prenatal visit guide

Your Guide to Prenatal Appointments

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Typical prenatal appointment schedule

Read this next, what happens during a prenatal care appointment, what tests will i receive at my prenatal appointments, what will i talk about with my practitioner at prenatal care appointments , first trimester prenatal appointments: what to expect, second trimester prenatal appointments: what to expect, third trimester prenatal appointments: what to expect, questions to ask during prenatal appointments  .

Prenatal care visits are chock-full of tests, measurements, questions and concerns, but know that throughout the process your and your baby’s wellbeing are the main focus. Keep your schedule organized so you don’t miss any appointments and jot down anything you want to discuss with your doctor and your prenatal experience should end up being both positive and rewarding.

What to Expect When You’re Expecting , 5th edition, Heidi Murkoff. American College of Obstetricians and Gynecologists,  Having a Baby After Age 35: How Aging Affects Fertility and Pregnancy , 2020. American College of Obstetricians and Gynecologists,  Routine Tests During Pregnancy , 2020. US Department of Health & Human Services, Office on Women’s Health,  Prenatal Care and Tests , January 2019. Journal of Perinatology ,  Number of Prenatal Visits and Pregnancy Outcomes in Low-risk wWomen , June 2016. Mayo Clinic,  Edema , October 2017. Mayo Clinic,  Prenatal Care: 2nd Trimester Visits , August 2020. Mayo Clinic,  Prenatal Care: 3rd Trimester Visits , August 2020. Jennifer Leighdon Wu, M.D., Women’s Health of Manhattan, New York, NY. WhatToExpect.com, Preeclampsia: Symptoms, Risk Factors and Treatment , April 2019. WhatToExpect.com, Prenatal Testing During Pregnancy , March 2019. WhatToExpect.com,  Urine Tests During Pregnancy , May 2019. WhatToExpect.com,  Fetal Heartbeat: The Development of Baby’s Circulatory System , April 2019. WhatToExpect.com,  Amniocentesis , Mary 2019. WhatToExpect.com,  Ultrasound During Pregnancy , April 2019. WhatToExpect.com,  Rh Factor Testing , June 2019. WhatToExpect.com,  Glucose Screening and Glucose Tolerance Test , April 2019. WhatToExpect.com, Nuchal Translucency Screening , April 2019. WhatToExpect.com, Group B Strep Testing During Pregnancy , August 2019. WhatToExpect.com,  The Nonstress Test During Pregnancy , April 2019. WhatToExpect.com,  Biophysical Profile (BPP) , May 2019. WhatToExpect.com,  Noninvasive Prenatal Testing , (NIPT), April 2019. WhatToExpect.com,  The Quad Screen , February 2019. WhatToExpect.com,  Chorionic Villus Sampling (CVS) , February 2019. WhatToExpect.com,  The First Prenatal Appointment , June 2019. WhatToExpect.com,  Breech Birth: What it Means for You , September 2018.

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Prenatal visits: What to expect and how to prepare

Regular prenatal visits are an important part of your pregnancy care. Find out how often you'll see a healthcare provider, what to expect at each appointment, and smart ways to prepare.

When to schedule a prenatal visit

Prenatal visitation schedule, how should i prepare for a prenatal visit, what happens during prenatal visits, how can i make the most of my pregnancy appointments.

Make an appointment for your first prenatal visit once you're aware you are pregnant – when you receive a positive home pregnancy test, for example. Booking it around week 8 of pregnancy is typical.

You'll come back regularly in the weeks and months following that initial appointment. Most people have between 8 and 14 prenatal visits throughout the course of their pregnancy.

During this time, you'll see a lot of your healthcare practitioner. That's why it's so important to choose someone you like and trust. If you're not comfortable or satisfied with your provider after your first visit or visits, don't be afraid to find someone with whom you have a better connection.

Typically, a pregnant woman will visit their doctor, midwife , or nurse practitioner every four weeks during the first and second trimesters. In the third trimester, you'll be seen more often – usually every other week until 36 weeks, and then every week until the baby is born.

For more information on what happens at these visits, see:

Your first prenatal visit

Second trimester prenatal visits (14 weeks to 27 weeks)

Third trimester prenatal visits (28 weeks through the end of pregnancy)

The specific number of scheduled appointments you'll have depends on if your pregnancy is considered to be high-risk. This is determined by your medical history and whether you have any complications or conditions that warrant more frequent checkups, such as gestational diabetes , high blood pressure , or a history of preterm labor . If you've had any medical problems in the past or develop any new problems during this pregnancy, you may need more prenatal visits than the average pregnant woman.

In the weeks before each visit, jot down any questions or concerns in a notebook or a notes app on your smartphone. This way, you'll remember to ask your practitioner about them at your next appointment. You may be surprised by how many questions you have, so don't miss the opportunity to get some answers in person.

For example, before you drink an herbal tea or take a supplement or an over-the-counter medication , ask your provider about it. You can even bring the item itself – or a picture of the label – with you to your next appointment. Then, your doctor, midwife, or nurse practitioner can read the label and let you know whether it's okay to ingest.

Of course, if you have any pressing questions or worries, or develop any new, unusual, or severe symptoms , don't wait for your appointment – call your practitioner right away.

In addition to your list, you may want to bring a partner, friend, family member, or labor coach with you to some or all of your prenatal visits. They can comfort you, take notes, ask questions, and help you remember important information.

The goal of prenatal visits is to see how your pregnancy is proceeding and to provide you with information to help keep you and your baby healthy. It's important that you go to all of your prenatal appointments, even if you're feeling just fine and believe that everything is progressing perfectly.

Your practitioner will start by asking how you're feeling physically and emotionally, whether you have any complaints or worries, and what questions you may have. They'll also ask you about your baby's movements once you begin to feel them, typically during the second trimester. Your practitioner will have other questions as well, which will vary depending on how far along you are and whether there are specific concerns.

Your midwife, doctor, or nurse practitioner will also:

• Check your weight , blood pressure , and urine
• Check for swelling
• Measure your abdomen
• Check the position of your baby
• Listen to your baby's heartbeat
• Perform other exams and order tests, as appropriate
• Give you the appropriate vaccinations
• Closely monitor any complications you have or that you develop, and intervene if necessary

Near the end of your pregnancy, your provider may also do a pelvic exam to check for cervical changes. You will also discuss your delivery plan in more depth.

At the end of each visit, your practitioner will review their findings with you. They'll also explain the normal changes to expect before your next visit, warning signs to watch for, and the pros and cons of optional tests you may want to consider. Lifestyle issues will likely be a topic of discussion, as well. Expect to talk about the importance of good nutrition , sleep, oral health, stress management, wearing seatbelts, and avoiding tobacco , alcohol , and illicit drugs.

Many people look forward to their prenatal appointments but are disappointed to find that, with the exception of the first visit, they're in and out of the office in 10 minutes. A quick visit is typical and is usually a sign that everything is progressing normally. Still, you want to make sure your concerns are addressed – and that you and your baby are being well cared for.

Here are some things you can do to ensure that your prenatal visits are satisfying:

• Speak up. Your practitioner isn't a mind reader and won't be able to tell what you're thinking just by performing a physical exam. So, if anything is bothering you, say your piece. Are you having trouble controlling your heartburn ? Managing your constipation ? Suffering from headaches ? This is the time to ask for advice. Consult the notebook of questions you've been compiling. In addition to physical complaints, let your practitioner know if you have emotional concerns or fitness or nutrition questions.
• Ask the staff about the administrative stuff. Save your questions about things like insurance and directions to the hospital for the office staff so your practitioner has more time to answer your health-related questions. Go to the admin staff with any inquiries about payments, scheduling, office policies, and your contact information.
• Be open-minded. When talking with your doctor, midwife, or nurse practitioner, you should feel comfortable speaking freely. But remember to listen, too. Take notes if you find it helpful.

Keep in mind, too, that some days are busier than others. This is especially true during the COVID-19 pandemic. That doesn't mean your practitioner doesn't have to answer your questions, but sometimes a discussion can be continued at the next visit if it's a really busy day or if your practitioner needs to head to the hospital to deliver a baby.

At the same time, don't tolerate a healthcare practitioner who won't give you thorough answers, doesn't show reasonable compassion, or barely looks up from your chart. You and your baby deserve more than that.

Now that you know what to expect during all those prenatal visits, you might like a sneak peek at what else is in store. Here's an overview of the next nine months .

Learn more:

• The ultimate pregnancy to-do list: First trimester
• 12 steps to a healthy pregnancy
• When will my pregnancy start to show?
• Fetal development timeline

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What happens at second trimester prenatal appointments

What to expect at your first prenatal appointment

What to expect from third trimester prenatal appointments

Prenatal testing

BabyCenter's editorial team is committed to providing the most helpful and trustworthy pregnancy and parenting information in the world. When creating and updating content, we rely on credible sources: respected health organizations, professional groups of doctors and other experts, and published studies in peer-reviewed journals. We believe you should always know the source of the information you're seeing. Learn more about our editorial and medical review policies .

MedlinePlus. (2021). Prenatal care in your first trimester. https://medlineplus.gov/ency/patientinstructions/000544.htm Opens a new window [Accessed September 21, 2021.]

March of Dimes. (2017). Prenatal Care Checkups. https://www.marchofdimes.org/pregnancy/prenatal-care-checkups.aspx Opens a new window [Accessed September 21, 2021.]

Office on Women’s Health. (2019). Prenatal Care and Tests. https://www.womenshealth.gov/pregnancy/youre-pregnant-now-what/prenatal-care-and-tests Opens a new window [Accessed September 21, 2021.]

NIH: Eunice Kennedy Shriver National Institute of Child Health and Human Development. (2017). What happens during prenatal visits? https://www.nichd.nih.gov/health/topics/preconceptioncare/conditioninfo/prenatal-visits Opens a new window [Accessed September 21, 2021.]

NIH: Eunice Kennedy Shriver National Institute of Child Health and Human Development. (2017). What is a high-risk pregnancy? https://www.nichd.nih.gov/health/topics/pregnancy/conditioninfo/high-risk Opens a new window [Accessed September 21, 2021.]

NIH: Eunice Kennedy Shriver National Institute of Child Health and Human Development. (2018). What are some factors that make a pregnancy high-risk? https://www.nichd.nih.gov/health/topics/high-risk/conditioninfo/factors Opens a new window [Accessed September 21, 2021.]

March of Dimes. (2020). Over-the-Counter Medicine, Supplements, and Herbal Products During Pregnancy. https://www.marchofdimes.org/pregnancy/over-the-counter-medicine-supplements-and-herbal-products.aspx Opens a new window [Accessed September 21, 2021.]

Associates in Women’s Healthcare (2021). Preparing for Your First Prenatal Visit. https://www.associatesinwomenshealthcare.net/blog/preparing-for-your-first-prenatal-visit/ Opens a new window [Accessed September 21, 2021.]

National Health Service (UK). (2018). Your baby’s movements. https://www.nhs.uk/pregnancy/keeping-well/your-babys-movements/ Opens a new window [Accessed September 21, 2021.]

MedlinePlus. (2021). Prenatal care in your third trimester. https://medlineplus.gov/ency/patientinstructions/000558.htm Opens a new window [Accessed September 21, 2021.]

UCLA Health. (2021). Schedule of prenatal care. https://www.uclahealth.org/obgyn/workfiles/Pregnancy/Schedule_of_Prenatal_Care.pdf Opens a new window [Accessed September 21, 2021.]

UCR Health. (2021). Healthy Pregnancy: The Importance of Prenatal Care.   https://www.ucrhealth.org/2018/07/healthy-pregnancy-the-importance-of-prenatal-care/ Opens a new window [Accessed September 21, 2021.]

Mayo Clinic. (2020). Prenatal care: 1 st trimesters visits. https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/prenatal-care/art-20044882 Opens a new window [Accessed September 21, 2021.]

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The Ultimate Pregnancy Appointment Guide: What to Expect Week by Week at Your Prenatal Visits

Central to ensuring the health and well-being of you and your growing baby is seeing your care team regularly for touchpoints and milestones that are part of your pregnancy appointment schedule. Diana Kaufman, MD , UnityPoint Health, shares the recommended timeline for prenatal visits, and the importance of each test and discussion that’ll prepare you for a safe pregnancy and delivery.

Confirming Your Pregnancy

Every woman’s body is unique, but it’s a good idea to visit a doctor to confirm a pregnancy when you’re experiencing early symptoms, such as a missed period or you’ve received a positive home pregnancy test. Typically, this visit happens at 6-8 weeks of pregnancy.

Your doctor may confirm your pregnancy through urine tests, blood tests or ultrasounds.

Initial Prenatal Appointment: 5-12 Weeks

Your first prenatal visit consists of important screenings and discussions, so your healthcare team can create a care plan that ensures you and baby stay healthy throughout your pregnancy. Prepare a few things for this visit, including:

• Complete medical history: It’s important for your doctor to know your past and present health conditions or concerns, medications and any history of disease, substance abuse or known genetic conditions in your family.
• Insurance information: This includes consents for care, your insurance carrier and other paperwork

Here’s what to expect at your first pregnancy appointment

• A physical, which will likely include a breast and pelvic exam.
• A urine sample is collected to check for certain infections and conditions that can occur during pregnancy. Urine tests may be taken at your following prenatal visits as well. Urine drug screening tests are also recommended for women, or their partners, with a history of substance use — including smoking.
• Routine testing that includes blood draws to check your blood type and complete blood count (CBC) and look for specific diseases including hepatitis, HIV, syphilis and checking for immunity against rubella. Other testing that may occur includes genetic screening and testing for diabetes.

Your care team will review prenatal educational materials with you and remedies for any unpleasant pregnancy symptoms, such as nausea or vomiting . Your team also will provide an estimated due date for baby.

It’s also important to take good care of your teeth and gums during pregnancy. Changing hormone levels make your gums more sensitive to disease, which increases your risk for a low-birth weight or premature baby. Consider making an appointment to see your dentist during your first trimester.

Prenatal Appointment: Second Trimester (13 – 26 Weeks)

During weeks 13-26, you’ll see your doctor every four weeks. It’s a good idea to write down questions or concerns before your appointments to ensure they’re addressed.

At each appointment throughout the rest of your pregnancy, your care team will check the following:

• Blood pressure
• Position of baby
• Baby’s heartbeat

Here are some additional things to expect.

• Prenatal genetic testing: There are many different options for prenatal genetic testing. Your care team will review these with you.
• Pregnancy blood tests: These are tailored to your specific needs. Most patients are tested for anemia and diabetes of pregnancy between weeks 24-28. Other recommended tests will be reviewed with you.
• Ultrasound: It’s common to have an ultrasound in the first trimester to confirm the estimated due date. Ultrasound is also common at 20 weeks to check on baby's growth and development. Further ultrasounds could be needed if changes in your pregnancy make it necessary, such as concerns about baby’s growth or to see if baby is head down.
• Discuss preterm labor signs: Preterm labor refers to labor that begins before the 37th week of pregnancy and requires medical attention. Knowing what to look for — such as contractions, changes in vaginal discharge  — is important for preventing potential complications.
• Childbirth classes: It’s a good idea to register for a class  to help you prepare for baby’s arrival.

When to Call Your Doctor

Pregnancy creates new and unfamiliar symptoms in many women. However, some symptoms need attention. Here’s when to call your doctor in the second trimester:

• Vaginal bleeding, even a small amount
• Leg pain with numbness or leg weakness
• Pain or tenderness in one of both calves that doesn’t go away
• Thoughts of hurting yourself or others
• Severe headaches that don’t go away with Tylenol
• Persistent changes in vision such as blurriness or floaters
• More than five contractions in an hour

Now, your visits to your care team become more frequent — happening every two weeks until you’re 36 weeks pregnant. Your care team continues to monitor you and baby. Here’s what else to expect:

Prenatal Appointments: Third Trimester (27 Weeks – Baby’s Arrival)

• Check fetal movement: It’s important to be aware of your baby's movements. If you notice a sudden change or absence of fetal movement, let you care team know.
• Rhogam injections: If an Rh-negative blood type was found during your initial prenatal visit, you’ll receive an injection to prevent immune system complications for future pregnancies. This usually happens at 28 weeks.
• Additional prenatal testing: Around 35-37 weeks, you’re checked to see if you carry group B streptococcus bacteria . This is one of many bacteria that can live on our skin and typically does not cause problems. However, it can infect a newborn when you deliver. Antibiotics are given during delivery to prevent infection in a newborn if you test positive.

Prenatal Appointments: 36 Weeks – End of Pregnancy

Once you’ve reached 36 weeks, you’ll see your doctor every week until you deliver. These visits are essential for ensuring the well-being of both you and your little one, as well as preparing for a safe and smooth delivery. In addition to routine physical examinations and checking baby’s heartbeat and movement, here’s what else you can expect:

• Cervical exams: If you’re having frequent contractions or preparing to be induced, your doctor will likely need to perform this exam.
• Discuss labor signs: You’ll likely discuss signs of labor with your doctor and when to go to the hospital.
• Discuss birth preferences: It’s not necessary to have a birth plan. Your care team has that covered. Our goal is to keep you and your baby healthy throughout the entire pregnancy and delivery process. However, if you have strong desires or needs for delivery, please discuss those during a prenatal appointment. It’s also helpful to write these things down and bring them to the hospital, since you may not be able to fully express your wishes during labor.

Postpartum Visits

After delivering baby, but before you leave the hospital, call your doctor to make your postpartum appointment, if it hasn’t been scheduled yet. This visit typically occurs around 6 weeks after you deliver. Other visits are scheduled based on your individual needs.

These visits are a time for your doctor to check on your healing , discuss normal or abnormal postpartum bleeding, talk about your well-being and any signs of postpartum depression or anxiety , discuss when it’s safe to start exercising again and address other questions or concerns you may have .

Our UnityPoint Health care team is here to care for you and baby throughout the entirety of your pregnancy and beyond. Call us  to schedule your first appointment or if you have questions about any future appointments.

More Maternity Content

Group B Strep in Pregnancy: Understanding Risks, Testing and Treatment

Second Time Mom Gets Wish of Vaginal Birth After C-Section

An OBGYN Answers 17 Questions to Help You Prepare for Postpartum

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Prenatal care

Prenatal care is the health care you get while you are pregnant. 

What is prenatal care?

Prenatal care is the health care you get while you are pregnant. Take care of yourself and your baby by:

• Getting  early  prenatal care. If you know you're pregnant, or think you might be, call your doctor to schedule a visit.
• Getting  regular  prenatal care. Your doctor will schedule you for many checkups over the course of your pregnancy. Don't miss any — they are all important.
• Following your doctor's advice.

Why do I need prenatal care?

Prenatal care can help keep you and your baby healthy. Babies of mothers who do not get prenatal care are three times more likely to have a low birth weight and five times more likely to die than those born to mothers who do get care.

Doctors can spot health problems early when they see mothers regularly. This allows doctors to treat them early. Early treatment can cure many problems and prevent others. Doctors also can talk to pregnant women about things they can do to give their unborn babies a healthy start to life.

I am thinking about getting pregnant. How can I take care of myself?

You should start taking care of yourself  before  you start trying to get pregnant. This is called preconception health. It means knowing how health conditions and risk factors could affect you or your unborn baby if you become pregnant. For example, some foods, habits, and medicines can harm your baby — even before he or she is conceived. Some health problems also can affect pregnancy.

Talk to your doctor before pregnancy to learn what you can do to prepare your body. Women should prepare for pregnancy before becoming sexually active. Ideally, women should give themselves at least 3 months to prepare before getting pregnant.

The five most important things you can do before becoming pregnant are:

• Take 400 to 800 micrograms (400 to 800 mcg or 0.4 to 0.8 mg) of  folic acid  every day for at least 3 months before getting pregnant to lower your risk of some birth defects of the brain and spine. You can get folic acid from some foods. But it's hard to get all the folic acid you need from foods alone. Taking a vitamin with folic acid is the best and easiest way to be sure you're getting enough.
• Stop smoking and drinking alcohol. Ask your doctor for help.
• If you have a medical condition, be sure it is under control. Some conditions include  asthma ,  diabetes ,  depression ,  high blood pressure ,  obesity , thyroid disease, or  epilepsy . Be sure your vaccinations are up to date.
• Talk to your doctor about any over-the-counter and prescription medicines you are using. These include dietary or herbal supplements. Some  medicines  are not safe during pregnancy. At the same time, stopping medicines you need also can be harmful.
• Avoid contact with toxic substances or materials at work and at home that could be harmful. Stay away from chemicals and cat or rodent feces.

I'm pregnant. What should I do — or not do — to take care of myself and my unborn baby?

Follow these do's and don'ts to take care of yourself and the precious life growing inside you:

Health care do's and don'ts

• Get early and regular prenatal care. Whether this is your first pregnancy or third, health care is extremely important. Your doctor will check to make sure you and the baby are healthy at each visit. If there are any problems, early action will help you and the baby.
• Take a multivitamin or prenatal vitamin with 400 to 800 micrograms (400 to 800 mcg or 0.4 to 0.8 mg) of folic acid every day. Folic acid is most important in the early stages of pregnancy, but you should continue taking folic acid throughout pregnancy.
• Ask your doctor before stopping any medicines or starting any new medicines. Some medicines are not safe during pregnancy. Keep in mind that even over-the-counter medicines and herbal products may cause side effects or other problems. But not using medicines you need could also be harmful.
• Avoid x-rays. If you must have dental work or diagnostic tests, tell your dentist or doctor that you are pregnant so that extra care can be taken.
• Get a flu shot. Pregnant women can get very sick from the flu and may need hospital care.

Food do's and don'ts

• Eat a variety of healthy foods.  Choose fruits, vegetables, whole grains, calcium-rich foods, and foods low in saturated fat. Also, make sure to drink plenty of fluids, especially water.
• Get all the nutrients you need each day, including iron. Getting enough iron prevents you from getting anemia, which is linked to  preterm birth  and  low birth weight . Eating a variety of healthy foods will help you get the nutrients your baby needs. But ask your doctor if you need to take a daily prenatal vitamin or iron supplement to be sure you are getting enough.
• Protect yourself and your baby from food-borne illnesses, including  toxoplasmosis  (TOK-soh-plaz-MOH-suhss) and  listeria  (lih-STEER-ee-uh). Wash fruits and vegetables before eating. Don't eat uncooked or undercooked meats or fish. Always handle, clean, cook, eat, and store foods properly.
• Don't eat fish with lots of mercury, including swordfish, king mackerel, shark, and tilefish.

Lifestyle do's and don'ts

• Gain a healthy amount of weight. Your doctor can tell you how much weight gain you should aim for during pregnancy.
• Don't smoke, drink alcohol, or use drugs. These can cause long-term harm or death to your baby. Ask your doctor for help quitting.
• Unless your doctor tells you not to, try to get at least 2 hours and 30 minutes of moderate-intensity aerobic activity a week. It's best to spread out your workouts throughout the week. If you worked out regularly before pregnancy, you can keep up your activity level as long as your health doesn't change and you talk to your doctor about your activity level throughout your pregnancy. Learn more about  how to have a fit pregnancy .
• Don't take very hot baths or use hot tubs or saunas.
• Get plenty of sleep and find ways to control stress.
• Get informed. Read books, watch videos, go to a childbirth class, and talk with moms you know.
• Ask your doctor about childbirth education classes for you and your partner. Classes can help you prepare for the birth of your baby.

Environmental do's and don'ts

• Stay away from chemicals like  insecticides , solvents (like some cleaners or paint thinners), lead, mercury, and paint (including paint fumes). Not all products have pregnancy warnings on their labels. If you're unsure if a product is safe, ask your doctor before using it. Talk to your doctor if you are worried that chemicals used in your workplace might be harmful.
• If you have a cat, ask your doctor about  toxoplasmosis . This infection is caused by a parasite sometimes found in cat feces. If not treated toxoplasmosis can cause birth defects. You can lower your risk of by avoiding cat litter and wearing gloves when gardening. 
• Avoid contact with rodents, including pet rodents, and with their urine, droppings, or nesting material. Rodents can carry a virus that can be harmful or even deadly to your unborn baby.
• Take steps to avoid illness, such as washing hands frequently.
• Stay away from secondhand smoke.

I don't want to get pregnant right now. Should I still take folic acid every day?

Yes! Birth defects of the brain and spine happen in the very early stages of pregnancy, often before a woman knows she is pregnant. By the time she finds out she is pregnant, it might be too late to prevent those birth defects. Also, half of all pregnancies in the United States are not planned. For these reasons, all women who are able to get pregnant need 400 to 800 mcg of folic acid every day.

How often should I see my doctor during pregnancy?

Your doctor will give you a schedule of all the doctor's visits you should have while pregnant. Most experts suggest you see your doctor:

• About once each month for weeks 4 through 28
• Twice a month for weeks 28 through 36
• Weekly for weeks 36 to birth

If you are older than 35 or your pregnancy is high risk, you'll probably see your doctor more often.

What happens during prenatal visits?

During the first prenatal visit, you can expect your doctor to:

• Ask about your health history including diseases, operations, or prior pregnancies
• Ask about your family's health history
• Do a complete physical exam, including a pelvic exam and  Pap test
• Take your blood and urine for lab work
• Check your blood pressure, height, and weight
• Calculate your due date
• Answer your questions

At the first visit, you should ask questions and discuss any issues related to your pregnancy. Find out all you can about how to stay healthy.

Later prenatal visits will probably be shorter. Your doctor will check on your health and make sure the baby is growing as expected.  Most prenatal visits will include:

• Checking your blood pressure
• Measuring your weight gain
• Measuring your abdomen to check your baby's growth (once you begin to show)
• Checking the baby's heart rate

While you're pregnant, you also will have some routine tests. Some tests are suggested for all women, such as blood work to check for anemia, your blood type, HIV, and other factors. Other tests might be offered based on your age, personal or family health history, your ethnic background, or the results of routine tests you have had. Visit the pregnancy section of our website for more details on  prenatal care and tests .

I am in my late 30s and I want to get pregnant. Should I do anything special?

As you age, you have an increasing chance of having a baby born with a birth defect. Yet most women in their late 30s and early 40s have healthy babies. See your doctor regularly before you even start trying to get pregnant. She will be able to help you prepare your body for pregnancy. She will also be able to tell you about how age can affect pregnancy.

During your pregnancy, seeing your doctor regularly is very important. Because of your age, your doctor will probably suggest some extra tests to check on your baby's health.

More and more women are waiting until they are in their 30s and 40s to have children. While many women of this age have no problems getting pregnant, fertility does decline with age. Women over 40 who don't get pregnant after six months of trying should see their doctors for a fertility evaluation. 

Experts define infertility as the inability to become pregnant after trying for one year. If a woman keeps having miscarriages, it's also called infertility. If you think you or your partner may be infertile, talk to your doctor. Doctors are able to help many infertile couples go on to have healthy babies.

Where can I go to get free or reduced-cost prenatal care?

Women in every state can get help to pay for medical care during their pregnancies. This prenatal care can help you have a healthy baby. Every state in the United States has a program to help. Programs give medical care, information, advice, and other services important for a healthy pregnancy.

To find out about the program in your state:

• Call 800-311-BABY (800-311-2229). This toll-free telephone number will connect you to the Health Department in your area code.
• For information in Spanish, call 800-504-7081.
• Contact your local Health Department.

Did we answer your question about prenatal care?

For more information about prenatal care, call womenshealth.gov at 800-994-9662 (TDD: 888-220-5446) or contact the following organizations:

• American College of Obstetricians and Gynecologists Phone:  202-638-5577
• American Pregnancy Association Phone:  972-550-0140
• Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, HHS Phone:  800-370-2943 (TDD: 888-320-6942)
• March of Dimes Phone:  914-997-4488
• National Center on Birth Defects and Developmental Disabilities, CDC, HHS Phone:  800-232-4636 (TDD: 888-232-6348)
• John W. Schmitt, M.D., Associate Professor of Clinical Obstetrics and Gynecology, University of Virginia Medical School
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Prenatal care: 3rd trimester visits

During the third trimester, prenatal care might include vaginal exams to check the baby's position.

Prenatal care is an important part of a healthy pregnancy, especially as your due date approaches. Your health care provider might ask you to schedule prenatal care appointments during your third trimester about every 2 or 4 weeks, depending on your health and pregnancy history. Starting at 36 weeks, you'll need weekly checkups until you deliver.

Repeat routine health checks

You'll be asked if you have any signs or symptoms, including contractions and leakage of fluid or bleeding. Your health care provider will check your blood pressure and weight gain, as well as your baby's heartbeat and movements.

Your health care provider might ask you to track of how often you feel the baby move on a daily basis — and to alert your health care team if the baby stops moving as much as usual.

Also, talk to your health care provider about any vaccinations you might need, including the flu shot and the tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) vaccine. Ideally, the Tdap vaccine should be given between 27 and 36 weeks of pregnancy.

Test for group B strep

Expect to be screened for group B streptococcus (GBS) during the third trimester. GBS is a common bacterium often carried in the intestines or lower genital tract that's usually harmless in adults. But babies who become infected with GBS from exposure during vaginal delivery can become seriously ill.

To screen for GBS , your health care provider will swab your lower vagina and anal area. The sample will be sent to a lab for testing. If the sample tests positive for GBS — or you previously gave birth to a baby who developed GBS disease — you'll be given intravenous antibiotics during labor. The antibiotics will help protect your baby from the bacterium.

Check the baby's position

Near the end of pregnancy, your health care provider might check to see if your baby is positioned headfirst in the uterus.

If your baby is positioned rump-first (frank breech) or feet-first (complete breech) after week 36 of pregnancy, it's unlikely that the baby will move to a headfirst position before labor. You might be able to have an external cephalic version. During this procedure, your health care provider will apply pressure to your abdomen and physically manipulate your baby to a headfirst position. This is typically done with ultrasound guidance by an experienced doctor. If you prefer not to have this procedure, or if your baby remains in a breech position, your health care provider will discuss planning a C-section delivery.

Keep asking questions

You will likely have plenty of questions as your due date approaches. Is it OK to have sex? How will I know when I'm in labor? What's the best way to manage the pain? Should I create a birth plan? Ask away! Feeling prepared can help calm your nerves before delivery.

Also, be sure to discuss signs that should cause you to call your health care provider, such as vaginal bleeding or fluid leaking from the vagina, as well as when and how to contact your health care provider once labor begins.

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• Frequently asked questions. Pregnancy FAQ079. If your baby is breech. American College of Obstetricians and Gynecologists. https://www.acog.org/Patients/FAQs/If-Your-Baby-Is-Breech. Accessed July 13, 2018.
• Prenatal care and tests. Office on Women's Health. https://www.womenshealth.gov/pregnancy/youre-pregnant-now-what/prenatal-care-and-tests. Accessed July 9, 2018.
• Cunningham FG, et al., eds. Prenatal care. In: Williams Obstetrics. 25th ed. New York, N.Y.: McGraw-Hill Education; 2018. https://www.accessmedicine.mhmedical.com. Accessed July 9, 2018.
• Hofmeyr GJ. External cephalic version. https://www.uptodate.com/contents/search. Accessed July 10, 2018.
• Lockwood CJ, et al. Prenatal care: Second and third trimesters. https://www.uptodate.com/contents/search. Accessed July 9, 2018.
• AskMayoExpert. Vaccination during pregnancy. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2018.

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Your Prenatal Care Appointments

If you're pregnant, especially if it's for the first time, you may be wondering what will happen at your prenatal care appointments with your doctor or midwife . Here's a rundown of everything you can expect at each appointment, including tests and exams.

Your First Prenatal Care Appointment

Your first prenatal appointment will probably be your longest one. Here you will give your doctor, midwife, or nurse your complete health and pregnancy history. This information is important because it will give your practitioner a good idea of how healthy you are and what type of problems you are most likely to experience during your pregnancy. You will learn what your estimated due date is as well.

There are many areas that may be checked during your physical exam, including:

• Blood pressure
• Breast exam
• Pelvic exam
• Pregnancy test
• Ultrasound (if you're having pain or bleeding or underwent fertility treatments)
• Urine screen for protein and sugar

You will probably be seen for your first appointment between 8 and 10 weeks gestation, though you may be seen earlier if you're having problems or if it's your doctor or midwife's policy.

Your Second Appointment

Your second prenatal appointment usually takes place about a month after your first appointment, unless you're having problems or need specific prenatal testing that is best performed in a specific time range. Here is what will most likely happen during this visit:

• Blood pressure check
• Listen to a fetal heartbeat using a Doppler
• Record your weight
• Urine screen for sugar and protein

Your baby's first heartbeat can usually be heard with a Doppler between 8 and 12 weeks gestation. If you have trouble hearing the baby's heartbeat, you will probably be asked to wait until your next visit when your baby is a bit bigger. Sometimes an ultrasound will be ordered as well.

Additional Testing

Additional testing may be performed at this appointment as needed. There are some optional tests you, your doctor, or your midwife may request:

• Chorionic villus sampling (CVS) (diagnostic test for many genetic diseases)
• Early amniocentesis (diagnostic test for many genetic diseases)
• Nuchal fold test (screening for Down syndrome)

Be sure to discuss all of your options regarding these tests, including the risks and benefits, how the test results are given, and whether the test is a screening test or a diagnostic test.

Your Third Appointment

Towards the third prenatal visit, you're most likely around 14 to 16 weeks pregnant. You're probably feeling better and the most dangerous part of pregnancy is over. You are now probably feeling more confident in your pregnancy and sharing your good news .

It has been about a month since you've seen the midwife or doctor. Here's what this appointment may look like:

• Check your blood pressure
• Listen for baby's heartbeat
• Measure your abdomen, called "fundal height," to check baby's growth
• Urine sample to screen for sugar and protein

Optional Testing

You may also have the following prenatal testing done if you request it:

• Amniocentesis (diagnostic test for many genetic diseases)
• Neural tube defect (NTD)/Down syndrome screening by way of maternal blood work (several tests can be used including alpha-fetoprotein (AFP), triple screen, and quad screen)

Your Fourth Appointment

You are most likely between 16 to 20 weeks at this point, and it has been about a month since your last appointment. You probably feel like you've grown a lot since your last appointment and you may now be wearing maternity clothes and possibly even feeling your baby move . Here's what this visit may involve:

• Measure your fundal height to check baby's growth

You may also have a  mid-pregnancy ultrasound screening  if you request it or if it's your doctor or midwife's policy.

Your Fifth Appointment

Between 18 to 22 weeks you'll likely have your fifth prenatal care visit. Here's what this appointment may involve:

• Check for swelling in your hands and feet
• Listen to the baby's heartbeat

Your Sixth Appointment

Your next prenatal care appointment will likely be between 22 to 26 weeks of pregnancy . You are probably still being seen monthly. Here's what this appointment may look like:

• Listen to the baby's heartbeat
• Measure your fundal height to check baby's growth
• Questions about baby's movements

Your Seventh or Eighth Appointment

Between 26 to 28 weeks of pregnancy , you'll likely have another prenatal care appointment. Here's what may happen:

• Check blood pressure
• Questions about baby's movements

Other Testing and Information

You may have other tests or procedures ordered, like the glucose tolerance test (GTT) used to screen for gestational diabetes or the RhoGam , shot around 28 weeks of gestation for women who are Rh-negative. Your doctor or midwife may also give you information on screening for preterm labor on your own.

Your Eighth, Ninth Appointments and Beyond

Your next appointment will likely be between 28 to 36 weeks of pregnancy. In fact, you're likely to have at least two prenatal visits during this period because you're now being seen every other week. Here's what these appointments may involve:

• Palpate to check baby's position (vertex, breech, posterior, etc.)

Screening for Group B strep (GBS) will normally be done between weeks 34 to 36. This involves rectal and vaginal swab. You will continue to be seen every other week until about the 36th week of pregnancy. At this point, your visits will likely be fairly routine with very few extra tests being performed.

Weekly Visits

Between 36 to 40 weeks of pregnancy, you're usually seen every week. Here's what these visits may entail:

You will continue to be seen every week until about the 41st week of pregnancy, at which point you may be seen every few days until your baby is born. Your visits are most likely fairly routine, with very few extra tests being performed.

You may also have an ultrasound to determine what position the baby is in at this point. Your doctor will also try to predict the size of your baby , but this is usually not very accurate. Because of this tendency for inaccuracy, it's not a great idea to have an induction of labor based on the predicted size of your baby.

If you're having a home birth , you may have a home visit during this time frame if your midwife doesn't do her normal prenatal visits there. You will be able to give her a tour of your home and answer questions she may have about where everything is located.

Overdue Pregnancy Visits

At 40 or 41 weeks of pregnancy, you may begin to see your midwife or doctor every few days. Here is what these visits may look like:

Since you are officially past your due date, your midwife or doctor may want to watch you and your baby more carefully until labor begins. This may include the following tests:

• Non-stress test (NST)
• Biophysical profile (BPP)

These tests will help determine if your practitioner needs to intervene with an induction of labor for the health of your baby or let your pregnancy continue.

National Institute of Child Health and Human Development. What Happens During Prenatal Visits ?

National Institute of Child Health and Human Development. What are some common complications of pregnancy ?

American College of Obstetricians and Gynecologists. How Your Fetus Grows During Pregnancy .

Mayo Clinic Staff.  Prenatal Care: 1st Trimester Visits . Mayo Clinic.

By Robin Elise Weiss, PhD, MPH Robin Elise Weiss, PhD, MPH is a professor, author, childbirth and postpartum educator, certified doula, and lactation counselor.

The Full Prenatal Care Guide

Getting good healthcare during your pregnancy is important for both you and your baby.

Prenatal care helps boost your chances of having a full-term pregnancy and delivering a healthy baby. Plus, having regular visits to your healthcare provider offers a great opportunity to get answers to any questions you have about your pregnancy and the birth of your baby.

You have lots of choices when it comes to your prenatal care. This guide can help you understand what types of prenatal care may be offered to you, and describes some of the options you may have.

Read on to find out why prenatal care is important, how to choose a good prenatal healthcare provider, what happens during your prenatal care visits, what tests might be recommended to you as part of your prenatal care schedule, and more.

What Prenatal Care Is and Why It’s Important

Prenatal care, as the name suggests, is the healthcare you get during your pregnancy. It consists of regular medical checkups that may include various types of tests and exams, along with a chance to discuss what might happen when it comes to your pregnancy, labor, and the delivery of your baby.

If you're wondering why prenatal care is important, it’s because it helps keep you and your baby healthy and safe. With prenatal care, your doctor, nurse, or midwife can spot any health problems early and treat them. Another benefit of prenatal care is that you have the opportunity to get guidance from your healthcare provider on how to have a healthy pregnancy.

It’s ideal if you visit your healthcare provider when you first decide you want to get pregnant. Taking care of your health and preparing for a successful conception helps put you on the path to a healthy pregnancy.

If you’ve just discovered that you’re pregnant and you didn’t get a chance to visit your provider beforehand, don’t worry. You’ll certainly still benefit from great prenatal care to help ensure you have a healthy pregnancy.

Once you’ve chosen a prenatal care provider, she will plan your prenatal care schedule, including the timing of your first prenatal checkup.

How to Choose Your Prenatal Care Doctor

Finding a healthcare provider is one of the most important decisions you’ll make in the early stages of your pregnancy.

You’ll want to choose a prenatal healthcare provider with a good reputation, of course, but it’s also crucial that she listens to you, cares about your preferences, and respects you. The key is to choose someone you feel comfortable with.

Another thing to consider as you begin your search for a prenatal healthcare provider is where you want to have your baby. If you’d prefer to have your baby at a specific hospital or birthing center, or if you’re considering a home birth, make sure your provider supports your choice and can deliver your baby in the place you want.

Your current healthcare provider can give you recommendations for a prenatal care provider, and you may also want to ask moms in your circle for their opinions about their prenatal healthcare providers.

Your health insurance provider will also have a list you can check to help you find a prenatal care provider.

As you do your research, you’ll find there are different types of healthcare providers who can give you care during pregnancy, labor, and childbirth. Depending on your pregnancy and preferences, you may end up with one or a combination of the following:

Obstetrician-gynecologists (ob-gyns). These medical doctors specialize in women’s healthcare.

Maternal-fetal medicine specialists. These doctors, also called perinatologists, have the same specialized training as ob-gyns do, plus additional training in high-risk obstetrics. This kind of doctor may be what you need if yours is a high-risk pregnancy.

Family physicians. Family care doctors also have some training in obstetrics. A family physician can care for you if yours is a low-risk, straightforward pregnancy.

Certified nurse-midwives (CNMs) and certified-midwives (CMs). These specially trained practitioners can provide care if you have a low-risk pregnancy. CNMs are registered nurses with a graduate degree in midwifery. CMs have graduated from an accredited midwifery educational program. CMs have completed the same midwifery requirements as CNMs but don’t have the additional training that nurses have. Both usually work with a qualified medical doctor, like an ob-gyn or a family physician, who provides additional support.

Family nurse practitioners (FNPs) or women's health nurse practitioners (WNPs). These nurses receive advanced training in caring for all family members or in caring for women of all ages, including pregnant women.

Doulas. Doulas aren’t medically trained and don’t stand in for a doctor or nurse, but they are trained to help coach you through your labor. Doulas can be supportive for you and your partner during childbirth and postpartum.

Timing of Your Prenatal Checkups

As soon as you find out that you're pregnant, call your healthcare provider's office to set up an appointment. This first prenatal visit might take place as early as 6 to 8 weeks of pregnancy.

If you don’t have any risk factors that complicate your pregnancy, your prenatal care provider may recommend the standard schedule for checkups, which is:

Every 4 weeks until you’re 28 weeks pregnant

Every 2 weeks between 28 and 36 weeks

Once a week from 36 weeks until the birth of your baby.

If yours is a high-risk pregnancy or if a special circumstance arises, your healthcare provider may recommend scheduling additional tests or more frequent prenatal checkups.

Your provider will determine whether your pregnancy is considered high risk by taking into account certain factors, such as if you

are 35 or older, or are 17 or younger

were underweight or overweight before you become pregnant

have high blood pressure, diabetes, depression, or another health issue

are pregnant with twins, triplets, or other multiples

had a previous pregnancy that included problems such as premature labor, or had a child with a birth defect.

What Might Happen at Your Prenatal Care Visits

Most of your prenatal checkups will include:

Checking your weight and blood pressure

Measuring your abdomen to monitor your baby’s growth

Checking your baby’s heart rate.

During each of your visits, your healthcare provider will ask several questions and sometimes offer you various prenatal tests.

Between visits, keep a list of any questions or concerns you have, and be sure to raise them during your next prenatal visit.

Of course, if something is urgent or distressing, or if you experience a pregnancy symptom you think shouldn’t be ignored, you can reach out to your healthcare provider anytime at all.

Types of Prenatal Tests

Prenatal tests are various medical tests you’ll be offered throughout your pregnancy. Some prenatal tests will be done several times during your pregnancy, and some you’ll get only at certain times or under specific conditions.

Two primary types of prenatal tests are screening tests and diagnostic tests:

Screening tests. These standard prenatal tests help determine if there’s a chance of a possible health risk for you or your baby. If screening tests show that you or your baby might be at risk for some kind of health condition, then a diagnostic test may be recommended. Screening tests typically pose no risk to you or your baby. Standard screening tests check things like:

Your blood type

Your blood pressure, which can help determine if you have a blood pressure disorder called preeclampsia

Whether or not you have a health condition such as anemia or gestational diabetes

Whether or not you have an STD or cervical cancer

Your protein levels, signs of infection, or blood sugar levels

Your baby’s size, age, and position in your uterus.

Diagnostic tests. These tests help your healthcare provider confirm whether your baby has a certain health condition. Diagnostic tests are conducted when results from a screening test indicate there might be a risk for you or your baby. Some diagnostic tests carry a slight risk for miscarriage, for example. Your healthcare provider will explain the risks and benefits so that you can make an informed choice about whether you would like such a test.

First Trimester Prenatal Care: Visits and Tests

During your first prenatal care visit, you’ll get a complete physical exam, have blood tests done, and get an estimate of your due date, which will let you know approximately how far along you are.

Your healthcare provider may prescribe you prenatal vitamins, such as a prenatal multivitamin that contains folic acid.

Folic acid is an important vitamin that can help protect your baby from neural tube defects and also from cleft lip and palate.

You might also be offered vaccinations, like a flu shot.

Your first prenatal care visit will include your healthcare provider taking a full health history, and you’ll be asked about your lifestyle and relationships, among other things. Be open and honest, because your answers help your provider determine how to provide you with the best prenatal care possible.

If you don’t feel comfortable sharing openly with your provider, consider finding one you trust.

During your first or second prenatal care visit, you may also have a pelvic exam, a breast exam, and a cervical exam, which includes a Pap test.

Your provider will also check your uterus. Some healthcare providers may do this via an ultrasound exam.

Near the end of your first trimester , your healthcare provider might use what’s called a Doppler to listen to your baby’s heartbeat. This is a thrilling moment as you finally get to hear that wonderful sign of life.

Here are descriptions of some tests and exams your prenatal care provider might recommend during the first trimester:

Early ultrasound. This helps determine how far along you are and also measures the clear space in the tissue at the back of your baby’s neck, called nuchal translucency. This screening test can give your healthcare provider important information about your baby’s health and development.

A blood test. This helps determine, among other things, your blood type and your hemoglobin levels. Low hemoglobin levels can be a sign that you have anemia, which can make you feel extremely fatigued. This test will also be used to check your Rh (Rhesus) factor, a protein on the surface of red blood cells. Most people have this protein, and are what's known as Rh positive. However, if you’re Rh negative and your baby is Rh positive, this Rh incompatibility may sometimes lead to health problems. Your healthcare provider will know how to manage this condition to keep you and your baby healthy.

Carrier screening test. This is a test of your blood or saliva to determine if you’re a carrier of certain genetic conditions that could have an effect on your baby.

Cell-free fetal DNA testing. Sometimes called a noninvasive prenatal screening, this test checks your blood for your baby’s DNA to see if certain genetic conditions may be present. Depending on the result, your healthcare provider may recommend further diagnostic testing, like amniocentesis.

Chorionic villus sampling. Also called CVS, this is a diagnostic test that checks the placental tissue to determine if your baby has a genetic condition like Down syndrome. Your healthcare provider will only recommend this diagnostic test if you have a screening test, such as the cell-free fetal DNA test, for example, that indicates there might be an issue.

Second Trimester Prenatal Care: Visits and Tests

During your second trimester prenatal care visits, your healthcare provider will

check your baby’s movement

monitor your baby’s heartbeat

track your baby’s growth.

Your healthcare provider will also continue to check your weight and blood pressure at every visit.

These prenatal tests, should you choose to have them, might be done during the second trimester:

Quad test. Also called maternal blood screening, this blood test measures four different substances in your blood to screen for things like Down syndrome or Edwards syndrome (trisomy 18). The substances measured in the QUAD test include the protein called alpha-fetoprotein and the pregnancy hormone hCG.

Ultrasound. An ultrasound exam can help your healthcare provider check for birth defects, see the position of the placenta , and track your baby’s growth. It’s also possible in a second trimester ultrasound to determine your baby’s gender.

Glucose screening. This tests to see if you might have gestational diabetes.

Third Trimester Prenatal Care: Visits and Tests

At one of your prenatal visits, your healthcare provider may recommend you start doing kick counts (also called fetal movement counts) to track how often your baby moves. Your provider will explain how to do these, but you may find this Fetal Movement Tracker helpful.

You might be offered a Tdap vaccination, which is a vaccination that protects you and your baby against pertussis (also called whooping cough ), an infection that's very dangerous for newborns, as well as tetanus and diphtheria.

Near the end of your third trimester , at around 36 weeks, , you’ll start having weekly prenatal checkups. Your healthcare provider will continue to check your baby’s heartbeat and movement, as well as your blood pressure and weight gain.

Your healthcare provider will also check the position of your baby. If your baby is not facing head down — for example, if he’s in a breech position — your provider will discuss your options with you.

This prenatal test, should you choose to have it, is done during the third trimester:

Group B strep test. Also called GBS, this tests fluid from your cervix to make sure you don’t have a strep infection that you could pass to your baby during delivery.

Prenatal Care Cost

The extra expense of prenatal care can be overwhelming even if you have health insurance.

Fortunately, every state has a program to help with prenatal care. If you’d like to see what no-cost or low-cost care you’re eligible for, start by contacting the U.S. Department of Health and Human Services or your local Health Department.

You might also find help through

local hospitals or social service agencies

the federal Women, Infants, and Children (WIC) Program

community clinics

places of worship.

Staying healthy during pregnancy, and helping your baby grow and develop, starts with good prenatal care. We hope our prenatal care guidelines have helped you better understand the benefits of prenatal care and given you a rough idea of your prenatal care schedule for the coming weeks, months, and trimesters of your pregnancy.

See all sources

• Mayo Clinic: Prenatal care
• March of Dimes: Prenatal Care
• Healthy Children: Prenatal Care
• CDC Gov: Prenatal care
• Womens Health: Prenatal Care
• Mayo Clinic: Fetal Ultrasound

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INTRODUCTION

This topic will discuss the initial prenatal assessment (which may require more than one visit) in the United States. Most of these issues are common to pregnancies worldwide. Preconception care, ongoing prenatal care after the initial prenatal assessment, and issues related to patient counseling are reviewed separately.

● (See "The preconception office visit" .)

● (See "Prenatal care: Second and third trimesters" .)

● (See "Prenatal care: Patient education, health promotion, and safety of commonly used drugs" .)

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Establishing a Positive Pediatrician-Family Relationship, a Crucial Part of the Patient-Centered Medical Home

Information from the prenatal and family history, anticipatory guidance and enhanced parenting skills; social determinants of health, positive parenting, connections to community resources, delivery and nursery routines, thoughts on feeding the newborn infant, circumcision, infant visit routines and care offered at the office, emotions in the newborn infant, emotions in the parents, decreasing the risk of serious illness and effective response to medical problems should they occur, information sharing with the family, types of prenatal visits, the full prenatal visit, the brief visit to get acquainted, the basic contact or telephone call, no prenatal contact, recommendations, examples of questions to use in the prenatal visit 66  , lead authors, committee on psychosocial aspects of child and family health, 2015–2016, the prenatal visit.

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.

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Michael Yogman , Arthur Lavin , George Cohen , COMMITTEE ON PSYCHOSOCIAL ASPECTS OF CHILD AND FAMILY HEALTH , Keith M. Lemmon , Gerri Mattson , Jason Richard Rafferty , Lawrence Sagin Wissow; The Prenatal Visit. Pediatrics July 2018; 142 (1): e20181218. 10.1542/peds.2018-1218

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A pediatric prenatal visit during the third trimester is recommended for all expectant families as an important first step in establishing a child’s medical home, as recommended by Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Fourth Edition . As advocates for children and their families, pediatricians can support and guide expectant parents in the prenatal period. Prenatal visits allow general pediatricians to establish a supportive and trusting relationship with both parents, gather basic information from expectant parents, offer information and advice regarding the infant, and may identify psychosocial risks early and high-risk conditions that may require special care. There are several possible formats for this first visit. The one used depends on the experience and preference of the parents, the style of the pediatrician’s practice, and pragmatic issues of payment.

As the medical specialty that is entirely focused on the health and well-being of the child, embedded in the family, pediatric care ideally begins before pregnancy, with reproductive life planning of adolescents and young adults, and continues during the pregnancy, with an expectant mother and father of any age. This clinical report is an updated revision of the original clinical report from the American Academy of Pediatrics (AAP) on the prenatal visit. 1 Although survey results show that 78% of pediatricians offer a prenatal visit, only 5% to 39% of first-time parents actually attend a visit. 2 The prenatal visit offers the opportunity to create a lasting personal relationship between parents and the pediatrician, one of the most important values in all ongoing pediatric care. The AAP has put forward the rationale and standards for the prenatal visit for pediatricians in Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Fourth Edition (Bright Futures), 3 as well as for parents and families ( www.healthychildren.org ). 4 This clinical report augments these approaches to making the prenatal visit an important part of the practice of pediatrics.

Less than 5% of urban poor pregnant women see a pediatrician during the prenatal period although they are at higher risk of adverse pregnancy outcomes; pregnant women in rural areas may have even more difficulty accessing a prenatal visit. 5 , 6 To attempt to reduce disparities in pregnancy outcomes, encouraging nonresident prospective fathers to attend the prenatal visit along with expectant mothers is particularly important, albeit challenging. 7  

Prenatal contact with a pediatrician may begin with a contact from a prospective parent to the pediatrician’s office to ask whether the practice is accepting new patients and to inquire about hours, fees, hospital affiliation, health insurance accepted, and emergency coverage. These questions may be answered by a member of the office staff or the pediatrician, and this exchange establishes an initial relationship between the office and the parent. During this conversation, the expectant parent can be encouraged to schedule a prenatal visit with the pediatric health care provider, and both parents can be encouraged to attend. The prenatal visit can be enhanced if the parents come prepared with questions. Optimally, this visit should occur at the beginning of the third trimester of pregnancy.

A prenatal visit with the pediatrician is especially important for first-time parents or families who are new to the practice; single parents; women with a high-risk pregnancy or who are experiencing pregnancy complications or multiple gestations; and parents whose previous pregnancies had a complication such as preterm delivery, an infant with a congenital anomaly, a prolonged course in the NICU, or a perinatal death. Same-sex couples and parents expecting via surrogacy may have questions unique to their circumstance. This visit also can be particularly valuable to parents who are planning to adopt a child, because they may have had previous experience with pregnancy complications and/or be sensitized to special vulnerabilities in their infant (see the AAP clinical report The Pediatrician’s Role in Supporting Adoptive Families at http://pediatrics.aappublications.org/content/130/4/e1040 ). If adoption occurs or is to occur across states or internationally, review of records, need for waiting periods, scheduling of initial visits, concerns about potential fetal exposure (eg, maternal substance use or fetal alcohol spectrum disorders), and additional recommended screenings and/or tests can be discussed. 8 , 9 If needed, pediatricians can consult experts in international adoption or the AAP Council on Foster Care, Adoption, and Kinship Care. 10  

The most comprehensive prenatal visit is a full office visit, during which a trusting relationship can be established and expectant parents can have time to express their needs, interests, and concerns and receive initial anticipatory guidance. Most pediatricians believe that the prenatal visit is helpful in establishing a relationship with families that is essential for the medical home. Because they may not be able to initiate these visits, pediatricians can discuss the concept with referring obstetricians, family physicians, and internists, who can, in turn, encourage their patients to contact pediatricians for a prenatal visit. Office Web sites and social media can also be used to advertise this service to expectant parents.

The following objectives for a prenatal visit are suggested as important topics to be addressed. 2 The actual range of topics covered can be determined by the preference of the provider, the interest of the expectant parent(s), or the presence of an existing complication with the pregnancy or the fetus. Topics not covered prenatally can be presented to parents during the newborn or first postnatal visit.

To provide a foundation on which to build a positive family-pediatric professional partnership, a crucial part of the patient-centered medical home.

To access pertinent aspects of the past obstetric and present prenatal history; to review family history of genetic or chromosomal disorders and to review fetal exposure to substances that may affect the infant.

To introduce anticipatory guidance about early infant care and infant safety practices.

To identify psychosocial factors (eg, perinatal depression) that may affect family function and family adjustment to the newborn (eg, social determinants of health, adverse child experiences, and promoting healthy social-emotional development and resiliency).

The prenatal period is an ideal time to start building the health care alliance that may last for many years, commonly until the patient reaches adulthood. 11 The prenatal visit often is an opportunity for the family to determine whether their relationship and their mutual philosophies will form the basis of a positive relationship.

The prenatal visit is also an opportunity for parents to invite other supportive adults, including grandparents, 12 , 13 to establish a relationship with the pediatrician and to encourage them to come to future visits and support the new parent(s). A prenatal visit can be used to introduce parents to the concept of a medical home for the child’s health and development needs. Parental familiarity with the pediatric health care provider prenatally may be helpful if a referral or transfer of care occurs because of perinatal complications or the newborn infant’s medical condition. 14 Adolescent parents 15 and older first-time parents may benefit from the opportunity to share their specific concerns with a knowledgeable professional.

Gathering information about pregnancy complications, parental depression, and family medical and social history (especially social determinants of health) is helpful as a background to the context of the pregnancy. This inquiry also conveys to parents an interest in the broader psychosocial environment of the infant, including areas in which support would be most useful, especially if there is any risk of domestic violence. 16 , – 18 Answering parents’ questions about the approach to pediatric care also is helpful. This is a good opportunity to review how the practice uses the tools of social media and e-mail to communicate with families.

Additional topics that may be addressed include:

developmental dysplasia of the hip, early urinary tract infections, asthma, lipid disorders, cardiac disease, sickle cell disease, substance abuse, psychiatric illness, domestic violence, chronic medical conditions, and ongoing medications;

plans for feeding, circumcision, child care, work schedules, and support systems;

parents’ plans regarding child care and expectations about work-life balance;

cultural beliefs, values, and practices related to pregnancy and parenting;

concerns regarding tobacco, alcohol, and other drug use 19 , 20 and exposure to environmental hazards; and

parents’ attitudes about and use of complementary and alternative medications and health care.

If there are other children in the family, pediatricians can provide helpful advice about managing the older sibling’s adjustment. Managing parental expectations about their child is important in laying the foundation for positive attachment. Questions useful to consider as the pediatrician approaches the prenatal visit are listed in the chapter on the prenatal visit in Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Fourth Edition . 3  

The prenatal visit offers an opportunity to discuss a range of concerns that may be of great interest to the expectant parents and pediatric provider. The following areas for discussion are meant to be a helpful reference. The conversation, the specific concerns of the parents, and time allowed will define which of these issues are discussed at the prenatal visit. The prenatal visit also offers an opportunity for assessment of family risk factors and connections to key evidence-based and other early learning, health, and development programs in the community.

One of the pediatrician’s tasks is to provide guidance to mothers, fathers, and other supportive adults to become more competent caregivers. This can begin with discussion of the parents’ concerns, planned strategies, and cultural and family beliefs and values. Advice can be offered about shared roles in parenting, such as diapering, bathing, nighttime care, and helping with feeding. Pregnancy and delivery make the central importance of the mother in the newborn infant’s life clear, but it is important to talk about the special role fathers and same-sex partners play in good outcomes for children as well. 21 A key goal of positive parenting is the reliable provision of the infants’ basic needs—food, shelter, love, and care—and in doing so, fostering the development of trust. 22 , 23 The adverse effects of poverty on child health have been well documented. 22 , 24 Optimal use of supports and resources (eg, the Special Supplemental Nutrition Program for Women, Infants, and Children [WIC]) can be discussed and information about access can be provided. Positive parenting also includes providing a steady emotional climate in which reasonable expectations are sustained consistently. 25 Avoiding and/or buffering adverse childhood experiences, such as parental postpartum depression, increasingly is seen as an evidence-based part of pediatric care, and this can begin by identifying prenatal risk factors. 26 It is important to share evidence-informed online information sources and other local resources about parenting and child development for families. Many excellent resources are available, such as the Building “Piece” of Mind program from the Ohio chapter of the AAP ( http://ohioaap.org/tag/parenting/ ), the Zero to Three program ( http://www.zerotothree.org/child-development/ ), the Triple P Positive Parenting Program ( http://www.triplep-parenting.net/glo-en/home ), and the Talk, Read, Sing tool kit available from the Clinton Foundation (Too Small to Fail [ www.toosmall.org ]).

The pediatrician can share with parents the knowledge that children, at an early age, can learn through playful serve-and-return interactions with adults and that playing with and daily reading, singing, and talking to children from birth onward are recommended, as is providing a language-rich environment and minimizing media exposure.

Office materials and Web sites can demonstrate provider awareness of key early childhood resources in the community, from home visiting, Early Head Start, child care resource and referral agencies, quality child care settings, local libraries, and parent support groups, as well as cardiopulmonary resuscitation courses. A discussion of the types of child care typically available (family care, in-home baby-sitting, family day care, child care centers) is helpful.

A discussion of the hospital routines around delivery and nursery care may include: who will be in the delivery room and how new infants behave in the first hours and days; qualifying who will provide newborn care in the hospital and what will happen if there is (1) an unanticipated urgent delivery away from the expected hospital, (2) a home birth, or (3) an admission to a special care nursery is also helpful. This discussion might include the newborn infant’s ability to seek and attach to the mother’s breast right after delivery, the related concept of skin-to-skin care, and the 12-hour postdelivery sleep phase after the adrenaline rush of labor. Mothers often choose to have the infant with them continuously during the entire hospital stay, which aids successful lactation.

This is an appropriate teaching moment for describing to both parents the many advantages of exclusive breastfeeding and how it improves outcomes for both the mother and infant. 27 , 28 Special breastfeeding training of expectant fathers or partners has been shown to increase their support of breastfeeding mothers as well as the duration of breastfeeding. 29 For parents living with food insecurity, breastfeeding offers economic advantages as well. Rooming in and avoiding unnecessary supplementation can be mentioned as ways to support nursing.

The benefits of breastfeeding can be reviewed if there are no contraindications, and lactation support services can be discussed. 30 , – 33 However, ultimately, decisions about feeding the infant are made by the parents. If formula feeding is the parents’ choice, they can be supported in their decision and given advice on formula type and preparation and proper bottle use. Ultimately, the goal is a growing, healthy infant and parents who enjoy feeding so that they can be supported in whatever decision they make. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) also is available to help with nutrition discussion and support prenatally, and mothers can be referred to determine whether they are eligible for a nutrition package during pregnancy, if not already participating in the program.

Parental expectations can be shaped so that parents do not become overly concerned if infants take a few days to learn to latch to the breast and lose some weight before the mother’s milk comes in. Infants commonly lose weight for a few days before the mother’s milk comes in but typically regain birth weight at or before 2 weeks of age. If mothers who plan to breastfeed are taking any medication, a helpful reference for the pediatrician to evaluate safety is the LactMed Drugs and Lactation Database ( http://toxnet.nlm.nih.gov/newtoxnet/lactmed.htm ). 34  

Screening for various infections and conditions that can affect the fetus is an important part of pregnancy, delivery, and birth. The prenatal visit is an excellent time to discuss the benefit of screening and the specific screening tests prospective mothers will experience. For example, the mother is regularly screened by her obstetrician to assess fetal growth and development and may have fetal testing for genetic diseases and chromosomal abnormalities. In addition, the mother may be screened for conditions that may affect the fetus, such as gestational diabetes, pregnancy-induced hypertension, and the presence of infectious agents, such as hepatitis B, cytomegalovirus, group B streptococci, and HIV.

For the infant, the main universal screening programs are used to detect metabolic diseases, sickle cell disease, cystic fibrosis, newborn jaundice, critical congenital cardiac disease, and hearing impairments. Parents may seek more information about risk factors for the management of newborn jaundice. Some discussion of these conditions can be helpful to many families so they understand what is being looked for, how the tests are performed, and what the response to test results will be. Family history may have led to detailed genetic testing and counseling and may warrant special discussion. 35 , – 38 Routine postpartum care can be discussed. The rationale for routine recommendations for vitamin K to prevent gastrointestinal or cerebral hemorrhage, eye ointment to prevent eye infection leading to blindness, and the birth hepatitis B vaccine can be explained.

Discussion of circumcision, including benefits, risks, the surgical process, and analgesia, can be presented at this visit, with particular attention to the family’s religious, personal, and cultural views. 39  

Most parents are interested in understanding what to expect for a routine pediatric visit as well as information about office and telephone hours, the appointment scheduling process, and coverage for night, weekend, and emergency care. The prenatal visit also is a good time to establish the pediatrician’s expectations of the family and explain the use of electronic communications during and after routine office hours, including billing for this service. The routine periodic schedule of well-child care visits from Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Fourth Edition 3 can be shared with the parents ( http://brightfutures.aap.org/clinical_practice.html ), along with information from Bright Futures about behavior, development, and the importance of social determinants of health.

The prenatal visit also is a good time to ask parents about their preferred approach to communication with the office, clarifying office policies on the availability of telephone and electronic communications. Preferred Web sites (HealthyChildren.org) for sharing information and other helpful resources and books can be recommended.

Safety is an important topic to discuss with the parents, particularly advice on “safe sleep” 40 and the importance of proper bedding, 40 , 41 proper holding of the infant, water temperature during bathing, the proper use of a pacifier, and hand washing. Encouraging a good family diet, regular checkups with the family physician or obstetrician 42 and dentist, 43 , 44 and appropriate rest and exercise also is important. Guidelines from the American College of Obstetricians and Gynecologists (ACOG) increasingly emphasize attention to oral health and smoking cessation during pregnancy, and pediatricians can reinforce these recommendations during the prenatal visit. 45 , 46 Specific safety issues to discuss include the use of car seats, gun safety in the home, smoke detectors and carbon monoxide monitors, and reducing exposures to toxins such as mold and lead.

For many families, including those with other children, the unique emotional life of a newborn infant is unfamiliar and can be challenging. It is key to manage expectations and raise parental awareness about the range of temperaments infants can have as well as the strengths and challenges of them. There can be some discussion on how crying can be a normal mode of communication, explaining that a common peak typically occurs during the evening hours at 6 weeks of age and giving advice on how best to respond to it. Parents can be given techniques for soothing fussy infants, such as holding, including cuddling and skin-to-skin contact 47 ; rocking; singing; talking quietly; and dimming lights and playing soft music.

The prenatal visit provides an opportunity to discuss how to recognize when crying is an indicator of actual pain or illness. It is important to establish strategies for parental coping with the stress of an infant crying and the demands of infancy, including setting clear plans for strategies to deal with stress.

The experience of enhanced, powerful emotions of a wide variety is likely universal to most parents during and after delivery. Even if no serious difficulties with emotions emerge, it is helpful for expectant parents to be aware of the special power of both positive and negative emotions that surround a new person being born and entering their life.

It is also important for all expectant parents to be aware that it is common for many mothers, as many as 10% to 20%, 48 and some fathers to experience depression before, during, and/or after delivery. Postpartum depression is largely unappreciated, because stigma prevents a majority of parents from being identified and accessing services. 48 Several states have recommended universal postpartum depression screening by pediatricians, and insurers are increasingly paying for these screens. The prenatal visit offers mothers a valuable opportunity to become aware of the facts about depression so they know to call for help from their primary care physician or their obstetrician if they experience significant persistent sadness, which can be compounded by fatigue from lack of sleep. 49 , – 51  

The pediatrician can instruct parents that infants usually awaken to feed every 3 hours during the night until approximately 3 months of age, when brain maturation enables one longer sleep stretch in every 24-hour cycle. To shape this longer stretch to the dark hours, parents can wake infants every 3 hours to feed during the day, keep the lights dim after dark to entrain circadian rhythms, and schedule a bedtime feeding at 11:00 pm right from birth so that the longer sleep stretch after 3 months of age begins then.

At the prenatal visit, pediatricians can listen for and make note of fathers’ or partners’ feelings about lack of parenting skills and decreased marital intimacy. This is an opportunity to lay the groundwork for pediatric providers to be available to fathers as well as mothers after the birth of the infant.

The prenatal visit is a good time to review family history of any illnesses or congenital diseases or any concerns the parents have had during the pregnancy. Adolescent parents often benefit from more guidance than more experienced parents, and older-than-usual parents also feel stressed and insecure. Single parents may not have family or other support systems and may benefit from postpartum referral to social service agencies, evidence-based home visiting programs, or parenting programs (Incredible Years, Triple P) in local communities, if available, for help. The absence of the father, parental conflict, a chronic parental physical condition or concern about mental health, and preterm birth or a birth defect in the infant may require additional medical visits and involvement of specialists 52 , – 55 and can present physical, emotional, and financial burdens for the parents. Many expectant parents wish to discuss the value of cord blood banking and the relative merits of private– versus public–cord blood donation. 56  

During the pregnancy, maternal obesity and maternal drug use 8 , 9 are risk factors for labor complications, birth defects, and/or developmental impairment. 57 , – 59 Maternal diet is important, and ACOG recommendations about the weight gain during pregnancy can be emphasized.

New data are increasingly available about the adverse health effects of environmental toxins during pregnancy (eg, mercury and fish), and pediatricians can work with obstetricians and the ACOG to knowledgably respond to parents’ questions on this topic. 60 , – 63 Pediatric providers may want to request direct contact with obstetric providers and request obstetric records to clarify prenatal complications, particularly regarding abnormalities detected on prenatal ultrasonography that may require postnatal follow-up. New understanding of the relationship between environmental toxins and epigenetic modifications have provided a stronger evidence-based recommendation highlighting the fetal programming of adult diseases. 64  

The prenatal visit also is a good time to give parents guidelines about the timing of taking their newborn infant out in crowded public places or inviting visitors/relatives to their home. With regard to preventing infections, this is a good moment to discuss and encourage parents and family members to be immunized against pertussis and, if during the right season, influenza. Tetanus-diphtheria-acellular pertussis (Tdap) immunization is recommended for every pregnant woman after 20 weeks’ gestation, for every pregnancy, and for fathers as well. 65 Underimmunized siblings at home also present a risk to a newborn infant, and expectant parents can be encouraged to ensure siblings are fully immunized before the delivery.

Many parents have questions about the recommended schedule of immunizations. The prenatal visit is a valuable opportunity to discuss the value of immunizations and the reason for the recommended schedule. It is an opportunity to listen to any parental concerns well before the infant is born, and the decision is on the family. It is also important for the pediatric provider to outline office immunization policy with regard to parents who wish to alter the standard immunization schedule.

Although the volume of information and advice may seem overwhelming to expectant parents, they can be given appropriate handouts to supplement and reinforce information provided at the prenatal visit. A follow-up visit or telephone call can be offered if they still have questions. A Web page can be a good source of information and can include parent questionnaires for subsequent visits.

The most comprehensive form of prenatal visit is a scheduled office visit with both expectant parents. Nurse practitioners can have a significant role in conducting prenatal visits. The objectives listed previously are accomplished through an in-person discussion with the provider. Discussion can include office and telephone hours; fees; office staff; hospital affiliations; coverage for night, weekend, and emergency care; arrangements for newborn care after delivery both at the hospital the pediatricians visit and at a hospital where the pediatrician is not on the staff; and the pediatrician’s expectations of the family. A handout containing this information can be helpful for the family, including information on how and when to schedule the first visit after newborn discharge and how to retrieve the discharge summary if care was provided by a hospitalist. This type of visit is most important for first-time parents, for adolescent and other young parents, when pregnancy complications or newborn problems are anticipated, or when parents are unusually anxious for any reason. The establishment of a mutual commitment to a sound and rewarding family-physician relationship usually results from the visit.

If women with high-risk pregnancies require bed rest, there may be a need for a prenatal visit with only 1 parent and/or telephone calls. These contacts can include the same content as the full prenatal visit. The outcome should be the same mutual commitment as from the full prenatal visit in the office. If an infant is born prematurely, before a prenatal visit could occur, it is often helpful to meet with the parents in a modified prenatal visit before the infant is discharged from the NICU. In the tragic circumstance of a pregnancy loss after a prenatal visit, a follow-up expression of sympathy by the pediatric provider can feel supportive.

Some pediatricians may offer a less formal prenatal visit than a full consultation, and some parents also may prefer this option. A meet-and-greet session, individually or in a group, can include meeting key staff members such as the practice manager, taking a short tour of the office, and receiving other administrative information and handouts. This type of visit may be appropriate for parents before deciding on scheduling a full prenatal visit. Other models include group visits at the maternity hospital as part of a prenatal class or at community events for expectant parents.

The initial prenatal contact often is an expectant parent’s call to the pediatrician’s office. The staff member can offer a brief description of the practice, basic information including a source of referral, expected delivery date, and type of insurance and can be invited to make an appointment for a full prenatal visit. An office information handout may be sent to the expectant parents, if requested.

If no prenatal contact has been made, the objectives and discussion of the prenatal visit can be presented to the parents in the newborn visit or first postnatal visit. Because of other priorities, the parents may not absorb some of this discussion; therefore, a handout containing pertinent information may be used at this type of visit. At the infant’s first office visit, parents should be encouraged to have an additional family member accompany them to care for the infant while the parents and pediatrician confer.

Pediatricians or office staff can discuss with parents whether the visit will be covered by the expectant parent’s insurance and whether a referral will be required. A discussion of insurance plans that the practice accepts may be included. Payment for a prenatal visit often requires advocacy with third-party payers, both individually and through pediatric councils. Both the recommendations of Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Fourth Edition 3 and this clinical report can provide further support for advocacy. Pediatric providers may seek advice from AAP coding resources and may review acceptable codes with their health plans.

A prenatal visit is an important first step to help expectant families (especially first-time parents) establish their child’s medical home. The visit is a unique opportunity to address the relationship between the family and practice and for the bidirectional sharing of information between the parents and pediatric provider.

Pediatric practices can effectively incorporate prenatal visits into their routine. Services can be flexible and designed to meet the needs of expectant parents. A full prenatal visit is preferred, if feasible.

Payment for full prenatal visits is supported by the evidence in Bright Futures and this report. State chapters of the AAP (as through pediatric councils) and pediatric practices can advocate to payers the short-term and long-term benefits of prenatal visits on the health outcomes of infants and their parents.

Pediatricians can share their established practices on prenatal visits with local obstetricians, internists, and family physicians, and with expectant parents.

Pediatric residents can effectively be taught during residency about the content and importance of the prenatal visit.

Increased partnerships with colleagues in obstetrics and gynecology, who are now routinely screening mothers for perinatal depression, are encouraged. Whenever risk factors are identified, obstetric and gynecologic colleagues can be encouraged to refer expectant parents for prenatal pediatric visits so that postpartum family care is optimized.

A comprehensive review of this topic with suggested questions and specific suggestions for expectant parents can be found in the Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Fourth Edition . 3  

Parents can find resources of value during the prenatal period at www.healthychildren.org . 4  

What kinds of previous experience with infants have you had?

Are you working? Are you planning to return to work after delivery?

How are the siblings adjusting to the pregnancy?

Have you attended prenatal classes, and have they been helpful?

What kind of relationship did you have with your parents when you were growing up?

Are you planning to rear your infant in a manner similar to or different from the way your parents reared you?

What expectations do you have about this infant?

What worries and concerns do you have?

What are your plans about feeding the infant (offer support, whether for breast or formula feeding)?

To specifically engage the father/partner, when appropriate, address at least one question to just the father/partner, for example, if the infant is a boy, do you plan to have him circumcised?

Was this a convenient time for you to be pregnant?

How do you cope when you are stressed?

American Academy of Pediatrics

American College of Obstetricians and Gynecologists

This document is copyrighted and is property of the American Academy of Pediatrics and its Board of Directors. All authors have filed conflict of interest statements with the American Academy of Pediatrics. Any conflicts have been resolved through a process approved by the Board of Directors. The American Academy of Pediatrics has neither solicited nor accepted any commercial involvement in the development of the content of this publication.

Clinical reports from the American Academy of Pediatrics benefit from expertise and resources of liaisons and internal (AAP) and external reviewers. However, clinical reports from the American Academy of Pediatrics may not reflect the views of the liaisons or the organizations or government agencies that they represent.

The guidance in this report does not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.

All clinical reports from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.

FUNDING: No external funding.

Michael Yogman, MD, FAAP

Arthur Lavin, MD, FAAP

George Cohen, MD, FAAP

Michael Yogman, MD, FAAP, Chairperson

Keith M. Lemmon, MD, FAAP

Gerri Mattson, MD, FAAP

Jason Richard Rafferty, MD

Lawrence Sagin Wissow, MD, MPH, FAAP

George J. Cohen, MD, FAAP

Sharon Berry, PhD – Society of Pediatric Psychology

Terry Carmichael, MSW – National Association of Social Workers

Edward R. Christophersen, PhD, FAAP (hon) – Society of Pediatric Psychology

Norah Johnson, PhD, RN, CPNP – National Association of Pediatric Nurse Practitioners

L. Read Sulik, MD – American Academy of Child and Adolescent Psychiatry

Stephanie Domain, MS

Competing Interests

Re: the prenatal visit.

We commend Drs. Yogman, Lavin and Cohen and the AAP Committee on Psychosocial Aspects of Child and Family Health on their recent clinical report, The Prenatal Visit (1), for drawing attention to the value of the third trimester in establishing a child’s medical home.

As the authors note, most pediatricians offer a prenatal visit, recommended by Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Fourth Edition (2), but most parents do not attend one. Pediatricians and families may never make up for this opportunity to address the most fundamental factors affecting the child’s health: their psychosocial risk factors and the social determinants of their health.

Prenatal visits are even less likely to take place for the urban poor, rural and minority families who may most need early intervention and anticipatory guidance. Achieving health equity demands extra efforts to pull in at-risk families and close the gap in access to the prenatal visit, especially as the rate of return on interventions is highest in the prenatal and earliest years (3).

Moreover, given how frequently this visit is skipped, we must remain attentive to the health of both the caregiver and child at the ‘postnatal’ well-child visits, especially for at-risk families. While caregivers may not access their own health care provider often, they visit their pediatrician four times a year on average (4). Providers can use these visits to provide guidance on healthy changes that will benefit the whole family – and they can bill for it.

Bright Futures sets periodicity schedules for screenings for substance and tobacco use and exposure; parental depression; and poverty, housing and food insecurity. These screenings are reimbursed by Medicaid under the Early and Periodic Screening, Diagnostic and Treatment services (EPSDT) benefit and by most private payers. Some states and health care systems have started successfully billing a child’s health insurance for caregiver health risk assessments that benefits the child. Effective January 1, 2017, providers can report CPT code 96161 for caregiver-focused, standardized health-risk assessments that can benefit the child (5).

The post-natal well-child visit, like the prenatal visit, offers critical, longitudinal, reimbursable opportunities for pediatricians to screen children for health-related social needs and caregivers for health risks. These opportunities are too important and costly to overlook.

References: 1.Yogman M, Lavin A, Cohen G. The Prenatal Visit. Pediatrics. 2018;142(1):e20181218 2. Hagan JF, Shaw JS, Duncan P, eds. Bright Futures: Guidelines for Health Supervision of Infants, Children and Adolescents. 4th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2017 3. Heckman Econ Inq. 2008:46(3): 289-324 4. Newacheck PW, Stoddard JJ, Hughes DC, Pearl M. Health Insurance and Access to Primary Care for Children. N Engl J Med 1998; 338:513-519 5. AAP News. AAP Division of Health Care Finance. May 24, 2017. Update on use of, payment for new health risk assessment codes. http://www.aappublications.org/news/2017/05/24/Coding052317

In their recent revision of the prenatal visit for pediatricians, Drs. Yogman, Lavin and Cohen and the Committee on Psychosocial Aspects of Child and Family Health (Yogman M, Lavin A, Cohen G. The Prenatal Visit. PEDIATRICS. 2018, 142(1):e20181218) state in the beginning,”As advocates for children and their families, pediatricians can support and guide expectant parents in the prenatal period. Prenatal visits allow general pediatricians to establish a supportive and trusting relationship with both parents, gather basic information from expectant parents, offer information and advice regarding the infant and may identify psychosocial risks early and high-risk conditions that may require special care”, yet it seems as if more could have been included to guide the general pediatrician in making the most of the prenatal visit to accomplish the above mentioned psychosocial objectives. The prenatal visit can be an excellent time for the pediatrician to discuss the innate capacities and capabilities of the infant, the concept of infant-parent (or infant) mental health, the role of the parent and pediatrician in helping to support the infant/parent dyad in promoting positive infant mental health, how early experiences/interactions with the parent play a major role in determining not only the psychosocial health of the infant (later child and adult) but in fact sculpt, shape, modify the developing infant’s physiologic regulatory and system functions. To accompany this, the general pediatrician could discuss when in the hospital seeing the newborn he could demonstrate these capacities and capabilities for the parents, and so in the process help establish or enhance a positive attachment relationship by utilizing the late T. Berry Brazelton’s Newborn Behavioral Observations. As recent literature has shown parenting neurobiology, circuitry and interactions are negatively affected by conditions that can have their origins in the parent’s early life experiences, and beyond screening for substance (drugs, alcohol, tobacco) or present domestic violence, screening using the ACEs questionnaire may provide for the pediatrician a more complete picture of a parent’s need for early supportive care to improve their reflective capabilities and capacities and so enable improved infant-parent interactions and outcomes. Perhaps the time has come for a new AAP committee that focuses on integrative and translational aspects of parenting and infant-parent mental health.

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SARAH INÉS RAMÍREZ, MD, FAAFP

Am Fam Physician. 2023;108(2):139-150

Related AFP Community Blog:   Practice Ancestry-Based Medicine, not Racial Essentialism

Related editorial:   Perinatal Care of Transgender Patients, Adolescent Patients, and Patients With Opioid Use Disorder

Author disclosure: No relevant financial relationships.

Well-coordinated prenatal care that follows an evidence-based, informed process results in fewer hospital admissions, improved education, greater satisfaction, and lower pregnancy-associated morbidity and mortality. Care initiated at 10 weeks or earlier improves outcomes. Identification and treatment of periodontal disease decreases preterm delivery risk. A prepregnancy body mass index greater than 25 kg per m 2 is associated with gestational diabetes mellitus, hypertension, miscarriage, and stillbirth. Advanced maternal and paternal age (35 years or older) is associated with gestational diabetes, hypertension, miscarriage, intrauterine growth restriction, aneuploidy, birth defects, and stillbirth. Rh o (D) immune globulin decreases alloimmunization risk in a patient who is RhD-negative carrying a fetus who is RhD-positive. Treatment of iron deficiency anemia decreases the risk of preterm delivery, intrauterine growth restriction, and perinatal depression. Ancestry-based genetic risk stratification using family history can inform genetic screening. Folic acid supplementation (400 to 800 mcg daily) decreases the risk of neural tube defects. All pregnant patients should be screened for asymptomatic bacteriuria, sexually transmitted infections, and immunity against rubella and varicella and should receive tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap), influenza, and COVID-19 vaccines. Testing for group B Streptococcus should be performed between 36 and 37 weeks, and intrapartum antibiotic prophylaxis should be initiated to decrease the risk of neonatal infection. Because of the impact of social determinants of health on outcomes, universal screening for depression, anxiety, intimate partner violence, substance use, and food insecurity is recommended early in pregnancy. Screening for gestational diabetes between 24 and 28 weeks is recommended for all patients. People at risk of preeclampsia, including those diagnosed with COVID-19 in pregnancy, should be offered 81 mg of aspirin daily starting at 12 weeks. Chronic hypertension should be treated to a blood pressure of less than 140/90 mm Hg.

Family physicians provide family-centered care for individuals and families before, during, and after the birth of a child. Well-coordinated prenatal care that follows an evidence-based, informed process results in fewer hospital admissions, improved education, greater care satisfaction, improved perinatal outcomes, and mitigates pregnancy-associated morbidity and mortality. 1 Family physicians are uniquely positioned to address social determinants of health while ensuring quality of care.

Prenatal Care Visits

Initiation of care between six and 10 weeks allows for identification of preexisting conditions that negatively affect maternal-fetal outcomes (e.g., diabetes mellitus, hypertension, obesity) 2 ; however, 22% of pregnant patients do not receive care during this time. 2 The COVID-19 pandemic resulted in a reevaluation of the number of physician visits needed, with an emphasis on increased flexibility, allowing for a combination of virtual and in-person visits depending on risk. 3 Table 1 outlines the components of prenatal care. 1 , 4 – 22 Table 2 provides opportunities for educating pregnant patients during prenatal care visits. 6 , 8 , 14 – 19 , 23 – 29

PHYSICAL EXAMINATION

Weight, height, and blood pressure should be measured at the first prenatal visit. Early identification of periodontal disease and treatment decreases adverse pregnancy outcomes. 7 Treatment may be performed in the second trimester, and emergent treatment may be completed at any time during pregnancy. 7 A bimanual pelvic examination has poor predictive value for clinical pelvimetry and screening for disease (i.e., sexually transmitted infections and cancer) but may be used as a diagnostic aid in patients with a discrepancy between uterine size and gestational age, which warrants ultrasonography assessment. 30 A pelvic examination is also useful in a symptomatic patient for evaluating spontaneous labor (e.g., cervical dilation, rupture of amniotic membranes). The clinical breast examination is a diagnostic aid in the symptomatic patient and addresses breastfeeding concerns or barriers but does not demonstrate benefit in patients already receiving screening mammograms and does not decrease mortality. 31 – 33

MATERNAL WEIGHT GAIN AND NUTRITION

A prepregnancy body mass index (BMI) greater than 25 kg per m 2 is associated with preterm delivery, gestational diabetes, gestational hypertension, and preeclampsia. A BMI greater than 30 kg per m 2 is also associated with an increased risk of miscarriage, stillbirth, and obstructive sleep apnea. 6 Prepregnancy BMI informs the timing of fetal surveillance, nutritional counseling, and goals for gestational weight gain. Table 3 lists general dietary guidelines for pregnant people. 8 , 17 , 34 , 35 For Black and Hispanic people, a prepregnancy BMI greater than 25 kg per m 2 and the associated poor outcomes are worse compared with non-Hispanic White people. 36

PARENTAL AGE AT CONCEPTION

Advanced maternal and paternal age (35 years and older) is associated with poor outcomes (i.e., aneuploidy, birth defects, gestational diabetes, hypertension, intrauterine growth restriction [IUGR], miscarriage, and stillbirth). Activities focused on improving perinatal outcomes for this group, such as a detailed fetal anatomic screening on ultrasonography, may decrease morbidity and mortality. 37

PREGNANCY DATING AND ULTRASONOGRAPHY

Accurate gestational age estimation is critical to quality care because it enables more precise timing of interventions (e.g., aspirin for preeclampsia prevention, steroids for fetal lung maturity), screening tests, and delivery. Up to 40% of people estimate their last menstrual period incorrectly; therefore, ultrasonography is recommended if uncertainty exists and for patients with irregular menstrual cycles, irregular bleeding, and discrepancy between uterine size and gestational age. 1 , 38 Ultrasonography before 24 weeks decreases missed multiple gestations and post-term inductions. 39 Although routine third-trimester ultrasonography may increase detection of IUGR, it does not improve outcomes. 40 If malpresentation is suspected on physical examination, confirmation with ultrasonography is recommended. 4

ALLOIMMUNIZATION

For patients who are RhD-negative and carrying a fetus who is RhD-positive, the alloimmunization risk is 1.5% to 2% in the setting of spontaneous abortion and 4% to 5% with dilation and curettage. The risk is decreased by 80% to 90% with anti-D immune globulin. 41 Testing for the ABO blood group and RhD antibodies should be performed early in pregnancy. A 300-mcg dose of anti-D immune globulin is recommended for RhD-negative pregnant patients at 28 weeks and again within 72 hours of delivery if the infant is RhD-positive. 41

Iron deficiency anemia increases the risk of preterm delivery, IUGR, and perinatal depression. The U.S. Preventive Services Task Force found insufficient evidence to assess the benefits and harms of screening for anemia in pregnancy. 42 Screening is recommended by the American College of Obstetricians and Gynecologists early in pregnancy, with iron treatment if deficient. 43 Intravenous iron should be considered for patients who cannot tolerate oral iron or in whom oral iron has been ineffective at correcting the deficiency. 43 Patients with non–iron deficiency anemia, or if iron repletion is ineffective within six weeks, should be referred to a hematologist for further evaluation. Iron supplementation in the first trimester decreases the prevalence of iron deficiency. 43

INHERITED CONDITIONS

Pregnant patients should be counseled and offered aneuploidy (extra or missing chromosomes) screening in early pregnancy, regardless of age. 44 In the United States, 1 in 150 infants has a chromosomal condition, the most common being trisomy 21 (Down syndrome). 44 Table 4 compares screening tests for Down syndrome. 1 , 45 , 46 If a screening test is positive, amniocentesis at 15 weeks or more or chorionic villous sampling between 11 and 13 weeks is recommended. Both procedures have similar rates of fetal loss. 47 At 35 years of age, the risk of Down syndrome (1 in 294 births) is similar to that of fetal loss from amniocentesis. 47 Serum and nuchal translucency testing can screen for other trisomies, including 13 and 18, the protocols for which have lower sensitivities and higher specificities compared with screening protocols for trisomy 21 because they are rarer. 47

Additional genetic screening should be based on maternal and paternal personal and family histories. Race is a social construct, necessitating a shift in genetic risk stratification from race-based to ancestry-based. Sickle cell disease affects up to 100,000 people in the United States, but its inheritance pattern (1:10) is based on people with African ancestry, which includes much of the world. 48 Cystic fibrosis is inherited mainly by people of European ancestry (1:25), but ignoring the possibility of European ancestry in certain racial and ethnic groups results in an underestimation of its prevalence: African (1:61), Hispanic (1:40), and Mediterranean (1:29). 49

NEURAL TUBE DEFECTS

In the United States, neural tube defects affect approximately 2,600 infants per year, with the highest prevalence in Hispanic populations. 35 , 50 All pregnant patients should be counseled and offered screening with maternal serum alpha fetoprotein. 35 Folic acid, 400 to 800 mcg daily, started at least one month before conception and continued until the end of the first trimester, decreases the incidence of neural tube defects by nearly 78%. 35 Patients taking folic acid antagonists (e.g., carbamazepine, methotrexate, trimethoprim) or who have a history of carrying a fetus with a neural tube defect should take 4 mg of folic acid daily, starting at least three months before conception. 35

THYROID DISORDERS

There is no evidence that screening for thyroid disorders improves pregnancy outcomes. Thyroid-stimulating hormone levels should be measured if there is a history of thyroid disease or symptoms of disease. If the level is abnormal, a free thyroxine test helps determine the etiology. 51 Hypothyroidism complicates 1 to 3 per 1,000 pregnancies and increases the risk of fetal loss, preeclampsia, IUGR, and stillbirth. Hyperthyroidism occurs in 2 per 1,000 pregnancies and is associated with miscarriage, preeclampsia, IUGR, preterm delivery, thyroid storm, and congestive heart failure. 51 The effect of subclinical hypothyroidism on a child's neurocognitive development is not well understood, and the effectiveness of treatment with levothyroxine is unproven. 51

CERVICAL CANCER

Intervals for cervical cancer screening are based on patient age, cytology history, and history of the presence of high-risk human papillomavirus (HPV). Routine screening for people at average risk of cervical cancer should begin at 21 years of age. Screening can be performed with either cytology alone every three years, HPV screening alone every five years, or cytology plus HPV screening every five years starting at 25 years of age. Screening is not indicated for people 65 years and older with negative screening in the previous 10 years, and no history of cervical intraepithelial neoplasia grade 2 or higher in the past 25 years. 52 Colposcopy is indicated when the risk of cervical intraepithelial neoplasia grade 3 is greater than 4%. Surveillance of high-grade lesions should be performed every 12 to 24 weeks. 52 , 53 Although colposcopy and cervical biopsy can be safely performed during pregnancy, endocervical sampling should be deferred until postpartum. 53

Infectious Disease

Bacteriuria.

Asymptomatic bacteriuria complicates up to 15% of pregnancies in the United States, 30% of which progress to pyelonephritis if untreated. 54 All pregnant patients should be screened for bacteriuria at the first prenatal visit. 54 A culture from a midstream or clean-catch sample with greater than 100,000 colony-forming units per mL of a single pathogen is considered positive and treated to decrease the risk of pyelonephritis and subsequent preterm delivery. 54

SEXUALLY TRANSMITTED INFECTIONS

Sexually transmitted infections can affect prenatal outcomes. 55 – 57 Table 5 lists routine screening and treatment for sexually transmitted infections in pregnancy. 55 , 56

Rubella immunity screening during the first prenatal visit is recommended. Postpartum vaccination should also be offered if the patient is not immune to prevent congenital rubella syndrome in subsequent pregnancies. 1 , 58 The presence of rubella immunoglobulin G should be interpreted with caution in patients recently migrating from areas where rubella is endemic because this may indicate a recent infection. 58 Rubella is a live vaccine and should not be administered during pregnancy but is safe during lactation after delivery. 59 , 60

Maternal varicella can result in congenital varicella syndrome (i.e., IUGR and limb, ophthalmologic, and neurologic abnormalities) and neonatal varicella; infection can occur from approximately five days before to two days after birth. A negative history of varicella infection or vaccination warrants serologic testing, and if immunoglobulin G is negative, varicella exposure should be avoided. Postpartum vaccination should be offered. 61

Although tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccination is recommended for anyone in close contact with the infant, only antenatal maternal vaccination ensures increased protection against neonatal pertussis. 62 Pregnant patients should receive a Tdap vaccine beginning at 27 weeks to maximize time for passive immunity to the fetus through the placental transfer of maternal antibodies; vaccination is recommended in each subsequent pregnancy. 62

INFLUENZA AND COVID-19

Influenza and COVID-19 infection in pregnancy increase the risk of intensive care unit admission, preterm delivery, stillbirth, and maternal death. 63 , 64 COVID-19 infection almost doubles the risk of developing preeclampsia 64 ; therefore, initiating low-dose aspirin (81 mg daily) starting at 12 weeks should be considered. 5 Pregnant patients and their household contacts should be vaccinated for influenza and COVID-19. 63 , 64

GROUP B STREPTOCOCCUS

In the United States, group B Streptococcus (GBS) is the leading cause of infection in the first three months of life; 25% of all pregnant patients are GBS carriers. 65 , 66 Screening with a vaginal-rectal swab for culture between 36 and 37 weeks is recommended. 67 Intrapartum antibiotic prophylaxis decreases neonatal mortality. Antibiotics are recommended when there is GBS bacteriuria with the current pregnancy, a history of a previous infant affected by GBS (e.g., septicemia, meningitis, pneumonia, death), or unknown GBS status and risk factors (e.g., preterm labor, rupture of membranes more than 18 hours before delivery, GBS in previous pregnancy). 67 Patients with GBS bacteriuria in the current pregnancy are assumed to be colonized and do not need subsequent screening. 67

Social Determinants of Health

Social determinants of health represent up to 80% of the factors that directly affect a person's health. 68 Physicians who provide prenatal care play a critical role in mitigating the burden that social determinants of health play on maternal-child health without compromising the quality of care delivered. 69 An increased burden from social determinants of health increases the risk of depression, anxiety, intimate partner violence, substance use, and food insecurity 70 , 71 ; therefore, universal screening is recommended early in pregnancy.

DEPRESSION AND ANXIETY-RELATED DISORDERS

After the COVID-19 pandemic, rates of perinatal depression and anxiety have increased. People who are non-White, 24 years or younger, or who have 12 years or less of education, lower socioeconomic status, or a history of intimate partner violence or sexual trauma are at higher risk. 11 , 72 , 73 If untreated, depression and anxiety-related disorders increase the risk of preeclampsia, preterm delivery, IUGR, substance use, maternal suicide, infanticide, psychosis, and homicide. 11

INTIMATE PARTNER VIOLENCE

Intimate partner–related homicide is the leading cause of death in the United States in pregnancy. Screening is recommended at the first prenatal visit and once per trimester. 13 Intimate partner violence increases the risk of miscarriage, placental abruption, premature rupture of membranes, IUGR, and preterm delivery. 13 Family physicians should be aware of the signs of intimate partner violence (e.g., frequent sexually transmitted infections, repeated requests for pregnancy tests when pregnancy is not desired, fear of asking a partner to use a condom), the effect of violence on health, and the increased risk of child abuse after delivery. 13

SUBSTANCE USE

Substance use during pregnancy increases the risk of IUGR, preterm delivery, stillbirth, fetal malformations, and maternal death. 74 The use of prescription opioids complicates 7% of pregnancies in the United States; of these, 20% of patients report misuse. 75 Opioid use in pregnancy increased by 131% from 2010 to 2017 in the United States, and the incidence of babies born with withdrawal symptoms in that time increased by 82%. 76 Fetal alcohol exposure is the leading cause of preventable neurodevelopmental disorders in the United States. 14 However, 14% of pregnant patients report current drinking, and 5% report binge drinking in the past 30 days. 77 Exposure to cigarette smoking in utero increases the risk of sudden intrauterine and infant death. 15

FOOD INSECURITY

Maternal food insecurity increases the risk of poor outcomes (e.g., IUGR, preterm delivery, gestational diabetes, hypertension, depression, anxiety). However, few patients disclose this due to concerns about social stigma; therefore, a universal approach to screening is encouraged. The Hunger Vital Sign tool may be used. 12

Complications of Pregnancy

Gestational diabetes.

Gestational diabetes complicates up to 14% of U.S. pregnancies, with up to 67% of patients developing type 2 diabetes later in life. 78 Racial and ethnic minorities are at the highest risk. 79 Gestational diabetes is associated with hypertension, macrosomia, shoulder dystocia, and cesarean deliveries. 80 Screening for undiagnosed type 2 diabetes at the initial prenatal visit is recommended for people at increased risk 80 ( Table 6 5 , 80 ) . Universal screening for gestational diabetes should occur between 24 and 28 weeks with a one-hour (50-g) glucose tolerance test and, if results are abnormal, should be followed by a confirmatory, fasting, three-hour (100-g) test. 80

HYPERTENSION

Blood pressure should be monitored at each prenatal visit, and education should be provided on preeclampsia warning signs. 5 Patients at increased risk of preeclampsia should be screened for thrombocytopenia, transaminitis, and renal insufficiency, including proteinuria, during the first or second trimester and started on prophylactic daily low-dose aspirin (81 mg) between 12 and 16 weeks 5 , 85 ( Table 6 5 , 80 ) . [Updated] Screening for proteinuria in isolation has little predictive value for detecting preeclampsia. 5 Chronic hypertension (hypertension before 20 weeks) is treated to less than 140/90 mm Hg. 81

PRETERM DELIVERY

Preterm delivery (between 20 and 37 weeks) is a significant cause of neonatal morbidity and mortality, complicating 10.5% of U.S. pregnancies. 2 Modifiable risk factors include prepregnancy BMI (less than 18.5 kg per m 2 and greater than 25 kg per m 2 ), substance use, and short interval between pregnancies (i.e., less than 18 months). 82 Several options are available for the prevention of preterm labor in a singleton pregnancy. 82 Patients with a previous preterm delivery before 34 weeks should have a cervical length assessment starting at 16 weeks through 24 weeks. 82 These patients should be treated with progesterone supplementation (vaginal or intramuscular). In the asymptomatic patient with a short cervix and without a history of spontaneous birth before 34 weeks, vaginal progesterone (200 mg) started between 16 and 20 weeks and continued through 36 weeks is recommended. 82

POST-TERM DELIVERY

Stillbirth complicates 3 per 1,000 post-term (42 weeks or greater) pregnancies. 20 Antenatal testing should be initiated at 41 weeks; if the results are not reassuring, induction of labor is recommended. 20 , 21

Cultural Considerations

Maternity care improves outcomes; however, vulnerable populations (i.e., racial, ethnic, and religious minorities) are less likely to engage in care if it is not culturally centered, which acknowledges the effect of culture on health conditions (e.g., depression) and enhances patient-physician trust. 83 Addressing cultural needs (e.g., doula, community health workers, interpreters) throughout pregnancy helps mitigate barriers and improves outcomes.

This article updates previous articles on this topic by Zolotor and Carlough 1 ; Kirkham, et al. 17 ; and Kirkham, et al. 84

Data Sources: A search was completed using the key terms prenatal care, COVID-19, oral health, pelvic examination, prepregnancy body mass index, pregnancy dating and ultrasound, maternal and paternal age and impact on pregnancy outcomes, aneuploidy screening, inheritance patterns of sickle cell disease and cystic fibrosis, anemia, cell-free DNA analysis, thyroid disease, cervical cancer screening, management of abnormal cervical cytology, screening guidelines for sexually transmitted infections in pregnancy, group B Streptococcus screening, social determinants of health and prenatal outcomes, intimate partner violence, polysubstance abuse, food insecurity, maternity care deserts, hypertension in pregnancy, progesterone for preterm birth prevention, post-term delivery, and preconception care. Also searched were PubMed, Essential Evidence Plus, the Cochrane database, U.S. Preventive Services Task Force, American College of Obstetricians and Gynecologists, American Cancer Society, American Family Physician , and reference lists of retrieved articles. Search dates: July 1, 2022; February 19, 2023; and June 16, 2023.

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American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Obstetrics; Committee on Genetics; Society for Maternal-Fetal Medicine. Screening for fetal chromosomal abnormalities: ACOG practice bulletin, no. 226. Obstet Gynecol. 2020;136(4):e48-e69.

Centers for Disease Control and Prevention. Data and statistics on sickle cell disease. May 2, 2022. Accessed October 12, 2022. https://www.cdc.gov/ncbddd/sicklecell/data.html#:~:text=In%20the%20United%20States&text=SCD%20affects%20approximately%20100%2C000%20Americans,sickle%20cell%20trait%20(SCT

Boston Medical Center. Genetic screening: ancestry based. Accessed September 30, 2022. https://www.bmc.org/genetic-services/ancestry-based

Mai CT, Isenburg JL, Canfield MA; National Birth Defects Prevention Network. National population-based estimates for major birth defects, 2010–2014. Birth Defects Res. 2019;111(18):1420-1435.

American College of Obstetricians and Gynecologists' Committee on Practice Bulletins–Obstetrics. Thyroid disease in pregnancy: ACOG practice bulletin, no. 223. Obstet Gynecol. 2020;135(6):e261-e274.

Fontham ETH, Wolf AMD, Church TR, et al. Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society. CA Cancer J Clin. 2020;70(5):321-346.

Perkins RB, Guido RS, Castle PE; 2019 ASCCP Risk-Based Management Consensus Guidelines Committee. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors [published correction appears in J Low Genit Tract Dis . 2020; 24(4): 427]. J Low Genit Tract Dis. 2020;24(2):102-131.

Smaill FM, Vazquez JC. Antibiotics for asymptomatic bacteriuria in pregnancy. Cochrane Database Syst Rev. 2019(11):CD000490.

Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep. 2021;70(4):1-187.

Centers for Disease Control and Prevention. Bacterial vaginosis. July 22, 2021. Accessed October 11, 2022. https://www.cdc.gov/std/treatment-guidelines/bv.htm

Brocklehurst P, Gordon A, Heatley E, et al. Antibiotics for treating bacterial vaginosis in pregnancy. Cochrane Database Syst Rev. 2013(1):CD000262.

Mehta NM, Thomas RM. Antenatal screening for rubella—infection or immunity?. BMJ. 2002;325(7355):90-91.

ACOG committee opinion, no. 741: maternal immunization. Obstet Gynecol. 2018;131(6):e214-e217.

Rubella vaccine. Drugs and Lactation Database (LactMed) . June 15, 2020. Accessed October 11, 2022. https://www.ncbi.nlm.nih.gov/books/NBK501097

Centers for Disease Control and Prevention. Chickenpox vaccination: what everyone should know. April 28, 2021. Accessed October 11, 2022. https://www.cdc.gov/vaccines/vpd/varicella/public/index.html

Centers for Disease Control and Prevention. Tdap (pertussis) vaccine and pregnancy. August 10, 2017. Accessed February 15, 2023. https://www.cdc.gov/vaccines/pregnancy/hcp-toolkit/tdap-vaccine-pregnancy.html

Grohskopf LA, Blanton LH, Ferdinands JM, et al. Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices – United States, 2022–23 influenza season. MMWR Recomm Rep. 2022;71(1):1-28.

Jamieson DJ, Rasmussen SA. An update on COVID-19 and pregnancy. Am J Obstet Gynecol. 2022;226(2):177-186.

Nanduri SA, Petit S, Smelser C, et al. Epidemiology of invasive early-onset and late-onset group b streptococcal disease in the United States, 2006 to 2015: multistate laboratory and population-based surveillance [published corrections appear in JAMA Pediatr . 2019; 173(3): 296, and JAMA Pediatr . 2019; 173(5): 502]. JAMA Pediatr. 2019;173(3):224-233.

Centers for Disease Control and Prevention. Active bacterial core surveillance (ABCs) report. Emerging infections program network, group B Streptococcus , 2018. May 19, 2020. Accessed October 12, 2022. https://www.cdc.gov/abcs/reports-findings/survreports/gbs18.pdf?CDC_AA_refVal= https%3A%2F%2Fwww.cdc.gov%2Fabcs%2Freports-findings%2Fsurvreports%2Fgbs18.html

Prevention of group b streptococcal early-onset disease in newborns: ACOG committee opinion, no. 797 [published correction appears in Obstet Gynecol . 2020; 135(4): 978–979]. Obstet Gynecol. 2020;135(2):e51-e72.

Institute for Clinical Systems Improvement. Going beyond clinical walls: solving complex problems. October 2014. Accessed October 11, 2022. https://www.icsi.org/wp-content/uploads/2019/08/1.SolvingComplexProblems_BeyondClinicalWalls.pdf

Partin M, Sanchez A, Poulson J, et al. Social inequities between prenatal patients in family medicine and obstetrics and gynecology with similar outcomes. J Am Board Fam Med. 2021;34(1):181-188.

Compton MT, Shim RS. The social determinants of mental health. Focus. 2015;13(4):419-425.

Kuhrau C, Kelly E, DeFranco EA. Social determinants of health associated with intimate partner violence in an urban obstetric population. Am J Obstet Gynecol. 2023;228(1):S110-S111.

Bauman BL, Ko JY, Cox S, et al. Vital signs: postpartum depressive symptoms and provider discussions about perinatal depression - United States, 2018. MMWR Morb Mortal Wkly Rep. 2020;69(19):575-581.

Lombardi BN, Jensen TM, Parisi AB, et al. The relationship between a lifetime history of sexual victimization and perinatal depression: a systematic review and meta-analysis. Trauma Violence Abuse. 2023;24(1):139-155.

Yazdy MM, Desai RJ, Brogly SB. Prescription opioids in pregnancy and birth outcomes. J Pediatr Genet. 2015;4(2):56-70.

Ko JY, D'Angelo DV, Haight SC, et al. Vital signs: prescription opioid pain reliever use during pregnancy–34 U.S. jurisdictions, 2019. MMWR Morb Mortal Wkly Rep. 2020;69(28):897-903.

Hirai AH, Ko JY, Owens PL, et al. Neonatal abstinence syndrome and maternal opioid-related diagnoses in the US, 2010–2017 [published correction appears in JAMA . 2021; 325(22): 2316]. JAMA. 2021;325(2):146-155.

Gosdin LK, Deputy NP, Kim SY, et al. Alcohol consumption and binge drinking during pregnancy among adults aged 18–49 years–United States, 2018–2020 [published correction appears in MMWR Morb Mortal Wkly Rep . 2022; 71(4): 156]. MMWR Morb Mortal Wkly Rep. 2022;71(1):10-13.

Diaz-Santana MV, O'Brien KM, Park YM, et al. Persistence of risk for type 2 diabetes after gestational diabetes mellitus. Diabetes Care. 2022;45(4):864-870.

Bower JK, Butler BN, Bose-Brill S, et al. Racial/ethnic differences in diabetes screening and hyperglycemia among US women after gestational diabetes. Prev Chronic Dis. 2019;16:E145.

American College of Obstetricians and Gynecologists' Committee on Practice Bulletins–Obstetrics. Gestational diabetes mellitus. ACOG practice bulletin, no. 190. Obstet Gynecol. 2018;131(2):e49-E64.

Tita AT, Szychowski JM, Boggess K, et al. Treatment for mild chronic hypertension during pregnancy. N Engl J Med. 2022;386(19):1781-1792.

American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Obstetrics. Prediction and prevention of spontaneous preterm birth. ACOG practice bulletin, no. 234. Obstet Gynecol. 2021;138(2):e65-e90.

Gopalkrishnan N. Cultural diversity and mental health: considerations for policy and practice. Front Public Health. 2018;6:179.

Kirkham C, Harris S, Grzybowski S. Evidence-based prenatal care: part II. Third-trimester care and prevention of infectious diseases. Am Fam Physician. 2005;71(8):1555-1560.

• Roberts JM, King TL, Barton JR, et al. Care plan for individuals at risk for preeclampsia: shared approach to education, strategies for prevention, surveillance, and follow-up. Am J Obstet Gynecol . 2023;229(3):193-213.

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How to Make the Most of Your First Prenatal Visit, and What to Ask!

• What to Gather
• What to Expect
• What to Ask

Congratulations, you’re expecting! You’ll want to schedule your first prenatal visit right away.  

Prenatal care overview.

Your first prenatal visit usually takes place when you are about 8-10 weeks pregnant. This appointment is often the longest, and will include a general physical and routine prenatal labs.

After your first appointment, prenatal appointments typically last as little as 15 minutes for uncomplicated pregnancies. Make sure that your provider answers any questions you have at these appointments, but don’t worry if your appointment feels short - a quick appointment is usually a good sign that your pregnancy is progressing normally.

For an uncomplicated pregnancy, women should plan to see their provider every 4 weeks through 28 weeks, every 2 weeks between 28 and 36 weeks, and weekly from 36 weeks to delivery. Every visit will include a weight check, blood pressure check, and a chance to listen to the fetal heart beat.

Your first prenatal appointment is one of the most important visits. Your doctor will take your medical history, and help you form a plan for your prenatal care. This is also a great time to ask any questions you have.

Here are three steps to help you make the most of your first prenatal visit.

 1. Gather important medical information before you go.  

Before you arrive at your appointment, you’ll want to educate yourself about your medical history. This medical history is more extensive than ones taken at check-ups, so make sure you have knowledge (and documentation, when possible) of the following details.

Your partner’s medical history will also affect the health of your baby, so he should attend this appointment if possible. If you or your partner were adopted, or if you used a donor egg or sperm, you may have less genetic information available to you, but your doctor will help you interpret the information you do have.

Make sure to include:

• General Medical History: Include any medical problems you have or have had. List types, dates, and treatments if applicable. Your doctor may classify your pregnancy as high-risk if you suffer from health problems including diabetes, cancer, kidney disease, epilepsy, or high blood pressure.
• Family Medical History: Your baby may be at higher risk for certain genetic disorders if they run in your family or your partner’s family. Ask family members about genetic disorders and birth defect history. Depending on your family medical history, your ethnic background, and other factors, your provider may recommend different screenings or tests. For example, people of Ashkenazi Jewish heritage have an increased risk of Cystic Fibrosis and Tay-Sachs Disease, and people of African descent have an increased risk of sickle cell disease.
• Fertility History: List your menstrual history, including regular/ irregular periods, history of cramping or PMS, and any medication you use to bring on a period. Describe any fertility treatments you have had and their outcomes. Include your pap smear history, any abnormalities detected, and treatments if applicable (ie ie colposcopy, cryosurgery, laser treatment, conization, LEEP procedure). 
• Past Pregnancies: I nclude live births, stillbirths, premature deliveries (less than 37 weeks), miscarriages (less than 20 weeks), ectopic/ tubal pregnancies, and/or elective terminations (abortions).
• Infection Exposure: Include chlamydia, gonorrhea, herpes, genital warts/ HPV, syphilis, HIV/AIDS, hepatitis.
• Medications You’re Taking: Include prescription as well as over-the-counter medications in this list. Also make a list of any herbal medicines, vitamins, or health supplements you take. Note any allergies to medication.
• Dietary Habits: Your doctor will ask about your caffeine, alcohol, and nicotine consumption. A moderate amount of coffee can be consumed during pregnancy, but no amount of nicotine, alcohol, or illicit drugs are considered safe. If you need help staying sober, reach out to your provider, and they will work with you to ensure a safe and healthy pregnancy.
• Mental Health History: Let your doctor know if you have a history of anxiety, depression, or other mental health conditions. Your doctor will help you find a treatment plan that cares for you and your  baby. In some cases, your doctor may recommend that you stop taking a certain medication. However, in other cases, the risks of stopping a medication outweigh the potential benefits. Talk to your doctor to find the plan that’s right for you.  

2. Know what to expect at your first prenatal appointment.    

Your first prenatal visit is usually the longest unless you experience complications with your pregnancy.

Routine Procedures

At this appointment, your provider will take your medical history, check your weight and blood pressure, and perform blood tests. These blood tests will test your blood type, Rh factor, exposure to hepatitis and syphilis, and immunity to German measles.

You may be able to hear your baby’s heartbeat at this appointment. However, if your prenatal appointment is on the earlierside, you may need to wait to hear your baby’s heartbeat. The fetal heartbeat is usually first detectable between 12 and 14 weeks.

HIV Testing

You may choose to take an HIV test during the early stages of your pregnancy. Any person who is sexually active is at least potentially at risk for HIV infection. Many people who are HIV positive do not belong to any particular high risk group, such as drug users.

HIV in pregnancy has potentially serious implications for mother and baby. We now  have the capacity to offer medications in pregnancy to help prevent transmission of the  virus to the baby. Obviously, we cannot offer medications unless we know your HIV  status. Most women will have a normal or negative result and will be relieved by having  this information. If you do test positive, we will help you in obtaining specialized care  for both yourself and your baby.

Prenatal Care Plan

3. Have a list of questions to ask your doctor.  

Depending on your unique situation, you may have many different questions for your doctor. Here are our top 10 questions all women should ask at their first prenatal visit:

• Are there changes I should make to my diet? Throughout your pregnancy, try to consume a wide variety of foods, including lean meats, whole grains, fruits, vegetables and unsaturated fats. Many women also take prenatal vitamins. Talk to your doctor about specific dietary recommendations.
• What foods should I avoid during pregnancy? Pregnant women should avoid raw or undercooked seafood such as sushi. Avoid unwashed fruits or vegetables to reduce your risk of congenital toxoplasmosis. Your doctor will look at your diet and help you avoid other foods that may harm your baby.
• How much weight should I expect to gain during my pregnancy? Healthy weight gain ranges depend on your pre-pregnancy BMI. Your doctor will help you establish healthy weight gain goals.
• How much should I be exercising? Regular exercise can reduce or prevent back pain, prevent excessive weight gain, and reduce the risk of gestational diabetes and high blood pressure. However, pregnant women should avoid activities with a high risk of falling or abdominal trauma, exercise at high altitudes, and scuba diving. Ask your doctor if you have questions about specific activities.
• Can I travel during my pregnancy? Many pregnant women drive throughout their pregnancies. Many women also fly until late in their pregnancies, and most airlines allow travel up to 37 weeks gestation. Talk to your doctor about safety measures to take when traveling.
• Will I be able to work throughout my pregnancy? Although you may need certain adjustments to your work style, in general, women can plan to work throughout a pregnancy. Talk to your doctor about strategies to stay comfortable at work, and what to do if you need special accommodations.  
• Can I continue taking my current medications? Few medications have been approved to be used during pregnancy. However, certain medications have not been shown to increase the risk of birth defects or adverse pregnancy outcomes when taken as directed. Before you take any medication during pregnancy, it’s important to weigh the severity of your symptoms against the possible risks to your baby. Ask your doctor for more information about specific medications.
• When will my next appointment be? For an uncomplicated pregnancy, women should plan to see their provider every 4 weeks through 28 weeks, every 2 weeks between 28 and 36 weeks, and weekly from 36 weeks to delivery. Your doctor may wish to see you more frequently if you have a high-risk pregnancy. Talk to your doctor about a plan for your prenatal care during this first appointment.
• Do you recommend any type of prenatal screening or testing? Depending on factors like your family medical history and your ethnic background, your doctor may recommend prenatal screening or testing. The decision to pursue prenatal screening or testing is personal, and there is no one right path. Your doctor will help you make an informed decision that is right for you.
• Do you recommend any prenatal classes? To prepare for delivery, you may also want to take a prenatal class. There are many different options for delivery, so you’ll want to choose a class that fits your needs. Ask your doctor about finding the right class for you.

Use these recommendations to make the most of your first prenatal visit . And remember – don’t be afraid to reach out to your doctor with questions! Your health, and your baby’s health, is their priority.

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Effective 3/13/23, ARC transitions to optional masking for our staff and physicians, with required masking during specific situations. Read more .

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Llene y envíe los paquetes de renovación y las solicitudes de información a tiempo. Comuníquese con la HHSC para reportar cualquier cambio (como información de contacto, si hay un embarazo y cambios en el hogar) lo antes posible.

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Actualice su información en YourTexasBenefits.com o llame al 2-1-1 y seleccione la opción 2.

COVID-19 vaccine update - 3/17/24

ARC has a limited supply of COVID-19 vaccines from Pfizer for ages 6 months and up. Patients can request the vaccine at already-scheduled visits. You can also schedule online at MyChartARC.com or call 512-272-4636. If online scheduling is not available, please check back frequently as COVID vaccine quantities change.

Actualización Sobre Renovando la Cobertura de Medicaid 

Como respuesta a la pandemia de COVID-19, el gobierno federal declaró una Emergencia de Salud Pública (PHE, por sus siglas en inglés) y aprobó una ley que le permitió a usted mantener automáticamente su cobertura de Medicaid (cobertura continua de Medicaid). Según la nueva ley federal, la elegibilidad para la cobertura continua de Medicaid se terminará el 31 de marzo, de 2023, por eso necesita renovar sus beneficios cuando se llegue el momento para asegurar que su cobertura va a continuar si usted todavía es elegible.

Pacientes deben buscar avisos de la HHSC en sobres AMARILLOS con el texto “ACCIÓN REQUERIDA” en letras ROJAS. Los avisos llegarán por correo y/o a través del portal en línea si los clientes eligieron recibir avisos electrónicos. Deberían responder con rapidez cuando lo reciban. 

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Due to technical maintenance, ARC MyChart will be unavailable  7pm Saturday, March 23 to 7:00am Sunday, March 24.

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• Health & Wellness
• Specialties & Services

A complete guide to prenatal care visits

February 07, 2024 2 min read

"One step in ensuring a healthy pregnancy involves regular prenatal care visits," says Shao-Chun Rose Chang-Jackson, MD, FACOG, Obstetrics/Gynecology (Ob/Gyn) at ARC Center Street in Kyle. "Each and every visit plays a crucial role in monitoring the well-being of both the expectant mother and the developing baby."

In this guide, we will walk you through the essential aspects of prenatal care visits, providing insights into when to schedule, what to expect, and the topics that might be covered.

How soon should you see an Ob/Gyn for a prenatal care visit?

One of the first steps toward a healthy pregnancy is scheduling your first prenatal care appointment with an Ob/Gyn. Ideally, this should be done as soon as you discover you're pregnant. Early prenatal care is associated with numerous benefits, including the identification and management of potential issues, creating a solid foundation for a healthy pregnancy.

What happens during your first prenatal visit?

Your first prenatal care visit is a crucial milestone, setting the tone for the entire pregnancy. The visit typically involves a comprehensive discussion about your health, medical history, and lifestyle. Expect your Ob/Gyn to cover topics such as your pregnancy history, underlying health conditions, medications, and any concerns you might have. Physical examinations, including a pelvic exam, pap smear, and blood tests, may also be conducted to assess your overall health.

Topics your Ob/Gyn might discuss during a prenatal visit

Subsequent prenatal care visits will delve into various aspects of your pregnancy. Your Ob/Gyn may discuss your weight, emotional well-being, and any signs of depression or stress. Topics such as diabetes management, potential complications, and lifestyle adjustments will be addressed to ensure a smooth and healthy pregnancy. These visits may also include guidance on things to avoid while pregnant, safety measures, and preparations for childbirth.

How often are prenatal care visits typically scheduled?

The frequency of prenatal care visits is often determined by the trimester and whether it's a low-risk or high-risk pregnancy. In the first trimester, monthly visits are common, increasing to bi-weekly or weekly as the due date approaches. High-risk pregnancies may require more frequent monitoring to address specific concerns and ensure the well-being of both mother and baby.

"From those initial appointments to the regular checkups, each prenatal visit is a positive step in ensuring the well-being of both you and your baby," says Dr. Chang-Jackson. "You and your Ob/Gyn are a team, working together to make your pregnancy journey not only healthy but also joyful. Following a regular prenatal care schedule will be key to achieving this goal."

Don't forget pre-pregnancy care visits!

In a recent ARC DocTalk video, Dr. Chang-Jackson also reviewed the importance of a pre-pregnancy exam. "When you decide that you want to have a baby, you should visit your Ob/Gyn before the pregnancy begins," said Dr. Chang-Jackson. "You want to make sure that you're in the best health possible." Learn more about the pre-pregnancy exam.

Make an appointment today

ARC Ob/Gyn doctors are primary care physicians who focus on women's health issues, including pregnancy, fertility, birth control, mammograms, menopause, STI (STD) testing, ultrasounds, and more.

Let Dr. Chang-Jackson help you with your pregnancy journey or other women's health issues today. Dr. Chang-Jackson accepts new patients, ages 12 and older, at ARC Center Street in Kyle. Call 737-404-0347 or make an appointment online through MyChart or ARC Help Me Book today.

• Related Items:
• Shao-Chun Chang-Jackson, MD, FACOG
• ARC Center Street
• Preparing for Pregnancy
• Obstetrics/Gynecology

Tags: Women's Health, Prenatal Care, Prenatal Visits

Pregnancy Tips

When to Schedule First Prenatal Visit: A Guide for Expecting Mothers

Table of Contents

Short answer when to schedule first prenatal visit:

The first prenatal visit should ideally be scheduled within the first 8-10 weeks of pregnancy. Prompt scheduling allows for early detection of any potential complications and enables healthcare providers to establish a comprehensive prenatal care plan.

When to Schedule Your First Prenatal Visit: A Step-by-Step Guide

Congratulations on your pregnancy! This exciting journey comes with a multitude of important decisions, and one of the first steps you’ll need to take is scheduling your first prenatal visit. It’s crucial to receive proper prenatal care to ensure both your health and the wellbeing of your growing baby.

So, when exactly should you schedule this all-important visit ? Let’s break it down step-by-step and guide you through this process.

Step 1: Confirm Your Pregnancy The moment you suspect that you might be pregnant, it’s essential to take a home pregnancy test. These tests are readily available at pharmacies or online and provide accurate results within minutes. Once the test confirms your pregnancy, it’s time to move on to step two.

Step 2: Consult with Your Healthcare Provider Reach out to your healthcare provider as soon as possible after confirming your pregnancy. They are best equipped to guide you through this exciting but overwhelming phase of life. Whether it be an obstetrician-gynecologist (OB/GYN), family physician, or midwife – they will work with you throughout your pregnancy journey.

If you don’t already have a trusted healthcare provider, now is the perfect time to start looking for one who specializes in prenatal care. Seek recommendations from friends, family members, or even online forums dedicated to motherhood experiences in your area.

Once you find a potential provider, set up an initial consultation where they will confirm your pregnancy results through additional tests if necessary.

Step 3: Time for Your First Prenatal Visit With confirmation of pregnancy and a healthcare provider onboard, it’s finally time for that highly anticipated first prenatal appointment!

Typically, most providers recommend scheduling this initial visit between week six and eight of your pregnancy. Opting for an early appointment allows them to establish an accurate due date based on several factors such as gestational age and the date of your last menstrual period.

Step 4: Discussion and Examinations During your first prenatal visit, expect a comprehensive discussion about your medical history and any pre-existing conditions that may impact your pregnancy. Your provider will ask questions regarding previous pregnancies, surgeries, allergies, medications you’re currently taking, and family medical history.

The physical examination will likely include blood pressure monitoring, height and weight measurements, breast examination, and an abdominal examination to assess the uterus’s size. Some providers may also conduct pelvic exams or Pap tests during this visit. Rest assured that these examinations are routine procedures performed to ensure a healthy pregnancy.

Step 5: Laboratory Tests Following the discussions and initial examinations, your healthcare provider may recommend various laboratory tests to gather essential information about both you and your baby’s health. These tests commonly include blood work to check for blood type, Rh factor compatibility with the baby, immunity to certain diseases like Rubella or Varicella-Zoster Virus (chickenpox), as well as HIV screening.

In addition to blood work, urine samples are typically required for urinalysis and screening for urinary tract infections or gestational diabetes.

Step 6: Ultrasound Examination Your first prenatal visit may also involve an ultrasound examination known as a dating scan. This non-invasive procedure uses high-frequency sound waves to create images of the growing fetus inside your womb. The dating scan helps determine accurate gestational age by measuring the baby’s size and confirming whether it is developing normally.

This exciting experience often provides expecting parents with their first glimpse of their tiny miracle!

Step 7: Follow-Up Appointments After completing your initial prenatal visit successfully, your healthcare provider will discuss a follow-up schedule tailored to meet your specific needs. Typically, subsequent appointments occur every four weeks until around week 30 of pregnancy when they become more frequent (every two weeks) until delivery.

Remember that each pregnancy is unique and requires individualized care, so your provider may adjust the frequency of appointments based on any complications or concerns.

In conclusion, scheduling your first prenatal visit involves several crucial steps to ensure a healthy pregnancy. It’s important to follow this step-by-step guide, starting with confirming your pregnancy, consulting with a healthcare provider, and finally attending your initial prenatal visit. From there, you can rest assured knowing you’re receiving expert guidance and care throughout this remarkable journey towards motherhood.

FAQ: When is the Best Time to Schedule Your First Prenatal Visit?

Congratulations! You’ve just found out that you’re expecting a baby, and the excitement is probably bubbling over. Amidst all the anticipation and joy, it’s important to remember to take care of the practical aspects of your pregnancy journey – including scheduling your first prenatal visit. So, when exactly is the best time to do this? Don’t fret; we’ve got you covered with all the information you need.

The ideal timing for your first prenatal visit can depend on a few factors, such as whether you have any pre-existing medical conditions, whether this is your first pregnancy or not, or if there are any complications or concerns about your health or the health of your baby. It’s always best to consult with your healthcare provider about their specific recommendations based on these factors – they will tailor their advice to suit you personally.

That being said, in general, most experts suggest scheduling your first prenatal appointment around eight weeks into your pregnancy. By this time, hormonal changes would have occurred enough for a reliable confirmation of pregnancy through various tests – ensuring accurate results and reassuring news for hopeful parents-to-be.

Why precisely eight weeks? Well, at this stage, your healthcare provider can perform an ultrasound examination to confirm the viability of your pregnancy by detecting fetal heartbeat(s) and determining gestational age more accurately. This is an exciting moment because hearing that little heartbeat for the first time can bring tears of joy (and perhaps some relief too!) to any expectant parent.

Moreover, during this visit, both you and your healthcare provider will engage in a plethora of discussions related to essential issues surrounding prenatal care. They will inquire about your medical history—any pre-existing conditions like diabetes, high blood pressure—as well as discuss genetic testing options if desired or necessary. These conversations create opportunities for personalized care plans tailored specifically for YOU.

Excitingly enough, it’s quite common during this initial appointment to receive valuable insights into maintaining a healthy lifestyle throughout your pregnancy. Your healthcare provider will likely provide guidance on nutrition, exercise, and prenatal vitamins that are crucial for your baby’s development and your overall well-being. They may also discuss any discomfort you might be experiencing, such as morning sickness or mood swings (which can occasionally turn into comedic tales that make great conversation at parties!).

Now, we’re aware that eight weeks may sometimes seem like a long wait when the anticipation is palpable. It’s natural to feel eager to share every small detail with your healthcare provider right from the get-go. But bear in mind that there are sound medical reasons behind waiting until this point – those precious eight weeks allow your body enough time to adjust to the changes of early pregnancy.

In cases where women have previously experienced complications or concerns—such as miscarriages or birth defects—it might be advisable to schedule an appointment even earlier than eight weeks. Remember, trust yourself and listen closely to what your body tells you – if you feel uneasy about anything, don’t hesitate to contact your healthcare provider promptly.

Ultimately, determining the best time for scheduling a prenatal visit can never fit into a one-size-fits-all approach. Every pregnancy is unique, so please consult with your trusted healthcare provider who has access to all pertinent information about both you and your unborn child.

So there you have it – scheduling your first prenatal visit around eight weeks is generally considered the sweet spot for most women embarking on this beautiful journey of motherhood. This appointment will provide you with valuable insights into maintaining a healthy pregnancy while ensuring that both you and your little miracle receive top-notch care.

Remember, it’s not only about accepting medical advice during these visits; it’s also an opportunity for heart-to-heart conversations with professionals who understand just how extraordinary this phase of life truly is. So go ahead, embrace those witty anecdotes and clever quips; after all, laughter plays its own part in ensuring a positive journey towards welcoming your bundle of joy!

The Importance of Timing: When to Schedule Your First Prenatal Appointment

When it comes to pregnancy, timing is everything. From determining your due date to monitoring the health of both you and your baby, timely prenatal care plays a crucial role in ensuring a healthy and successful pregnancy. So, let’s dive into the importance of timing when it comes to scheduling your first prenatal appointment.

Firstly, it’s essential to understand that early prenatal care is vital for both maternal and fetal well-being. By visiting your healthcare provider as soon as you suspect you’re pregnant or have confirmed with a home pregnancy test, you give yourself the best chance of receiving necessary medical support from the start.

So when should you schedule that all-important first appointment ? Generally, most healthcare professionals recommend making an appointment within the first eight weeks of pregnancy. This early visit allows your doctor or midwife to establish a baseline for your health and begin monitoring any potential risks or complications.

One significant reason why timing matters profoundly is that certain conditions can be detected early on through specific tests during this initial appointment. For example, screenings like blood tests and ultrasounds can assess the risk of chromosomal abnormalities in fetuses while also evaluating genetic disorders. Detecting these concerns early allows for ample time to discuss possible next steps and create a comprehensive plan tailored specifically to you and your baby’s needs.

Moreover, scheduling an early prenatal appointment enables healthcare providers to address any existing health issues you may have before they potentially impact your pregnancy journey. Conditions such as high blood pressure, thyroid problems, or diabetes can significantly impact both maternal health and fetal development if left unmanaged during pregnancy.

The timing of this initial visit also presents an opportunity to receive important information about lifestyle changes that need careful consideration during pregnancy. Your healthcare provider will guide you on proper nutrition, exercise routines suitable for each trimester, avoiding harmful substances like alcohol or tobacco use, and addressing any concerns related to medications.

Beyond these medical considerations lies another element where timing takes center stage: emotional support. The early prenatal appointment can be a transformative experience, particularly for first-time parents. Navigating the journey of pregnancy and parenthood can be overwhelming, but by scheduling your visit at the right time, you’ll have the comfort of knowing that you’re not alone.

Additionally, starting prenatal care early allows ample time for guidance on managing common discomforts associated with pregnancy like morning sickness or fatigue. Your healthcare provider can provide insightful advice to address these challenges effectively, ensuring a more comfortable and enjoyable journey throughout these nine months.

In conclusion, timing is crucial when it comes to scheduling your first prenatal appointment. By proactively seeking care within the recommended timeframe, you give yourself and your baby the best chance at a healthy pregnancy. From detecting potential complications early to receiving vital information and support for both physical and emotional well-being, proper timing ensures that you receive optimal care from day one. So make that call today and embark on this exciting chapter of your life with confidence!

How and Why You Should Schedule Your First Prenatal Visit

How and Why You Should Schedule Your First Prenatal Visit: Unveiling the Essential Steps to a Healthy Pregnancy

Congratulations! You’ve just received one of life’s most exciting news – you’re pregnant! As you embark on this remarkable journey towards motherhood, it’s imperative to prioritize your health and well-being, not only for your sake but also for the precious little one growing inside you. And that’s where scheduling your first prenatal visit comes into play.

But why is it so crucial to have these visits? What exactly happens during them? And how can you ensure a smooth sailing and enjoyable experience during this period? Fear not, dear expectant mothers; we’re here to address all your queries in this comprehensive guide on How and Why You Should Schedule Your First Prenatal Visit.

The Importance of Prenatal Visits: Wellness Above All Else

First things first – what makes these prenatal appointments such a vital step in your pregnancy journey? Well, these visits allow healthcare professionals, including doctors or midwives, to monitor both your health and the development of your unborn child. It serves as a platform for regular check-ups, ensuring any potential complications are detected early on and appropriate actions are taken promptly.

Moreover, prenatal visits open up an avenue for valuable education. Experienced specialists provide invaluable guidance on diet, exercise routines, medications (if necessary), emotional support, childbirth classes, breastfeeding assistance – essentially everything you need to know to foster a healthy pregnancy. These interactions empower expectant mothers with knowledge that will pave the way towards making informed decisions throughout their pregnancy.

Booking Your First Prenatal Visit: The Sooner, The Better!

Now that we understand its significance let’s delve into when and how should you schedule your first prenatal visit. Typically speaking, experts recommend making an appointment as soon as you confirm with a home pregnancy test or receive confirmation from a medical professional. This ensures early access to essential care recommendations aiding in the healthy growth of your baby.

To initiate this process, reach out to your healthcare provider, be it a general practitioner or an obstetrician/gynecologist (OB/GYN). Communicate your pregnancy news and inquire about the earliest available slot. Some providers even have designated prenatal clinics catering exclusively to expectant mothers. If possible, bring along any medical records you have that pertain to previous pregnancies, surgeries, or chronic conditions. These documents enable healthcare professionals to have a comprehensive understanding of your medical history.

The Journey Begins: What Happens During Your First Prenatal Visit?

As you set foot into your first prenatal visit, let’s explore the typical elements that constitute these appointments:

1. Initial Intake: Your healthcare professional will begin by assessing vital details such as height, weight, blood pressure, and other general health parameters. 2. Medical History Review: Expect a series of questions delving into previous pregnancies (if any), family history of genetic disorders or birth complications, past surgeries or procedures – essentially anything contributing to your overall health status. 3. Laboratory Tests: To establish a baseline for future comparisons, healthcare providers may request blood work and urine analysis for further assessments. 4. Pelvic Examination: A part of routine care includes a gentle pelvic exam and pap smear test to check the cervix and ensure its optimal health. 5. Ultrasound Magic: Brace yourself for an ethereal moment – hearing or seeing the baby’s heartbeat through ultrasound is often one of the highlights during this visit! 6. Health Education & Counseling: Prepare to receive a wealth of valuable information related to nutrition during pregnancy; potential risk factors like smoking or alcohol consumption; safe exercises; recommended supplements; emotional well-being maintenance tips, et al.

Maximizing Your Prenatal Visit Experience

While all this might appear daunting or overwhelming at first glance, remember that this is just the beginning – the starting point on an incredible journey. To make the most out of your prenatal visits, here are some tips to ensure a smoother experience:

1. Come Prepared: Keep a journal or app handy to jot down questions or concerns you may have leading up to the visit. This helps you stay organized and ensures that all your queries get addressed promptly. 2. Enlist Support: Involve your partner or a close family member in these appointments, as their presence provides emotional reinforcement and ensures they are well-informed about the pregnancy progress. 3. Open Communication: Establish an honest and open dialogue with your healthcare provider. Share any discomforts, anxieties, or issues you encounter throughout the process – remember that they are here to support and guide you.

Now that we’ve unveiled the importance of scheduling your first prenatal visit, along with some insider tips for maximizing this experience let’s embark on this magnificent journey towards motherhood together! Cherish each step of this remarkable adventure – for it is one filled with love, joy, and countless moments of awe-inspiring wonderment!

Common Questions Answered: When to Book Your Initial Prenatal Appointment

Welcome to our blog series where we address common questions and concerns related to prenatal care. In today’s post, we’ll tackle the topic of when to book your initial prenatal appointment – a question that often leaves expecting parents feeling confused and uncertain. With so much information out there, it can be overwhelming to figure out the right time to schedule that all-important first visit with your healthcare provider.

Before we dive into the nitty-gritty details, let’s remind ourselves why booking an initial prenatal appointment is crucial. This appointment sets the foundation for a healthy pregnancy by allowing you and your provider to establish a relationship, discuss any pre-existing conditions or risks, address any concerns you may have, and create a personalized care plan tailored specifically to you and your growing baby.

Now let’s move on to the main event – when should you book this highly anticipated appointment? The short answer: as soon as possible! But don’t worry; we’re here to break this down for you in a way that helps alleviate any stress or confusion.

First things first, once you discover those two little lines on that pregnancy test or receive confirmation from a medical professional, it’s time to start thinking about scheduling that initial prenatal visit. The sooner you get in touch with your healthcare provider’s office, the better chances are of securing an appointment during the crucial early weeks of pregnancy.

So why are those early weeks so important? Well, during this time, various tests and screenings can be done that offer valuable insight into your baby’s development and overall health. Plus, it gives both you and your healthcare provider ample time to create an effective prenatal care plan suited specifically for your unique needs.

But wait – what if morning sickness has hit you like a ton of bricks? Fear not! We understand how debilitating those pesky symptoms can be. If severe morning sickness interferes with contacting your healthcare provider immediately after getting that positive test result, no need to fret. In such cases, it’s always a good idea to reach out to your provider as soon as you feel able to do so. They will work with you to accommodate your situation and find the best available appointment slot.

Now, let’s tackle some common myths and misconceptions that may cloud the decision-making process when it comes to scheduling that initial prenatal visit.

Myth #1: “I haven’t missed my period yet, so there’s no need to schedule an appointment.”

While missing a period is commonly associated with pregnancy, it shouldn’t be used as the sole indicator for booking your first prenatal visit. Remember, every woman is different, and pregnancies can vary significantly from person to person. Scheduling an appointment early on provides you with optimal guidance and support during this exciting journey.

Myth #2: “I am feeling great; I don’t need an appointment just yet.”

Feeling fantastic? That’s wonderful! However, even if you’re experiencing minimal or no pregnancy-related discomforts, an early prenatal visit serves as a preventive measure. It allows your healthcare provider to closely monitor any potential issues before they become problematic – ensuring a healthy pregnancy for both you and your baby.

Myth #3: “I already have a general practitioner; I don’t need a separate prenatal appointment.”

While having a primary care physician is undoubtedly valuable, booking an initial prenatal visit with an obstetrician or midwife who specializes in pregnancy care brings its own set of advantages. These specialists possess the expertise necessary to handle the unique challenges that come with gestation and childbirth – giving you the best possible care during this significant stage of life.

In conclusion, whether those two lines appeared on your test yesterday or several weeks ago, booking your initial prenatal appointment sooner rather than later is essential. This foundational step in your pregnancy journey ensures that both you and your growing baby receive the highest standard of healthcare from day one.

So what are you waiting for? Pick up that phone, schedule that appointment and let the excitement of this miraculous journey begin! Remember, you’re not alone – our healthcare providers are here to guide and support you every step of the way.

What to Expect at Your First Prenatal Visit: Scheduling a Timely Appointment

Are you eagerly counting down the days until your first prenatal visit? Congratulations on this exciting new chapter in your life! As you prepare for this important appointment, it’s essential to understand what to expect and how to schedule a timely visit . Don’t worry; we’ve got you covered with all the information you need.

Scheduling your first prenatal visit should ideally happen as soon as you find out that you’re expecting. Time is of the essence when it comes to ensuring a healthy and successful pregnancy, so making an appointment promptly is crucial. However, before diving into the nitty-gritty of scheduling, let’s talk about what happens during this initial visit.

Your first prenatal visit serves as a foundational milestone where you establish a connection with your healthcare provider and embark on an incredibly personalized journey. During this appointment, your doctor or midwife will gather comprehensive information about your medical history, discuss any pre-existing conditions or concerns that may impact your pregnancy, and address any questions you might have.

Expect thorough discussions around family medical history, as this information helps identify potential hereditary issues that could affect your baby’s health. Your healthcare provider will also ask about previous pregnancies (if any) and birth experiences to gain valuable insights.

Since every woman is unique, tailored advice about exercise routines and diet choices suited specifically for pregnant women will be shared during the first prenatal visit. Understanding which foods are safe and which ones should be avoided is pivotal in ensuring the optimal development of your baby.

Additionally, vital routine tests are conducted during this visit to determine your overall health status and assess any risk factors that may require further attention. These tests typically include blood work for various parameters such as blood type analysis, complete blood count (CBC), testing for HIV and other sexually transmitted infections (STIs), screening for genetic disorders if desired or indicated, urine test to check for urinary tract infections (UTIs), and possibly more depending on individual circumstances.

Now getting back to scheduling a timely appointment – let’s break it down. As mentioned earlier, time is of the essence when it comes to prenatal care. Once you find out you’re expecting, promptly pick up the phone and call your preferred healthcare provider or clinic specializing in prenatal care. They will guide you on the next steps and ensure that an appointment is scheduled as soon as possible.

It’s crucial to keep in mind that providers tend to have busy schedules due to the high demand for their services. Therefore, don’t be discouraged if you can’t get an appointment for the very next day. While every effort should be made to book a timely visit, there may be a slight waiting period depending on availability.

In case you encounter any roadblocks while trying to schedule your first prenatal visit, consider reaching out to multiple healthcare providers or clinics in your area. This way, you increase your chances of finding an available slot earlier rather than later.

Another option worth exploring is seeking recommendations from friends or family members who have been through pregnancies themselves. They might have valuable insights into efficient ways of securing an early appointment with reputable healthcare providers.

Lastly, if you find yourself unable to secure an immediate prenatal visit despite proactive efforts, remember not to panic or stress excessively; it is important not only for your mental well-being but also for promoting a positive pregnancy experience. Instead, utilize this waiting period by taking care of yourself and adopting healthy habits e.g., ensuring proper nutrition, engaging in light exercise (if permitted by your doctor) like walking or swimming, practicing mindfulness techniques such as meditation or yoga which can help alleviate stress levels associated with pregnancy.

In conclusion, scheduling a timely prenatal visit sets the stage for a successful and joyful journey towards motherhood. Remember that each pregnancy is unique; thus, establishing good communication with your healthcare provider during this initial visit lays a strong foundation for personalized care throughout your pregnancy. So pick up that phone and make that appointment because your exciting journey to motherhood begins now.

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