you need to avoid over the next nine months as well. Make a point to speak with your doctor about the specific medications and supplements that you take regularly and if they are safe to continue throughout pregnancy. This should also include over the counter pills and herbal teas. Furthermore, inquire about prenatal classes that are available to you through your hospital system. This can help you to be better prepared for what is to come throughout pregnancy, labor and delivery, and beyond!
4. Vaccinations
Another important topic to discuss is what vaccinations you should be receiving throughout the next 40 weeks. The Centers for Disease Control and Prevention recommends that all moms-to-be receive a flu shot and a Tdap vaccine. While you may be wondering why you are required to get a tetanus shot every time you get pregnant, the answer is actually quite logical. The “p” in Tdap stands for pertussis, otherwise known as whooping cough. By getting this vaccine, you are giving your baby antibodies that will keep them protected during their first few months of life, before they are eligible to receive vaccinations. Additionally, the CDC now also states that the COVID-19 vaccine is also safe for expectant mothers. Just remember to speak with your physician prior to getting any of these vaccines as the timing is key for ensuring optimal protection for you and your little one. More specifically, the TDap should be administered during the third trimester to guarantee the most antibodies are transferred to your child whereas the flu vaccine should be given just before the peak of flu season, which can vary from year to year. Lastly, there are a handful of vaccines that are not safe for your unborn child. Some of these include the chickenpox vaccine, the MMR (measles, mumps, and rubella) vaccine, the human papillomavirus (HPV) vaccine, and travel inoculations to protect against yellow and typhoid fever.
Your Specific Concerns
At the end of your first visit, you will have a chance to discuss any questions or concerns that you may have regarding you and your baby. Therefore, have a list of questions ready! This is a brand new experience and every pregnancy is different so don’t be afraid to ask what is on your mind. Two of the top subjects to discuss are what symptoms are normal (and what are not) as well as your doctor’s stance on certain procedures like episiotomies, inductions, scheduled c-sections, and delayed cord clamping. While it may seem like a long way off, if their views do not align with your own, you will want to find a different OB-GYN in your region sooner rather than later. Lastly, take the time to ask if they have an after hours number that you can call if you notice irregular symptoms or have pressing concerns at an odd hour. This can save you the headache of a potentially unnecessary hospital visit.
Prenatal Care Matters
Most women find out that they are pregnant a few days or weeks after their missed period. For those ladies who have irregular periods and go for longer amounts of time before discovering their big news, remember that it is never too late to receive prenatal care. What you may not realize is that for the first seven months of pregnancy, women’s health experts advise that expectant moms only visit their doctor once a month, unless they are placed in the high risk category based on specific test results. In other words, even if you waited until 12 weeks to see your physician, you will likely go on to have a healthy pregnancy without any complications. Nonetheless, in order to achieve the best health outcomes for you and your baby, it is crucial that you receive prenatal care throughout these 40 weeks. While the cost can be high, there are lots of affordable solutions available and most appointments and testing are covered with regular insurance. If you are concerned, speak with your physician about skipping unnecessary check-ups. First time moms normally see their OB-GYN more frequently since this is uncharted territory.
Take Precautions Before Conception
Lastly, if you are a woman of reproductive age and you are sexually active, one of the best ways to protect yourself and your future little one is to simply take prenatal vitamins daily, whether or not you intend to conceive. This better guarantees that if you were to become pregnant unexpectedly, that your baby is getting the majority of the essential nutrients that they need to thrive and grow.
