If you are newly pregnant or thinking of conceiving, expect to have a planned schedule of prenatal visits and lab tests during your prenatal care. Make sure you keep all your appointments and follow your OB provider's coordinated care plan until your baby is born. Close medical attention during your pregnancy improves the chance you and your baby will have the best possible outcome.
Your Initial Prenatal Visit
OB specialists follow practice guidelines for comprehensive prenatal care recommended by healthcare groups. The initial prenatal intake visit sets the stage for a series of doctor's or midwife's mother and baby assessments, prenatal testing, and opportunities for you to learn and ask questions.
The Intake History
Your prenatal care enrollment visit begins with a complete review and documentation of your history to begin a full baseline perspective on the status of your health and pregnancy. This includes the following:
- Initiation of your prenatal record that will be added to at each follow-up prenatal visit and will follow you to labor and delivery
- Confirmation of your pregnancy with urine and/or blood pregnancy testing, if not yet done
- Calculation of the gestational age of your pregnancy from the date of your last menstrual period and estimation of your due date
- A complete review of your past medical history including:
- Gynecologic, obstetric, and surgical, and any history of infectious diseases
- Any personal or family history of chronic diseases such as high blood pressure or heart disease, or psychological problems
- Your immunization history such against german measles (Rubella) or chicken pox (Varicella)
- Use of any medications or recreational substances such as tobacco, caffeine, and alcohol, or illicit drugs
- Work, social, and lifestyle history, including your diet and physical activities
The Initial Physical Exam
You will have a complete baseline physical exam including:
- Your weight, height, blood pressure, and temperature
- Breast, abdomen, and pelvic exam, and the first sizing of your pregnant uterus
- A Pap smear and specimens from your cervix to check for sexually transmitted infections (STIs) such as gonorrhea and chlamydia
Initial Assessment and Care Plan
Based on your history and your initial exam your pregnancy doctor or midwife will:
- Have a good initial assessment of your current overall health and pregnancy status, and any potential risks for you and your baby including the effect of your age.
- Be able to designate whether at this point you have a low risk or high risk pregnancy
- Initiate prenatal teaching, which includes how to reduce risks for you and the baby, such as:
- Quitting smoking, caffeine, alcohol, and drugs
- Healthy nutrition, recommended pregnancy weight gain, and exercise during pregnancy, including yoga and other lifestyle tips
- Getting appropriate recommended immunizations
- Food, toxins, and infections you should avoid, such as mercury in fish, toxoplasmosis, and listeria
- Refer you to other physician specialists, such as a high-risk OB doctor
- Refer you to support medical services, such as a nutritionist or a diabetic teaching nurse if you have diabetes or you are at risk
- Have you talk to a social worker or a financial counselor so you can sign up for Medicaid or other maternal health insurance or get help to find maternity grants or other support, if needed
- Give you prescriptions for prenatal vitamins, iron, and folic acid to decrease the risk for neural tube defects, as well as any other relevant medicines
- Answer your questions (don't hesitate to ask), on such topics as the normal development of your baby, the safety of sex and other activities in pregnancy, and the schedule of your follow-up prenatal visits and lab tests
Initial Screening Lab Tests
Intake prenatal lab testing includes:
- Blood count to check for anemia,
- Blood typing and Rh factor
- Blood group antibodies
- Blood glucose level
- Blood screening tests for Rubella, Hepatitis B, and syphilis
- HIV screen if needed
- An ultrasound to date your pregnancy or check on the health of your fetus if needed
Follow-up Prenatal Visits
During each follow-up prenatal visits, your OB specialist will check to make sure you and your baby are doing well. He or his support staff will do the following:
- Take an interim history and ask you about any changes or problems since your last visit
- Measure your blood pressure and weight and, starting around 10 to 12 weeks of pregnancy, check the fetal heart rate
- Examine and measure your belly to assess the growth of your baby
- Before your uterus grows out of your pelvis at about 13 to 14 weeks and can be felt in your belly, you will have a pelvic exam at each visit to check your uterine size and growth of your baby
- Check your urine in the office for sugar, protein, ketones, and signs of infection and send it to the lab for further analysis if needed - protein in your urine can be caused by high blood pressure or associated preeclampsia
- A review of:
- Managing the normal symptoms of pregnancy, such as breast tenderness and first trimester morning sickness
- Early warning signs and symptoms of problems to watch for in each trimester, such as an ectopic pregnancy, a miscarriage, or preterm labor and the risks of having a premature baby
- When to call your doctor or midwife, or what to do if your water breaks later in your pregnancy
- Review of follow-up prenatal visits and future testing such as screening for a risk of congenital birth defects
Standard Schedule of Prenatal Visits
This is the standard schedule of prenatal visits:
- Up to 28 weeks: Every month
- From 28 to 36 weeks: Every two weeks
- From 36 weeks to delivery: Every week
Your OB provider might see you more often if you have a problem or a high risk pregnancy.
Additional Prenatal Testing
After the initial prenatal screening lab tests at your first visit, your OB provider will order a series of other tests that are recommended at certain points in your pregnancy. He will also order any others based the individual needs of you or your baby.
A United States Office on Women's Health summary lists the following possible prenatal tests:
- OB ultrasound: This is not a routine part prenatal care but is usually done to date a pregnancy if needed, or to evaluate a pregnancy problem. In general, most women will have an ultrasound at 18 to 20 weeks to check for normal fetal growth and development. This ultrasound might be able to show if your baby is a boy or a girl.
- Tests to evaluate for risk of birth defects or genetic abnormalities:
- Chorionic villus sampling (CVS): A biopsy of placental tissue at 10 to 13 weeks for genetic and other defects
- First trimester screen: At 11 to 14 weeks - includes a blood test of hormone levels and an ultrasound the measure the translucency of the fold of tissue at the back of the baby's neck to screen for genetic disorders such as Down's syndrome
- Amniocentesis: Performed at 14 to 20 weeks to screen for birth defects and chromosomal disorders
- Triple screen: A blood test at 15 to 20 weeks to screen for certain birth defects
- Fasting blood glucose screen and further testing to diagnose gestational diabetes: Done at 26 to 28 weeks
- Group B streptococcus: A culture of vaginal secretions at 36 to 37 weeks; the bacteria can cause severe problems for a newborn
- Fetal monitoring tests during the third trimester if necessary: Includes nonstress test (NST) an biophysical profile (BPP)
Some tests are suggested because of your medical and family history, your age, your partner's history, and other risk factors, or based on problems that come up during the pregnancy.
Preparing and Planning for Delivery
Discussions about preparing for labor and delivery might start early in your pregnancy. Specific delivery planning begins in the third trimester as you approach your due date. Topics include:
- Prenatal birthing classes
- What to expect during childbirth
- Your birth plan preferences, including opinion on episiotomy
- Vaginal versus cesarean section
- Preparing for breast feeding
- Review of early signs of labor and how to tell if your water breaks
- Planning for an overdue pregnancy
- Arranging maternity leave
- Choosing a car seat
- Postpartum care and recovery
- Pediatrician to care for your baby
- Postpartum birth control and family planning
Talking With Your OB Provider
Each visit is an opportunity to ask questions and feel comfortable. Talk with your doctor, midwife, or support medical staff about anything that concerns you and ask any questions you have.
The more you learn and understand, the easier and less stressful your journey through your pregnancy will be. Equip yourself to be more prepared to manage in an emergency, such as heavy vaginal bleeding or premature contractions. Ask your friends and family for recommendations so you can choose an OB-Gyn doctor or midwife you can be comfortable with.
Preconception Health and Preparation
If you are not yet pregnant but planning to be soon, it is a good idea to think about your preconception health. The preparation for a healthy pregnancy starts before you conceive to make sure you are in the best shape possible:
- Get a complete medical check-up including a Gyn exam and a dental exam and dental care.
- Talk to your doctor to help you assess and attend to any factors you and your partner have that might put your baby at risk, including prescription and over-the-counter medicines, smoking, drinking, drugs, and genetic problems.
- Get help to quit smoking, drinking, and misuse or abuse of drugs.
- Eat a healthy diet and improve any other unhealthy lifestyle habits.
- Start taking a multivitamin and don't forget to take folic acid to protect your baby from neural tube defects.
- Start making sure your immunizations are up to date at least three months before getting pregnant.
Prenatal Care for a Healthy Pregnancy
Consistent, regular prenatal care is important for a healthy pregnancy. Keep up with your scheduled prenatal visits and tests to decrease the risk of complications such as premature birth other poor outcomes for you or your baby.