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Navigating Prenatal Appointments


By Judith A. Lothian, RN, PhD, LCCE, FACCE, and Charlotte De Vries Adapted from Giving Birth with Confidence

Your prenatal appointments are all about you and your baby, so it’s important that you take the opportunity to ask questions, speak up about concerns. This builds trust and helps to make sure everyone is working toward the same goal.

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While there are exceptions to every rule, in general, doctor visits are shorter and tend to focus on recognizing and responding to problems in pregnancy, while midwives offer longer visits and care that is centered on helping you stay healthy and avoid problems. Whoever your health care provider may be, their care should support your individual needs. If, at any point, you feel uncomfortable with your provider’s philosophy and approach, consider finding someone else.

Your first visit will be longer than other prenatal appointments. If possible, bring your support person so that you both have a chance to ask any questions—no matter how silly you think they may be! Also, come prepared to review your medical and family history; this will alert your provider to any medical issues that might require close attention during your pregnancy.

Some questions you may wish to ask during your first visit include: 

  • Whom do I call if I have a concern?
  • How can nutrition affect my pregnancy?
  • What can I expect during my prenatal care?
  • What testing do you recommend? How do you support women to make informed choices about which tests to have?
  • What are your views on weight gain during pregnancy?
  • Can I expect you to attend my birth, or will someone else be on call?
  • Can I meet any other providers who might be present at my birth?
  • And more: Here are additional questions you may ask.

To calculate your estimated due date, bring the date of your last menstrual period and the date you think you conceived. If you have irregular menstrual cycles or can’t remember when you last had a period, your midwife or doctor may order an ultrasound to estimate your due date. Remember, regardless of whether it’s determined by ultrasound or your last period, your due date is just that—an estimate!

During your initial visits, also expect to have a complete physical examination, blood work and lab tests. While some tests are standard and necessary, you have the right to ask what tests your provider recommends and why, and to decline any with which you’re not comfortable. See below for five tests that you definitely need and information on those you don’t.

The Essentials

BLOOD PRESSURE CHECKS are necessary because rising blood pressure, especially in the last trimester, can indicate pregnancy-induced hypertension (also called preeclampsia or pretoxemia), which, if not treated, can be dangerous for you and your baby.

WEIGHT CHECKS make sure that you’re gaining enough weight for your baby’s health; they are not to keep you from gaining too much. And, by tracking the growth of the uterus, your health care provider can ensure that your baby is growing well. If your uterus gets larger more quickly than expected, it may indicate something quite different: Multiple babies.

BLOOD TESTS help establish your overall wellness by identifying a number of factors, including your blood type and cell count, iron level, immunity to chicken pox and other diseases, Rh factor and certain sexually transmitted diseases or infections.

FETAL HEART TONES can be monitored by your health care provider with a fetoscope (a type of stethoscope) or handheld Doppler device. This test may reassure you that all is well, but your own knowledge of your baby’s movements throughout the day and night is equally important. There is no need for sonograms or electronic fetal monitoring to test these indicators.

The Others

CERVICAL CHECKS are invasive and provide little useful information on their own early in pregnancy, and there is no evidence that they should be a routine part of prenatal care. A pap smear can diagnose sexually transmitted diseases and other infections, but so can a blood test. The only time a cervical check may really help is if you are two weeks past your due date and your health care provider is trying to determine if induction is appropriate.

ULTRASOUND EXAMINATIONS (sonograms) create a picture of a baby inside the womb using sound waves. They are often used to determine a due date or to attempt to diagnose problems, but they are not always reliable. Misread sonogram results may lead to unnecessary or incorrect interventions.

CHORIONIC VILLUS SAMPLING (CVS) attempts to detect some birth defects by looking for chromosomal abnormalities. It is not routinely offered, but can be done at around ten to 12 weeks to check for certain disorders, such as Down’s syndrome, or conditions like cystic fibrosis or sickle cell anemia. There is a small chance of getting a false positive (a result that incorrectly indicates that there might be something wrong), so CVS often leads to amniocentesis (see below) for confirmation. When the test is done too early in pregnancy, it has been associated with limb defects, such as missing fingers or toes, and miscarriage.

MATERNAL SERUM SCREENING TESTS are done at 15 to 20 weeks to look for the presence of proteins or hormones in your blood that may signal a genetic or developmental problem in the baby. These screens have a high rate of false positives that are often discovered when further testing yields different results or when babies are born without problems. The results can cause unnecessary anxiety as well as more tests than needed.

You have a right to refuse these screens. Before you decide, think about what you would do with the results. If you don’t want to take the next step, amniocentesis (see below), it makes sense to consider not having these screens at all. If you have a family history of genetic diseases, including neural tube defects, you might consider them, but you can decline.

AMNIOCENTESIS is a procedure in which a needle is used to withdraw a small amount of amniotic fluid and cells from the sac surrounding the fetus, which are tested for Down’s syndrome or other birth defects. Many women, especially those older than 35, are pressured to have this test. What may not be emphasized is that it is invasive and puts a woman’s body and baby at risk for infection, causing bleeding, the leaking of more amniotic fluid, premature labor, fetal distress and even miscarriage.

GLUCOSE SCREENING is a test for gestational diabetes, which is diagnosed in about five to seven percent of women. Taken at 24 to 28 weeks, the test consist of a blood sample being measured for its glucose level after ingesting sugary foods or drink. If the level of glucose is too high, you may have gestational diabetes. It’s important to know, however, that your baby needs glucose to grow and develop. 

GROUP B STREPTOCOCCUS (GBS) is a type of bacteria that lives in the vagina and rectum that can be passed to a baby during birth. While most babies who get GBS do not have any problems, a few do become sick. This illness can cause serious health problems and even death in newborn babies. GBS usually can be detected in mothers with a routine swab test that is given between 35 weeks and 37 weeks of pregnancy. For 90 percent of all pregnant people who are GBS positive, one dose of antibiotics is effective in reducing the exposure of the baby to the bacteria during labor. If labor is preterm, if your membranes ruptured more than eighteen hours ago, or if you have a fever in labor, the risks are a bit higher but at least one to two hours of antibiotics during labor significantly reduces the risk of GBS newborn infection.

You Decide

Routine prenatal testing can make you feel that your health, happiness, and baby’s perfection is ensured, or it may scare you into believing that your baby won’t be born healthy. Either way, prenatal tests cannot guarantee any specific outcome, so it may not be worth the extra emotions it brings.

If you refuse to have some prenatal testing done, remember that you are not the first or the last family to make this choice. Not everyone needs or wants to know that there may be problems with their baby. What your doctor sees as an absolutely necessary test may not be what a midwife sees. And, it may not be what you see either.

Decide what’s best for you.

 

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