What to expect at your first pregnancy visit
The main aims of the first pregnancy visit are for your Lead Maternity Caregiver (LMC) to obtain detailed information about your health, medical and pregnancy history as well as provide you with information about various aspects of the pregnancy and your care and perform (or order) some routine pregnancy tests.
Your first pregnancy visit will basically involve:
- The caregiver obtaining information and discussing health issues relating to the pregnancy.
- Discussing your expectations for the remainder of your pregnancy care, as well as possibly the labour, birth and postnatal care.
- Having a physical examination (maybe including a pap test if required).
- Ordering (or taking) blood tests and perhaps discussing the timing of a pregnancy ultrasound(s) or possibly the need for genetic testing.
- Providing information, resources and contacts you may require for the pregnancy, such as childbirth preparation classes, exercise or physiotherapy services, dieticians, social workers or chemical use in pregnancy services.
Your caregiver will also ask you about any past pregnancies and what the outcomes of these were. For example:
- The birth of previous children. Their date of birth, sex, birth weight, where they were born, how they were born (a normal birth, forceps or ventouse or Caesarean), if they were born around the due date (or premature or overdue), if an induction was needed. What was used to induce the labour if this was done? How long was the labour? Did you need your waters broken? Were there any complications for you or your baby? What pain relief did you use (if any)? Did you tear or have an episiotomy? Did you have any complications after the birth? Did you breastfeed your baby(s)? If so for how long? Did you have any difficulties feeding?
- Miscarriages Have you had any miscarriages? If so, when did the miscarriage(s) occur? How far pregnant were you when it happened? What were the circumstances surrounding the miscarriage? Were there any complications? Did you require an operation? The same type of information would be asked of a past stillbirth and the circumstances surrounding this, discussing possible causes for the baby dying and plans for this pregnancy
- Terminations of pregnancies (abortions). When did they occur? How far pregnant were you? Where did you have the termination and what method was used? Were there any complications?
Be aware that it is usually important for your caregiver to know about past terminations of pregnancies, adopted babies and pregnancies with past partners.
Folic acid supplements:
If you are less than 12 weeks and haven't already started taking folic acid supplements, your caregiver will probably ask you to start taking them. However, folic acid supplements are usually of no benefit after 12 weeks of the pregnancy, and if you have been taking them up until 12 weeks, your LMC will probably let you know that it is acceptable to now stop taking them.
Once you and your LMC have discussed everything you need to, your LMC will then perform a physical examination.
This usually entails:
- Asking you to weigh yourself and perhaps measuring your height (or they may ask you if you know what these are approximately).
- Taking your blood pressure.
- Feeling your pregnant belly (if you are more than 12 weeks pregnant) and perhaps measuring the height of your fundus, and possibly listening to your baby's heart beat. This will depend on how far pregnant you are. Being able to hear your baby's heart beat will very much depend on what equipment your caregiver has to listen to your baby. In many cases the caregiver will try to listen to the heartbeat, but it may be too early in the pregnancy for them to hear anything just yet.
Some caregivers will also do an overall physical health check involving listening to your heart and lungs, feeling the front of your throat to see if your thyroid gland is enlarged, checking your breasts for lumps and looking at your legs to check for varicose veins.
Tests, ultrasounds and genetic testing:
The first pregnancy visit will involve having many blood tests. Your caregiver will either order your blood tests to be taken by someone else (either at the hospital or a private pathologist) or they will take the blood themselves during the pregnancy visit. You may be asked to provide a urine specimen for testing, or bring a urine specimen with you in a clean jar to the pregnancy visit.
Your caregiver may order an ultrasound (or more than one) at various times during the pregnancy, for different reasons. Routine ultrasounds are not compulsory (and some women do decline them) but the most common routine ultrasound is usually scheduled for around 18 to 20 weeks of the pregnancy. This is aimed at:
- Measuring the growth of the baby and relating this to how far pregnant you are estimated to be.
- Trying to detect any obvious physical defects in the baby.
- Identifying the location of the placenta and seeing if there is an adequate amount of amniotic fluid surrounding the baby.
You may have an earlier ultrasound if you experienced bleeding during early pregnancy, or your pregnancy may need to be 'dated', if you are unsure about when your last period was (or you didn't have a last period to speak of). Sometimes an early ultrasound is done as a genetic test, known as a nuchal translucency scan. Some caregivers purchase ultrasound machines to perform 'informal' ultrasounds at every pregnancy visit in their private rooms (however, this is not essential and you can decline having this done if you prefer). Generally, the ultrasound your caregiver does can only provide a limited amount of information. You would need to have an ultrasound performed by a qualified technician and reported on by a qualified ultrasonographer, to definitely confirm your caregiver's ultrasound findings.
Genetic testing may be offered to you (or you may request it) to screen for inherited abnormalities in your baby. There are many options to consider, with these tests usually being organised after a consultation with a genetic counsellor. This is covered in more detail in genetic testing and early ultrasound.
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