I am newly pregnant. What I should expect to happen at my prenatal visits?

M.

Congratulations on your pregnancy! It is a wonderful time, and I hope you can savor all the changes you will experience -- I loved being pregnant.

As for what to expect during your prenatal visits, I will tell you what I do in my practice. Every doctor or midwife is a bit different, so you will need to discuss your care with your own practitioner.

During the first visit, you will be asked for details about your complete medical history, including medical conditions, surgeries, past pregnancies and habits such as smoking and drinking alcohol. Either the doctor or an assistant may ask you these questions. You will have a complete physical as well, with examination of the heart, lungs and breasts in addition to a Pap smear and pelvic exam. The doctor may order tests to rule out sexually transmitted diseases. You will need to give samples of blood for tests to assess your blood type and blood count, to see whether you have hepatitis or HIV, and to check whether you are immune to rubella (German measles). Additional testing may be done depending on your history.

Subsequent exams are usually every four weeks until your 28th week of pregnancy, then every two weeks until your 37th week. After that, you will be seen weekly. Most of these visits involve checking your weight and blood pressure and testing your urine for protein and sugar. The doctor or midwife will listen to the baby's heartbeat (usually not heard until after eight to 10 weeks) and measure your uterus; between 20 and 34 weeks, the size of the uterus in centimeters should equal the weeks of pregnancy, give or take 2cm. She will ask how you are feeling, whether the baby is moving (after about 20 weeks) and whether you are experiencing any problems such as cramping, bleeding, headaches or excessive swelling. You should write down any questions you have and ask them each visit. During the last few weeks of pregnancy, your doctor may wish to do a pelvic exam to see if your cervix has begun to dilate.

In addition to the routine blood work with the first visit, blood tests are done between 16-20 weeks and again at 28 weeks. The former is an optional test (AFP or triple screen) to screen for neural-tube defects (such as spina bifida) and Down syndrome. The latter is a test for gestational diabetes and, possibly, a repeat blood count to check for anemia. Depending on your age or a family history of certain birth defects, you may be offered genetic testing (CVS or amniocentesis) early in the pregnancy.

If there is more than one doctor of midwife in the practice, you should see all of them, as you will not be able to know in advance who will be on call when you go into labor. If your doctor shares call with another practice, you should be told this ahead of time; in this situation, you may not be able to meet all the doctors before you deliver.