What to Expect at Your Prenatal Appointments
As I've talked with pregnant moms over the years, one thing has become clear: there is a lot of confusion around prenatal appointments. I've received questions like:
Why does my doctor want to wait until I'm 12 weeks pregnant for my first appointment?
What should I expect at each appointment?
My friend got an ultrasound at 14 weeks and found out the gender of her baby. Why do I need to wait until 20 weeks?
Why does my doctor want to take my weight at every appointment?
When are all of the tests (like gestational diabetes and GBS) done?
I have a million questions while I'm at home, but when I get to the doctor's office, my mind goes blank. How can I help this?
I'm going to try to answer all of these questions in this blog! A few caveats before I do:
First, every doctor and clinic does things a little differently. I'm outlining the general recommendations, and I hope that as you read, you will come up with a list of questions to ask your doctor at your next appointment.
Second, you may see one doctor your entire pregnancy, or you may rotate between providers because you won't be able to choose who will attend your birth. If you prefer to see one doctor and have that doctor deliver your baby, then do your research to find clinics that offer this option.
Also, your clinic may not do some of the tests at all, or if they do, they do them differently. For example, some clinics offer an ultrasound to confirm your pregnancy (at around 8 weeks).
Lastly, what I include in this relates to U.S.-based obstetricians. If you are being seen by a midwife or live in another country, your care will likely be very different. I was seen by midwives for all three of my pregnancies, and while their care was different, they also took the time to explain everything to me and give me options. My appointments were on average 45 minutes long, talking with the midwife!
Read on to learn more about prenatal appointments in each trimester 👇🏼
First Trimester Appointments
In general, you will have appointments every 4 weeks during your first trimester. Some doctors will have you come in right after you have found out you're pregnant, while others may have you wait until 10-12 weeks.
Monitoring & Blood Draw
At your first appointment, you will confirm that you are, in fact, pregnant. Hooray! You will also get a few other labs done to check your pregnancy levels. You will have a pelvic exam done, and your doctor will likely take your weight and blood pressure so they have baseline measurements.
Urine Tests
You may also get a urine test done at your first appointment. Every clinic is different - some have you collect a urine sample at every appointment, while others check intermittently. This test is to monitor your urine for sugar, protein, ketones, bacteria, and blood cells to ensure you don't have a UTI, gestational diabetes, or preeclampsia. Be sure to have a full bladder before you come to each appointment. Nothing worse than chugging water while sitting in the waiting room so you can have a urine sample (I've definitely been there).
Ultrasound
You may get an ultrasound (this is via your vaginal canal, FYI. Don't want you to be freaked out by the ultrasound wand) to measure your baby and check on the health of your pregnancy and baby. This measurement and information about your menstrual cycle will give you your "due date."
Should Partners Come?
We highly recommend that your partner try to attend the first 1-2 appointments with you. Seeing your baby on the screen or hearing its heartbeat is so special and can make your pregnancy feel real. If you're unsure what your clinic does in terms of ultrasound, it may be worth asking when you first call to tell them you're pregnant so you can plan for your partner to attend.
Doppler
Once your baby is around 10 weeks old, your doctor can listen to its heartbeat using a small device called a doppler. They will continue to listen to the heart rate throughout the rest of your pregnancy to check on your baby.
Genetic Screening
Your doctor will also discuss genetic screening with you. There are multiple methods of genetic screening with risks/benefits for each. Some are more or less invasive, and there is a specific window of time in which this screening needs to be done. It may be helpful to have your partner come to this appointment as well, in case they have questions.
Birth Preferences
The first trimester (or second) is a great time to begin asking questions about your birth preferences. This may feel overwhelming to do, so we have a blog post with questions to ask your provider if you'd like an unmedicated birth. If your provider isn't a good fit for your wishes, you'll have plenty of time to interview others and switch, if necessary.
Second Trimester Appointments
You will continue to have appointments every 4 weeks. These appointments tend to be quick and "low-key."
Asking Questions
You may have symptoms that you'd like to discuss with your doctor, so be sure to bring a list of questions to your appointment. I recommend starting a note on your phone so that you can quickly add questions as they come to your mind, instead of sitting down and trying to think of every question you've had since your last appointment.
Monitoring
Your doctor will continue to monitor your weight, blood pressure, and listen to your baby's heart. You will likely make your appointment for your anatomy scan, which typically happens around 20 weeks.
Gender Reveal: Blood Test or Early Ultrasound
If you've had an ultrasound for any other reason from 12 weeks on, there's a chance you can find out your baby's gender from that ultrasound. You can also find out your baby's gender from one of the genetic abnormality screenings, the NIPT. If that's something you're interested in, be sure to ask your doctor.
Weight Checks
If you struggle with having your weight checked at every appointment, discuss with your doctor your concerns. Your doctor checks your weight because there is strong evidence that excess weight gain can contribute to complications and is a warning sign for gestational diabetes and preeclampsia. However, your doctor should never shame you for your weight. If you feel this way, you have the right to deny weight checks or limit them. Discuss your concerns with your doctor, and remember that you can always find another provider that's a better fit for your situation.
Anatomy Scan
You will have your anatomy scan to check for any abnormalities and, if desired, to find out the gender. Be sure to have a full bladder for this one, and be aware that there will be a lot of pressing in that area. It's a little uncomfortable, but necessary to get the right images.
Gestational Diabetes Screening
You will receive a screening for gestational diabetes usually around 26-28 weeks. This involves drinking a glucose drink (hint, the lemon/lime has been rated the best - tastes like a flat Sprite) and getting your blood drawn to check your blood sugar levels. Every clinic has a different protocol:
Some do an initial 1-hour glucose tolerance test to see if you pass. If you fail this test, then you go on to do a 3-hour glucose tolerance test that's more involved.
Some clinics go straight to the 3-hour test.
Usually, you do not have to fast with the initial 1-hour test, so I recommend eating a protein-rich breakfast. If you do fast for either test, be sure to have some protein ready to eat right after. It's a lot of sugar and it's common to feel nauseated.
Partners
You will definitely want your partner to be at the anatomy scan, if at all possible! Another good appointment to have your partner around is the gestational diabetes screening. You may not feel well afterward, so it's nice to have someone to feed you and drive you home.
Third Trimester Appointments
Most doctors will begin seeing you twice a month in the third trimester, and once a week from 36 weeks until you have your baby. Most of these appointments are pretty standard, but here are some things to be prepared for:
Birth Plan
You will begin discussing your birth plan with your provider. This is a great opportunity to ask questions as you learn more about birth in your birth class. Don't have a birth class? Take ours!
Monitoring
They will continue to monitor your urine, weight, and blood pressure as well as your baby's heart rate.
Tdap Vaccine
This is a vaccine given to protect your baby from pertussis (click here to learn more about this). It's best to get it done early in your third trimester for the best antibody protection.
Fundal Height
If your doctor hasn't already, they'll start measuring your fundal height. This is a way to measure your uterus to determine if your baby is growing at the right rate. It correlates cm from your pubic bone to the top of your uterus to the number of weeks you are pregnant (so you may be measuring 34 cm and be 34 weeks pregnant). It's common for the measurement to be off by a couple of weeks here and there, but if your fundal height is consistently low or high, your doctor may recommend an ultrasound to do more diagnostic measurements.
Group-B Strep Test
This is a test given sometime between 35-37 weeks. This is to test to see if you are positive for group-B Streptococcus, which is an infection that can cause complications for your baby if you are positive during birth. Your doctor will swab your vagina and rectum to test for it. Read more on this here.
Cervical Checks
Your provider may begin offering cervical checks as early as 36 weeks to check for cervical dilation and effacement. Some moms love knowing this information, while it can cause anxiety and impatience for other moms. You have the right to deny cervical checks. Talk with your doctor about your wishes.
Non-Stress Tests
You may receive an NST if you are past your due date or if there is a concern for your baby's wellbeing. During this test, you will recline as they monitor your baby's heart rate and movements with a sensor around your abdomen. If your baby isn't moving enough or has a concerning heart rate, your doctor will order further tests or will discuss the need for induction.
Partners
Your partner may want to join more of your appointments as you get later into your pregnancy. Be sure to give him plenty of room to ask questions. There were times that Ben asked more questions than me (is this really surprising to anyone, though? 😅)
Conclusion
Whew! That may seem like a lot, but I promise it goes by quickly. My last note is this: many doctors are notorious for keeping their appointments super short. However, you have the right to ask questions. Don't feel intimidated by your doctor's efficiency! Come armed and ready with all your questions.
If you feel rushed or lack connection with your doctor - it's okay to switch doctors. Really, it is! I switched my provider to a midwife at 31 weeks with my first, and I never went back. I cannot stress the importance of a good relationship with your provider; it's worth the effort to find one that you love.
