My favorite thing about OB is establishing a relationship with you and your family. I just had a visit with a kindergartner I delivered six years ago. That’s fun for both the family and me. I know the patients well, and the kids are comfortable with me.
Your first prenatal appointment is the start of that relationship. We’ll tailor the visit to your level of pregnancy knowledge, but there are a few things that need to happen no matter what your particular situation.
1. Determine how far along you are
The over-the-counter pregnancy test you took at home is a qualitative test, meaning it’s either positive or negative. But it doesn’t help us know how far along you are, which is important to gauge whether your baby is developing at the right pace throughout your pregnancy.
If you know for sure your period is every four weeks and you can set your calendar by it, that makes it easier to determine how far along you are. When we can hear the baby’s heartbeat and everything in your exam matches up with when you had your last period, we can be pretty sure of your due date.
If your period is more irregular or you can’t remember when you had it last, we have other methods including a blood test and what’s known as a dating ultrasound.
If you test at home right away after you think you’re pregnant, like two to five days before you’re supposed to have your period, it’s too early for an ultrasound to determine your due date. Dating ultrasounds are best done six to 10 weeks after your last period.
The blood test is called a quantitative beta HCG test, and it measures the level of a pregnancy hormone in your blood.
There’s a threshold number – roughly 1,500 – when we expect to be able to accurately set a due date. If your quantitative test is low, we might just need to do that test again in two or three days. In almost all normal pregnancies, we anticipate that every 48 to 72 hours that number should double.
2. Get a detailed medical history
We go through a very robust medical history: the mom’s history, the dad’s history, the family history – anything that pertains to the baby’s genetics. We’ll ask you about Down Syndrome, genetic diseases, and any spinal cord issues, brain defects, or congenital birth defects in the family.
We’ll go through your vaccination history. The ones we would be most concerned about are rubella (also known as German measles) and varicella (also known as chicken pox). Both rubella and chicken pox can cause birth defects. And once you’re pregnant, you’ll have to wait to get vaccinated for these two illnesses.
But there are many other vaccines you can safely get while pregnant, and we’ll review what you need. We can look up a lot of that if you’ve had your vaccinations in Minnesota. If you’ve not been seen at a Fairview location before or if you’ve had your vaccinations out of state, it would be helpful to bring your records with you.
Be prepared to discuss what medications you’re taking, including over-the-counter medications and herbal supplements.
Two other things we particularly want to know about your health is if you have diabetes or high blood pressure. Those will require extra precautions during your pregnancy. We’ll also discuss what exercise you can still do and how much weight you should expect to gain.
3. Draw blood for lab tests
At some clinics, including mine, we try to get your lab tests before your visit with me. But if that hasn’t happened, we’ll take your blood at the appointment.
First of all, we want to know your blood type. There’s more screening that happens if you’re RH negative. If mom’s blood type is RH negative and baby’s is RH positive, sometimes mommies make antibodies against the baby’s blood. We can give you a preventative medication called RhoGAM to keep you from making those antibodies.
We’ll assess your red blood count and make sure your hemoglobin is okay. If you’re anemic (meaning a low red blood count), we’ll make sure you get extra iron with your prenatal vitamin.
We also do basic screening tests that could have implications for the pregnancy: HIV, hepatitis B, syphilis, chlamydia. These are all sexually transmitted infections, and if they cross the placenta, they could affect the baby or create complications for delivery. I always tell patients that I trust you don’t have them, but I still have to do the tests. It’s double-checking to make sure we don’t have to worry.
We also screen your urine for other types of bacteria.
4. Perform a pelvic exam
A pelvic exam gives me an idea if I should expect any issues with a vaginal delivery. Rarely have I recommended against a women having a vaginal delivery. But depending on your medical history or the shape or size of your pelvis, it may increase the risk for you or baby and we just want to be prepared.
If you’re far enough along, I can also check the size of the baby and make sure it’s matching up with expected size.
5. Answer your questions
I get questions from new moms about every possible topic. At the first visit, nausea is a big one. I’ve had a lot of personal experience with that, because my wife had a lot of issues with nausea during our three pregnancies. By now, there are few questions I haven't already heard and I look forward to answering yours.
The first visit is a lot of Q&A – for both you and me – and a lot of prep work for what the rest of the pregnancy will be like. We’re setting the stage for your prenatal care, how often you’re going to need to see me, and preparing for the main event – your delivery.
It may seem overwhelming, but we do all we can to guide you through it. My job is to be with you every step of the way.