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Prenatal care: 1st trimester visits

Pregnancy and prenatal care go hand in hand. During the first trimester, prenatal care includes blood tests, a physical exam, conversations about lifestyle and more.

Prenatal care is an important part of a healthy pregnancy. Whether you choose a family physician, obstetrician, midwife or group prenatal care, here's what to expect during the first few prenatal appointments.

The 1st visit

When you find out you're pregnant, make your first prenatal appointment. Set aside time for the first visit to go over your medical history and talk about any risk factors for pregnancy problems that you may have.

Medical history

Your health care provider might ask about:

• Your menstrual cycle, gynecological history and any past pregnancies
• Your personal and family medical history
• Exposure to anything that could be toxic
• Medications you take, including prescription and over-the-counter medications, vitamins or supplements
• Your lifestyle, including your use of tobacco, alcohol, caffeine and recreational drugs
• Travel to areas where malaria, tuberculosis, Zika virus, mpox — also called monkeypox — or other infectious diseases are common

Share information about sensitive issues, such as domestic abuse or past drug use, too. This will help your health care provider take the best care of you — and your baby.

Your due date is not a prediction of when you will have your baby. It's simply the date that you will be 40 weeks pregnant. Few people give birth on their due dates. Still, establishing your due date — or estimated date of delivery — is important. It allows your health care provider to monitor your baby's growth and the progress of your pregnancy. Your due date also helps with scheduling tests and procedures, so they are done at the right time.

To estimate your due date, your health care provider will use the date your last period started, add seven days and count back three months. The due date will be about 40 weeks from the first day of your last period. Your health care provider can use a fetal ultrasound to help confirm the date. Typically, if the due date calculated with your last period and the due date calculated with an early ultrasound differ by more than seven days, the ultrasound is used to set the due date.

Physical exam

To find out how much weight you need to gain for a healthy pregnancy, your health care provider will measure your weight and height and calculate your body mass index.

Your health care provider might do a physical exam, including a breast exam and a pelvic exam. You might need a Pap test, depending on how long it's been since your last Pap test. Depending on your situation, you may need exams of your heart, lungs and thyroid.

At your first prenatal visit, blood tests might be done to:

• Check your blood type. This includes your Rh status. Rh factor is an inherited trait that refers to a protein found on the surface of red blood cells. Your pregnancy might need special care if you're Rh negative and your baby's father is Rh positive.
• Measure your hemoglobin. Hemoglobin is an iron-rich protein found in red blood cells that allows the cells to carry oxygen from your lungs to other parts of your body. Hemoglobin also carries carbon dioxide from other parts of your body to your lungs so that it can be exhaled. Low hemoglobin or a low level of red blood cells is a sign of anemia. Anemia can make you feel very tired, and it may affect your pregnancy.
• Check immunity to certain infections. This typically includes rubella and chickenpox (varicella) — unless proof of vaccination or natural immunity is documented in your medical history.
• Detect exposure to other infections. Your health care provider will suggest blood tests to detect infections such as hepatitis B, syphilis, gonorrhea, chlamydia and HIV , the virus that causes AIDS . A urine sample might also be tested for signs of a bladder or urinary tract infection.

Tests for fetal concerns

Prenatal tests can provide valuable information about your baby's health. Your health care provider will typically offer a variety of prenatal genetic screening tests. They may include ultrasound or blood tests to check for certain fetal genetic problems, such as Down syndrome.

Lifestyle issues

Your health care provider might discuss the importance of nutrition and prenatal vitamins. Ask about exercise, sex, dental care, vaccinations and travel during pregnancy, as well as other lifestyle issues. You might also talk about your work environment and the use of medications during pregnancy. If you smoke, ask your health care provider for suggestions to help you quit.

Discomforts of pregnancy

You might notice changes in your body early in your pregnancy. Your breasts might be tender and swollen. Nausea with or without vomiting (morning sickness) is also common. Talk to your health care provider if your morning sickness is severe.

Other 1st trimester visits

Your next prenatal visits — often scheduled about every four weeks during the first trimester — might be shorter than the first. Near the end of the first trimester — by about 12 to 14 weeks of pregnancy — you might be able to hear your baby's heartbeat with a small device, called a Doppler, that bounces sound waves off your baby's heart. Your health care provider may offer a first trimester ultrasound, too.

Your prenatal appointments are an ideal time to discuss questions you have. During your first visit, find out how to reach your health care team between appointments in case concerns come up. Knowing help is available can offer peace of mind.

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• Lockwood CJ, et al. Prenatal care: Initial assessment. https://www.uptodate.com/contents/search. Accessed July 9, 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.
• Lockwood CJ, et al. Prenatal care: Second and third trimesters. https://www.uptodate.com/contents/search. Accessed July 9, 2018.
• WHO recommendations on antenatal care for a positive pregnancy experience. World Health Organization. http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/anc-positive-pregnancy-experience/en/. Accessed July 9, 2018.
• Bastian LA, et al. Clinical manifestations and early diagnosis of pregnancy. https://www.uptodate.com/contents/search. Accessed July 9, 2018.

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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.

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What happens during prenatal visits?

What happens during prenatal visits varies depending on how far along you are in your pregnancy.

Schedule your first prenatal visit as soon as you think you are pregnant, even if you have confirmed your pregnancy with a home pregnancy test. Early and regular prenatal visits help your health care provider monitor your health and the growth of the fetus.

The First Visit

Your first prenatal visit will probably be scheduled sometime after your eighth week of pregnancy. Most health care providers won't schedule a visit any earlier unless you have a medical condition, have had problems with a pregnancy in the past, or have symptoms such as spotting or bleeding, stomach pain, or severe nausea and vomiting. 1

You've probably heard pregnancy discussed in terms of months and trimesters (units of about 3 months). Your health care provider and health information might use weeks instead. Here's a chart that can help you understand pregnancy stages in terms of trimesters, months, and weeks.

Because your first visit will be one of your longest, allow plenty of time.

During the visit, you can expect your health care provider to do the following: 1

• Answer your questions. This is a great time to ask questions and share any concerns you may have. Keep a running list for your visit.
• Check your urine sample for infection and to confirm your pregnancy.
• Check your blood pressure, weight, and height.
• Calculate your due date based on your last menstrual cycle and ultrasound exam.
• Ask about your health, including previous conditions, surgeries, or pregnancies.
• Ask about your family health and genetic history.
• Ask about your lifestyle, including whether you smoke, drink, or take drugs, and whether you exercise regularly.
• Ask about your stress level.
• Perform prenatal blood tests to do the following:
• Determine your blood type and Rh (Rhesus) factor. Rh factor refers to a protein found on red blood cells. If the mother is Rh negative (lacks the protein) and the father is Rh positive (has the protein), the pregnancy requires a special level of care. 2
• Do a blood count (e.g., hemoglobin, hematocrit).
• Test for hepatitis B, HIV, rubella, and syphilis.
• Do a complete physical exam, including a pelvic exam, and cultures for gonorrhea and chlamydia.
• Do a Pap test or test for human papillomavirus (HPV) or both to screen for cervical cancer and infection with HPV, which can increase risk for cervical cancer. The timing of these tests depends on the schedule recommended by your health care provider.
• Do an ultrasound test, depending on the week of pregnancy.
• Offer genetic testing: screening for Down syndrome and other chromosomal problems, cystic fibrosis, other specialized testing depending on history.

Prenatal Visit Schedule

If your pregnancy is healthy, your health care provider will set up a regular schedule for visits that will probably look about like this: 1

Later Prenatal Visits

As your pregnancy progresses, your prenatal visits will vary greatly. During most visits, you can expect your health care provider to do the following:

• Check your blood pressure.
• Measure your weight gain.
• Measure your abdomen to check your developing infant's growth—"fundal height" (once you begin to "show").
• Check the fetal heart rate.
• Check your hands and feet for swelling.
• Feel your abdomen to find the fetus's position (later in pregnancy).
• Do tests, such as blood tests or an ultrasound exam.

Talk to you about your questions or concerns. It's a good idea to write down your questions and bring them with you.

Several of these visits will include special tests to check for gestational diabetes (usually between 24 and 28 weeks) 3 and other conditions, depending on your age and family history.

In addition, the Centers for Disease Control and Prevention and the American Academy of Pediatrics released new vaccine guidelines for 2013 , including a recommendation for pregnant women to receive a booster of whooping cough (pertussis) vaccine. The guidelines recommend the shot be given between 27 and 36 weeks of pregnancy. 4

• Centers for Disease Control and Prevention. (2013). Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (TDAP) in pregnant women―Advisory Committee on Immunization Practices (ACIP), 2012. Retrieved September 20, 2013, from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6207a4.htm

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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 checkups

Prenatal care is medical care you get during pregnancy. at each prenatal care visit, your health care provider checks on you and your growing baby., call your provider to schedule your first prenatal care checkup as soon as you know you’re pregnant., getting early and regular prenatal care can help you have a healthy pregnancy and a full-term baby., go to all your prenatal care checkups, even if you’re feeling fine..

What is prenatal care and why is it important?

Prenatal care is medical care you get during pregnancy. At each visit, your health care provider checks on you and your growing baby. Call your provider and go for your first prenatal care checkup as soon as you know you’re pregnant. And go to all your prenatal care checkups, even if you’re feeling fine.

Getting early and regular prenatal care can help you have a healthy pregnancy and a full-term baby. Full term means your baby is born between 39 weeks (1 week before your due date) and 40 weeks, 6 days (1 week after your due date). Being born full term gives your baby the right amount of time he needs in the womb to grow and develop.

Don’t be afraid to talk to your provider about personal things. Your provider needs to know all about you so she can give you and your baby the best care. She asks lots of questions about you, your partner and your families. Your medical information and anything you tell her are confidential. This means she can’t share them with anyone without your permission. So don’t be afraid to tell her about things that may be uncomfortable or embarrassing, like if your partner hurts or scares you or if you smoke , drink alcohol , use street drugs or abuse prescription drugs .

Who can you go to for prenatal care?

You can get prenatal care from different kinds of providers:

• An obstetrician/gynecologist (also called OB/GYN) is a doctor who has education and training to take care of pregnant women and deliver babies. The American College of Obstetricians and Gynecologists  can help you find an OB in your area. 
• A family practice doctor (also called a family physician) is a doctor who can take care of every member of your family. This doctor can take care of you before, during and after pregnancy. The American Board of Family Medicine can help you find a family practice doctor in your area. 
• A maternal-fetal medicine (also called MFM) specialist is an OB with education and training to take care of women who have high-risk pregnancies. If you have health conditions that may cause problems during pregnancy, your provider may want you to see a MFM specialist. The Society for Maternal-Fetal Medicine can help you find a specialist in your area.
• A certified nurse-midwife (also called CNM) is a nurse with education and training to take care of women of all ages, including pregnant women. The American College of Nurse-Midwives  can help you find a CNM in your area.
• A family nurse practitioner (also called FNP) or a women’s health nurse practitioner (also called WHNP). A FNP is a nurse with education and training to take care of every member of your family. A WHNP is a nurse with education and training to take care of women of all ages, including pregnant women. The American Association of Nurse Practitioners can help you find these kinds of nurse practitioners in your area.   

Think about these things to help you choose a provider:

• Is the provider licensed and board certified to take care of you during pregnancy, labor and birth? Licensed means the provider can legally practice medicine in a state. To have a license, a provider has to have a certain amount of education and training and pass certain tests to make sure he can safely take care of patients. Board certified means that a provider has had extra training in a certain area (called a specialty).
• Is the provider covered by your health insurance ? 
• Have you heard good things about the provider? Is she recommended by your friends or family? How does your partner feel about her as your prenatal care provider?  
• Would you rather see a man or a woman provider? How old to you want the provider to be? Does he explain things clearly? 
• Is the office easy to get to? Do the office hours fit into your schedule? Is the office staff friendly and helpful? 
• Who takes care of phone calls during office hours? Who handles them after hours or in an emergency? Do you have to pay if your provider spends time with you on the phone? 
• Is the provider in group practice? If yes, will you always see your provider at prenatal care checkups? Or will you see other providers in the practice? Who will deliver your baby if your provider’s not available when you go into labor? 
• What hospital or birthing center does the provider use? What do you know about it? Is it easy for you to get to?  

How often do you go for prenatal care checkups?

Most pregnant women can follow a schedule like this:

• Weeks 4 to 28 of pregnancy. Go for one checkup every 4 weeks (once a month).
• Weeks 28 to 36 of pregnancy. Go for one checkup every 2 weeks (twice a month).
• Weeks 36 to 41 of pregnancy. Go for one checkup every week (once a week).

If you have complications during pregnancy, your provider may want to see you more often.

Your partner or support person (a friend or someone from your family) is welcome at your prenatal checkups.

How can you get ready for your first prenatal care checkup?

Be ready to talk with your provider about:

• The first day of your last menstrual period (also called LMP). Your provider can use this to help find out your baby’s due date .
• Health conditions you have, like depression , diabetes , high blood pressure , and not being at a healthy weight . Conditions like these can cause problems during pregnancy. Tell your provider about your family health history . This is a record of any health conditions and treatments that you, your partner and everyone in your families have had. Use the March of Dimes Family Health History Form and share it with your provider. If you have a record of your vaccinations , take it to your checkup.  A vaccination is a shot that contains a vaccine that helps protect you from certain harmful infections. 
• Medicines you take, including prescription medicine , over-the-counter medicine, supplements and herbal products . Some medicines can hurt your baby if you take them during pregnancy, so you may need to stop taking it or switch to another medicine. Don’t stop or start taking any medicine without talking to your provider first. And tell your provider if you’re allergic to any medicine. You may be allergic to a medicine if it makes you sneeze, itch, get a rash or have trouble breathing when you take it.
• Your pregnancy history. Tell your provider if you’ve been pregnant before or if you’ve had trouble getting pregnant. Tell her if you’ve had any pregnancy complications or if you’ve had a premature baby (a baby born before 37 weeks of pregnancy), a miscarriage or stillbirth . Miscarriage is when a baby dies in the womb before 20 weeks of pregnancy. Stillbirth is when a baby dies in the womb after 20 weeks of pregnancy.
• Smoking, drinking alcohol, using street drugs and abusing prescription drugs. All of these can hurt your baby. Alcohol includes beer, wine and liquor. Street drugs are illegal to use, like heroin and cocaine. Abusing prescription drugs means you use them differently than your provider tells you to. This means you take more than your provider says you can take, you take it with alcohol or other drugs or you use someone else’s prescription drugs.
• Stress you feel. Stress is worry, strain or pressure that you feel in response to things that happen in your life. Talk to your provide about ways to deal with and reduce your stress. High levels of stress can cause complications during pregnancy.
• Your safety at home and work. Tell your provider about chemicals you use at home or work and about what kind of job you have. If you’re worried about abuse during pregnancy and ask about ways you can stay healthy and safe at home and work.

What happens at your first prenatal care checkup?

Your first checkup is usually the longest because your provider asks you lots of questions about your health. At your first prenatal care checkup, your provider:

• Gives you a physical exam and checks your overall health. Your provider checks your weight and height to figure out how much weight you should gain during pregnancy.
• Checks your blood, blood pressure and urine. Blood tests can tell your provider if you have certain infections, like syphilis , hepatitis B and HIV. Your provider also uses a blood test to find out your blood type and Rh factor and to check for anemia. Anemia is when you don't have enough healthy red blood cells to carry oxygen to the rest of your body. Rh factor is a protein that most people have on their red blood cells. If you don’t have it and your baby does, it can cause Rh disease in your baby. Treatment during pregnancy can prevent Rh disease. Blood pressure and urine tests can help your provider diagnose a serious condition called preeclampsia . This is a kind of high blood pressure that can happen during pregnancy. Having too much protein in your urine may be a sign of preeclampsia. Urine tests also can tell your provider if you have a kidney or bladder infection or other conditions, like diabetes.  
• Gives you a pelvic exam and a Pap smear. Your provider checks the pelvic organs (pelvis and womb) to make sure they’re healthy. For the Pap smear, your provider collects cells from your cervix to check for cancer and for infections, like chlamydia and gonorrhea. The cervix is the opening to the uterus (womb) that sits at the top of the vagina.
• May give you vaccinations, like a flu shot. It’s safe to get a flu shot any time during pregnancy. But some vaccinations are best at certain times and some aren’t recommended during pregnancy. Talk to your provider about what’s best and safe for you and your baby.
• Tells you your due date. Your provider usually uses your LMP to figure out your due date. But you may get an early ultrasound to confirm that you’re pregnant and help your provider figure out your baby’s age. An ultrasound uses sound waves and a computer screen to show a picture of your baby inside the womb.
• Prescribes a prenatal vitamin. This is a multivitamin made for pregnant women. Your prenatal vitamin should have 600 micrograms of folic acid in it. Folic acid is a vitamin that every cell in your body needs for healthy growth and development. If you take it before pregnancy and during early pregnancy, it can help protect your baby from birth defects of the brain and spine called neural tube defects (also called NTDs), and birth defects of the mouth called cleft lip and palate .
• Talks to you about prenatal tests. These are medical tests you get during pregnancy. They help your provider find out how you and your baby are doing. You may want to have certain tests only if you have certain problems or if you’re at high risk of having a baby with a genetic or chromosomal condition , like Down syndrome . If your provider thinks you’re at risk for having a baby with one of these conditions, he may recommend that you see a genetic counselor . This person has training to help you understand about genes, birth defects and other medical conditions that run in families, and how they can affect your health and your baby’s health.

What happens at later prenatal care checkups?

Later prenatal care checkups usually are shorter than the first one. At your checkups, tell your provider how you’re feeling. There’s a lot going on inside your body during pregnancy. Your provider can help you understand what’s happening and help you feel better if you’re not feeling well. Between visits, write down questions you have and ask them at your next checkup.

At later prenatal care checkups, your health care provider:

• Checks your weight and blood pressure. You also may get urine and blood tests.
• Checks your baby’s heartbeat. This happens after about 10 to 12 weeks of pregnancy. You can listen, too!
• Measures your belly to check your baby’s growth. Your provider starts doing this at about 20 weeks of pregnancy. Later in pregnancy, she also feels your belly to check your baby’s position in the womb.
• Gives you certain prenatal tests to check you and your baby. For example, most women get an ultrasound at 18 to 20 weeks of pregnancy. You may be able to tell if your baby’s a boy or a girl from this ultrasound, so be sure to tell your provider if you don’t want to know! Later in pregnancy, your provider may use ultrasound to check the amount of amniotic fluid around your baby in the womb. Between 24 and 28 weeks, you get a glucose screening test to see if you may have gestational diabetes . This is a kind of diabetes that some women get during pregnancy. And at 35 to 37 weeks, you get a test to check for group B strep . This is an infection you can pass to your baby.
• Asks you about your baby’s movement in the womb. If it’s your first pregnancy, you may feel your baby move by about 20 weeks. If you’ve been pregnant before, you may feel your baby move sooner. Your provider may ask you to do kick counts to keep track of how often your baby moves.
• Gives you a Tdap vaccination at 27 to 36 weeks of pregnancy. This vaccination protects both you and your baby against pertussis (also called whooping cough). Pertussis spreads easily and is dangerous for a baby.
• Does a pelvic exam . Your provider may check for changes in your cervix as you get close to your due date.

How can you get free or low-cost prenatal care?

If you don't have health insurance or can't afford prenatal care, find out about free or low-cost prenatal care services in your community:

• Call (800) 311-BABY [(800) 311-2229]. For information in Spanish, call (800) 504-7081.
• Visit healthcare.gov to find a community health center near you. Community health centers can provide low-cost prenatal care.

Last reviewed: June, 2017

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Taking a Hospital Tour During Pregnancy

Medical review policy, latest update:.

Updates to text, information, guidelines, formatting and sources, and new medical review.

Is a hospital tour necessary?

Read this next, when should you take a hospital tour , why are so many hospital tours virtual and how do virtual tours work, what can you learn during a hospital tour, questions to ask during a hospital or birthing center tour, updates history, jump to your week of pregnancy, trending on what to expect, signs of labor, pregnancy calculator, ⚠️ you can't see this cool content because you have ad block enabled., top 1,000 baby girl names in the u.s., top 1,000 baby boy names in the u.s., braxton hicks contractions and false labor.

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What to expect from third trimester prenatal appointments

During the third trimester, you’ll see your doctor every two weeks, then every week, to check for signs of preterm labor and assess your baby's growth and well-being. Here's exactly what will happen, and questions to ask your doctor. 

How often will you have prenatal appointments during the third trimester?

What happens at your third trimester appointments, third trimester testing, questions to ask your ob-gyn during your third trimester, remember to discuss postpartum considerations.

By the time you hit the third trimester ( 28 weeks through the end of pregnancy), you're probably anxious for the baby to arrive and want to get some much-needed rest while you can.

The good news is you'll meet with your doctor more frequently to check on the growth and development of your baby, so you'll have a better sense of when it might be "go" time. In the third trimester, you'll have a prenatal appointment every two weeks from 28 to 36 weeks, then you'll have a prenatal visit once a week during the last month until you deliver.

In some practices where multiple practitioners share the on-call pool, you may make your rounds to get to know everyone as your due date draws near. After all, there's a chance your doctor won't be available when you give birth.

Like your previous prenatal appointments, you can expect to get your blood pressure and weight checked. Some practices have you provide a urine sample to screen for protein, sugar, and infection. Your doctor will also evaluate the baby's heartbeat using a Doppler and measure the fundal height (the distance between your pubic bone and the top of your uterus). At this stage, the measurement should match the number of weeks you're pregnant. So, if you're 37 weeks, your fundal height should be around 37 centimeters.

If your baby is measuring too small or too big , your doctor may order a third trimester ultrasound to evaluate their growth and your amniotic fluid levels. And if you have a high-risk pregnancy , your doctor may also order a third trimester ultrasound to do a biophysical profile (BPP) test, where they'll examine your baby's movement and fluid level.

Your doctor may also order an ultrasound if they aren't sure about your baby's position from an abdominal exam. If it turns out your baby is breech, you may be offered an external cephalic version, which are maneuvers done to try to turn your baby into a vertex (head-down) position.

Past your due date ? Your doctor may check your cervix to see if it's softening, effacing (thinning out), and dilating (opening). The cervical exam may give an idea of what method of induction of labor to use if it's needed. (If you do have a pelvic exam late in pregnancy, you might have a little spotting afterward.) Generally, practitioners won't do cervical checks unless they feel it's necessary, so if you're not comfortable, you can decline them.

You were screened to check whether you're Rh-negative during your first trimester. If it turns out you are Rh-negative, you will be given an injection of Rh immune globulin (sometimes called RhIg or RhoGAM) to prevent your body from producing antibodies for the last part of your pregnancy.

And as always, your doctor will also discuss results from previous tests and follow up on issues that were brought up at your last prenatal appointment.

Some questions you can expect from your practitioner are:

• How are you feeling?
• Do you feel any unusual pain and aches?
• Are you experiencing Braxton-Hicks contractions , which are false labor pains?
• Are you having contractions?
• How often do you feel your baby move?
• Do you have any sudden swelling?
• How is your mood?
• Are you getting enough sleep at night?
• How is your diet?

Whether or not they ask, let your doctor know about any symptoms you're having, even if they seem like the usual fatigue, moodiness, or aches and pains.

Be sure to also let your doctor know if you notice your baby is less active than usual (they may ask you to count your baby's movements for a set period of time each day).

Inside pregnancy: Weeks 28 to 37

A 3D animated look at a baby in the third trimester of pregnancy.

Group B strep

Between 36 and 37 weeks, your practitioner will swab your vagina and rectum to check for a common infection called group B strep . If your test is positive, you'll be given antibiotics during labor to help keep you from passing it on to your baby.

(If you've had a group B strep urinary tract infection during this pregnancy, you won't need this test because even though the infection was treated, you'll automatically get antibiotics during labor. Likewise, you'll be automatically treated during labor if you've previously had a baby infected with group B strep.)

Gestational diabetes

If you were diagnosed with gestational diabetes , your doctor will continue to monitor your blood glucose levels and ensure that you're following a healthy diet and exercise routine. Your doctor may also order a third trimester ultrasound to check your baby's growth and development.

Preeclampsia

Preeclampsia (very high blood pressure) usually develops during the third trimester. Some of the signs of preeclampsia are sudden swelling in the face and hands and protein in the urine. Most of the time, patients with preeclampsia have no symptoms and it's incidentally diagnosed in the office with new onset high blood pressure. If you're past 37 weeks of pregnancy, then your doctor may want to deliver your baby. But if you're not at 37 weeks, your doctor will order an ultrasound and heart rate monitoring to check your baby's well-being. In severe cases, your doctor may want to admit you to the hospital and consider delivering your baby early.

Twins and multiples

Carrying twins, triplets, and higher-order multiples is considered a high-risk pregnancy. Because you're at risk for preterm birth , you may need more frequent prenatal appointments, sometimes weekly. You'll also need more tests, including an ultrasound and/or non-stress test, which tracks your babies' heart rate for a period of time. If you're experiencing symptoms of preterm labor, such as contractions, vaginal spotting, and abdominal cramps, be sure to alert your doctor.

Placenta previa

If you were found to have placenta previa, which is what happens when the placenta partially or totally covers the cervix, you'll have a third trimester ultrasound to check whether the previa has resolved. If it hasn't, you'll most likely have a C-section to deliver your baby safely. Some women with placenta previa experience heavy bleeding, and in this case, your doctor may recommend a C-section to deliver your baby earlier. You'll most likely be given corticosteroids to help your baby's lungs develop faster if your delivery is scheduled before 37 weeks.

Additional tests

Your blood may be checked again for anemia, particularly if you were anemic earlier in your pregnancy.

If you're at risk for sexually transmitted infections, you'll be tested again for syphilis, chlamydia, gonorrhea, and HIV.

Vaccination

You should get the Tdap vaccine to help protect you and your baby from pertussis (whooping cough). Even if you've been vaccinated before, the U.S. Centers for Disease Control and Prevention (CDC) recommend all pregnant women get a booster between 27 and 36 weeks.

If flu season is here or approaching, your practitioner should talk with you about the benefits of getting a flu shot if you haven't already had one. Your doctor will also talk to you about the COVID-19 vaccine , which helps protect you from the virus and lessens the severity of the illness if you become sick. Studies show that antibodies are also passed to the fetus.

Before your appointment, it's a good idea to write down any questions you may have for your doctor. This is also a great time to start thinking about your birth plan as well as what to expect postpartum. Here are some common questions you may want to ask:

• Where can I take childbirth classes?
• Where should I go if I'm in labor and ready to deliver?
• What are signs of labor that I should look out for?
• What happens if my water breaks or I go into labor in the middle of the night?
• What's the difference between my water breaking and leaking fluid/having discharge?
• How do Braxton-Hicks contractions feel, and how are they different from real labor contractions?
• How should I time my contractions?
• If my contractions are getting more intense and closer together, should I give you a call or head straight to the labor and delivery center?
• Will you be there throughout my labor or at my delivery?
• What exactly happens during delivery?
• How long should I expect to stay at the hospital?
• Does the hospital offer lactation support if I'm breastfeeding?
• Will the hospital reach out to my baby's pediatrician to transfer records after giving birth?
• When should I schedule a postpartum appointment?

Since you may not be in any shape to make important decisions right after delivery, now's the time to start talking about whether you want your baby boy circumcised, whether you plan to breastfeed, and what you'd like to do for contraception after you have your baby. (Of course, you can always change your mind between now and then.)

And if you haven't found a doctor for your baby, it's time to get started. Your practitioner can give you some names.

Finally, your practitioner may screen you for signs of depression during pregnancy. But don't wait to be asked. If you're feeling depressed or anxious, let your caregiver know. They can refer you to someone who can help.

They may also ask you about your support network at home after you've given birth and mention the signs of postpartum depression (PPD) . It's helpful to know how to distinguish normal " baby blues " brought on by fatigue and hormones from true postpartum depression. If you think you may be suffering from depression or anxiety, it's important to get help immediately.

Learn more about what to expect at your prenatal appointments:

• What to expect at your prenatal visits
• Your first prenatal visit
• Second-trimester prenatal visits

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Prenatal visits: What to expect and how to prepare

Your third trimester pregnancy guide and checklist

What happens at second trimester prenatal appointments

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 .

Kids's Health. Prenatal Tests: Third Trimester. [Accessed August 2021]

Mayo Clinic. Biophysical Profile https://www.mayoclinic.org/tests-procedures/biophysical-profile/about/pac-20393061 Opens a new window [Accessed August 2021]

Lamaze. Check Your Cervix at Prenatal Appointments? You Don't Have to — Here's Why Some Decline https://www.lamaze.org/Giving-Birth-with-Confidence/GBWC-Post/check-your-cervix-at-prenatal-appointments-you-dont-have-to-heres-why-some-decline-1 Opens a new window [Accessed August 2021]

American College of Obstetricians and Gynecologists. The Rh Factor: How It Can Affect Your Pregnancy. https://www.acog.org/womens-health/faqs/the-rh-factor-how-it-can-affect-your-pregnancy Opens a new window  [Accessed August 2021]

U.S. National Library of Medicine. High Blood Pressure in Pregnancy. https://medlineplus.gov/highbloodpressureinpregnancy.html Opens a new window [Accessed August 2021]

Mayo Clinic. Preterm Labor. https://www.mayoclinic.org/diseases-conditions/preterm-labor/symptoms-causes/syc-20376842 Opens a new window [Accessed August 2021]

Mayo Clinic. Placenta Previa. https://www.mayoclinic.org/diseases-conditions/placenta-previa/symptoms-causes/syc-20352768 Opens a new window [Accessed August 2021]

Centers for Disease Control and Prevention. COVID-19 Vaccines While Pregnant or Breastfeeding. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/pregnancy.html Opens a new window [Accessed August 2021]

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Content of First Prenatal Visits

The purpose of this study was to examine the content of the first prenatal visit within an academic medical center clinic and to compare the topics discussed to 2014 American College of Obstetrics and Gynecologists guidelines for the initial prenatal visit.

Clinical interactions were audio recorded and transcribed (n = 30). A content analysis was used to identify topics discussed during the initial prenatal visit. Topics discussed were then compared to the 2014 ACOG guidelines for adherence. Coded data was queried though the qualitative software and reviewed for accuracy and content.

First prenatal visits included a physician, nurse practitioner, nurse midwife, medical assistant, medical students, or a combination of these providers. In general, topics that were covered in most visits and closely adhered to ACOG guidelines included vitamin supplementation, laboratory testing, flu vaccinations, and cervical cancer screening. Topics discussed less often included many components of the physical examination, education about pregnancy, and screening for an identification of psychosocial risk. Least number of topics covered included prenatal screening.

Conclusions for Practice

While the ACOG guidelines may include many components that are traditional in addition to those based on evidence, the guidelines were not closely followed in this study. Identifying new ways to disseminate information during the time constrained initial prenatal visit are needed to ensure improved patient outcomes.

Introduction

A significant and long-standing problem in healthcare is the timing, volume, and variety of care and education that could be covered during busy prenatal visits. Guidelines for the content of the first prenatal visit have been developed and endorsed by a variety of professional and public health organizations for over a century. The most recent guidelines for prenatal care, including first prenatal visits, are the 2014 American College of Obstetricians and Gynecologists (ACOG). Early and complete first prenatal visits are promoted as opportunities for screening, identifying, and addressing risk factors to improve pregnancy outcomes, provide important pregnancy education information, and establish the importance of prenatal care. However, little is known about how these guidelines are actually applied in the first prenatal visit.

There has been a rapid expansion of knowledge about the importance of the mother’s health before and during pregnancy and an increase in the number of topics to discuss within a time limited clinical encounter to adequately care for pregnant women. For example, ACOG recommends that all pregnant women, regardless of age, disease history or risk status, be routinely offered prenatal genetic screening (" ACOG Practice Bulletin No. 77: screening for fetal chromosomal abnormalities," 2007 ). Some research indicates that discussing the importance of breastfeeding during the first prenatal visit may increase rates and duration of breastfeeding ( Chung et al., 2008 ; " Primary care interventions to promote breastfeeding: U.S. Preventive Services Task Force recommendation statement," 2008 ). However, most care and education provided to women is decided upon by the individual prenatal care provider. It is unknown what care is typically provided and what topics are discussed, especially in the first prenatal visit. Before any interventions or educational tools are developed to improve how prenatal education and screening options are communicated to women, we first need to understand what care is actually provided and what health education topics are discussed.

The goal of prenatal care is to ensure the birth of a healthy baby with minimal risk for the mother through the determination of gestational age, identification of maternal risks, ongoing evaluation of the health status of the mother and fetus, anticipation of problems and necessary interventions, and patient education and communication ( ACOG/AAP, 2012 ). Early prenatal care also focuses on assessing maternal risk factors to support early intervention, providing of advice, offering health education, and teaching ways to address the minor problems of pregnancy ( Al-Ateeq & Al-Rusaiess, 2015 ). However, guidelines for this content vary greatly and have been criticized for failing to focus on the pregnant woman ( Hanson, VandeVusse, Roberts, & Forristal, 2009 ).

In 1925, the U.S. Department of Labor issued the Standards of Prenatal Care: An Outline for the Use of Physicians ( U.S. Department of Labor, 1925 ). Sixty years later in 1989, the U.S. Public Health Service issued a report describing the components of prenatal care, basing their recommendations on the current scientific evidence ( PHS, 1989 ). Adherence to these guidelines, as well as the 1959 ACOG guidelines, was examined in the late 1980s. Kogan et al. examined providers’ adherence to the subsequently published US P.H.S. 1989 guidelines by interviewing almost 10,000 pregnant women. Almost half of women reported that they failed to receive the recommended early prenatal examinations, laboratory tests, and health education ( Kogan, Alexander, Kotelchuck, Nagey, & Jack, 1994 ). Baldwin, et al. (1994) examined the adherence of 249 prenatal care providers (obstetricians, family physicians, certified nurse midwives) to the ACOG Guidelines of 1959 that had been in place for almost 30 years. They found that the providers followed the well established guidelines on average 80–90% of the time (range 13% to 94%).

The broad categories in these historical documents remain much the same in the most recent guidelines issued by the American College of Obstetricians and Gynecologists (2014) and separately by the American Academy of Family Practice ( Zolotor & Carlough, 2014 ). However, there has been a significant increase in the content of each category with many more patient history questions, laboratory tests, and health education topics recommended on the first prenatal visit. The result of this increased burden in terms of adherence has not yet been examined. The purpose of the current study was to examine the content of the first prenatal visit within a university hospital clinic. Clinical interactions were audio recorded and the content analyzed to identify adherence to the 2014 ACOG guidelines (" ACOG Committee Opinion no. 598: Committee on Adolescent Health Care: The initial reproductive health visit," 2014 ).

Thirty first prenatal visits were audio recorded. The purpose of the recordings was described to the providers and pregnant women as assessing the type of topics covered in the prenatal visit, such as breastfeeding, vitamins, and prenatal screening. Data collection occurred in a Level 3, academic medical center obstetric clinic serving a diverse group of women receiving care under a variety of health care payment plans. All providers of care and patients were eligible for participation in this study. Patients being seen for their first prenatal visit were approached for study consent and enrolled in the examination room. Providers of care were obstetricians (MDs), certified nurse midwives (CNM), nurse practitioners (NPs), and medical students (MS). Staff involved were medical assistants (MAs). Some first prenatal visits included either an MD or NP, an MD and an NP, a CNM, and an MD and a MS. The recorder was turned on when the patient consented and prior to any interactions with a provider. The recordings were stopped when the patient exited the examination room. Audio-recordings were later transcribed verbatim and were used in the analysis. All visits took place between October 2014 and December 2014. The study was approved by the University of Utah Institutional Review Board and all patients signed written informed consent prior to any study procedures.

Audio recording transcripts were read in their entirety by the researchers. ACOG recommendations for content of first prenatal visit topics were used for comparative analysis (see Table 1 . ACOG Guidelines). The transcribed text for all first prenatal visits were uploaded into ATLAS.ti® for analysis. ( Atlas.ti, 2015 ). A qualitative content analysis was used to analyze the data. A distinguishing feature of a content analytic approach is the use of a consistent set of codes to designate data segments that contain similar material ( Elo & Kyngas, 2008 ). Consistent with our work ( Author et al., 2012 ; Author et al., 2011 ), the codes were generated from the data, and rather than using search algorithms, careful readings of the data were performed to generate the codes. Then the codes were systematically applied to the transcripts, with the ability to add codes that might have been missed with the initial development of the codebook. After coding was completed, they were summarized to identify the most frequently reported topics across the clinical visits. We addressed trustworthiness and rigor of the data to maintain data integrity during the analysis through methods of credibility and auditability ( McBrien, 2008 ). Upon completion of the coding, all data were queried within Atlas.ti® and reviewed by the research team. This allowed reviewing, verifying, and auditing the coding schema and associated data.

Percent of Visits – Adherence to ACOG Guidelines Overall (n=30 clinic visits)

After the initial analysis was complete, the content of the clinical visits was compared to the ACOG guidelines for the first prenatal visit (see Table 1 ). Any text addressing any component of each of the ACOG categories was counted as addressing the category. Incidence and density of topics were determined by the frequency of codes. However, because we relied only on verbal content, some aspects of the physical exam may have been missed if the provided did not mention it (i.e. I am taking your blood pressure now.) Descriptive statistics were used to further characterize the adherence to ACOG recommendations in these first prenatal visits by type of provider (see Table 1 ).

The analysis included thirty separate clinical visits of women seen for their first prenatal visit. An unknown number of providers of care were included and some providers could have been included more than once. Data collection was over one month and allowed a range of different providers and patients to be included in this study. Selection of participants and providers was random. Of the providers recorded there were 5 visits that included both an MD and NP, 8 visits with NP only, 14 visits with MD only, 2 with a MD and MS, and 1 with CNM. All participants and providers were English speaking. Demographic data for the patients and providers were not collected. The primary purpose of this study was the visit content discussed and adherence to ACOG guidelines for the initial reproductive visit.

Incidence of Topics Discussed

ACOG Guidelines provide a comprehensive list of topics for education and counseling to be provided at the first prenatal visit. The percent of visits in which adherence to ACOG Guidelines was identified is shown in Table 1 . Identification of adherence included mere mention of a topic and extensive discussion and/or provision of specific ACOG-recommended care or patient education. Yet, the time devoted to each topic was not accessed. In other words, these results do not represent the extent or the amount of time dedicated to the specific recommended content of prenatal care.

In this study, a clinic overview was provided to every woman. This included a number of topics, i.e. schedule of visits, availability of providers, and making appointments. In almost every visit, there was evidence of some history taken or a portion of a physical examination provided, as well as mention of routine blood testing.

Discussion of cervical cancer / pap smears and urine testing occurred in 80–83% of the visits. A confirmatory examination for pregnancy in this sample, largely represented by auscultation of fetal heart tones, occurred in three quarters of the visits. A discussion of routine laboratory testing and available genetic testing was found in 70–75% of the visits. Prenatal vitamins and iron were also routinely addressed in over 70% of visits, and flu vaccine was offered (57%).

Gathering of a family medical history, assessment of and education about alcohol, tobacco, and / or drugs were found in slightly over half the visits. Exercise counseling occurred in about half the visits. As specific complications were not known for each woman, any mention of complications in the transcripts, such as twins or vaginal birth after cesarean, was counted as fulfilling the ACOG recommendation, occurring in 26% of visits. Any discussion of the process of pregnancy was identified as fulfilling the ACOG recommendation of educating the women about the expected course of pregnancy, found in 20% of visits. Psychosocial needs assessment visit guidelines were followed in less than 10%.

None of the recordings indicated that a complete initial history, assessment for pre-term labor risk, or complete physical examination was completed (i.e. abdomen, breasts and inquiries about bladder and bowel functions, weight gain, and vital signs). ACOG guidelines indicate a complete needs assessment should be done. This complete assessment was not found on recordings of any visits although additional visits could have addressed these patient needs. Screening for domestic violence or depression was not found in any recording, with depression rarely addressed in the first prenatal visit. Education on most ACOG recommended first prenatal visit topics (labor & delivery, working, air travel, dental care, over the counter medication use, pets and seat belt use) was rarely or never found on recordings. Psychosocial issues were rarely addressed on the audio tapes. Prenatal classes, while often not attended until late in pregnancy, were never mentioned nor was there an investigation of any barriers to receiving care in any visit. Specific content of the routine laboratory and diagnostic testing was not discussed in the recordings or known to researchers. As no histories of the women were available to researchers, women who were at risk for gestational diabetes (GDM) or pre-term labor were not identified to know who merited education or early screening. GDM screening was not discussed with any woman.

First prenatal visits are often scheduled throughout an MD / CNM / NP’s clinical day, interspersed with other types of pregnancy and gynecologic patient visits. Providers work under time constraints with multiple patients scheduled in quick succession. This can result in abbreviated visits, omission of ideal health education, reliance on other staff to collect information and provide patient education, and addressing only the most obvious problems. Given clinical time constraints, many providers rely on provision of printed materials to patients to compensate for the lack of time available for direct face-to-face patient education. Whether printed materials are an effective or optimal approach to delivering patient education or not, is questionable ( Nolan, 2009 ). Further, some topics may be discussed in future visits to account for the limited time in only one clinical visit.

The study results suggest that several ACOG guidelines are being addressed, particularly those related to medical care and intervention – vitamins and iron, blood and urine laboratory studies, flu vaccine, and screening for cervical cancer. However, the extent of discussion or amount of time dedicated to meeting ACOG recommendations, are unknown. For example, the mention of “genetic screening” in the transcribed audio recording was coded and reported as “addressed” during the prenatal visit. However, genetic screening is a complex topic and it is unknown if it was fully discussed during the visit or was it merely mentioned that information about genetic screening as provided in the printed material distributed to the patient.

It is unknown what information was already contained in the EMR, although the EMR format is known to allow for the documentation of all the ACOG recommended information. Initial historical information, family history, genetic history, and risk of pre-term labor could have already been in the EMR or data could have been entered outside the examination room. Video recordings, rather than audio recordings, could have revealed that a physical examination occurred, as there was no specific mention of a completed physical examination in the audio recording. Finally, as discussed above. first visit prenatal education recommended by ACOG may have occurred in a different formast, for example, printed materials distributed to patients. Further, some of the patients may have undergone a “confirmatory pregnancy” appointment and topics not discussed in this recorded visit could have occurred as well as in future visits. Audio recordings revealed that packets of prenatal information were often given, however the exact content is unknown.

The prenatal visit discussions in this study were focused on information gathering with mostly closed ended questions used by providers, usually resulting in patient responses of “yes or no”. This style of questioning discourages full and meaningful responses that could have provided additional information of importance to patient care. The providers in this study addressed concerns that were expressed by the women, but rarely asked women about their concerns or fears. Discussing a woman’s concerns and fears can reveal risk factors that should be addressed or a further discussion can allay fears once identified. Many providers referenced the authoritative recommendations of health care profession groups, such as ACOG and others, without further discussion. An explanation of the risks, benefits, and/or alternatives to that recommended care was rarely offered.

A larger question that should be considered is how the content of the ACOG recommendations can be addressed while including patient driven needs and preferences in these guidelines. Many of the components of the ACOG Guidelines are based on tradition with a limited number of topics supported by careful research ( Zolotor & Carlough, 2014 ; Kirkham, Harris, & Grzybowski, 2005 ). Further research is needed to explore the value of all of the components, with the goal of including only those that have proven value. Women’s needs and preferences have not been routinely included in published guidelines ( Hanson et al., 2009 ), implying that these are of lesser importance or additional avenues outside the clinic visit need to be explored to address patient.

Lastly, forming relationships with patients requires time, the use of open-ended questions, and repeated visits. It is unreasonable to assume that such a close relationship will occur at the first prenatal visit. This study demonstrated the issues of provider time constraints based on their recorded comments are related to lack of adherence to ACOG’s education recommendations,, and lack of screening for unstated problems.

Limitations

This study took place in one outpatient clinic in a Level 3, academic medical center obstetrics clinic. Other practice settings, such as a private office, birth center or home birth setting, may structure first prenatal visits very differently. The majority providers of care were MDs and no comparisons can be made of their care to the care of the few CNMs or NPs in this study. Further, the content of the visit was descriptively compared between different providers. It would be interesting to assess how different professionals prioritize different topics during time limited clinical encounters as well as how patients’ driven questions influence the topics covered. Researchers lacked access to knowledge about existing information in the EMR or when the EMR was used. Audio recordings missed the visual information and nuances of a video recording, which would have provided additional information about first prenatal visit content. Lastly, content analysis did not address the extent to which ACOG guidelines were followed, nor the amount of time dedicated to provision of care or patient education. Future studies should include these aspects of ACOG guideline adherence to better understand the effectiveness of prenatal care and include additional prenatal visits.

This study demonstrated that standard ACOG guidelines for first prenatal visit content were inconsistently followed at one site by one group of providers based on audio recordings. Providers more closely adhered to ACOG guidelines that addressed vitamin supplementation, laboratory testing, flu vaccinations, and cervical cancer screening. Content addressing many components of the examination, education about pregnancy, and screening for an identification of psychosocial risk was identified less often. Providers routinely used an interview style that did not elicit extensive information. While the ACOG guidelines may include many components that are traditional in addition to those based on evidence, the guidelines were not closely followed in this study.

Acknowledgments

We would like to thank the University of Utah College of Nursing Research Committee for helping fund this study.

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Your first antenatal visit

7-minute read

• Antenatal visits check the wellbeing of you and your baby during pregnancy.
• During your first visit, your doctor or midwife will check your health.
• They will also work out when your baby is due to be born.
• During your visit you will learn how to keep healthy during your pregnancy.
• Regular antenatal care is likely to positively affect the health of you and your baby.

Antenatal visits check the wellbeing of you and your baby during pregnancy. Antenatal care throughout your pregnancy is likely to positively affect the health of you and your baby.

Your first antenatal care appointment is an important one. During your visit, your doctor or midwife will:

• confirm your pregnancy
• check your health
• give you some information that you will need in the months ahead

You will also be able to talk about the type of care you want during your pregnancy.

When should I make my first appointment?

It’s best to have your first antenatal visit before 10 weeks into your pregnancy. Ideally this will happen when you are about 6 to 8 weeks pregnant. This is because there are lots of things to learn about. Also, some tests are recommended early in your pregnancy.

Your first appointment may be with a midwife or your doctor. It may be at a clinic or hospital — you can choose.

What does an antenatal visit involve?

Taking your medical history.

During the visit, your doctor or midwife will ask about your health. This includes finding out about:

• any prior pregnancies
• any illnesses or operations you’ve had
• what medicines you’re taking, including those from a pharmacy or supermarket
• if you have any current health problems
• if you are allergic to any medicines

Your doctor or midwife will ask you if you:

• drink alcohol
• take recreational drugs
• are stressed
• have any signs of depression or anxiety
• about the support you may get from people at home and work

These questions aren’t to judge you. The more your doctor or midwife knows about you, the better they can support you during your pregnancy.

It’s up to you whether you answer these questions. Anything you say will be kept in confidence.

If you are experiencing family violence you should let them know. It’s important to get professional help and they can support you to do this.

Your family medical history

Finding out about the health of your family is also important because it may affect you or your baby. This includes any family history of:

• genetic conditions
• chronic illnesses such as diabetes

You may wish to do screening tests for certain genetic conditions . You can talk about this with your doctor or midwife.

What tests will I have?

Your doctor or midwife will check your health and measure your:

• blood pressure

They may suggest a urine (wee) test to see if you have a urinary tract infection (UTI) or any kidney problems.

You will also be offered a blood test to check your blood group and rhesus factor. They will also check for:

• infectious diseases — rubella
• sexually transmitted infections (STIs)
• bacteria that may affect your baby — group B streptococcus
• infections that can be passed on through blood-to-blood contact — hepatitis C and HIV

Some STIs that can affect your pregnancy don’t have any symptoms. It’s possible to have an STI and not know.

Find out more about the check-ups, tests and scans you can have during your antenatal visits.

If you have any questions about these tests, ask your midwife or doctor.

Finding out about your baby

Your doctor or midwife will work out how many weeks you have been pregnant. This will let them work out the due date of your baby.

If you’re not sure when your last period was, they may book a dating scan . This is an ultrasound that will help figure out which week of pregnancy you are in.

Tests are available to check for some problems that may affect your baby. You don’t have to have these tests — it’s up to you. Your midwife or doctor will tell you about the tests and how much they will cost.

Discussing your antenatal care options

During your first appointment, your midwife or doctor will give you information about antenatal care. They will talk with you about which model of care you would like for your pregnancy and birth. You'll be able to discuss:

• who will be your main maternity carer
• where you would like to receive your antenatal care
• how many antenatal visits you will have and when
• where you would like to give birth
• where to find local antenatal classes or education sessions

How can I have a healthy pregnancy?

Your midwife or doctor will talk to you about keeping healthy during your pregnancy. They will also ensure you have good support and care.

This may cover:

• help to stop smoking or stop drinking alcohol (if needed)
• advice about healthy eating , exercise and weight gain
• advice on which vitamins and minerals you should take during pregnancy
• referrals to support services if you need them

They will answer questions about any issues that worry or concern you.

If this is your first pregnancy, The Australian Pregnancy Care Guidelines advise you have 10 antenatal care visits. If there are complications with your pregnancy, you may need to have more visits.

If you’ve been pregnant before, The Australian Pregnancy Care Guidelines advise you have 7 antenatal care visits. Again, if you have any complications with your pregnancy, you may need more visits.

Speak to a maternal child health nurse

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Last reviewed: November 2022

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Antenatal visits

Introduction, pregnancy and covid-19, your first antenatal visit, your first visit to the hospital or maternity unit, subsequent visits, employment and antenatal visits, employment and antenatal classes, further information.

An antenatal visit is any appointment with your GP or maternity unit that relates to your pregnancy.

If you have registered for the Maternity and Infant Care Scheme you will have some of your antenatal appointments with your GP and the others with your maternity unit. The schedule of antenatal appointments can be different depending on your pregnancy.

• If it is your first pregnancy, you will usually have 6 antenatal appointments with your GP, and 6 antenatal appointments at your maternity unit or hospital.
• If it is a second or subsequent pregnancy, you will usually have 7 antenatal appointments with your GP, and 5 antenatal appointments at your maternity unit or hospital.

You may have additional appointments if you are diagnosed with a pregnancy-related condition (such as high blood pressure or gestational diabetes, or if you are pregnant with twins or multiple babies).

You will also have 2 postnatal appointments with your GP after your baby has arrived, at 2 weeks (for your baby) and 6 weeks (for you and your baby).

If you have registered for the Maternity and Infant Care Scheme , these antenatal and postnatal visits are free.

You are entitled to take paid time off from your employment to attend antenatal appointments (and some antenatal classes). Your employment rights during pregnancy are protected in Irish law .

If you are pregnant and think you may have been exposed to COVID-19, contact your GP. Most women who test positive and have mild symptoms can safely self-isolate at home (7 days). Routine antenatal or ultrasound appointments should be postponed until after the period of self-isolation.

If you have not had any COVID-19 vaccines, you can get your first round of COVID-19 vaccination or first booster at any stage of your pregnancy.

If you had a booster dose during your current pregnancy, then a second booster dose is not needed.

If you had a booster dose before this pregnancy, you can get your second booster at or after 16 weeks of your pregnancy.

Find more information on getting the COVID-19 vaccine during pregnancy , and getting the vaccine while trying for a baby or breastfeeding on the HSE website.

If you are unsure about whether to get a vaccination before, during or after pregnancy, you can read the HSE’s information booklet (pdf) .

Many hospitals have made changes to how they deliver their services due to COVID-19. If you have an upcoming antenatal visit, you may have to attend your appointment alone. Check what visitor restrictions are in place with your maternity hospital/unit. The HSE has up-to-date information on hospitals in every county so you can check about appointments and what visitor restrictions are in place before you go.

If you have registered for the Maternity and Infant Care Scheme , your first appointment will be with your GP. They will do antenatal checks (such as blood pressure and urine checks) and give you information on how to have a healthy pregnancy. They will help you estimate your due date, and they might discuss folic acid, exercise and healthy eating with you.

Your GP will also talk to you about vaccines. You will be offered a flu vaccine during one of your appointments (the flu season is from October to April). While the appointment will be free, you may be charged for the administration of the flu vaccine if you do not have a medical card.

When you are between 16-36 weeks, you will also be offered a vaccination to protect your baby from whooping cough (pertussis) . This is available free of charge.

Your first visit to the hospital or maternity unit is called a ‘booking visit’.

During this appointment, you will:

• Tell a midwife about your medical history, family history and any previous pregnancies.
• Have your blood pressure checked.
• Have your urine checked.
• Have a blood test .
• Get information about antenatal classes and breastfeeding .
• Be referred for specialist appointments if needed (for example, with physiotherapists, dietitians, smoking cessation specialists or alcohol cessation specialists).
• Have the opportunity to ask the midwife any questions.

In some hospitals, you may have an ultrasound scan on your first visit, at others you will have it at around 20 weeks.

Your first visit to hospital will last approximately 2 hours. If your pregnancy is normal, follow-up visits will be much shorter.

At each follow-up antenatal visit, your blood pressure will be checked, you will give a urine sample, and you will be examined.

If you have any questions or worries related to your pregnancy, you should ask the midwife or doctor.

At 20-22 weeks

You have reached the halfway point of your pregnancy.

You may be offered a foetal anomaly or anatomy scan at the hospital. Some hospitals offer this to every pregnant woman and other hospitals can only offer this to women with higher risk pregnancies. Most scans will show you that your baby is developing normally. However, sometimes a baby is born with a health problem. A foetal anatomy scan will detect many of these problems.

If an anomaly is detected, a referral will be made to an obstetrician who specialises in foetal anomalies. This allows you and your obstetrician to make plans for the birth and for any aftercare you and your baby may need.

From 28 weeks

Your midwife or doctor will continue to monitor your health. They will check for signs of high blood pressure or other complications.

They will also check the position of your baby and the baby’s development, as well as the height of your womb (uterus) and your baby’s heart rate.

You may not need to be scanned after your scan at 20 weeks , unless you are advised that you need one.

Your midwife or obstetrician will also talk to you about:

• Preparing for the birth
• Breastfeeding
• Any concerns you may have

If you become pregnant while you are employed, you are entitled to paid time off work to attend antenatal appointments .

You should tell your employer in writing (providing medical evidence of your pregnancy) that you need time off to attend antenatal appointments. You should give at least 2 weeks' written notice of the date and time of your appointments.

If this notice is not given for reasons out of your control, then you can retain your entitlement, provided you write to your employer with an explanation and with the notice. You will need to do this within 1 week of the appointment.

For any visit after the first appointment, your employer may ask to see your appointment card. You are entitled to medical visits after the birth of your baby for 14 weeks following the birth, including any period taken on maternity leave following the birth.

You may also be entitled to take paid time off from work to attend antenatal classes . Check with your local hospital about antenatal classes as many have moved online.

Antenatal classes cover a wide range of topics such as pain relief, breastfeeding , nutrition, maintaining a healthy lifestyle, and preparing you and your family for the birth of your baby. Most hospitals offer antenatal classes (sometimes called parent craft classes) which you can attend near the time of birth. Your partner or a friend can attend these classes with you.

If you are an expectant mother, you are entitled to attend 1 set of classes (except the last 3 in a set) over all your pregnancies while in employment. For example, if you are attending a set of 8 classes and this is your first pregnancy in employment, you are only entitled to paid time off work to attend 5 of those classes. The last 3 classes would normally occur after your maternity leave has started.

If you are an expectant father, you have a once-off right to attend the 2 classes immediately prior to the birth .

For further information on pregnancy, birth and becoming a parent, visit the HSE’s mychild.ie .

Related documents

• Antenatal classes Antenatal classes can help you to prepare for the birth of your baby. Find out more. 941.8926
• Choices in antenatal care This page describes the options available for antenatal care in Ireland. 904.30853
• What happens to a deceased person's money and possessions? How to get access to the deceased person's money and property, the rights of family members under wills and how property is distributed. 774.22437

If you have a question about this topic you can contact the Citizens Information Phone Service on 0818 07 4000 (Monday to Friday, 9am to 8pm).

You can also contact your local Citizens Information Centre .

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