The medical care that a woman and her fetus receive during pregnancy is called prenatal care. It is typically provided by an obstetrician or obstetrician-gynecologist (ObGyn). However, it may also be provided by a certified nurse-midwife and, in some instances, a family practitioner.
Prenatal care is designed to monitor the progress of a patient’s pregnancy and detect any potential problems before they affect the expectant mother or baby. All women can benefit from prenatal care, regardless of their age, health status or number of previous pregnancies.
During prenatal care visits, a physician will:
Teach the expectant mother about pregnancy
Monitor any pre-existing health conditions (e.g., high blood pressure)
Test for any new health conditions (e.g., gestational diabetes)
Test for potential problems with the fetus
Provide referrals to services (e.g., childbirth education classes)
Prenatal care visits generally take place once a month for the first four to 28 weeks of pregnancy and twice a month during weeks 28 through 36. After week 36, patients may have to meet with their physician as often as once a week. Women with chronic medical conditions and those with high-risk pregnancies may have to visit their healthcare provider more frequently. The first prenatal care appointment generally takes longer than the other checkups that follow.
About prenatal care
Prenatal care refers to the medical care that a woman and her fetus receive during pregnancy. It is typically provided by a physician called an obstetrician who specializes in caring for pregnant women through childbirth and the recovery period after delivery. Many obstetricians also specialize in gynecology (general women’s health care). These physicians are known as obstetrician-gynecologists (ObGyns). Prenatal care may also be provided by a certified nurse-midwife (a registered nurse with advanced training in the care of pregnant women and the delivery of babies) and, in some instances, a family practitioner. According to the March of Dimes, approximately eight out of 10 pregnant women select an obstetrician as their healthcare provider during pregnancy.
Pregnancies are typically considered “high risk” if the patient is older than age 35, carrying multiple fetuses or has a chronic medical condition, such as diabetes. In such cases, patients may be referred to a physician (perinatologist) who specializes in treating women with high-risk pregnancies.
Prenatal care is designed to monitor the progress of a woman’s pregnancy and detect any potential problems before they harm the expectant mother or baby. Approximately 4 million women give birth every year in the United States, according to the Centers for Disease Control and Prevention (CDC). Although about two-thirds of these pregnancies are free from complications, all expectant mothers should begin receiving prenatal care as early in their pregnancy as possible to better ensure their health and the well-being of the developing fetus. According to the Maternal and Child Health Bureau, babies born to mothers who do not receive prenatal care are three times more likely to be born at a low birthweight and five times more likely to die than those whose mothers receive prenatal care.
All women can benefit from prenatal care, regardless of their age, health status or number of previous pregnancies. In addition to the many health benefits of prenatal care, the visits also provide physicians with an opportunity to educate and counsel women about different aspects of pregnancy (e.g., physical activity, nutrition). Women can also ask questions and discuss concerns about labor and delivery and infant care.
Ideally, patients should meet with their physician for a preconception visit before becoming pregnant. During this visit, the physician may:
Perform routine tests to confirm that the patient is in good health
Discuss the potential impact of any existing medical conditions on the pregnancy
Review risk factors, such as tobacco use and alcohol consumption, which may pose a risk to the baby
Recommend that the patient begin taking a prenatal vitamin that contains sufficient amounts of folic acid, calcium and iron
Discuss genetic testing if either the woman or her partner is a potential carrier of a significant genetic disorder
Women should schedule their first prenatal care appointment as soon as they suspect they may be pregnant. They should also make an effort to attend every prenatal care appointment thereafter, even if they are feeling fine. According to the March of Dimes, women who meet with their healthcare provider regularly during pregnancy:
Are less likely to experience pregnancy complications
Have a lower rate of premature delivery
Have healthier babies
During prenatal care visits, the physician will:
Teach the patient about pregnancy
Monitor any preexisting health conditions (e.g., high blood pressure)
Test for any new health conditions (e.g., gestational diabetes)
Test for potential problems with the baby
Provide referrals to services (e.g., childbirth education classes)
Pregnancy is divided into three trimesters, and patients will meet with their physician more frequently each trimester. A typical prenatal care schedule for a low-risk woman with a pregnancy that is progressing normally is as follows:
Frequency of Visits
Stage of Pregnancy
Once a month
Four to 28 weeks
Twice a month
28 to 36 weeks
Once a week
36 weeks to delivery
Women with chronic medical conditions and those with high-risk pregnancies may have to visit their healthcare provider more frequently.
Prenatal care during the first trimester
The first prenatal examination should take place during the first six to eight weeks of pregnancy, or when a woman’s menstrual period is two to four weeks late. The first prenatal care appointment typically takes longer than the other checkups that follow. During this visit, the physician will try to gather as much information as possible about the medical and family histories of the patient and her partner. The patient should answer the physician’s questions honestly, even if they make her feel uncomfortable or embarrassed. Anything that a patient tells her physician is confidential, meaning that the physician cannot disclose information to a third party without permission.
During this visit, the patient will be asked to answer questions about her:
pregnancy history (if applicable)
Menstrual cycle (e.g., first day of last period)
Contraceptive practices
Use of over-the-counter or prescription medications
Allergies, medical conditions and diseases (past and present)
Past surgeries
Lifestyle factors, including exercise habits, diet, alcohol consumption, tobacco use and recreational drug use
Sexually transmitted disease (STD) risk factors (e.g., having multiple sex partners)
Work environment
Home environment
The patient’s answers to these questions and others will influence the care she receives. In addition, the patient will have the opportunity to ask the physician any questions she may have about the pregnancy. The patient may choose to compile a list of questions to ask the physician ahead of time and bring it with her to the appointment. This helps to ensure that important questions are not overlooked.
After the patient has answered all relevant questions, the physician will perform a physical examination. During the physical exam, the physician will check the woman’s height, weight and blood pressure, and assess her general health.
The physician will perform a pelvic examination and rectal exam. During a pelvic exam, the physician inserts a device called a speculum into the woman’s vagina. The speculum separates the vaginal walls and allows the physician to view the cervix (the opening of the uterus [womb]). The pelvic exam enables the physician to check for:
Clues about the baby’s due date. To estimate the baby’s due date, most physicians add seven days to the first day of the patient’s last period, and then subtract three months. For instance, if the woman’s last period began on June 23, the estimated due date would be April 30 (June 23 + 7 = June 30 – 3 months = April 30). The majority of babies are born within two weeks of their predicted due date. Changes in the cervix and in the size of the uterus can also help the physician predict the baby’s due date. Determining the baby’s approximate due date in early pregnancy allows the physician to monitor the baby’s growth and interpret laboratory results as accurately as possible. In addition, knowing the baby’s due date affects how the physician might manage preterm labor, should it occur.
Cervical abnormalities or infections. The physician will also perform a Pap smear. During this procedure, the speculum remains in place while the physician gently collects mucus and cells from the woman’s cervix. This screening procedure is used to detect cervical changes before cancer develops. The test also detects infection. Cervical infections, such as the STDs chlamydia and gonorrhea, can adversely impact a pregnancy and the health of the developing fetus.
Size and position of the ovaries and uterus. To determine this information, the physician will remove the speculum and insert two gloved fingers into the patient’s vagina. This allows the physician to check the cervix. The physician will then place the other hand on top of the patient’s abdomen to check the size of the ovaries and uterus.
Many physicians also evaluate the size and shape of the woman’s birth canal at this time. These determinations can help the physician predict whether the patient may experience problems during labor and delivery. For instance, the patient’s pelvis may not seem wide enough for the baby’s head to pass through or the pelvis arch may be narrow, resulting in problems in the labor process. Although it is difficult to make an accurate prediction this early in the patient’s pregnancy, the physician may make a note to re-evaluate this at a later date.
The physician will also take blood and urine samples during the initial prenatal care visit. Additional blood and urine tests may be done at later appointments as well.
Routine first trimester lab tests include blood tests to screen for:
Blood type (A, B, AB or O)
Complete blood count (CBC)
Rhesus factor (Rh negative or Rh positive)
Red blood cell antibodies (typically Rh antibodies, which increase the baby’s risk of developing conditions such as anemia or jaundice following birth)
Exposure to hepatitis B, chickenpox (varicella), measles, mumps or rubella
HIV (optional)
Syphilis, gonorrhea, chlamydia and other STDs
Toxoplasmosis (optional)
Sickle cell trait or sickle cell disease (for women at high risk such as women of African or Mediterranean decent)
Cystic fibrosis (optional)
First-trimester urine tests typically screen for:
Bladder or kidney infection (both of which require treatment)
Elevated blood sugar (which may indicate diabetes)
Protein (which may indicate kidney disease)
After the exams and blood and urine tests, the physician will discuss general pregnancy guidelines and restrictions with the patient. If the patient or her partner is a potential carrier of a hereditary disease, genetic testing may be offered at this time. This might be offered as well to women who are older (over the age of 35) as they also are at a higher risk for genetic problems.
The remaining first-trimester prenatal care appointments will be briefer than the initial visit. They will all include physical exams. Patients will rarely require another pelvic exam unless the physician discovers something unusual during the initial visit or if the patient reports certain types of symptoms. Ultrasound (sonogram) is often scheduled for the sixth or seventh week to confirm the pregnancy. At around 10 to 13 weeks, the physician may perform a chorionic villus sampling (CVS), in which a portion of the patient’s placenta is removed and analyzed to identify certain birth defects. This is typically done when women are over age 35 because there is an increased risk of chromosomal conditions, such as Down syndrome. CVS may also be performed if:
A woman has given birth to a child with a birth defect in the past
There is a family history of a particular genetic disorder
There is an abnormal screening during the first trimester
In addition, a new and less invasive screening technique that may soon become standard prenatal testing is the integrated prenatal screening (IPS). The IPS test is performed in two stages. First, an ultrasound examination is done between the 11 and 13 weeks plus six days of pregnancy to measure the fluid accumulation behind the fetus’ neck (nuchal translucency). After the ultrasound exam, the physician will perform a blood test on the expectant mother to measure the level of a protein normally found in the blood of every pregnant woman, PAPP-A (pregnancy associated plasma protein-A). The second stage of IPS involves another blood test performed on the mother at 15 to 20 weeks of pregnancy, ideally at 15 to 16 weeks for the earliest possible results. The second blood test measures the levels of four proteins normally found in the blood of all pregnant women: AFP (alpha-fetoprotein), hCG (human chorionic gonadotropin), E3 (unconjugated estriol) and inhibin A. Results from the ultrasound and both blood tests are then integrated into a single analysis.
It should be noted that results from the IPS can only be obtained after the ultrasound AND both blood tests are completed (typically not before 17 weeks of gestation). However, IPS has a high-accuracy rate for detecting chromosomal abnormalities including Down syndrome and neural tube defects such as spina bifida, which can eliminate the need for more invasive testing like CVS. Patients interested in IPS should consult with their ObGyn to determine if they are good candidates for the test.
Prenatal care during the second trimester
During the second trimester of pregnancy (weeks 13 to 24), patients will continue to see their physician monthly. These prenatal care visits will focus on:
Predicting the due date more accurately. The size of the woman’s uterus (womb), measured from the pubic bone to the top of the uterus in centimeters (cm), is called fundal height. The fundal height is an indicator of the baby’s age. The patient will be asked to empty her bladder before the fundal height is measured. The physician will then gently tap and press on the abdomen and measure along the front of the abdomen from that point to the patient’s pubic bone. At the middle of a patient’s pregnancy, the fundal height commonly equals the number of weeks the patient has been pregnant.
Tracking the baby’s growth and health. The patient’s weight and blood pressure will be checked at every prenatal care visit. She will also be asked about any symptoms she may be experiencing. In addition, the physician will start checking the baby’s position, size and heart rate at this time using an ultrasound (sonogram) device.
Assessing movement of the fetus. Patients often feel the baby move inside them by 20 weeks of pregnancy. Women should note the date they first notice fetal movement and report it to their physician at their next prenatal care visit. This date can help the physician predict the baby’s due date more accurately.
Prenatal testing. Patients may be offered prenatal testing during the second trimester of pregnancy, which can identify genetic and congenital problems that may affect the developing baby. A physician who is aware of such problems ahead of time may be able to treat the condition more effectively or help prepare the parents for attending to the special needs of the baby. Prenatal tests may include:
Alpha-fetoprotein (AFP) screening. Measures the level of the antigen AFP in the patient’s blood. This test can identify multiple fetuses, Down syndrome and other types of chromosome problems or neural tube defects such as spina bifida.
Multiple marker screening. Measures specific hormones in the blood. This test can identify a fetus at risk for specific chromosomal abnormalities or birth defects.
Amniocentesis. A sample of the amniotic fluid is removed and tested for certain fetal abnormalities, such as spina bifida or Down syndrome. Usually this procedure is recommended only for women over age 35 and those at increased risk of having a baby with one of these conditions.
Screening for complications. Near the end of the patient’s second trimester, she will be screened for pregnancy complications such as gestational diabetes (diabetes that occurs only during pregnancy), Rh antibodies (antibodies that when present increase the baby’s risk of developing conditions such as anemia or jaundice following birth) and anemia (a condition characterized by a deficiency in red blood cells and low iron levels).
The level of protein in the urine will also be measured. High protein levels can indicate preeclampsia (a dangerous condition characterized by high blood pressure and proteinuria [protein in the urine]).
Many changes take place during the second trimester of pregnancy. Therefore, it is imperative, for the sake of both the expectant mother and the developing baby, that patients notify their physician of any symptoms they may experience during this time. Patients may also want to begin asking questions about the upcoming childbirth and breastfeeding.
Prenatal care during the third trimester
Patients may visit their physician weekly during the third trimester of pregnancy (week 25 to delivery). The physician will continue to monitor the patient’s weight and blood pressure as well as fetal movement and activity during this time. Third-trimester prenatal care visits also include:
GBS (group B streptococcus) testing. Patients will be screened for GBS, a typically harmless bacterium that may inhabit the body, at some point between 33 and 36 weeks of pregnancy. The physician will take a culture from just inside the woman’s vagina and rectum. The culture will then be tested for the bacterium. GBS poses no health risks to expectant mothers. However, it can be passed to a baby during labor and delivery and this infection can be serious to the newborn resulting in blindness, deafness, mental retardation, physical disability and even death. If this bacterium is detected, the patient will be given antibiotics when she begins labor.
Checking the position of the baby (presentation of the fetus). The physician may be able to determine the baby’s position during the patient’s seventh month of pregnancy. Most babies move into a head-down position in the uterus a few weeks before they are born. The physician will check the baby’s presenting part, the portion of the baby that is furthest down in the pelvis, at this time. The physician can often feel the baby’s head in the lower abdomen just above the patient’s pubic bone, or at the top of her birth canal, during a vaginal examination. An ultrasound may be performed if the presenting part cannot be determined with a vaginal exam.
Babies positioned rump- or feet-first are in “breech position,” and must usually be delivered by Caesarean section. If the baby is breech, and is not positioned too far down in the patient’s pelvis, the physician may perform an external version approximately two to four weeks before the baby is due. This procedure involves applying pressure to the abdomen in an effort to move the baby into the desirable head-down position. The physician may determine the “station” of the baby’s presenting part, or how far down the baby is positioned in the pelvis, closer to the baby’s due date.
Checking to see if the patient’s cervix is dilated and effaced. As the baby’s due date grows nearer, a vaginal exam will determine the following:
How much the cervix is starting to soften
How much the cervix has dilated (opened)
How much the cervix has effaced (thinned out)
The progress of a patient’s dilation and effacement is measured in centimeters (cm), and percentages (e.g., 3 cm dilated and 30 percent effaced). Babies are not delivered until the cervix is 10 cm dilated and 100 percent effaced.
Patients should not put too much emphasis on these measurements. Generally, this exam is used only to predict if the patient is a good candidate for induction of labor. Some women may be 3 cm dilated for weeks, whereas others may go into immediate labor that is not preceded by any dilation or effacement. In fact, the physician may not even perform this exam unless the patient is being considered for labor induction.
Questions for your doctor on prenatal care
Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor or healthcare professional the following questions about prenatal care:
How often will I need to see you during my pregnancy?
Should I have genetic testing? Should my partner also be tested?
What other types of tests will you perform?
Am I a good candidate for integrated prenatal screening (IPS)?
How will my preexisting health condition affect my baby’s health? How will it affect my delivery?
Will my current medications affect the health of my baby? Are there any medications that are safe to take during pregnancy?
Should I take prenatal vitamins?
Will the due date for my baby change?
What physical activities may affect the baby’s health?
Will sexual intercourse harm the baby?
For what reasons should I call your office?
I have morning sickness (any time of day) that does not go away. What can I take for my nausea and vomiting? Is the medication safe for my baby?
Are there any foods I should avoid during pregnancy?
