A Healthy Pregnancy Begins with Prenatal Care

Being pregnant is a wonder-filled time for parents-to-be. In nine short months, an entirely new human being—from belly button and nose to wee little fingers and toes—will enter the world and your lives. But caring for your little one begins well before delivery in the form of prenatal care visits with your OB/GYN.

In most pregnancies, a pregnant individual will have somewhere between 10 to 15 prenatal visits with their doctor. For most complication-free pregnancies, prenatal appointments typically follow this schedule:

• Weeks 6 to 12: Initial visit

• Weeks 12-28: Every four weeks

• Weeks 28-36:  Every 2 weeks

• Week 36 until birth: Every week

NOTE: For high-risk pregnancies, the number and frequency of visits may be higher throughout the entire nine months.

Here’s a look at what you can expect at these appointments:

0-12 weeks: As soon as you believe you’re pregnant, it’s important to set up a meeting with your provider to share your medical history, receive a pelvic exam, and draw blood for a series of screening tests. Your doctor will also talk about potential future screenings for your baby, such as cell-free fetal DNA testing to screen for genetic concerns.

16 weeks: This is an exciting visit as it may be the first time you’ll hear your baby’s heartbeat. In addition, your doctor will check your blood pressure and other vitals, schedule an ultrasound for 20 weeks, and an AFP (alpha-fetoprotein) blood test to measures levels of AFP, a protein that develops in the fetus's liver. Irregular AFP levels can point to problems such as genetic disorders or neural tube defects.

20 weeks: In addition to checking your vitals, your doctor will review the ultrasound report with you at this appointment. The ultrasound offers an incredibly up-close look at how your baby is growing. From organs to limbs, your doctor can determine if growth is on track as well as spot any congenital defects or structural issues.  In many cases, the ultrasound can reveal the sex of the baby.

24 weeks: At this appointment, your doctor will check your vitals, listen to the baby’s heartbeat, and measure your belly to gauge your baby’s growth. In addition, you’ll learn about upcoming labs, including glucose screening. If you have a negative blood type, your doctor will discuss having an Rh-factor blood test done and arranging Rhogam injection. You’ll also be encouraged to schedule a phone visit and possibly a tour of Women’s and Children’s Services, and to learn about special programs and classes for families-to-be.

28 weeks: Your doctor will check yours and the baby’s vitals, review the findings from your recent lab work and schedule a TDap booster vaccine for you. The TDap is a vaccine against tetanus, diphtheria, and pertussis (whooping cough). By getting the vaccine while pregnant,  pregnancy, you pass on the antibodies your body creates to your baby. These antibodies will help protect your baby for a short time after they are born until they can get vaccinated themselves.

30 weeks: At 30 weeks, the frequency of your prenatal appointments increase to every other week. The reason for this is that certain pregnancy complications and issues with your baby's growth only appear in the third trimester. At this visit, your doctor measures your vitals, assesses your baby, and may discuss if you’d like to have a sterilization procedure done at the time of delivery.

32 weeks: Now is when you’ll schedule a second ultrasound to check how your baby is growing. Along with the usual weight, urine and blood pressure checks, your doctor will listen to the baby’s heartbeat, ask about any contractions, leaking fluid, or bleeding you may be experiencing, to assess concerns for preterm labor. You’ll also be encouraged to find a pediatrician for your child if you don’t already have one as well as to connect with your insurance provider to learn if circumcision is covered by your plan, if that is what you are planning for your child.

34 weeks: You’re getting close! Given that, now is the time to think about your preferences for your labor and to share them with your doctor and whoever else might be accompanying you at the birth. If you have questions or concerns about breast or bottle feeding, now is the time to bring them up with your doctor.

36-40 weeks: At the 36-week mark you’ll begin visiting your doctor on a weekly basis until delivery. In addition to getting vitals checked and regular ultrasounds, you will be tested for Group B Strep (at 35-37 weeks), take a depression screening (at 36 weeks), and will be encouraged to consider what you’ll be using for birth control post-delivery. Depending upon the size and position of your baby and any known complications, your doctor may also discuss options for inducing labor. This is also your chance to talk about your wishes for your birth experience, including pain management options, and to ask any last-minute questions you may have.

Yes, prenatal visits are filled with various tests, measurements, screenings, and exams. But the information gathered is critical to keeping track of your baby’s development, spotting any potential complications or concerns, and to ensuring you mentally and physically prepared for delivery and what lies ahead. Every appointment is important. Do your best to make every appointment and always be sure to share any concerns or questions you have.

Themarge Small, MD, FACOG, is an obstetrics & gynecology specialist at Southwestern Vermont Medical Center.