My patient’s time matters to me. When they set out 10 – 20 minutes out of their work week to come for prenatal visits, I want it to be useful and meaningful to them. Each medical provider has their own way of doing things. Because of this, you should go to a medical provider you resonate and connect with (believe me it will be worth it in the end)! I always want to be everyone’s best friend, healthcare crusader and baby whisperer. I put my patient’s health and well-being at the top of my priority list. Still, I’m sure I’m not everyone’s favorite (just almost everyone’s favorite).
I plan out what I am going to talk about at each prenatal visit, but it varies patient to patient. There are some basic talking points that every provider should be touching upon in each prenatal visit. I will list out what goes into each prenatal visit during the course of pregnancy. And give you recommendations to optimize your prenatal visits so that they are the most beneficial to you!
So what has to get done at each prenatal visit?
Every visit a provider should ask you how you are feeling and listen to the baby’s heartbeat. This could be done via visual ultrasound or (doppler audible ultrasound). Every visit, you should have a blood pressure, weight and fundal height measured. Depending on your weeks’ gestation, different visits require different teaching points.
Weeks 8 – 12: First visit is the longest visit (about an hour) and will include a dating ultrasound to see how your peanut is doing at this early stage. Talking points include genetic chromosomal testing, blood work for you, welcoming you to the obstetric side of the practice, restrictions, nutrition, and expectations. It’s a lot to go over, it’s normal not to have any questions yet. They should notify you of which hospital they deliver at and different options for providers (midwives).
Weeks 12 – 16: Results from bloodwork to be reviewed. Weight gain expectations and testing of alpha fetal protein discussed at this visit. Now that nausea and vomiting are better in the second trimester, exercise can be encouraged. Your next big ultrasound of the baby (this the anatomy screen done between 18-22 weeks) needs to be scheduled.
Weeks 16 – 20: Results of the anatomy ultrasound are discussed. Relief to common pregnancy complaints is my usual talking point as they start around this time. Consider joining a prenatal exercise class and get connected with women in your area that are expecting around the same time as you!
Weeks 20 – 24: Blood sugar testing will be discussed, as well as, 28-week blood work. This is a set of labs that will make sure your iron levels are sufficient and that no new diseases have been acquired. Fetal movements are in full swing at this time. Going over normal anxieties and concerns is a good idea.
Weeks 24 – 28: Last visit within the second trimester! This is a catch-all visit to make sure everything is up to date, the baby sounds good and is measuring appropriately and that you have started to prepare for birth. It is a good time to consider joining a birth class (or take my online, easily accessible birth classes if you didn’t already start my 9-month complete course)!
Weeks 28 – 32: Weight gain is reviewed, as well as blood pressure. Important talking points are when to call the doctor if preterm labor is suspected. I review red flags and worrisome signs at this time. Exercise is still good and I review new common complaints like shortness of breath at this time.
Weeks 32 – 36: Another test for group B streptococcus is to be performed around this time. You will probably start to see your provider weekly after this visit. Discussions on delivery information and options should be had, as well as, your birth plan. If you haven’t already, sign up for my free birth plan here! It’s super comprehensive and gets you really thinking about what matters to you.
Weeks 36 – 40: Lastly, many things will need to be considered in those last few weeks. Making sure that you are in the best of health to deliver a healthy baby is very important. Blood pressure, weight, signs of preeclampsia or fetal distress will be reviewed. You might need to go in for a non-stress test or a biophysical profile of the baby. These are all ways to make sure the baby is tolerating contractions and has a good health status.
So there is a lot that happens during each visit. Let’s get to how you can make the most of each visit so that it benefits you the best!
10 Best ways to improve your prenatal visits
1. bring you last delivery’s records with you to the new provider
If you have delivered before at a different hospital or with a different provider, your new office will need these to include in your file. Your previous pregnancies and deliveries are very important to your next pregnancy and delivery. Certain conditions can increase the likelihood of recurrence in each pregnancy thereafter. If you have an emergency delivery with your last pregnancy, it is very important your delivery provider is made aware ahead of time.
2. write a list of questions and bring it with you
Prenatal visits are roughly every 4 weeks apart until you are near your due date. I loved when my patients wrote down their questions that had been building up over the last 4 weeks so that they would get answered. No matter how trivial, your provider should be able to answer all those questions. Be patient. Some providers need to accomplish everything that has to get done first, but they should be more than willing to sit down and go over your question list at the end.
3. schedule morning visits if possible
Your weight will be more accurate in the morning and will stress you out less. Yes, the number is going to steadily go up at each and every visit. This is hard for some women, but it is normal and natural. A lot of women felt the need to have an excuse for weight gain because of the lunch she just ate, don’t worry about that! Lastly, providers get fatigued at the end of the day. Morning visits are the best because you get us as fresh and clear-headed as ever. We are slightly less concerned about running over time because we have a lunchtime buffer ahead.
4. request a print out of your next tests and ultrasounds
Many providers skip the step of printing out your visit summary at the end of the visit. This is because of time constraints, but it benefits you to have a clear list of the tests and ultrasounds that you have coming. Instead of writing them all out on paper, I like to print out a list of tests I just order instead. Furthermore, it’s easier and a printout includes the place where you are supposed to have those tests performed.
5. bring your partner, but leave your children if you can
Pregnancy fog is real. If you have a partner or family member with you at the time of your visit, they can help remember things said or recommendations your provider makes. Children playing during a visit can be distracting to both you and the provider. It’s totally understandable if you don’t have childcare for a short prenatal visit, so no harm is done if you need to bring them, but it won’t do you any favors either.
6. Bring everything with you
Bring your vitamins, your support hose, your belly band, your blood pressure recordings, and your blood sugar numbers and any else you want to be reviewed. Having actual products and numbers with you helps the provider give you a real answer as to if something is safe for pregnancy or not. Prenatal vitamins differ among brands and some don’t carry enough folic acid or vitamin D3. I like to give real answers instead of weak ones that prolong the problem or your question.
7. don’t be afraid to come in sooner
If you are afraid about a symptom you are having don’t be afraid to call the office to have an unscheduled visit that day. I’d much rather my patients call and come in, then fearfully wait and see what happens. I can so easily relieve someone of their worst fear and it would not even be much work for me to say, listen to your baby’s heartbeat or test your urine for a urinary tract infection, or make sure your lungs are clear from your recent cold. Providers are here for you!
8. vbac? ask to review the consent form
If you are considering a vaginal birth after cesarean section (VBAC), you should review the consent form first. It is relatively safe, but you will have to consent to the very few risks that come with a VBAC before you go into labor. This should be a topic discussed at length with your delivery provider because the terms at which you had your first cesarean might make it dangerous to VBAC.
9. scoliosis? ask to make a visit with the anesthesiology team
If you are considering an epidural but you have scoliosis or you’ve had back surgery, it is good to speak with anesthesiology first. You will want to have an initial consult with them to make sure an epidural is even a possibility for you and this should be done before you go into labor. It’s a small thing, but a good idea for both anesthesia and you!
10. my recommendations for you
In conclusion, it’s hard to squeeze in everything you need to know during prenatal visits alone. My number one piece of advice for new moms is to prepare as much as you can because once you go into labor, you are relying on your coping skills. Labor and contractions can really surprise you, so if you have a plan and a few coping strategies in your pocket you can go for a while avoiding an epidural. It’s really a mental endurance test (with a heavy dose of physical endurance too).
Partners tend to be just as caught in the headlights of labor as you are too. It’s okay! They need childbirth education too and relying 100% solely on your partner can be good and bad depending on the couple.
Breastfeeding is the long game. It’s much easier said than done, but once you have the hang of it, a few weeks in, it’s the easier option of the two. Preparing to breastfeed should be of equal importance to preparing to birth. You will never know how much dedication and determination you need to get through those first weeks. But, then you can really enjoy the breastfeeding high that everyone talks about!
Chloe Quinn, MSN, RN, APRN, WHNP-BC is a women’s health nurse practitioner with 10 years of experience in infertility, birth and breastfeeding. You can find her coaching women through all 9 months, especially in her pregnancy, birth and breastfeeding course. Pick up her free birth plan at thepregnancyprep.com/classes! Chloe has worked with women as a labor and delivery nurse at St. Vincent’s Medical Center, a nurse practitioner at Yale University and now lives in Seattle privately providing fertility coaching. Questions? Email [email protected]