What to expect at your first Doctor’s Visit
Brittany Peats

As soon as you suspect you're pregnant, schedule an appointment with your pregnancy health care provider. Prenatal care is very important should begin as soon as possible. Besides medical care, visits to the doctor will include education about pregnancy and childbirth, and allow you to follow the exciting progress of your fetus. These visits are a great time to ask all the questions you have about pregnancy.

The first visit is designed to confirm your pregnancy and to determine your general health. The doctor will determine your due date; she will also ask about your medical history as well as those of your family members. You will be asked about previous pregnancies and surgeries, medical conditions and exposure to any contagious diseases. Also, notify your healthcare provider about any medications (prescription or over-the-counter) you have taken or are currently taking. This will help determine whether you have any pregnancy risks based on your age, health, or family history.

Many women have lots of question that they want to ask their doctor at their first visit. Here are some common questions:

• What is my due date?
• Do I need prenatal vitamins?
• Are the symptoms I'm experiencing normal?
• Is it normal not to experience certain symptoms?
• Is there anything I can take for morning sickness?
• What are the specific recommendations regarding weight gain, exercise and nutrition?
• What activities, foods, substances (for example, medicine, caffeine and alternative sweeteners like Equal) should I avoid?
• Can I have sex while I am pregnant?
• For what symptoms should I call you?
• What is the definition of a high-risk pregnancy? Am I considered to be high risk?

Your provider may perform some, or all, of these preliminary tests and exams. They are routine and do not indicate that you are unhealthy in any way:

Exams:

• Physical exam: You are weighed and your blood pressure, heart, lungs and breasts are checked.
• Pelvic exam: During the pelvic exam, a Pap smear is taken to screen for cervical cancer and cultures are taken to detect sexually transmitted diseases (such as gonorrhea and chlamydia). In addition, a bimanual internal exam (with two fingers inside the vagina and one hand on the abdomen) will be performed to determine the size of your uterus and pelvis. This exam will also check for any abnormalities of the uterus, ovaries or fallopian tubes.

Tests to see if you have the following diseases:

• HIV test : This test is optional, but recommended.
• RPR: This test screens for syphilis (a sexually transmitted disease) that can be transmitted to your unborn child. If left untreated, it can cause a dangerous condition called congenital syphilis in the baby that leads to bone and tooth deformity, nerve damage, or brain damage. Also, the baby may not be breathing when he or she is born (stillborn).
• Rubella: This test screens for immunity (protection) against German measles. Most Americans received vaccinations against rubella as children and are immune. If you aren't you will need to avoid people with the disease (which is rare in the U.S.) as it can have serious consequences for your developing baby.
• Varicella: This test screens for immunity (protection) against chickenpox. It is usually done only if you don't have a history of the disease, since an initial exposure during pregnancy can be harmful to the developing baby.
• HBsAg: This test screens for hepatitis B (a liver infection) that is transmitted through contaminated needles or blood, or through saliva, semen or vaginal fluid. Infected mothers can transmit this disease to their baby during childbirth. You could have this disease and not know it.

Pregnancy – related tests:

• Urinalysis: During this test you will urinate in a cup and the urine will be tested for kidney disease or bladder infections and high levels of sugar that might indicate diabetes. These infections are very common in pregnant women and are easily treated. If left untreated, bladder infections can quickly progress to kidney infections, which can cause problems for the baby or premature labor.
• Complete Blood Count (CBC): to screen for blood problems such as anemia (usually due to low levels of iron).
• Ultrasound: A device using sound waves to look at pictures of the baby on a screen which verifies your due date and checks the baby's heartbeat.
• Type and screen blood test: This test determines your blood type and Rh factor. Everyone is either Rh negative or Rh positive; if the mother's blood is Rh negative and your partner's blood is Rh positive, your baby's blood type may not match yours which can be a problem during delivery as your body may produce antibodies to protect itself from this "foreign" substance. This phenomenon is called Rh incompatibility and it occurs in about 15% of all pregnancies. If this is the case, you will be given an injection of Rh immune globulin (called Rhogam) during the 28th week of your pregnancy.
• Genetic Tests: Depending on your ethnic background and medical history, you may also be tested for sickle-cell anemia, Tay-Sachs disease and thalassemia. Blacks, Jews, French Canadians and people of Mediterranean descent are most at risk for these illnesses. All of these diseases can be passed onto the baby because of defective genes that the parents may carry (even if they don't have the disease.) Your provider may offer you a test for cystic fibrosis, an inherited disease that can affect breathing and digestion in your baby if you and your partner are carriers.

 

Discovering the Gender

Though some couples opt to wait until birth to discover the gender of their baby, there are three tests which can be performed during the pregnancy to determine the gender of the fetus. All have a margin of error and have a slight risk of damage to the baby. They are best performed at certain times during the pregnancy.

• 8 – 11 weeks: Chorionic Villus Sampling (CVS)
• 9 – 18 weeks: Amniocentisis
• 18 - 26 weeks: Ultrasound

A Chorionic Villus Sampling (CVS) test is usually performed if there is a high possibility of genetic abnormality. A small needle/catheter is placed either through the abdomen or through the vagina near the uterus to collect a small sample of choirionic villi. There is a 1 – 2% miscarriage rate and a slight increase in limb deformities. Test results, including the gender of the baby are available 7 – 14 days after the test.

In an Amniocentisis, which is used to determine if your baby has a chromosomal disorder or for fetal lung maturity, a small needle is placed through the abdomen into the uterus to collect a small sample of amniotic fluid. There is a one percent risk of a miscarriage or other pregnancy complications. The tests take about 2-4 weeks to run. There is a small chance that the sex they tell you is incorrect.

An Ultrasound is a very simple test in a lot of ways and can give your practitioners a lot of valuable information. It can help a doctor date a pregnancy, rule out ectopic pregnancy, check for fetal viability, test for genetic defects, and determine gender. The American College of Obstetricians and Gynecologists, however discourages excessive use of ultrasounds as it can change the way cells reproduce and move. The test is done with an abdominal or vaginal probe, depending on the stage of the pregnancy and what they are looking for. For the abdominal ultrasound, cold gel will be applied to your stomach to aid in the visualization of the baby. The transducer is moved slowly over your abdomen and the signals are sent back to the machine which will project the images of your baby. The vaginal ultrasound is used earlier on in pregnancy; a vaginal probe will be inserted into your vagina for a better view.

Telling friends, relatives and children about your pregnancy

When to tell friends and relatives about your pregnancy is a very personal matter. Some women are afraid that they will tell people early into their pregnancy and then they will have a miscarriage and be forced to explain to everyone what happened. Others who have miscarriages are happy to have the support of those they have told so they don’t have to go through the devastating experience by themselves. Women who have had multiple miscarriages sometimes wait to tell until after the first trimester, when they feel more certain that they will carry the baby to term.

Telling younger children that they will soon have another sibling can be difficult but is necessary. It is generally a good idea to tell them after the first trimester when the pregnancy is well established. Since children are very tuned into their mothers, they may become anxious if they see their mother getting bigger and acting sick without an explanation. Some mothers choose to bring their children to prenatal visits as a way to include them.

Sources:

http://pregnancy.about.com/od/gettingpregnant/p/duedate.htm

http://www.babycenter.com/expert/toddler/toddlerdevelopment/2597.html