Wow! You’re Pregnant!

At each visit, you will be called back by a nurse to urinate in a cup (so we can check it for your nutritional status and the presence of bacteria) and get your blood pressure and weight checked. Additionally, at the New OB, we perform a full physical exam, including Pap smear (unless one has been done very recently), gonorrhea and Chlamydia testing, urine for culture and necessary blood work. We will calculate your due date at this appointment, which will also determine the time of your return visit. Ideally, your first visit takes place around 8 weeks (We talk in weeks, not months!) from the first day of your last menstrual period. However, everybody has different circumstances, some of which cause delayed entry into care. We try to get everybody on the same schedule of return visits, which are outlined below.

12 weeks
This is a quick one; we want to make sure you are eating all of that protein we’ve been telling you about and drinking so much water your urine is lighter than lemonade! If you had nausea, it should be starting to pass now, but if not – we’ll keep working on it! Special prenatal vitamins for nausea should be changed now to one with iron as this is a very important mineral during the latter part of pregnancy. Usually, you can hear the baby’s heartbeat at this gestational age! See you in four weeks…

16 weeks
Oooo… if this isn’t your first baby, you may be feeling that pulling and poking around your sides as your uterus grows. This is called round ligament pain and can be eased with proper hydration (water, water, water!), good body mechanics and heat application. These measures will not completely eliminate your pain, but you will be comforted to know that these twinges are signs of growth and health and not signs of danger. It’s easy to feel the top of your uterus (fundus) about halfway between your pubic bone and your belly button. (Well, it’s easy for us, but you might be able to feel it, too.) We’ll have another listen to the baby’s heartbeat and offer you the AFP Quad (or AFP Tetra) test. See you in four more weeks…

20 weeks
Ahhh… the day all modern pregnant American women wait for:
The Ultrasound Day! Typically, this is the only ultrasound done during pregnancy. We are looking to make sure your baby is developing well and you get several pictures to take home. If the genitals can be seen and you want to know the sex, this is the time Bonnie will tell you. Some babies are positioned so that gender can not be determined, which is not a medical reason to repeat ultrasound. Parents who feel the need to know this information can pay a nominal fee for a “sex shot” or visit Prenatal Imaging. Bonnie will tell you your due date as determined by ultrasound, but this does not mean your final due date has changed. You will meet with one of the practitioners to review the ultrasound results and answer any questions you may have. Many moms have felt fetal movement by this time. If not, you will definitely feel it by the next time we see you – in four weeks…

24 weeks
Today we’re going to measure your belly with a measuring tape for the first time during the pregnancy. The measurement from your pubic bone to the fundus should be your gestational age in centimeters, plus or minus two. So, at 24 weeks, you should be measuring between 22 and 26 centimeters. We will keep an eye on the overall trend of growth, being mindful of the fact that fetuses, just like kids, are prone to growth spurts and growth lags here and there. Be sure to keep up that great protein-rich diet, high water intake, daily vitamin and exercise as much as you can. Now is the time you should start looking into prenatal classes, as they are highly recommended for all expectant parents. Let us know what class you’ve chosen once you’ve decided. You’re blooming! Come back in four weeks for some important testing…

28 weeks
Did you eat your protein-only breakfast (eggs, meat, cheese and water)? We tell you “protein-only” in order to improve the accuracy of the gestational diabetes screening test. When you check in, you will be sent to our lab for a yummy glucola drink (It tastes like flat orange pop). One hour later, your blood will be drawn to see how your body is metabolizing sugar during pregnancy. (We will call you by the following week if you have an abnormal result.) During this hour waiting period, you will see a practitioner for a regular visit and fill out pre-registration paperwork, if you haven’t already done so in the office or online. We’ll also be checking that you are getting enough iron (so be sure you’re taking that prenatal vitamin!). If you are Rh negative, you will be getting a RhoGAM shot sometime before your next visit (usually within a week) based on the blood work done today. If you haven't already done so, you should choose a pediatrician and register for prenatal classes. We'll see how they are going when we see you in three weeks!

31 weeks
Just a brief visit today – no poking or prodding. We’re keeping track of fetal growth and checking to make sure your blood pressure and nutrition are the best they can be. You may have already noticed some pre-labor contractions. These little twinges are a sign that your uterus is warming up for the big event. As long as the contractions do not take on a pattern, they are nothing to really note. If they become regular, every 10 minutes for an hour (like clockwork! Not 10, 9, 2, 3, 15, 20, 3…), then drink 2 glasses of water and lay down to take weight off of your cervix. If they spread out or get less intense over the next hour, you’re just fine. If they persist or get closer over the next hour, then call us so we can screen you for preterm labor. Keep pushing the protein and water, water, water (that’s short for “non-caffeinated, sugar-free beverage”)! We’ll do this again in three weeks…

34 weeks
This is ditto of the 31-week check. The best part about these visits is hearing the fetal heartbeat. The growing weight of the baby and your shift in posture are probably making you a little uncomfortable by now. Aches and pains of pregnancy are numerous and normal. When you consider the size of the little person inside and how your organs have to accommodate the invasion of space, it’s no wonder you ache! To make you more comfortable, we always first advise good hydration. While this may not totally eliminate your discomfort, it will help as will a Prenatal Cradle. You can use heat application with a low-set heating pad or rice sock. (Fill a sock with uncooked rice and tie a knot in the open end. You can add lavender leaves, tealeaves or any essential oils you like before you close the sock. Heat in the microwave for 2-3 minutes to suit your comfort and shake well to distribute the heat evenly before applying.) You can also use Tylenol for these pains. Tylenol PM or Benadryl (generics are okay) may be used as sleep aids. If you find you are having difficulty getting to sleep, make sure you are using plenty of support. Sleep on your side and place pillows in any combination of areas: behind your head, behind your back, between your belly and the bed, between your knees and in front of your chest (for hugging!). Lavender essential oil (not to be confused with lavender scented products) can be used in evening bathwater or applied to the temples or forearms to help you sleep. You can also use Sleepy Time tea (available at the grocery store). Not much longer… We’ll see you in just two weeks!

36 weeks
Today you start to give away your modesty… In addition to the routine assessment, we will do a painless vaginal swab to check for GBS or Group Beta Strep. We will let you know the result at the next visit. Today is the first routine check of your cervix to see if dilation (opening) and effacement (thinning) have started. (Of course, you know these terms because you took childbirth education classes!) Don’t worry if your cervix hasn’t changed – every body has a different pace for every thing. Especially if this is your first baby, it is not unusual for your cervix to remain “closed” for a couple more weeks. If you are having a scheduled cesarean section, we will plan that date today. We will review signs of labor with you and let you know when to call. (No need to call for lost mucus plugs!) See you back in one week…

37 weeks until The Birthday
Every office visit from this point on is to check fetal well-being, as always, and monitor your developing contraction pattern with correlating cervical progress. If induction is necessary, this is not usually done before 39 weeks unless there is a medical indication that either the mother or fetus would fair better upon delivery. We will continue to review signs of labor and how you and your body, in particular, are preparing. We will see you weekly now until your baby is born. After some time home with the family, you will come back to the office for your Postpartum visit.