When you think you're pregnant, you may have a sweeping range of emotions, spanning from excitement to fear. And then there are the questions. Am I really pregnant? Are these symptoms normal? What do I do now?
Your first visit to the doctor and subsequent prenatal appointment schedule will depend on a combination of your personal health history, how your pregnancy is progressing and your health care provider's process. Unless you have a history of pregnancy loss or fertility issues, your first prenatal visit won't likely be scheduled until sometime between week eight and week 12, but it's still best to call your healthcare provider as soon as you suspect you're pregnant. Some will confirm your pregnancy with a lab test before your first prenatal appointment and others may not, but the sooner you begin receiving prenatal care, the better.
Your first prenatal visit will probably be your longest. Many doctors will encourage you to invite your partner or another family member along -- expectant mothers aren't the only ones with questions! Before you go, brainstorm a list of questions you have about your pregnancy -- we'll get you started with 10, beginning with whether you really are pregnant.
You missed your period this cycle -- could you be pregnant? There are two basic types of home pregnancy tests, and both pretty easy to use. You either pee in a cup and dip the test stick into it, or you pee on the test stick itself. Reading the results can sometimes be a bit trickier. There are digital tests that display "Pregnant" or "Not Pregnant" in the result window, as well as tests that show your results with lines or symbols. Home pregnancy tests vary in sensitivity, but no matter which you choose, you won't get a correct reading until the fertilized egg implants itself in the uterus and your body begins secreting a hormone called human chorionic gonadotropin (hCG). It can take that egg anywhere from about six to 12 days to complete its journey. Take the test too early, and you may get a false negative.
Home pregnancy tests aren't foolproof -- according to the American Pregnancy Association, you can expect your home pregnancy test to be about 97 percent accurate. For even better accuracy, your doctor will offer a blood test. There are two types: one that measures whether or not you're pregnant (called a qualitative hCG blood test) and one that measures the amount of hCG there is in your blood (called a quantitative blood test). At your first prenatal appointment, a blood pregnancy test will be part of your workup.
You need one piece of information to calculate your baby's estimated due date: the date of the first day of your last menstrual period (also known as your LMP). An average pregnancy lasts 40 weeks from that date, although it's common for babies to arrive any time after the 38th week. According to the American Congress of Obstetricians and Gynecologists, only about 5 percent of babies are born on their due date, so keep in mind that your baby's estimated due date is truly just an estimate.
One quick method for calculating your estimated due date is to add 7 days to the date of the first day of your LMP. Jump ahead one year, and subtract 3 months.
If your cycles are irregular, your doctor may schedule you for an early ultrasound, in addition to the physical exam, to verify how far along you are in your pregnancy.
Part of the first prenatal visit will include a detailed account of your personal medical history, including all the medications and supplements you currently take. While some medicines are safe to use during pregnancy, others may cause birth defects and should be stopped as soon as possible.
In the United States, the FDA gives drugs a pregnancy rating: A, B, C, D and X. Medications rated category A and B are generally considered safe during pregnancy because they haven't been shown to cause any problems when used by pregnant women. Drugs in category C have unknown outcomes for pregnant women -- studies haven't determined whether they're safe or not. Those rated D have caused harm to some fetuses, and those rated X are considered off-limits to pregnant women.
While many women try to avoid taking any medications during their pregnancies, sometimes that's not an option -- it's a decision you and your doctor will make based on whether or not the benefits outweigh the risks. Depending on the condition your medication is treating, you may be advised to stop taking it, or your doctor may prescribe a different drug that's considered safer for your growing fetus. Take a list of all your medications to your first appointment so you and your doctor can decide what's best for you.
Certain pre-existing conditions may mean your pregnancy is considered to be high risk: Either you or your baby has an increased risk of complications during pregnancy and after delivery.
Lots of factors count as preexisting conditions, including:
- Age (older than 35 or younger than 15)
- Heart disease
- Sexually transmitted diseases
- Autoimmune diseases, such as lupus, rheumatoid arthritis or gluten sensitivity
Women who have a history of pregnancy-related or fertility-related problems are often also considered to have high-risk pregnancies.
Conditions may also arise that turn an otherwise healthy pregnancy into a high-risk one. Being pregnant with multiples increases your risks, as does developing Rh disease, preeclampsia, gestational diabetes or any other chronic illness such as cancer or HIV. If your doctor hasn't already taken a complete medical history, he or she will at your first appointment to determine whether you're in a high-risk category.
Consider part of your first prenatal visit a fact-finding mission: Not only will you want to know how often you'll be seen during your pregnancy, but you'll also want to talk to your doctor about what tests to expect during your pregnancy and when (or if) they should be performed.
Tests include screening for birth defects, such as Down syndrome, trisomy 18, neural tube defects, heart defects and abdominal wall defects. Here are some examples of the tests you may have during your pregnancy:
- A nuchal translucency ultrasound with a blood test is a relatively new test that measures plasma protein A (PAPP-A) and hCG to screen for Down syndrome in the first trimester.
- Amniocentesis screens for chromosomal and genetic defects and is usually performed between 15 and 20 weeks of pregnancy. It involves using a needle to remove some amniotic fluid, which is analyzed in the lab.
- Chorionic villus sampling (CVS) screens for the same birth defects as amniocentesis but earlier in the pregnancy (between 10 and 12 weeks). CVS tests material from the uterus, which is collected by sending a tube through the vagina and cervix.
- Quad screen is a blood test that measures hormone (hCG and estriol) and protein (AFP and Inhibin-A) levels to screen for chromosomal abnormalities. It's performed between 16 and 18 weeks.
- Alpha-fetoprotein (AFP) screens for spina bifida, anencephaly, chromosomal and congenital problems and is usually performed between 15 and 20 weeks.
Routine exercise for most pregnant women is healthy and, according to the American Congress of Obstetricians and Gynecologists, it may be beneficial for your changing body. Getting 30 minutes of exercise every day is great for improving your strength and endurance (both will help during labor, as well as during your postpartum attempts to recover your pre-pregnancy body). Exercise may help to lift your mood, reduce pregnancy symptoms (including those unwelcome backaches, constipation and bloating), decrease your chances of developing gestational diabetes, and help you sleep.
Despite the persistent myth, exercise won't increase your risk of miscarriage. If you're just starting, ask your healthcare provider for help in developing an appropriate exercise program to follow during your pregnancy. If you already exercise regularly, be sure to discuss your routine with your doctor, as there are some modifications you may need to make while you're pregnant.
Women who are at a healthy weight when they become pregnant shouldn't expect to gain much in the first trimester -- only about 1 to 4 pounds (0.4 to 1.8 kilograms). The rest of the pregnancy averages about a pound of weight per week, totaling about 25 to 35 pounds (11 to 16 kilograms). Women who are overweight or obese may be advised to gain less, and vice versa for women who begin pregnancy underweight. If you're expecting multiples, expect a greater weight gain. Your doctor will council you on reasonable weight goals during your first visit.
Where does it all go? It may feel as if your pregnancy weight gain is all in your belly, breasts and thighs, but a woman's weight gain is distributed among her breasts, uterus, blood, fat, muscle, placenta and amniotic fluid -- plus the baby. And no, it's not your imagination: You're retaining about 4 pounds (1.8 kilograms) of water.
For many women, it's their breasts, not a home pregnancy test, that clue them into their pregnancy. The hormonal changes during early pregnancy can cause breasts to feel swollen, tender, tingly or heavy. Fatigue and cramping (sometimes with a small amount of spotting) are also common early pregnancy symptoms.
As the first trimester gets underway, symptoms may also include morning sickness (which can happen throughout the day), hormonal headaches, constipation (thank the increase in progesterone for that), mood swings, dizziness, and both food craving and aversions.
Symptoms vary from woman to woman and from pregnancy to pregnancy, and while some pregnancies may be symptom-free, others may have all the classics. Still others may have symptoms you don't normally associate with pregnancy, like a stuffy nose or carpal tunnel syndrome. Make a list of any symptoms that are troubling you before your first visit so you don't forget about any of them once you're in the doctor's office.
Aches, pains and bleeding can all be symptoms of a normal pregnancy, but that doesn't make them any less scary when they happen. According to the National Institutes of Health, as many as 10 percent of women experience vaginal bleeding during their pregnancies, most in the first trimester. Everything from gas to Braxton Hicks contractions can mimic the sensations of labor. And once you've started to feel your baby move, a few hours of stillness can be frightening.
While friends and family members who are or have been pregnant can be great sources of comfort and support, your doctor is the best person to tell for sure whether what you're experiencing is a sign of trouble. Discuss all your symptoms, alarming or otherwise, with your doctor during your first visit. Then, find out how your doctor would like you to handle troubling symptoms in the future. Your doctor may give you the number of a nurse line or on-call service in case you have urgent questions.
And, even though many women experience bleeding in the first few weeks of their pregnancy, it's a good idea to contact your doctor if you experience spotting, bleeding or pain as your pregnancy progresses.
Pregnant women need more folic acid, iron and calcium than before they were pregnant, and taking a prenatal vitamin will help to cover the gaps that even a well-intentioned diet may leave. Folic acid is important for reducing brain and spinal cord defects in the growing fetus. In the U.S., flour and many breakfast cereals are enriched with folic acid, and it is also found in dark green leafy vegetables, legumes, beans and citrus.
In addition to recommending a healthy, balanced diet and adding prenatal vitamins to your daily routine, your doctor will likely also advise you to avoid alcohol, caffeine and certain foods. Other foods doctors advise pregnant women to avoid include:
- Raw meats, eggs and shellfish (no uncooked sushi during pregnancy)
- Deli meats and hot dogs (which could carry listeria, a foodborne illness that's dangerous for pregnant women)
- Smoked meats (such as lox or jerky)
- Fish that may have high levels of mercury or industrial pollutants
- Soft cheeses made with unpasteurized milk
On top of all that, be sure to wash your fruits and veggies thoroughly before eating while you're pregnant.
Your first visit to the doctor is your opportunity to ask questions and make plans for later in your pregnancy. To learn more about how pregnancies progress and how to care for yourself during your pregnancy, follow the links on the next page.
HowStuffWorks takes a look at the fascinating case of a woman who experienced ectopic lactation after childbirth.
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- "Food-borne Risks in Pregnancy." March of Dimes. 2008.http://www.marchofdimes.com/professionals/14332_1152.asp
- "High-Risk Pregnancy." National Institute of Child Health and Human Development. National Institutes of Health. 2006.http://www.nichd.nih.gov/health/topics/high_risk_pregnancy.cfm
- "Human Chorionic Gonadotropin (hCG)--The Pregnancy Hormone." American Pregnancy Association. 2007.http://www.americanpregnancy.org/duringpregnancy/hcglevels.html
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- "Nuchal Translucency." Greater Baltimore Medical Center. 2010.http://www.gbmc.org/body.cfm?id=251
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- "Quad Screen." American Pregnancy Association. 2009.http://www.americanpregnancy.org/prenataltesting/quadscreen.html
- "Routine Prenatal Tests." March of Dimes. 2009.http://www.marchofdimes.com/pnhec/159_519.asp
- "Symptoms of pregnancy: What happens right away." MayoClinic.com. Mayo Foundation for Medical Education and Research. 2009.http://www.mayoclinic.com/health/symptoms-of-pregnancy/PR00102
- "Understanding Pregnancy Tests: Urine & Blood." American Pregnancy Association. 2006.http://www.americanpregnancy.org/gettingpregnant/understandpregnancytests.html
- "Vaginal bleeding in pregnancy." MedlinePLUS Medical Encyclopedia. National Institutes of Health. U.S. National Library of Medicine. 2010.http://www.nlm.nih.gov/medlineplus/ency/article/003264.htm
- "Weight Gain During Pregnancy." March of Dimes. 2009.http://www.marchofdimes.com/pnhec/159_153.asp
- "What To Expect After Your Due Date." Patient Education Pamphlet. The American Congress of Obstetricians and Gynecologists. 2006.http://www.acog.org/publications/patient_education/bp069.cfm