WHAT TO EXPECT AT PRENATAL VISITS

What's below:
• How many prenatal visits will I have?

• Is there anything I need to do to prepare for my prenatal visits?

• What happens during these appointments?

• It seems like my prenatal visits are over before they even start. How can I slow them down?

• See also
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How many prenatal visits will I have?
You'll see a lot of your healthcare provider during your pregnancy; that's why it's so important to choose someone you like and trust. Most pregnant women have between 10 and 18 prenatal visits. Typically, a woman will visit her doctor or midwife once during the first trimester, once every four weeks during her second trimester, once every two weeks until 36 weeks, then weekly until the baby is delivered. But the number of scheduled appointments you'll have depends on your medical history and whether you have any illnesses or complications such as high blood pressure that warrant more frequent checkups. If you've had any medical or obstetrical problems in the past, you may need more prenatal visits than average.

Is there anything I need to do to prepare for my prenatal visits?
During the weeks preceding each visit, you may want to jot down any questions or concerns in a notebook so you'll remember to ask your practitioner about them at your next appointment. You may be surprised at how many questions you have, so don't miss the opportunity to get some answers in person. (Of course, if you have any pressing questions or develop any unusual symptoms, don't wait for your appointment — call your practitioner right away.) If you have a partner or labor coach, you may want that person to come to some of your appointments with you.

What happens during these appointments?
Your practitioner will probably start by asking you how you're feeling and what questions you may have. The primary goal of prenatal visits is to ensure that your pregnancy is proceeding well and that you're not developing any complications. To that end, your midwife or doctor will check your weight, blood pressure, and urine, measure your abdomen to keep track of the growth and position of the fetus, and listen to the baby's heartbeat.
Though your pattern of weight gain can be an important reflection of your baby's growth, some pregnant women find getting weighed at every checkup nerve-wracking. If hopping on the scale bothers you, try not to look during weigh-ins. Just tell your physician you want to know what your weight is only if it indicates that something is wrong. And take off your shoes and bulky clothing if it makes you feel better.

It seems like my prenatal visits are over before they even start. How can I slow them down?

Many women look forward to their monthly prenatal appointments but are disappointed to find they're in and out of the office in ten minutes. A quick visit is actually a sign that everything is progressing normally. If you feel like you don't have enough time to voice your concerns, though, take these steps before your next appointment:

• Write down your concerns. Between visits, jot down your questions. Be sure to bring the list to each appointment so you can run through it with your practitioner. And if anything else is bothering you, speak up. Your caregiver isn't a mind reader and won't be able to tell what you're thinking just by performing a physical examination.

• Mention everything, no matter how small. In addition to any physical complaints you may have, let your practitioner know if you have any emotional concerns or fitness or nutrition questions.

• Get the go-ahead. Before you take any herbal teas, supplements, or over-the-counter medications, bring them with you to your next appointment so your doctor or midwife can read their labels and let you know whether they're okay to take.

• Be open-minded. When talking to your doctor or midwife, state your preferences rather than making demands. And remember to listen. If your practitioner really doesn't have time to talk as long as you'd like, ask to see a nurse or someone else in the practice who has time to address your concerns. At the same time, don't tolerate a healthcare provider who won't give you complete answers, doesn't show reasonable compassion, or barely looks up from your chart. You and your baby deserve more than that.

By now you're probably feeling pretty good about your pregnancy. The nausea and fatigue that dominated your first three months are diminishing, your hormones have begun to level off, and your fears that you could lose the baby have probably subsided (the chance of miscarriage drops dramatically after 12 weeks). The second trimester isn't called the 'golden' stage of pregnancy for nothing: Most pregnant women report a surge of energy and an emotional boost during this time.
Expect to see your practitioner about every four weeks until you're 28 weeks. Besides repeating some of the routine procedures you had done at your first visit, including getting weighed, having your blood pressure taken, and having a urine test, she'll review the results of any lab tests that have been done since the last visit and ask you if anything has changed since the last visit: Are you still nauseous? Are you feeling the baby move yet? Had any unusual symptoms?

Here's what else you're in for this trimester:



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What's below:
• Listening for your baby's heartbeat

• Measuring your growth

• Prenatal tests

• Other questions

• See also
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Listening for your baby's heartbeat
Your doctor or midwife may be able to pick up the swoosh-swoosh of your baby's heartbeat as early as 10 weeks using a handheld ultrasound device called a Doppler. But don't be alarmed if you didn't hear it that early — it's more common to hear it for the first time at your 12 weeks visit. If you're overweight or your practitioner miscalculated your due date, the heartbeat may prove elusive. The baby's position in your uterus can also make it hard to pick up the sound. And some kinds of dopplers are more sensitive than others. If you don't hear it at 12 weeks but your uterus seems to be the right size for your stage, your practitioner may ask you to come back in a couple of weeks to listen again. If your uterus doesn't seem to be the right size or you're having spotting or bleeding, she may order an ultrasound to confirm your baby's gestational age and to make sure everything is okay.

Measuring your growth
From 20 weeks to 36 weeks, your practitioner will measure your belly starting from your pubic bone to the top of your uterus (the fundal height) to check your baby's size, growth rate, and position. The measurement (in centimeters) will roughly correspond to how many weeks pregnant you are, so if you're 24 weeks pregnant, your belly should measure approximately 24 centimeters. Your practitioner will examine your hands and feet for swelling and your legs for varicose veins. She'll also be on the lookout for signs of preeclampsia, such as unusual weight gain (more than two pounds in a week) or an increase in blood pressure, which normally decreases slightly in the second trimester.

Prenatal tests
You'll be offered the multiple marker test, which is routine blood work done between 15 and 18 weeks to screen for possible neural tube defects and chromosomal problems such as Down syndrome.
If you're over the age of 35, if your genetic history puts your baby at risk for certain birth defects, or if the results of your multiple marker screen raise some concerns, your practitioner will offer you an amniocentesis any time between 15 and 18 weeks for a more definitive diagnosis of any chromosomal defects. If you need more information before deciding whether to have this test, she'll refer you to a genetic counselor.

Most practitioners routinely request an ultrasound between 16 and 20 weeks as a mid-pregnancy diagnostic tool to check for physical abnormalities or to verify your baby's due date.

You'll be also be given a glucose screening test between 24 and 28 weeks to test for gestational diabetes.

Your practitioner will also answer any questions you have and review with you the list of danger signs — symptoms that may indicate that something's wrong. If your weight seems too high or too low, she'll ask about your diet and give you specific advice on how to eat better.

The second trimester is also a good time to ask your caregiver about childbirth education classes. Are they offered at the hospital where you plan to deliver? Have any other patients told her about classes they found helpful? You should also find out about baby CPR and breastfeeding classes, so you can cross them off your list by your ninth month of pregnancy.

Finally, toward the end of the second trimester, your practitioner may start talking about your options for birth control after the baby is born so that you can make some decisions about that and have a plan in place when the time comes

Believe it or not, you're in the home stretch! As the weeks go by, you'll probably start to get more uncomfortable as your growing belly slows you down and the fatigue you felt in the first trimester returns. You may also find yourself alternating between fear and excitement over your impending labor and delivery. Finally, you may be realizing that although the arrival of a new baby is a thrilling proposition, life as you know it will never be the same again. These conflicting feelings are par for the course.
Between 28 and 36 weeks, your practitioner will probably ask you to come in every two weeks. Expect the same routine you've had during previous doctor's visits (weight check, blood pressure, urine tests, fetal heart rate checks, fundal height), plus:

• Your practitioner will ask about how much you're feeling the baby move and may recommend that you count your baby's kicks a few times a day to keep track.

• If you're Rh-negative (up to 15 percent of women are missing a protein called the Rh factor from their blood cells), you'll need an Rh-immune globulin injection between 28 and 29 weeks of pregnancy to make sure that you won't have problems carrying an Rh-positive baby in the future.

• At some point during the third trimester, your practitioner will probably ask whether you want your baby to be circumcised if it's a boy and whether you want this to be done in the hospital before you take your newborn home.

• Between 35 and 37 weeks, you'll probably be tested for Group B strep (a common infection that could be passed on to your baby during delivery).

• Around this time, your practitioner will do an abdominal exam to tell whether your baby is head down or 'breech' (feet first), and give you a rough estimate of the baby's weight.

• Starting at 36 weeks, your practitioner will check your cervix for effacement (thinning) and dilation (opening) — signs that you may be going into labor soon. She'll also tell you when your baby has 'dropped,' that is, moved down into your pelvic cavity in preparation for birth, and what signs to look for to let you know that it's time to come to the hospital.

• If you're a week past your due date, your doctor or midwife will give you a non-stress test to check your baby's heart rate and a biophysical profile to check your level of amniotic fluid. If you don't have your baby by 42 weeks, your practitioner will need to induce labor, as the risks to your baby increase after that time.