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What to Expect at Your Prenatal Visits Pampered Pregnancy www.pamperedpregnancy.com What to Expect at Your Prenatal Visits During your pregnancy, you and your doctor are going to see each other at least once a month for the next 7 months, then twice a month, and even more often than that as your due date draws nearer. By staying in close contact with your doctor throughout your pregnancy, your doctor can monitor your baby’s growth and your health throughout your pregnancy and avoid a lot of complications and/or risks. Whether you’ve gotten a positive result on a home pregnancy test or you suspect that you may be pregnant because you’ve missed a period, it’s time to make an appointment with your family physician or your OB/GYN. Your doctor would likely prefer that you wait until about 8 weeks after your estimated conception date to schedule your first prenatal appointment. After that, you’ll have regular appointments throughout your term. 2 What to Expect at Your Prenatal Visits What is prenatal care and why do you need it? When you hear your doctor or other experts refer to “prenatal care”, they mean the medical attention and monitoring you receive during your pregnancy. These visits to the doctor are usually little more than checkups and opportunities for you to ask your doctor questions about your changing body and your baby’s health. They are usually not invasive or uncomfortable, but they are very important to your health and the health of your child. 3 What to Expect at Your Prenatal Visits According to the US Department of Health and Human Services’ Office on Women’s Health, women who do not seek regular prenatal care are three times more likely to give birth to underweight babies. Their babies are also five times more likely to die in infancy than women who did nothing more than make regular visits to their doctors and follow their doctors’ advice during their pregnancies. With regular checkups, your doctor can monitor your weight, blood sugar, and other changes in your body. If, for example, you’re showing signs of developing gestational diabetes, your doctor can spot this early on and make sure that you take the necessary measures to keep yourself and your fetus healthy. 4 What to Expect at Your Prenatal Visits How often should you see your doctor? Between weeks 4 and 28, starting around week 8, you should see your doctor monthly. Between weeks 28 and 36 you should make bi-monthly prenatal appointments, and from week 36 until birth, you should see your doctor once a week. Weeks 4-28: Monthly Weeks 28-36: Bi-Monthly Week 36 until birth: Once a Week 5 What to Expect at Your Prenatal Visits Do you need to prepare for prenatal visits? Because your prenatal visits will be – for the most part – standard checkups, you don’t have to do anything special to physically prepare for your visits with your doctor. However, you might want to keep a notebook with you as you go about your day and jot down any questions that occur to you about your baby, your body, your lifestyle, exercise, and diet choices. For example, you certainly already know to avoid alcohol and tobacco during pregnancy. However, if you were a smoker before you got pregnant, should you quit cold turkey now? Or is it better for the baby if you avoid that shock to your system and just cut back to one or two cigarettes per week? Your doctor can answer all of your lifestyle and diet questions, as long as you remember to ask them. So take your notebook with you wherever you go, in case something pops into your head throughout the course of your day. To prepare for your first prenatal visit, make a list of all medications, supplements, and herbs you take now or are considering taking in the future. If you have any of these on hand, bring them with you. Your doctor can point out chemicals, herbs, etc. that could be harmful to your baby and recommend alternatives. 6 What to Expect at Your Prenatal Visits First and second trimester prenatal visits During your first and second trimesters – roughly from weeks 4 through 20 – you’ll go to your doctor once every 4-6 weeks. Your doctor will first ask you how you’re feeling, both physically and emotionally, and encourage you to voice any concerns and/or questions you may have. Remember, there are no stupid questions, and no one is born knowing how to be a mother – or even how to bring a healthy baby to term. Asking a lot of questions can only result in more knowledge and confidence in yourself and your health. Asking too few can actually be incredibly dangerous for your baby. During these visits, your doctor will also weigh you, take your blood pressure, measure your uterus’ growth and the growth of your baby, and listen to your baby’s heartbeat. Your doctor may also take a urine sample to check for the presence of protein and/or sugar, both of which are signs of gestational diabetes. *N.J.S.A. 26:4B-4, -5 7 What to Expect at Your Prenatal Visits Late-term prenatal visits Between weeks 15 and 20, your doctor will most likely offer to perform a Quad Screen test to check for genetic and/or spinal abnormalities. If your doctor doesn’t offer this screening, you may request one. At this point, your doctor will probably also want to perform an ultrasound to take a look at the placenta, as well as your baby’s growth and organ health. Around week 27 or 28, your doctor will want to check again for gestational diabetes with a glucose challenge test. Pelvic exams and hemoglobin tests are also not uncommon at this stage. As you enter your final trimester, your doctor will make sure that you’re aware of warning signs and symptoms of problems late in your pregnancy. After this, you’ll start seeing your doctor every 2-3 weeks until week 36 of your pregnancy. Your doctor will continue weighing you, taking your vitals, and measuring the growth of your baby. As long as nothing out of the ordinary occurs, you can expect these visits to be the same as earlier visits. At week 36, your doctor will perform a pelvic exam and check the position of the baby. If he/she isn’t head down yet, your doctor may suggest some exercises to encourage movement. From this visit until your due date at week 40, you should see your doctor once a week to check your baby’s size, your vitals, and your cervix dilation. If you go past your due date, your doctor may recommend an ultrasound, biophysical profile, or another non-stress “post-date” test before inducing labor or performing a C-section. 8 What to Expect at Your Prenatal Visits Questions to ask on your first visit – and a few answers Especially if this is your first pregnancy, your first prenatal visit can seem overwhelming. You know that it’s only going to be a checkup and a confirmation that you’re pregnant and when you’re due, but there’s so much that you still don’t know! This is a common, sometimes paralyzing feeling, but having a few common questions answered can help you focus on what you need to know now, what you’re concerned about, and how you will feel moving forward. 9 What to Expect at Your Prenatal Visits Am I pregnant? This may seem silly, especially if you’ve missed a period and taken a home pregnancy test. However, while a missed period is usually indicative of pregnancy, and false positives are rare, they do occur. So, you’ll want to confirm with your doctor that you are pregnant before you continue with any more prenatal care. When is my due date? You don’t actually need a doctor to determine your estimated due date. Just add 40 weeks to the first day of your first missed menstrual cycle, and you have your due date as closely as your doctor can estimate it. Once you’ve calculated that, the two of you will set up a schedule for your prenatal care based on your estimated conception and due dates. 10 What to Expect at Your Prenatal Visits What medications, food, or drink should I avoid? During your first visit, your doctor will want your medical history and a list of any current medications or supplements you’re taking. Your doctor will advise you on which medications are safe and which you should avoid. While you should always ask your doctor before starting any new over-the-counter medications or supplements, you can find out if the FDA approves certain drugs for use during pregnancy based on a simple grading system. The FDA pregnancy ratings are: • A or B – These are considered safe because no adverse effects have been recorded. • C – No conclusive studies have been performed determining the safety of using these drugs during pregnancy. • D – These have been found to do some harm in some cases. • X – These are entirely off limits during pregnancy. 11 What to Expect at Your Prenatal Visits In addition to pharmaceuticals, some of your favorite foods may be off limits for the next 9 months. For example, pregnant women should avoid eating: • Fish containing higher levels of mercury (swordfish, tuna, mackerel, shark) • Raw or undercooked foods including meat, fish and eggs • Deli meats • Unpasteurized dairy products and soft cheeses Your doctor will be happy to help you with a list of safe foods that will nourish your baby and keep you healthy throughout your pregnancy. If you want to get a head start, pick up some fruits and vegetables that are rich in vitamin C and folic acid, as both are great for a growing fetus. 12 What to Expect at Your Prenatal Visits How much weight should I be gaining? In the first trimester you might not gain much at all. Most women gain between one and four pounds in these weeks as their babies just begin to form. From the beginning of the second trimester to the end of your pregnancy, though, you can expect to gain about a pound a week. Overall, most women gain 25-35 pounds during pregnancy. Depending on your current weight and health, your doctor may advise you to attempt to gain more, or not as much. Every pregnancy is different, and you and your doctor will monitor your weight and your baby’s growth over the next 9 months. 13 What to Expect at Your Prenatal Visits What kind of exercise is okay? The American College of Obstetricians and Gynecologists and the Office of Women’s Health both recommend 30 minutes of light cardiovascular exercise per day. You may want to avoid load bearing exercises, especially later in your term, but you should discuss this with your doctor at your first prenatal care visit. If you are an athlete, and you exercise vigorously every day, your doctor will most likely not recommend that you quit entirely, but might advise that you switch to less intense, stressful exercise. Instead of running, yoga might be advisable. If you are not currently active, your doctor may recommend daily walks or light aquatic aerobics to build stamina and cardiovascular health without putting a lot of strain on your body and your baby. 14 What to Expect at Your Prenatal Visits What do I do if I think something is wrong? Ask your doctor about common symptoms in the first month of pregnancy. The more you know, the less likely you’ll be to make an emergency appointment for something that turns out to be quite normal. In fact, each time you visit your doctor, you should feel free to ask your doctor what you can expect between now and your next prenatal visit. For example, some light bleeding and achiness can be expected early on in your term, but if the bleeding gets heavier or your aches turn to sharp pains, something may be wrong. 15 What to Expect at Your Prenatal Visits Is my pregnancy considered high-risk? If you have one or more pre-existing conditions, your pregnancy may be considered high-risk. These include, but are not limited to: • Hypertension • Diabetes • Cancer • Autoimmune diseases, such as rheumatoid arthritis or lupus • Heart disease Women over 35 have been traditionally considered higher risk, but that thinking is changing as medical science and prenatal care continue to advance. However, if you are in the 35-45 year age range, your doctor may still want to see you more often than if you were having a baby at a younger age. 16 What to Expect at Your Prenatal Visits With this information, you should be ready for your first prenatal visit, and you should have a basic idea of what to expect from your subsequent visits for the rest of your term. Remember, you can never ask too many questions. 17