If you could see your baby, you’d notice that she has teeny webbed fingers and toes and perhaps even small eyelids that will soon cover her sensitive eyes. The very tip of her nose may also be starting to form, as well as the upper lip. Behind the face, nerve cells are beginning to connect with one another and form what will eventually become complex neural pathways.
A little farther down, your baby’s breathing tubes are developing to reach her lungs. Moreover, her very important aortic and pulmonary valves in her heart have formed, helping the muscle to beat at an amazing 150 pulses per minute.
If your pregnancy is considered high risk, you’ll likely have already been to see your health care provider. However, for many pregnancies, the first prenatal visit takes place somewhere between now and week 10.
At your first appointment, your health care provider will complete a comprehensive health history. He or she will ask whether you have any medical or psychosocial issues, the date of your last menstrual period, your history of birth control methods and other medications, if you’ve previously been hospitalized, whether you have any drug allergies and about your family’s medical history. You may want to write down these details if you think you could have trouble remembering everything.
The visit will include measuring your blood pressure, height and weight, as well as a breast and pelvic exam, with a pap test if you haven’t had once recently. They’ll also likely take blood to test for your blood type,anemia and other medical and genetic conditions. It’s still a little early to hear your baby’s heartbeat, so this exciting milestone may have to wait until your next visit.
Your health care provider may also talk to you about more extensive genetic testing and offer you screening tests that can give you some information about your baby’s risk for Down syndrome as well as other chromosomal problems and birth defects.
There is a new two-part prenatal screening that can be done between weeks 9 and 13. It combines a blood test and a specialized ultrasound to assess your baby’s risk for Down syndrome or trisomy 18. This screening is less invasive than amniocentesis or chorionic villus sampling (CVS) but is not definitive. If risk is indicated, the screening may help you decide whether you want further testing.
If so, CVS is a genetic test that can be performed between weeks 10 and 12 of pregnancy. The doctor removes a small piece of your placenta to check for potential genetic problems. Although CVS cannot detect neural tube defects, some women prefer it because they can get results sooner than with an amniocentesis, which is usually done between weeks 15 and 18.
Both tests are invasive and include a very slight risk of complications, including miscarriage, so it’s important to do your research and talk to your partner and health care professional to decide what testing is right for you. Finally, your provider may speak to you about lifestyle considerations, including nutrition and exercise. Bring a list of questions regarding your concerns and current habits. Now is the time to ask about activities that you are concerned about continuing during pregnancy.
You also might want to ask about the practice’s birth philosophy to make sure it’s in line with your own. For instance, if your goal is to have a natural childbirth, talk to them about it and make sure they are supportive of your plans.
If you leave your visit doubting your choice of providers, keep in mind that you can always change practices if you feel uncomfortable or are concerned that their philosophy of childbirth differs from yours. If you want to continue with the provider you’ve chosen, you’ll likely schedule an appointment for four weeks later before leaving the office.
Ten Weeks? Are you crazy?
What if something happens to the baby?
Then I remembered to breath.and I realized that there really isn’t anything a midwife could do to “save” my baby in these very precious early weeks. And so I surrendered. And waited. And wondered. What do I need to bring to my first prenatal visit? Can I prepare in any way? And what exactly goes on during the first prenatal visit?
When is my first prenatal visit?
Typically women see their healthcare provider for prenatal care between 8 and 12 weeks. If you are seeing a midwife they may suggest you wait until 10 – 12 weeks for your first appointment. This is because this is about the time when you can hear your baby’s heartbeat on a doppler. Don’t be sad or scared if they still can’t find the heartbeat, as it is really more like 12-14 weeks for a definite reading. Many OBs and even family doctors expect you to schedule your first prenatal care appointment much earlier than this though.
An ultrasound can pick up a heartbeat as early as 6-7 weeks, and some women are led to believe that an early ultrasound is necessary for a healthy pregnancy. This analysis shows that routine ultrasound does not improve perinatal outcomes while this analysis shows no improvement in maternal outcomes.
Another reason that some doctors want you to schedule an earlier appointment is for a full pelvic exam. The reasoning is that, for some women, prenatal care is their first or only chance to see a doctor and undiagnosed STDs can be dangerous for the baby.
Your provider may also take the opportunity to do a pap smear to check for cervical cancer. However, vaginal exams do carry a small risk of infection, so if you are relatively healthy and don’t have a history of ectopic pregnancy or other serious concerns, then you are probably fine to wait until around 12 weeks.
What should I expect at my first prenatal visit?
What happens during the first visit will vary from provider to provider, but for the most part you can expect to do four main things.
Build a relationship
One of the advantages to using midwives is that you have continuity of care, meaning that the midwife you see at each (or most) appointments will be the one who attends your birth. Even in a larger office with multiple midwives, at least each appointment was nice and long with plenty of time to talk and bond with these awesome ladies. By the end of my pregnancy, I knew I was in good hands no matter which midwife was on call and this is a very good feeling!
At the first prenatal visit you can get to know your midwife or doctor, learn about her background, and begin to build a relationship of trust. You can ask questions and get information on good books to read or specialists you may want to see during your pregnancy, such as a chiropractor or lactation consultant.
If you are using a family doctor, then you may have a similar continuity of care. With OBs in hospitals you aren’t likely to be able to choose the OB that attends your birth, so a prenatal visit won’t always focus on this kind of relationship building.
Assess your Health
Your midwife will ask about your health history, family health history, and present health to get a baseline for what is normal for you. She will counsel you on nutrition, exercise and holistic healing and wellness. She will address common pregnancy complaints and offer holistic, natural remedies.
She will also ask if you are having unusual symptoms that may be a sign of something serious. Headaches are common in early pregnancy, but can also be a very early sign of preeclampsia. Your midwife will want to know if you are having headaches or other symptoms and will keep a record of them.
Your midwife will order a different blood tests that will tell her your blood type, red and white blood cell counts, hematocrit, hemoglobin, and platelet count. Your midwife needs to know your blood type for your safety, but the other tests should be optional.
These blood tests will also tell your midwife if you are Rh positive or negative. If you are positive (or you are negative and your partner is negative) you have nothing more to do. If you are negative and your partner is positive or you don’t know, your midwife may discuss your receiving an Rhlg shot to prevent any complications.
Your midwife will also tests for various Sexual Transmitted Diseases like syphilis, gonorrhea, chlamydia, which could harmfully affect your pregnancy if not treated. She will also take your blood pressure, pulse, weight, and check the baby’s heartbeat if you are ok using a doppler, which contains ultrasound waves. I chose to use the doppler for the first appointment so I could really believe I was pregnant and then waited till 20 weeks to use the fetoscope for the baby’s heartbeat.
She may palpate your abdomen to check the fundal height (a measure of the size of your uterus). She will rule out any medical problems that may affect your pregnancy and assess whether a homebirth or birth center birth is safe for you (it usually is).
You will also be asked to test your urine for the presence of protein (a sign of toxemia), sugar (a sign of gestational diabetes), or bacteria (a sign of Group B Strep positive). You will pee into a cup and dip a test strip in. Depending on the brand of test strips you will read it after 60 second or immediately. You will do this test at every appointment until birth.
Do your research for prenatal care
Do your best to pick the practitioner who is right for you. But if you go to your first visit and don’t like him or her, remember that you can change at any time! My dear friend changed her care at 34 weeks! And she was so happy that she did.
Your midwife needs to know your blood type for your safety, but the other tests should be optional. A good practitioner will let you know at each appointment what tests or procedures will be coming up at the next appointment so you can have time to research and decide what’s best for you.
A good practitioner should also be able to guide you and answer any questions you have about tests and procedures.
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