Your First Obstetrical Appointment

 


 

Your Baby at 7 weeks!

Many of us count the weeks, the days, the hours until our first OB appointment!  You may have been experiencing a wide range of emotions, am I  really pregnant?  Is everything ok?  What are they going to do to me?  Will it be painful?  These are all thoughts that many of us have, and after that first appointment, for many it makes the pregnancy “real”.

 

Your first appointment generally takes place when you are 8 weeks pregnant; some busier offices are not seeing patients until 10-12 weeks.  Pregnancy is calculated from the first day of your last menstrual period, and will probably be the first thing they ask you on the phone when you call for an appointment.

 

Q. I conceived two weeks ago, how can I be 4 weeks pregnant?

As stated above, pregnancy is calculated from the first day of your last menstrual period, which is confusing to many women!  If your last period started on December 1st, you probably conceived around the 12-16th (if you are on a 28 day cycle).  Let’s say you took a pregnancy test on January 2nd, you would be 4 weeks and 3 days pregnant! Pregnancy lasts 40 weeks, 38-40 weeks is considered full term.

Q. I called to set up my first appointment and they cannot see me until I am 10 weeks, how do I know that the baby is ok?  Are there things I should avoid?

It can be very disappointing to have to wait until you are 10-12 weeks to be seen, and you always have the option of calling around to several offices.  You also have the right to set up an “interview” with your doctor to ensure that you are the right “fit”

Things to avoid:

1. Smoking:  This is the best time to quit, and now you have a great reason to flush those cigarettes!  Some women do better on a taper versus “cold turkey”, this is one of the best things you can do for yourself and your baby!

2. All alcoholic beverages, illicit drugs, including marijuana.

3. Over the counter medications: always consult a professional before taking over the counter medications and herbal preparations.

What you can do:

1.  Start taking a daily prenatal vitamin, you can purchase these over the counter.

2.  You should not take any medications during pregnancy unless your doctor has approved them first. If a problem does not resolve or you need medication, your caregiver can give you advice on relief options that are safe during prgnancy. Take good care of yourself by eating nutritious foods, exercising lightly, drinking extra water and getting an adequate amount of rest.

3.  Stay active and fit!  The rule is you can continue to do whatever your were doing prior to pregnancy as far as an exercise routine.  This is not the time to start an intense aerobics class, but a daily walk does wonders!

  What is going to happen at my first OB appointment?

1.  Prenatal interview

This is generally a half hour appointment with a Nurse or Medical Assistant.  You will be questioned about your health, living conditions, family history, and a zillion more questions.  If you are sure of you last menstral period, you will be told how far along you are and when your expected due date is.  Many offices hand out “goodiebags” filled with pregnancy information, samples, and coupons.

2.  Physical Exam

After the interview, you will be asked to undress in preparation for a physical exam        by your Dr/Midwife.  This is what will be done:

  • Breast exam: to check for any lumps, masses, and to also evaluate your nipples.  Some women have “inverted, or flat” nipples that may require preparation for breastfeeding.
  • Palpation of your abdomen:  Your Dr/Midwife will feel the outside of your abdomen, and try to feel for your uterus.  If you are greater than 10 weeks, a Doppler will be used to check for a fetal heart beat. 

Pelvic exam: 

  • You will be asked to lie down on your back and place your feet in stirrups.  This exam is almost identical to a “pap smear exam” if you have had one.
  •   A speculum will be placed into your vagina which will allow your Dr./Midwife to visualize your cervix.  Several swabs will be taken to test for the presence of several sexually transmitted diseases, and your cervix will be “brushed” to collect cells (this is called a pap-smear).  The head of the brush is then put into a container of fluid that is sent to be examined for any abnormal/changing cells. 
  • The speculum will then be removed, and your dr/Midwife will insert two fingers to feel the size of your uterus, and ovaries.  During this part of the exam, your Dr/Midwife is also estimating the size of your pelvic outlet (how much room there is between two prominent pelvic bones that the baby has to pass between)
  • You will then have time to ask questions, it is always good to have a list with you at your first appointment. Your Dr./midwife will also go over your chart with you and discuss your health history, nutrition, habits, family dynamics, and explain what the various tests performed are for.  You can expect to have your results at your next appointment if not sooner.

3. Blood Work (prenatal Panel) 

Q. Will the exam hurt?

A pelvic exam is not comfortable.  You may experience discomfort when the speculum is placed in your vagina, and you may feel as if you need to have a bowel movement.  The “swabs” usually are painless, you may experience some slight cramping when your cervix is examined and “brushed” to collect cells.

Q. Will I have an ultrasound?

Many practitioners are now doing early ultrasounds routinely.  If you are unsure of your dates, and ultrasound will be preformed to give you an idea of how far along you are, and your due date.  An early ultrasound is usually a vaginal ultrasound (the transducer is placed into the vagina).

 

 

          A Vaginal Ultrasound

 

 

The gestational sac can be visualized as early as four and a half weeks of gestation and the yolk sac at about five weeks. The embryo can be seen and measured by about five and a half weeks!

Q.How often will I see my doctor, and when will I have my first ultrasound if they do not do an early ultrasound?

You will see your Dr/Midwife once a month until you are 28 weeks.  After 28 weeks, you will be seen every 2 weeks until you are 36 weeks.  After 36 weeks, you will be seen every week until you deliver!

An “anatomical” ultrasound is performed from 18-22 weeks.  It is during this ultrasound that you can determine the sex of the baby if you have decided to “peek”.  Not all babies cooperate during these ultrasounds, and may “hide” their parts from you, so expect the possibility that you may not find out! 

What you can expect at every prenatal visit:

1. Weight check

2. Urine analysis

3. Blood pressure check

4. Palpation of your uterus, uterine measurement.

Your Dr/Midwife will use a paper “tape measure” to measure your uterine growth. The end of the tape is paced right above your pubic bone and is brought over your abdomen to the top of your fundus (where your uterus stops) Interesting enough, at 20 weeks you will measure approximately 20 cm!