Prenatal Care (Obstetrics)

By convention, your "pregnancy" begins the first day of your last menses and not at conception. You don't conceive until 2 weeks after your period begins, for a typical 28 day cycle, so in actuality you have only been pregnant for four weeks when you are "six weeks" pregnant. This can be confusing, but that is how we base the term of your pregnancy.We measure pregnancies in weeks in the medical field. Your due date is exactly 40 weeks from the first day of your last menstrual period. Yes, a typical pregnancy is nine months long but measuring in months would be too vague and not a reliable gauge for calculating your due date.

NOTE: We do a lot of ultrasounds in our office and have the ability to record them for you.  Please bring a USB Flash Drive to your visit and we will record your ultrasound for no charge.

Below is our recommended schedule for pregnancy visits.

 4-6 weeks

Your pregnancy test is positive and you should come in for your first visit around this stage in pregnancy.

What to expect at your visit: Your first visit is the most involved. We discuss our practice, take a full medical history, do a full physical exam including a pap smear and then perform an ultrasound. Since the embryo is very tiny, the ultrasound is usually done vaginally. This allows us to make important checks, such as the number of embryos, the position of the embryo, whether it is in the uterus and not in the tubes or elsewhere, and sometimes even see a heart beat. The heart beat is the most reassuring sign that you're not going to have a miscarriage. This is a better gauge than a blood test. We will also give you some literature on pregnancy and samples of prenatal vitamins at this visit. Before you leave your first visit, we draw a small sample of blood.

Normal symptoms at this stage of pregnancy: The most common complaint in early pregnancy is fatigue. It is very common at this stage to sleep long hours but have no energy. Breast tenderness and some early nausea are also common. Although most bleeding is benign in early pregnancy, if you have any bleeding you should call us immediately.

6-11 weeks

What to expect at your visit: At every visit the baby's growth and heartbeat are assessed. At this stage in the pregnancy the baby is very small and these two tasks are difficult. The best way to evaluate the baby early in pregnancy is with ultrasound. We perform the ultrasound and measure the size of the baby and the baby's heartbeat. You can usually hear the heartbeat during this visit. A baby's heartbeat is about twice as fast as an adult, normally 110 to 160 beats per minute, and at this early stage can be even faster.  We also do a blood test that checks for accurately for Down Syndrome and the babies gender.  Yes, you can find out the gender with a blood test as early at 10 weeks gestation.

Normal symptoms:The biggest hurdle at this point in your pregnancy is nausea, usually referred to as morning sickness. This term is not wholly accurate since the nausea can occur at any time of the day or night, and in some pregnancies, all the time. You may also feel some mild menstrual type cramps as the uterus begins to stretch and grow.

11-14 weeks

What to expect at your visit:Again we perform an ultrasound to measure the size of the baby and listen to the heartbeat. We also do a measurement that screens for some birth defects such as Down Syndrome and heart defects. This measurement is done with ultrasound and measures a small pocket of fluid underneath the skin on the back of the baby's neck ("nuchal translucency"). Studies have shown that some babies with Down Syndrome have an increased thickness of this layer. 

Normal symptoms:As your uterus stretches you may occasionally feel some menstrual type cramps. This is completely normal. If you have bleeding or you experience cramps regularly you need to call us immediately.

14-18 weeks

What to expect at your visit:At this point in your pregnancy, we should be able to hear the baby's heartbeat by placing a small listening device, called a Doppler, on your abdomen. We also measure your abdomen to make sure the uterus is growing appropriately. At this point in the pregnancy (16-19 weeks), there is a blood test done to check for Down Syndrome and spina bifida. This test , which has become standard practice for many years, checks 4 different chemicals in your blood. These results and other information, such as age, weight, and race, are input into the lab's computer and a risk assessment for Down Syndrome (DS) and neural tube defects, also known as spina bifida, is given. We consider a risk for DS greater than 1 in 270 to be positive. The only sure way to rule out DS is with amniocentesis and this may be recommended as the next step. If you will be 35 years of age or older when the baby is born, we may discuss skipping this blood test and proceeding directly with amniocentesis.

Normal symptoms:You usually begin to feel movement at this point in the pregnancy. The traditional name for feeling the first movements was 'the quickening.' Many believed this was when the baby's soul entered its body and it sprang to life. We now know that babies are moving as early as 8 weeks, they're just too small for you to feel.

19-21 weeks

What to expect at your visit:At this stage in the pregnancy we do a full ultrasound to look at the baby's anatomy and check for growth. At this visit we can find out the sex of the baby. Many birth defects can be seen using ultrasound, but the smaller the problem, the harder it is to see and some issues can't be seen at all. Of course issues that are genetic or metabolic, like Down Syndrome or Sickle cell anemia, can't be seen at all. At this visit we'll ask you to please bring a recordable DVD so we can record the ultrasound. A standard recordable DVD is perfect.

Normal symptoms:Headaches are very common at this point in pregnancy and are very similar to migraine headaches. Unfortunately, most medicines used to treat migraines are not safe to use during pregnancy. Luckily, Tylenol is usually enough for the majority of headaches that can occur.

22-25 weeks

What to expect at your visit:At this point in your pregnancy, the baby is growing quickly. As with previous visit, we will take a urine specimen for protein, ketones, and glucose. We will also weigh you, check your blood pressure, measure your uterus, and listen to the baby's heart with a Doppler. When measuring the baby's growth, we measure from the pubic symphysis to the top or "fundus" of the uterus. This should roughly be the same number of centimeters as weeks in your pregnancy. For example at 24 weeks your fundal height should be 24 cm. At this visit we will give you your registration packet from your hospital. Inside the packet you will find all the information you need to sign up for classes on everything from baby CPR to childbirth to breast feeding.

Normal symptoms:A very common symptom during this point of the pregnancy is "round ligament pain." The round ligaments are two very small ligaments that go from each side of the uterus to the pelvis floor. They're about the size and length of your little finger and as the uterus grows they get stretched. This usually presents itself as a sharp pain on one side or the other that gets worse with various movements such as walking or rolling over in bed. Near the end of this stage you may also experience "Braxton-Hicks" contractions also referred to as uterine cramping.

26-28 weeks

What to expect at your visit:During this stage of your pregnancy we perform a test for gestational diabetes. Diabetes is when your blood sugar is too high and this form is a special kind of diabetes found only in pregnancy. The test involves drinking a very sugary drink, usually given at the previous visit, followed by having blood drawn one hour later. If this blood sugar value is above 140 you need to take an additional test that will clearly tell us if you have gestational diabetes. After this visit, the time between appointments decreases one month to two weeks. We also perform an ultrasound during this visit to check the growth of your baby and make sure the baby is head down, also referred to as "vertex." Our ultrasound instrument takes 4-D pictures, so make sure to bring a USB flash drive.

Normal symptoms:Uterine cramping or "Braxton-Hicks" contractions are very common at this stage in your pregnancy. The more times you have become pregnant, the earlier they begin and the stronger they can feel. Most women have only a few of these contractions in a single day. If you have more than six in an hour, this could be signs of preterm labor and you should call us.

29-34 weeks

What to expect at your visit:During this stage your visits will occur every two weeks unless there is a complication with your pregnancy and we need to see you more often. At every visit, we will check the growth of your uterus and indirectly, your baby, and listen to the baby's heartbeat. There are no routine labs or tests done during this period. This is also the time when you should be signing up for birthing classes and a scheduling tour of the hospital.

Normal symptoms:Back pain is very common at this point in your pregnancy. As the baby grows, their weight puts a lot of strain on your lower back. Massages and heat on your back, NOT on your abdomen, work the best to relieve pain. Heartburn is also common as the baby starts to push up on your stomach. We have a list of safe medicines for this and other common problems available if you have not already received one.

35-40 weeks

What to expect at your visit: You're getting very close now! During the final stages of your pregnancy your visits will be every week. Around 36 weeks we perform a test for the Group B Strep (GBS) bacteria on all women. This bacteria usually doesn't cause infections in adults, but can cause serious infections in newborns. The test involves a quick vaginal swab and takes about a week to get the results. If you have this bacteria, about 1 in 4 women do, you'll receive antibiotics in labor to protect the baby. The antibiotics are administered in your IV. They cross the placenta and end up in the baby's circulation so that they are protected during birth. During the final weeks, we start performing checks to see if your cervix, the opening of the uterus/womb where the baby comes out, is dilating.

Normal symptoms: Labor is the obvious sign to look for at this point in your pregnancy. If you have contractions every five minutes for an hour, any vaginal bleeding, a sudden gush of fluid, or your baby is not moving, call us immediately. 

We have four signs we tell our patients to look for:

1. Contractions are most common- they usually start out far apart and get closer and stronger.  Once they are every 5 minutes for an hour, you should go to the hospital.
2. Water breaking- when the amniotic sac ruptures, it's usually not subtle.  There's about 2 liters of amniotic fluid and a lot comes out when the water breaks.  If you're not sure, please call us.  Of course if you are sure, head to the hospital.
3. Decreased fetal movement- the baby should move a lot as they grow and develop.  If you're every concerned about the baby not moving enough, please go to a quiet place to focus on the movements.  Less than 10 movements in a 2 hour period is concerning- you can try something cold and sweet (like juice) to wake them up.  Please call us immediately if the baby is not moving like they normally do.
4. Bleeding- you should really never bleed during pregnancy.  There can be bleeding during implantation in the very beginning.  And some bloody show is common in labor.  But we would never consider bleeding to be "normal" and you should always call us if you see blood during your pregnancy.