first nurse visit pregnancy

Pregnancy Changes and The First Prenatal Visit

Pregnancy is a transformative and exciting journey that brings profound physical and emotional changes for expectant mothers. As nursing professionals, understanding and addressing these changes is essential in providing comprehensive care during pregnancy. The first prenatal visit holds immense significance as it sets the foundation for a successful pregnancy journey, ensuring optimal maternal and fetal well-being through early detection, education, and tailored care plans.

This article aims to serve as a comprehensive nursing guide, focusing on the common pregnancy changes experienced by women and the critical aspects of the first prenatal visit. This serves as a valuable resource, equipping nursing professionals with the knowledge and skills necessary to provide comprehensive care, support, and education to women embarking on the beautiful journey of pregnancy.

Presumptive signs, probable signs, positive signs, reproductive system changes, breast changes, integumentary system, respiratory system, cardiovascular system, gastrointestinal system, urinary system, skeletal system, endocrine system, mood swings, changes in sexual desire, introversion/extroversion, social changes, cultural changes, family changes, individual changes, first trimester: accepting the pregnancy, second trimester: accepting the baby, third trimester: preparing for the baby, breast tenderness, palmar erythema, constipation, nausea, vomiting, pyrosis, muscle cramps, hypotension, varicosities, hemorrhoids, heart palpitations, frequent urination, ankle edema, braxton hicks contraction, recommended weight gain, energy needs, protein needs, vitamin needs, mineral needs, fluid needs, fiber needs, healthy signs of good nutrition, health history, demographic data, chief concern, history of past illnesses, history of family illnesses, social profile, gynecologic history, obstetric history, systemic assessment.

Papanicolaou Smear (Pap smear)

Blood Studies

Glucose tolerance test, ultrasonography, preconception classes, expectant parenting classes, sibling education classes, breastfeeding classes, preparation for childbirth classes, the bradley method, the dick-read method, the lamaze method, the appropriate setting, the birth attendant and support person, hospital birth, alternative birthing centers, physiological changes in pregnancy.

A woman certainly undergoes a lot of changes during pregnancy. Some gain changes permanently, others have changes that are very subtle. These changes, however, are welcomed by mothers with open arms because they are signs that a new life is being formed inside of her.

The Diagnosis of Pregnancy

Before a pregnancy is confirmed, the woman might see small and big changes in her body that could help in determining if she is already pregnant.

Presumptive signs are signs that are least indicative of a pregnancy. These changes can only be felt by the woman but cannot be documented by the healthcare provider.

Breast changes (swollen), nausea and vomiting , amenorrhea, frequent urination , fatigue , uterine enlargement, quickening , linea nigra, melasma, and striae gravidarum are the presumptive signs of pregnancy.
However, these signs may also denote other conditions that the body is undergoing.

Probable signs of pregnancy are objective and can be seen primarily by the healthcare provider. These can be taken through laboratory tests and home pregnancy tests by detect the presence of human chorionic gonadotropin in the blood or in the urine .

Chadwick’s sign or a change in the color of the vagina from pink to violet is a probable sign of pregnancy.
Goodell’s sign is a probable sign that depicts a softening of the cervix.
Hegar’s sign is the softening of the lower uterine segment.
Ballottement is described as the rise of the fetus felt through the abdominal wall when the uterine segment is tapped on a bimanual examination.
An evidence of a gestational sac found during ultrasound is another probable sign.
Braxton-Hicks contractions are periodic uterine tightening and contractions.
The fetal outline can also be now palpated by the examiner through the abdomen.

There are only three positive signs of pregnancy that are documented by the health care providers.

Evidence of a fetal outline on ultrasound.
With the use of a Doppler, an audible fetal heart rate is another positive sign.
The last is fetal movement felt by the healthcare provider.

The system that will greatly feel the changes is the reproductive system. It includes the ovaries, uterus, and vagina.

On the first trimester in the ovaries, the corpus luteum starts to become active. By the second trimester, it begins to fade until the third trimester where it has already disappeared.
The uterus increases in growth starting from the first trimester. On the second trimester, the placenta is forming estrogen and progesterone .
The vagina undergoes changes during the first trimester wherein a whitish discharge is present. From the second until the third trimester, the whitish discharge increases in amount.
Amenorrhea also occurs, or the absence of menstruation .
The cervix undergoes a more vascular and edematous appearance owing to the increased level of estrogen.
Breast changes start from the first trimester as the woman feels tenderness and fullness of her breasts.
As the pregnancy progresses, the breast size increases a size or two, as the mammary alveoli and fat deposits increase in size.
The areola of the nipples become darker and its diameter increases.
The vascularity of the breast also increases, as evidenced by the prominent blue veins over the surface.
The Montgomery’s tubercles or the sebaceous glands of the areola protrudes and enlarges.

Systemic Changes

After the changes that occurred mainly in the reproductive system of a pregnant woman, systemic changes will also start to occur in different body systems.

The stretching of the abdomen causes rupture of the small segments of the connective layer of the skin.
Striae gravidarum or pinkish to reddish marks on the sides of the abdominal wall are the result of the rupture.
Linea nigra is a narrow, brown line that runs from the symphysis pubis to the umbilicus and separates the abdomen into right and left hemispheres.
Melasma or chloasma (mask of pregnancy) refers to the darkened areas on the cheeks or the nose that may appear during pregnancy.
Telangiectasis is red, branching spots that can be seen on the thighs. It is also called as vascular spiders.
Palmar erythema also occurs because of the increase in the estrogen level of the pregnant woman.
A pregnant woman usually experiences stuffiness or marked congestion because of the increasing estrogen levels.
Shortness of breath is also a common discomfort of pregnancy as the pregnant uterus pushes the diaphragm upward.
The total oxygen consumption of a pregnant woman increases by 20%.
The blood pressure of the pregnant woman decreases in the second trimester and then returns to its prepregnancy level on the third trimester.
The cardiac output increases 25% to 50%.
Plasma volume also increases up to 3600 mL, marking the condition called pseudoanemia early in the pregnancy.
Heart rate also increases to 80 to 90 beats per minute.
The blood volume increases up to 5,250 mL during pregnancy.
Nausea and vomiting is one of the first signs of pregnancy that a woman feels.
Slower intestinal peristalsis occurs during the second trimester of the pregnancy which causes heartburn, flatulence, and constipation .
Hemorrhoids also occur from the increased pressure of the uterus on the veins in the lower extremities.
The total body water of a pregnant woman increases up to 7.5 L for a more effective placental exchange.
Even when the woman has an increased urine output, her potassium levels are still adequate due to progesterone, which is potassium -sparing.
The bladder capacity increases to accommodate 1,000 mL of urine during pregnancy.
On the first trimester, the frequency of urination already increases. By the last two weeks of pregnancy it reaches up to 10 to 12 times per day.
By the 32 nd week of pregnancy, the symphysis pubis widens for 3 to 4 mm.
The center of gravity of a pregnant woman changes, and to make up for it she tends to stand straighter and taller than usual and with the abdomen forward and the shoulders thrown back, the ‘pride of pregnancy’ or commonly ‘lordosis’ occurs.
A slight enlargement in the thyroid and parathyroid gland increases the basal metabolic rate of a pregnant woman and for better consumption of calcium and vitamin D.
Thyroid hormone production increases.
The insulin produced from the pancreas decreases early in the pregnancy, thereby increasing glucose available for the fetus.
Increase in insulin occurs in the first trimester because estrogen, progesterone and HPL have insulin antagonistic properties.
FSH and LH decreases causing anovulation .
As the breasts are prepared for lactation, prolactin increases in production.
The increase in melanocyte-stimulating hormones causes increase in skin pigment.
The human growth hormone increase to aid the fetus in growing.
Estrogen and progesterone aids in uterine and breast enlargement.
Human placental lactogen increases glucose levels to supplement the growing fetus.
Relaxin increases to soften the cervix and collagen of joints.

The changes in the physiologic status of a pregnant woman are just one of the many phases of changes that occur during pregnancy. Most of these are normal, but when the pregnant woman experiences an excessive manifestation of these signs, it would be best to consult your healthcare provider.

Psychological Changes in Pregnancy

The various changes that a woman undergoes during pregnancy entirely sweep the entirety of the human body. Almost every aspect is altered, hormones get together to create a whole new modifications in the mind, the body, and the emotions. Psychological aspects would also be given a new perspective as it also alters together with the rest of the woman’s body.

How a Woman Responds to Pregnancy

Mood swings, grief , changes in sexual desires, and stress are only some of the psychological changes that a pregnant woman experiences. The couple might misinterpret these changes, so health education must be integrated in the care of the pregnant woman.

Grief may arise from the realization that one’s roles would be changed permanently.
A pregnant woman would be weaned off her role as a dependent daughter, or as a happy-go-lucky girl, or a friend who is always available.
Even the partner would have to leave the roles or the life he has been accustomed to as a man without a child to support.
Also known as emotional lability, this psychological reaction can be caused by two factors: hormonal changes or narcissism.
The comments that she had brushed off in her nonpregnant state can now touch a nerve or hurt her.
Crying is a common manifestation of mood swings, during and even after the pregnancy.
Women who are on the first trimester of pregnancy experience a decrease in libido mainly because of breast tenderness, nausea, and fatigue .
On the second trimester, sexual libido may rise because of increased blood flow to the pelvic area that supplies the placenta.
The third trimester might bring an increase or decrease in sexual libido due to an increase in the abdominal size or difficulty in finding a comfortable position.
Estrogen increase may also affect sexual libido as it may bring a loss of desire.
The couple must be informed that these changes are normal to avoid misunderstanding the woman’s attitude.
Pregnancy is a major change in roles that could cause stress.
The stress that a pregnant woman feels might affect her ability to decide.
The discomforts that she may feel could also add up to the stress she is experiencing.
Assess whether the woman is in an abusive relationship as it may contribute further to the stress.
Introversion refers to someone who focuses entirely on her own body and a common manifestation during pregnancy.
Some pregnant women also manifest extroversion, or acting more active, healthier and more outgoing than before their pregnancy.
Extroversion commonly happens to women who had a hard time conceiving and finally hit jackpot.
In the past, a pregnant woman is isolated from her family starting from visiting for prenatal consultation until the day of birth.
She is isolated from her family and the baby a week after birth.
Today, having a support system for pregnant women is highly encouraged, like bringing along someone to accompany her during prenatal visits and allowing the husband to be with the wife during birth if he chooses to.
Opinions on teenage pregnancy, late pregnancies, and having the same sex parents are now widely accepted compared to being taboos in the past.
A pregnant woman’s culture and beliefs may also greatly affect the course of her pregnancy.
Assess if the woman and her partner have particular beliefs that might affect the way the take care of the pregnancy so you can integrate them in your plan of care.
Despite the modern ages, there are still groups who firmly believe in their culture’s explanations about birth complications and the health care providers must respect this.
Myths that surround the pregnancy should always be respected, but the couple should be educated properly regarding what could be dangerous for the fetus’ health.
The environment where the woman grew influences the way she would perceive her pregnancy.
Family culture and beliefs also affect a woman’s perception of pregnancy.
If she is loved as a child, she would have an easy time accepting her pregnancy compared to women who were neglected by her family during childhood.
A woman who has been told of disturbing stories about giving birth and pregnancy would view her own in a negative light, while those who grew with beautiful birth stories would more likely be excited for their pregnancy.
A positive attitude would only result from a positive outcome and influence from the woman’s own family.
Becoming a new mother is never an easy transition. The woman must first be able to cope with stress effectively, as this is a major concern during pregnancy.
She needs to have the ability to adapt effectively to any situation, especially if the pregnancy is her first because there might be a lot of new situations that would arise.
Her ability to cope with a major change and manage her temper would be put to a test during motherhood.
The woman’s relationship with her partner also affects her ability to accept her pregnancy easily.
If she feels secure with her relationship with the father of her child, she would have an easier time accepting her pregnancy as opposed to an unstable relationship where she feels insecure and may doubt the decision of keeping the pregnancy.
A woman who feels that the pregnancy may rob her of her looks, her freedom, a promotion, or her youth would need to have a strong support system so she could express her feelings and unburden her chest.
The father’s acceptance of the pregnancy also influences the woman’s ability to accept the marriage.
Utmost support from her husband would be very meaningful for the woman especially during birth.

The Psychological Tasks of Pregnancy

Both the woman and her husband walk through a tangle of emotions during pregnancy. Accepting that a new life would be born out of your blood is not as easy as others may think. There are several stages that both should undergo, the psychological way.

The shock of learning about a new pregnancy is sometimes too heavy for a couple, so it is just proper for the both of them to spend some time recovering from this major life-altering situation and avoid overwhelming themselves at first.
One of the most common reactions of a couple who would be having a baby for the first time is ambivalence, or feeling both pleased and unhappy about the pregnancy.
The woman and her partner will start to merge into the role of novice parents as second trimester closes in.
Emotions such as narcissism and introversion are commonly present at this stage.
Role playing and increased dreaming are activities that help the couple embrace their roles as parents.
At this stage, the woman and her partner must start to concentrate on what it will feel like to be parents.
The couple starts to grow impatient as birth nears.
Preparations for the baby, both small and big, takes place during this stage.
The baby’s clothing and sleeping arrangements are set and the couple is excited for his arrival.

The transition of a woman from the start until the end of the pregnancy is a big turning point for her and the people who surround her. Every single one of them must be prepared physically, mentally and emotionally because pregnancy is also considered a crisis in life; something that could turn your world upside down.

Discomforts of Pregnancy

Pregnancy ultimately builds up a woman. It is the pinnacle of life wherein women become more than just women; they become mothers. The journey of pregnancy is also a tough one but is meaningful and wonderful. The discomforts a woman would undergo are just bumps along the road of fulfillment once she has delivered her child.

Discomforts during the First Trimester

There are a number of discomforts that can be felt during the first trimester. This is the time when the body is just starting to adjust to the pregnancy, and hormones are still in chaos. The woman must be educated on how to ease these discomforts to help her adjust slowly.

Breast tenderness is one of the first symptoms that the woman would notice in early pregnancy. The tenderness may vary between women; some hardly notice the sensation at all.

Advise to wear a bra with a wide shoulder strap. The support it gives helps ease the tenderness.
Dress warmly and avoid cold. She should also dress warmly as exposure to cold increases the tenderness.
Get examined. Women who experience intense pain should have to examine the presence of nipple fissures or breast abscess to rule out these conditions.

Palmar erythema is the constant itching and redness of the palms but is not considered an allergy . Increased estrogen levels possibly cause the pruritus.

Palmar erythema. Image via thebileflow.wordpress.com

No it’s not an allergy . Educate the woman that she has not developed an allergy, and this is normal during pregnancy.
Calamine lotion to the rescue. To soothe the itchiness, calamine lotion can be applied.
Disappears naturally. Palmar erythema would naturally disappear once the body has adjusted to the increased estrogen levels.

Constipation is caused by slow peristalsis due to the pressure from the growing uterus.

Increase fiber in the diet. Encourage the woman to move her bowels regularly and increase the fiber in her diet.
Drink water. Advise her to drink at least 8 to 10 glasses of water every day.
Iron supplements. Educate her that iron supplements can cause constipation but need not be stopped because it helps build up fetal iron stores.
Don’t use mineral oil. The use of mineral oil to relieve constipation is not advisable because it absorbs the fat-soluble vitamins A, D, K, and E.
Don’t use enemas. Enemas are also prohibited as it may initiate labor .
So as OTC laxatives. Over-the-counter laxatives are also contraindicated unless prescribed.
Avoid gas-forming foods. Advise the woman to avoid gas-forming food to prevent excessive flatulence.

Nausea and vomiting are also one of the earliest symptoms of pregnancy. Pyrosis or heartburn typically occurs when the woman ate a large meal.

Small frequent feedings. Advise the woman to take small, frequent meals and avoid greasy foods.
Upright position after. Encourage her to keep in an upright position after meals to avoid reflux.

Pregnant women experience fatigue mostly in early pregnancy because of increased metabolic requirements .

Rest and sleep . Advise her to increase the amount of rest and sleep and to continue with her normal nutrition intake.
Take short breaks. For women who still work, advise her to take short breaks, especially if her work involves being up and about the whole day.

Muscle cramps are caused by decreased serum calcium levels, increased phosphorus levels, or interference in the circulation.

Lie down. Advise the woman that when this happens, she should lie on her back and extend the affected leg while she keeps her knee straight and dorsiflexes the foot.
Magnesium citrate or aluminum hydroxide gel. Magnesium citrate or aluminum hydroxide gel is prescribed to women who have frequent and unrelieved muscle cramps.
Raise those feet. The woman should elevate her lower extremities frequently to promote circulation.

When the woman lies on her back and the uterus presses upon the vena cava , supine hypotension might occur, impairing blood return to the heart.

Sleep sideways. Advise woman to rest or sleep on her side, not on her back.
Rise slowly. Encourage her to rise slowly and dangle feet over the bed for a few minutes; avoid standing for extended periods.

Varicosities are tortuous veins caused by the pressure of the uterus to veins at the lower extremities.

Raise legs. Advise the woman to rest in Sim’s position or on the back with the legs raised against the wall.
Don’t cross legs. Discourage sitting with legs crossed or knees bent and the use of constrictive knee-high hose or garters.
Support stockings do wonders. The use of elastic support stockings is advised to relieve varicosities.
Exercise and walk. Exercise is also effective through taking walk breaks from chores or from standing or sitting for too long.
Vitamin C helps. Vitamin C is also recommended to reduce varicosities for the formation of blood vessel collagen and endothelium.

Hemorrhoids are varicosities of the rectal veins that occur because of the pressure of the veins from the weight of the uterus.

Evacuate daily. Advise the woman to evacuate her bowels daily and resting on a Sim’s position.
Knee-chest position . Encourage the woman to assume a knee-chest position for 10-15 minutes at the end of the day to relieve the pressure on the rectal veins.
Stool softener. If the woman already has hemorrhoids , a stool softener would be recommended.
Relieving hemorrhoids. The pain of hemorrhoids could also be relieved by applying witch hazel or cold compresses to external hemorrhoids.

Heart palpitations may occur when upon sudden movement the woman experiences bounding palpitation of the heart. This is mainly due to circulatory adjustments necessary to accommodate her increased blood supply during pregnancy.

Slow and steady. Advise the woman to move in slow, gradual movements to prevent heart palpitations.

The pressure of the uterus on the bladder causes frequent urination . Frequency occurs early in the pregnancy and late in the pregnancy.

No fluid restriction. Advise the woman not to restrict her fluids to diminish the frequency of urination, instead; caffeine intake should be diminished.
Offer assurance. Assure the woman that voiding frequently is a normal occurrence during pregnancy.
Kegel’s exercises. Kegel’s exercise also helps to reduce the incident of stress incontinence and helps regain the strength of urinary control and strengthens perineal muscles for birth.

Discomforts during the Second and Third Trimester

The last trimesters of pregnancy also have their set of discomforts that you have to differentiate from complications that might arise.

Lumbar lordosis develops as pregnancy progresses to maintain the balance.

Low heels. Advise the woman to wear shoes with low to moderate heels to reduce the amount of spinal curvature necessary to maintain an upright position.
Warm compress. Backache can be relieved by applying local heat on the area.
Body mechanics. Advise the woman to squat rather than bend over to pick up objects.
Close to center of gravity. Advise the woman to lift objects by holding them close to the body.

Dyspnea results from the pressure of the expanding uterus on the diaphragm. Dyspnea is prominent especially when the woman lies flat on the bed at night.

Proper sleeping position. Encourage the woman to sleep with her head and chest elevated.
Limit activities. Advise her to limit her activities during the day to prevent exertional dyspnea .

Late in pregnancy, some women experience swelling of the ankles and feet. The edema is caused by general fluid retention and reduced blood circulation in the lower extremities.

Watch out for proteinuria or eclampsia . Assess if the woman has hypertension or proteinuria to rule out eclampsia.
Sleep on the left side. Advise the woman to lie on her left side when resting or sleeping.
Sit. Encourage her to sit half an hour in the afternoon and in the evening with legs elevated and to avoid constrictive clothing.

From the 8 th to the 12 th week of pregnancy, the uterus periodically contracts and relaxes, and this is termed as Braxton Hicks contraction.

Give assurance. Assure the woman that these are not signs of early labor , but they can inform their healthcare provider about them.

A pregnant woman would always want reassurance that her pregnancy is healthy. These discomforts may alarm her, especially if she knows little about the physiology of pregnancy, so it is the role of healthcare providers to guide her and be there for her whenever she needs them throughout the pregnancy.

Nutritional Health During Pregnancy

One of the most important aspects in pregnancy is the woman’s nutritional status . Despite the discomfort she may feel towards eating early in pregnancy, she should never take her nutrition for granted because of the life that is dependent inside of her.

An average weight gain during pregnancy is 11.2 to 15.9 kg or 25 to 35 lbs.
For a more precise estimation of adequate weight gain, compute using the body mass index , which is the ratio of weight to height.
Weight gain during pregnancy occurs due to fetal growth and accumulation of maternal stores.
On the first trimester, approximately 0.4 kg or 1 lb per month weight gain is recommended.
On the last two trimesters, a weight gain of 0.4 kg or 1 lb per week is recommended.
Excessive weight gain occurs with 3 kg or 6.6 lbs of weight gain per month during the last two trimesters.
A weight gain of less than 1kg or 2.2 lbs in the second and third trimesters is less than usual.

Nutrition for the Pregnant Woman

The DRI or Dietary Reference Intake of calories of women of childbearing age is 2200.
For pregnant women, an additional of 300 calories for a total of 2500 calories is recommended.
This addition in calories provides more energy to the fetus and an elevated metabolic rate to the woman.
Advise woman to obtain calories from complex carbohydrates like cereals and grains because these are digested more slowly to regulate glucose and insulin .
Encourage women to prepare healthy snacks such as carrot sticks, cheese, and crackers at the start of the day.
Assess the weight that the woman is gaining so you can determine if the woman’s caloric intake is adequate.
Advice the woman not to restrict caloric intake as the fetus is rapidly growing in the final weeks.
The DRI for protein in women is 46g/d.
If protein needs are met, overall nutritional needs are met as well except for vitamins C, A, and D.
Vitamin B12 is found in animal protein; therefore inadequate protein means vitamin B12 deficiency.
Complete protein or protein that contains the nine essential amino acids can be found in meat, poultry, fish, eggs, yogurt, and milk.
Incomplete protein or the protein that does not contain all essential amino acids comes from non animal sources.
When the woman has a history of hypercholesterolemia, advise her to consume lean meat, olive oil, and to remove the skin from poultry.
Milk is also a rich source of protein, and for women who are lactose intolerant, she can add lactase supplement, take calcium supplements, or buy lactose-free milk.
Yogurt or cheese can also be a substitute for milk.
Linoleic acid is a fatty acid that cannot be manufactured by the body and must therefore be obtained from other sources.
Vegetable oils such as olive, corn, and safflower contains linoleic acid that must be consumed by the pregnant woman.
Advise the woman to avoid animal fats such as butter.
Encourage intake of omega-3 oils found in fish, omega-3 fortified eggs, and spreads.
Vitamin D which is essential for calcium absorption, when lacking in a pregnant woman would result to diminished maternal and fetal bone density.
Lack of vitamin A results in tender gums and poor night vision .
Advise the woman to consume plenty of fruits and vegetables and her daily prenatal vitamins to meet the daily vitamin intake requirements.
Advise the woman not to use mineral oils as laxative because it prevents the absorption of fat-soluble vitamins.
Folic acid is important for the production of red blood cells and can be found mostly in fresh fruits and vegetables.
Calcium and phosphorus is needed for bone and teeth formation and should be consumed by the pregnant woman.
The woman needs to ingest iodine for the proper functioning of the thyroid gland, and it is most commonly found in seafood.
The DRI for iron for pregnant women is 27 mg, so the woman must ingest foods rich in iron and iron supplements to build more hemoglobin for the fetus.
Sodium maintains fluid in the body, so it is advisable for the pregnant woman to continue adding salt into her food if not restricted.
Advise the woman to drink extra amounts of water to promote kidney function.
Encourage intake of 2 to 3 glasses of fluid daily over three servings of milk.
To prevent constipation, encourage the woman to eat plenty of fruits and green, leafy vegetables to provide fiber.
Fiber can also lower cholesterol levels and removes carcinogenic contaminants from the intestine .
The hair is shiny and strong with good body.
The woman has good eyesight especially at night; the conjunctivae are moist and pink.
There are no cavities in the teeth, no swollen or inflamed gingiva, no cracks or fissures at the corners of the mouth , the mucous membranes are moist and pink, the tongue is smooth and non tender.
The neck has a normal contour of the thyroid gland.
The skin is smooth with normal color and turgor, no ecchymosis and petechiae present.
The extremities have a normal muscle mass and circumference; normal strength and mobility , and edema are minimal.
The fingernails and toenails are smooth, pink, and normal in contour.
The weight should be within normal limits of ideal weight before the pregnancy.
The blood pressure is within normal limits for length of pregnancy.

The woman must stay healthy through the entirety of her pregnancy, and most of the nutrients she needs come from food sources. Proper health and nutrition education should be discussed by the healthcare provider to ensure that the pregnant woman is getting the right amount of nutrients that she and the fetus needs.

First Prenatal Visit

The pregnant woman’s first prenatal visit should be the building block of a healthy, happy pregnancy. Everything is established during the first visit, such as the assessment , whether the pregnancy is confirmed, and a little bit of planning for the future. It’s time to focus on the woman herself and the details that could make or break her pregnancy glow.

Initial Interview

The first prenatal interview could take a long time, so the person who is scheduling appointments for the visits should make the woman aware to avoid cancelling of appointments or rushing of the interview because the woman has an errand to attend to.
It is important that the healthcare provider should establish rapport even on the first visit because information such as what the woman feels about her pregnancy and if she has any fears can only be taken once the woman trusts her healthcare provider.
Personal interviews can also make the woman feel important and that she is not just one of the patients that would immediately be forgotten after the visit.
The interview must take place in a private, quiet environment because it would be difficult for the woman to answer all the questions when you are in a sitting room full of waiting patients or on the hallway.
The woman must also understand your role in the assessment , because if she views you only as the interviewer you would only get superficial information from her.
One of the purposes of the initial interview is to assess the health history of the pregnant woman.
Establishing a baseline health data is crucial especially when there is a new symptom that arises from the woman and it could only be identified as new based on the data gathered from her health history.
The demographic data are the superficial data that can be obtained from the woman.
These include the name, age, address, telephone number, and health insurances.
The chief concern of the woman when she visits the clinic is she thinks she might be pregnant.
Assess the first day of the last menstrual period of the woman.
Assess any early signs of pregnancy such as nausea and vomiting , fatigue , and breast tenderness.
Inquire if she has tried any home pregnancy test kit or had a pregnancy test from a clinic to establish her pregnancy.
It is important to assess any past illness because it might become active during or after the pregnancy.
Assess if there are any infections from the past, especially sexually transmitted diseases so you could educate the woman and suggest any vaccines available.
There are vaccines that are not friendly for a pregnant woman; however, vaccines such as influenza and poliomyelitis can be administered.
Assess any allergies present even before pregnancy to avoid triggers that could also affect the fetus.
Assess the presence of family illnesses such as hypertension , diabetes , or asthma on both the father and mother.
There are illnesses that could become a potential problem during pregnancy or one that could be transferred to the fetus.
Assess the woman’s current nutrition profile, or ask her to have a 24-hour recall to obtain nutrition information.
Assess the frequency, type, and amount of exercise she does to determine if her pattern of activities is still recommended during pregnancy.
Assess if the woman smokes or drinks, its frequency, and amount because these vices could cause fetal alcohol syndrome or preterm birth.
Assess history of medication intake and what medication the woman is taking during pregnancy to determine its possible effects on the fetus.
Obtain the age of the woman’s menarche, her usual cycle, the duration, and the amount of menstrual flow.
Assess any past reproductive tract surgery as it can affect the present pregnancy, such as tubal surgery from ectopic pregnancy .
Assess the reproductive planning method that the woman used or will be using after pregnancy, and also her sexual history to educate her about safe sex practices.
Assess the woman’s pregnancy history using GTPALM .
G is the gravid classification or the number of times the woman became pregnant.
T is the number of full term infants born.
P is the number of preterm infants born.
A is the number of miscarriages or therapeutic abortions.
L is the number of living children .
M refers to multiple pregnancies.
Assess the woman’s respiratory system , if she is currently experiencing cough , asthma , pain upon breathing, or any serious respiratory illnesses such as tuberculosis .
Assess the cardiovascular system and any history of heart murmurs, heart diseases, hypertension , and if she knows her blood pressure level and any experience of blood transfusion .
Assess her gastrointestinal system ; ask about her pre-pregnancy weight, any discomforts such as vomiting , diarrhea or constipation, hemorrhoids, and changes in bowel habits.
Assess her genitourinary system and ask about any urinary tract infections, STIs, PIDs, any difficulties in conceiving, and hematuria .
Assess any breast lumps, secretions, pain upon palpation of the breast, or tenderness.
Assess the woman’s last dental exam, the use of any dentures, the condition of the teeth, and if she is experiencing any difficulty in swallowing.

Laboratory Assessment

Papanicolaou smear (pap smear).

Pap smear is performed to detect and diagnose the presence of precancerous and cancerous conditions of the cervix, vulva, or vagina.
The test also reveals infectious diseases and inflammation.
The classification of Pap smear can be seen in the Bethesda classification of Pap smears.
Women who have multiple sexual partners, smoke cigarettes, have a history of HPV, and sexually active before 21 years old should have Pap smear done more frequently.
Complete blood count should be taken to assess the hemoglobin, hematocrit, and red cell index and determine the presence of anemia .
White blood cell count and platelet count must also be obtained to assess for infection clotting ability.
Blood typing with Rh factor is also important because blood needs to be available if ever the woman experiences bleeding during pregnancy.
Maternal serum alpha fetoprotein detects birth defects such as neural tube defects if elevated and chromosomal anomalies if decreased.
Antibody titers for rubella and hepatitis B or HBsAG determine whether the woman is protected against rubella and if the newborn would have a chance of developing hepatitis B.
A woman with a history of diabetes , large for gestational age babies, obese, or has glycosuria should undergo glucose tolerance test.
A 50-g oral toward the end of the first trimester should be performed to rule out gestational diabetes .
The plasma glucose level should not exceed 140mg/dl at 1 hour.
Urinalysis is performed to assess proteinuria, glycosuria, and pyuria.
These can be done through test strips or microscopic examination of the urine.
To confirm pregnancy, an ultrasound must be scheduled especially if the woman is unsure of the date of her last menstrual period.
Ultrasonography would also determine the growth of the fetus, but only the gestational sac would be seen at this stage.

Childbirth Education

Most expectant parents, especially the first timers are eager yet anxious to know the rules to becoming a parent even before the birth of their child. There are several courses or classes for parents regarding childbirth that would fill up the gap of knowledge that the couple is yearning for.

The birth of childbirth education started in the early 1900s to encourage women to involve themselves in prenatal care .
It progressed because of the additional birth choices that emerged later on.
The goal of childbirth education is to prepare expectant parents physically, mentally, and emotionally for childbirth.
Childbirth educators have a professional degree and a certificate from a childbirth education course.
Some of the topics that childbirth educators teach are the physical and emotional aspects of pregnancy, early parenthood and coping skills, and labor support techniques.
Childbirth classes are mostly taught in group; and today there are instructors who also employ the use of slides, videotapes, and demonstrations.
Childbirth education is more effective if both the parents are interactive, as they would be able to share their fears and hopes about the pregnancy and learn together as a couple.
A lot of studies have been conducted regarding the efficacy of childbirth classes when it comes to pain reduction, shortening the length of labor, decreasing the amount of medication used, and the increase of enjoyment in the overall experience of childbirth.
It is now generally accepted that childbirth courses could increase the satisfaction and control of feelings and reduce the amount of pain felt during childbirth.

The Childbirth Plan

The childbirth plan consists of the choice of setting, birth attendant, birthing positions, medication options, and plans for immediate postpartum , etc.
Classes encourage the couple to write a birth plan and deal with these issues before the day of birth to avoid stressing out at the last minute.
Make sure that the couple also understands that the birth plan should be flexible in case some complications may arise.
Preconception classes are classes for couples who are planning to get pregnant within a short span of time.
These couples most likely want to learn more about what they can expect in a pregnancy and what could be their possible birth setting and procedure choices.
The class includes recommendation of preconception nutrition changes and physical and psychological changes that pregnancy brings.
Overall, preconception classes emphasize the importance of pre-pregnancy preparations to ensure a healthy fetus and mother.
Expectant parenting classes are for couples who are already pregnant and expecting.
The focus of the topics is on the family health, nutrition during pregnancy, health changes during pregnancy, and newborn care .
Pregnant women come to these classes accompanied by their support persons, and the class usually lasts for 4 to 8 hours over a 4 to 8-week period.
The classes are individualized for each group according to their special needs, such as for adolescent pregnancy, pregnant women with disabilities, or expectant adoptive parents.
Sibling classes are designed for older brothers and sisters to give them awareness of what would happen during birth and what they can expect a newborn would act like.
Simple things that a child can do during the period of pregnancy, such as eating nutritious food together with their mother and how babies grow are taught in these classes.
The information given during sibling classes should be appropriate to their age to make sure that the classes are effective.
Women who take breastfeeding classes appreciate over time the importance of breastfeeding and the advantages it gives both the mother and the baby.
Topics include the physiology of breastfeeding, its psychological aspects, and the advantages of exclusive breastfeeding.
The classes would also emphasize on ways on how a busy mother could still breastfeed her child despite a busy work schedule so the breastfeeding could continue for at least the first full year of the baby.
The focus of preparation for childbirth classes is mainly in the birth process.
The class would help the woman and her support person prepare for the childbirth experience.
Pain management and reduction is also a part of these classes, both with nonpharmacologic and pharmacologic measures.

Pain Management During Labor

Also known as the Partner-Coached Method, it centers on the idea that the woman’s partner should play an important role during pregnancy, labor, and childbirth until early newborn care.
Originated by Robert Bradley, it sheds light on the fact that pregnancy and birth are joyful natural processes.
The woman is taught to use an internal focus point as a disassociation technique, and she is encouraged to walk during labor.
This is a method proposed by Grantly Dick-Read wherein the premise is that fear leads to tension, which leads to pain.
The idea is for the woman to prevent the fear and break the chain between tension and pain, so she can reduce the pain of labor contractions.
Lack of fear is achieved through education on childbirth and relaxation , and pain management techniques.

The Lamaze Method is one of the most widely taught methods in the United States.
The theory is based on stimulus-response conditioning, wherein women can learn to use controlled breathing to reduce the pain of labor.
Formal classes are organized by Lamaze International or the International Childbirth Education Association.
Topics from Lamaze include prenatal nutrition and exercises, common discomforts of pregnancy, and information to prepare couples for unexpected circumstances such as cesarean birth or the need for anesthesia .
The gating control theory of pain is emphasized in Lamaze where the use of controlled breathing and imagery can block incoming pain sensations.
Lamaze classes are kept small so that there would be enough time for individualized instruction and attention to each couple.
The support person that the woman brings would act as her coach in labor.

The Birth Setting

One of the most important choices that a couple should also consider is the birthing center where their baby would be delivered. Choosing the place where the woman would give birth depends on the health of both the fetus and the mother, and should be in accordance with the preferences of the kind of assistance the couple would want during delivery.

Hospitals have not always been the place for birth. In earlier times, childbirth always takes place at home without any analgesia and the women give birth the natural way. However, today a lot of birthing choices were developed, and birthing centers have become hospitals instead of at home.

Women are still given the freedom to choose where they would want to give birth provided that the woman does not have a complicated pregnancy, and the health of the fetus is stable.
Women who have complicated pregnancies have less freedom in choosing that the usual because they are advised to give birth only at hospitals for provision of emergency care if needed.
Birthing centers are now fully equipped with resources that could compete with hospital facilities, which is why most couples consider giving birth here than going to the hospital.

Most women who give birth are always attended to by their physicians or obstetricians. But as there are more and more courses offered for family practitioners to become certified birth attendants, even with only a midwife or nurse -midwife to attend to a birth is now considered as appropriate and preferred by couples.

Alternative birthing centers employ more nurse-midwives to attend to births.
Another consideration that a woman should make is who would become her support person during labor up until her delivery.
In the past, experienced women in the community take up the role of the support person.
Later on, support persons became the father of the baby.
Today, any family member may take up the role of a support person.
Doulas are also preferred by more women today, as an addition to their support person.
Doulas are women who are specially prepared to assist with childbirth, and they are helpful especially when the support person would find it hard to provide enough support during labor.
When a woman’s support person becomes too emotional to assist the woman in labor, the doula could take in charge to allow the father or any support person to enjoy the experience and involve them emotionally in the situation.
The support of the doula can also reduce the rates of cesarean births, epidural anesthesia , and oxytocin augmentation, according to some research.

Hospital Birth VS Alternative Birthing Centers

Hospital birth has always been preferred by women when they want to ensure their safety during delivery and to be certain that the baby would be handled by professionals. However, the emergence of alternative birthing centers gave women the chance to choose which setting they would want to give birth in, as both could have advantages and disadvantages to consider.

Hospitals have standards when it comes to their maternity services as influenced by the First Consensus Initiative of the Coalition for Improving Maternity Services.
The organization provides a set of practices that would make a hospital mother and baby friendly.
The mother should be able to consider her experience as healthy and joyous regardless of her age or circumstances.
The mother should have access to a full range of options regarding her pregnancy, birth, and care of the newborn.
The mother should receive utmost support when it comes to her birthing choices based on her beliefs or culture.
The mother should be allowed to give birth in any environment where she would feel safe and secure.
The mother should receive information and updates about anything that could affect her pregnancy and her baby, with the rights to informed consent and refusal.
At hospitals, women are encouraged to control the discomfort and pain of labor through nonpharmacological measures despite the availability of epidural anesthesia .
Information is readily given to women regarding the birthing process and to help her decide on procedures that would be performed.
Breastfeeding is highly encouraged at hospitals to promote bonding between the mother and the baby and to aid in uterine contractions.
Labor, birth, and postpartum care can be done in one single room at hospitals which could provide more ease and comfort for the woman.
Skilled professionals attend to the woman during birth, and emergency care is readily available if the situation warrants it.
However, the family and the woman might be separated for one night during delivery, and the mother may sometimes feel that she is not in full control of her experience.
Alternative birthing centers are wellness-oriented childbirth facilities that encourage birth outside of the hospital setting while still being able to provide medical resources appropriate for any emergency that might arise.
Nurse-midwives attend to the birth at ABCs.
Before a woman is permitted to give birth at an alternative birthing center, she is screened for complications first to avoid increasing the mortality rate of mothers and infants in this setting.
Women are also encouraged to deal with labor pain through nonmedical measures.
Family members are allowed to accompany the woman throughout the experience.
Skilled professionals attend to the woman during birth, and emergency care is also readily available.
High-risk care may not be easily and immediately arranged at alternative birthing centers.
The stay of the woman at the facility may only be brief, so fatigue is most likely encountered after birth.
The woman is also expected to monitor her postpartal status independently because of her brief stay in the healthcare setting.
Women remain at the ABC 4 to 24 hours after birth because the woman can recover quickly because of the minimum analgesia used.

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Prenatal care: 1st trimester visits

Pregnancy and prenatal care go hand in hand. During the first trimester, prenatal care includes blood tests, a physical exam, conversations about lifestyle and more.

Prenatal care is an important part of a healthy pregnancy. Whether you choose a family physician, obstetrician, midwife or group prenatal care, here's what to expect during the first few prenatal appointments.

The 1st visit

When you find out you're pregnant, make your first prenatal appointment. Set aside time for the first visit to go over your medical history and talk about any risk factors for pregnancy problems that you may have.

Medical history

Your health care provider might ask about:

Your menstrual cycle, gynecological history and any past pregnancies
Your personal and family medical history
Exposure to anything that could be toxic
Medications you take, including prescription and over-the-counter medications, vitamins or supplements
Your lifestyle, including your use of tobacco, alcohol, caffeine and recreational drugs
Travel to areas where malaria, tuberculosis, Zika virus, mpox — also called monkeypox — or other infectious diseases are common

Share information about sensitive issues, such as domestic abuse or past drug use, too. This will help your health care provider take the best care of you — and your baby.

Your due date is not a prediction of when you will have your baby. It's simply the date that you will be 40 weeks pregnant. Few people give birth on their due dates. Still, establishing your due date — or estimated date of delivery — is important. It allows your health care provider to monitor your baby's growth and the progress of your pregnancy. Your due date also helps with scheduling tests and procedures, so they are done at the right time.

To estimate your due date, your health care provider will use the date your last period started, add seven days and count back three months. The due date will be about 40 weeks from the first day of your last period. Your health care provider can use a fetal ultrasound to help confirm the date. Typically, if the due date calculated with your last period and the due date calculated with an early ultrasound differ by more than seven days, the ultrasound is used to set the due date.

Physical exam

To find out how much weight you need to gain for a healthy pregnancy, your health care provider will measure your weight and height and calculate your body mass index.

Your health care provider might do a physical exam, including a breast exam and a pelvic exam. You might need a Pap test, depending on how long it's been since your last Pap test. Depending on your situation, you may need exams of your heart, lungs and thyroid.

At your first prenatal visit, blood tests might be done to:

Check your blood type. This includes your Rh status. Rh factor is an inherited trait that refers to a protein found on the surface of red blood cells. Your pregnancy might need special care if you're Rh negative and your baby's father is Rh positive.
Measure your hemoglobin. Hemoglobin is an iron-rich protein found in red blood cells that allows the cells to carry oxygen from your lungs to other parts of your body. Hemoglobin also carries carbon dioxide from other parts of your body to your lungs so that it can be exhaled. Low hemoglobin or a low level of red blood cells is a sign of anemia. Anemia can make you feel very tired, and it may affect your pregnancy.
Check immunity to certain infections. This typically includes rubella and chickenpox (varicella) — unless proof of vaccination or natural immunity is documented in your medical history.
Detect exposure to other infections. Your health care provider will suggest blood tests to detect infections such as hepatitis B, syphilis, gonorrhea, chlamydia and HIV , the virus that causes AIDS . A urine sample might also be tested for signs of a bladder or urinary tract infection.

Tests for fetal concerns

Prenatal tests can provide valuable information about your baby's health. Your health care provider will typically offer a variety of prenatal genetic screening tests. They may include ultrasound or blood tests to check for certain fetal genetic problems, such as Down syndrome.

Lifestyle issues

Your health care provider might discuss the importance of nutrition and prenatal vitamins. Ask about exercise, sex, dental care, vaccinations and travel during pregnancy, as well as other lifestyle issues. You might also talk about your work environment and the use of medications during pregnancy. If you smoke, ask your health care provider for suggestions to help you quit.

Discomforts of pregnancy

You might notice changes in your body early in your pregnancy. Your breasts might be tender and swollen. Nausea with or without vomiting (morning sickness) is also common. Talk to your health care provider if your morning sickness is severe.

Other 1st trimester visits

Your next prenatal visits — often scheduled about every four weeks during the first trimester — might be shorter than the first. Near the end of the first trimester — by about 12 to 14 weeks of pregnancy — you might be able to hear your baby's heartbeat with a small device, called a Doppler, that bounces sound waves off your baby's heart. Your health care provider may offer a first trimester ultrasound, too.

Your prenatal appointments are an ideal time to discuss questions you have. During your first visit, find out how to reach your health care team between appointments in case concerns come up. Knowing help is available can offer peace of mind.

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Lockwood CJ, et al. Prenatal care: Initial assessment. https://www.uptodate.com/contents/search. Accessed July 9, 2018.
Prenatal care and tests. Office on Women's Health. https://www.womenshealth.gov/pregnancy/youre-pregnant-now-what/prenatal-care-and-tests. Accessed July 9, 2018.
Cunningham FG, et al., eds. Prenatal care. In: Williams Obstetrics. 25th ed. New York, N.Y.: McGraw-Hill Education; 2018. https://www.accessmedicine.mhmedical.com. Accessed July 9, 2018.
Lockwood CJ, et al. Prenatal care: Second and third trimesters. https://www.uptodate.com/contents/search. Accessed July 9, 2018.
WHO recommendations on antenatal care for a positive pregnancy experience. World Health Organization. http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/anc-positive-pregnancy-experience/en/. Accessed July 9, 2018.
Bastian LA, et al. Clinical manifestations and early diagnosis of pregnancy. https://www.uptodate.com/contents/search. Accessed July 9, 2018.

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Your First Prenatal Appointment

Medically reviewed for accuracy.

When should I schedule my first prenatal visit?

When will my first prenatal visit take place, read this next, how should i prepare for my first pregnancy appointment, what will happen at my first prenatal visit, will i see my baby on an ultrasound at my first prenatal visit, about what to expect, popular articles, tools & registry.

What to Expect at Your First Prenatal Visit

March 26, 2024

Maternal Health , OB-GYN

When you find out you’re pregnant, your to-do list instantly becomes much longer. There are people to tell, nurseries to decorate and names to consider. You also need to establish where you’ll receive your prenatal care.

Your first prenatal appointment should be scheduled seven to nine weeks after your last menstrual period.

“Early prenatal care is important because it gives your provider an opportunity to review your health history and identify risk factors we need to be proactive about,” says UNC Health certified nurse-midwife Rebeca Moretto . “It’s also an opportunity for you to ask questions about the process of pregnancy so that we address your concerns.”

Moretto and UNC Health obstetrician-gynecologist Kimberly Malloy, MD , talk about what to expect at the first prenatal visit.

Selecting Prenatal Care

“I always encourage patients to have established OB-GYN care and to have a preconception counseling appointment,” Dr. Malloy says. “We discuss your medical history and any medications you’re taking so you can prepare for a healthy pregnancy.”

You may already have a relationship with a practice that delivers babies, and your provider might know that you were preparing for pregnancy. If you don’t have a provider, Dr. Malloy recommends starting by identifying where you want to deliver .

“Patients typically choose the facility that’s closest to them, but if you have a complicated medical or obstetric history, you may want to travel farther if it means you can have access to more accommodations of care, such as a NICU [neonatal intensive care unit] or a maternal-fetal medicine department,” Dr. Malloy says.

Also, think about the people you want to be involved in your prenatal care and delivery, considering these factors:

You may be able to see a family medicine provider for part of your prenatal care.
Maybe you prefer a practice with nurse-midwives .
You might not be able to identify specific providers to be in the room for your delivery, as they rotate hospital shifts.
At an academic institution, medical students, residents and fellows could be part of your care team.

“With a team-based approach , you’ll be able to see a variety of wonderful providers, and a team ensures there are multiple eyes identifying issues,” Dr. Malloy says.

Be sure to confirm with your insurance provider that your selected healthcare practice is included in your coverage.

Preparing for Your First Prenatal Visit

Once you’ve scheduled your first appointment, there are a few things you can do to prepare and help your provider. If you are a new patient to the practice or health system, arrange to have your prior records sent to your new team or obtain copies so you can bring them to the first appointment.

“If you have a record of your most recent Pap test, or any information about prior pregnancies or complications, bring that to the appointment,” Moretto says. “If you’ve had a cesarean section , an operative report is important, especially if you want to pursue a vaginal birth after cesarean.”

Also, bring a list of any medications you take—better yet, bring the packaging or pictures of the prescription labels —so your provider can review them and make adjustments as necessary.

Start a written list of questions you have about your pregnancy, so you don’t forget to ask them when you see your provider. Talk to your family and your partner’s family about hereditary medical issues that could affect your baby so that you can share those details with your doctor.

While you’re waiting for your initial appointment date, know that you can reach out to your care team with questions or concerns.

“Vaginal bleeding and spotting are common in early pregnancy,” Dr. Malloy says. “If it’s a persistent problem, call the provider so they can assess whether you need to be seen sooner.”

Testing at the First Prenatal Visit

The first prenatal visit probably will be the longest of your pregnancy. It will include a complete physical exam, including pelvic and breast exams. Your blood pressure and weight will be recorded at this and future visits.

A urine sample will be taken so that your provider can check for signs of infection and dehydration and levels of protein and glucose.

You’ll also have your blood drawn for a variety of labs, including anemia, immunity to certain infections, blood type and Rh factor .

At this appointment you might have your first ultrasound, depending on the practice. Some providers schedule the first one beforehand so that the images can be reviewed at this visit. You may also be able to see or hear fetal heart tones.

All of this testing helps your provider identify and monitor potential risk factors and issues that could arise during pregnancy, such as hypertension, diabetes and preeclampsia .

In addition to this testing, you’ll have a consultation with your provider, who will review your entire health history, including medications, surgeries and prior pregnancies. If you have concerns about genetic issues, your provider can identify additional screenings or tests you might wish to pursue.

The care team will also give you guidance on how to make your pregnancy as healthy as possible and to prepare for the rest of pregnancy , childbirth and lactation .

“We’ll go over nutrition issues , such as anticipated weight gain and additional caloric intake,” Dr. Malloy says. “We’ll review vaccines that may be necessary during pregnancy, make recommendations for any medications you may need and discuss precautions you may need to take.”

Moretto adds, “It’s also a time to talk about mental health resources. Pregnancy is impactful on mental health , so we can help make connections for therapy and other relevant resources if needed.”

Your due date will be set at your first prenatal visit, but you won’t find out the sex until the second trimester. Finally, your provider will review the schedule for the rest of your prenatal care, dependent on your individual needs and risks.

If you’re pregnant or thinking about becoming pregnant, you should talk to your doctor. Need a doctor? Find one near you .

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What happens during prenatal visits?

What happens during prenatal visits varies depending on how far along you are in your pregnancy.

Schedule your first prenatal visit as soon as you think you are pregnant, even if you have confirmed your pregnancy with a home pregnancy test. Early and regular prenatal visits help your health care provider monitor your health and the growth of the fetus.

The First Visit

Your first prenatal visit will probably be scheduled sometime after your eighth week of pregnancy. Most health care providers won't schedule a visit any earlier unless you have a medical condition, have had problems with a pregnancy in the past, or have symptoms such as spotting or bleeding, stomach pain, or severe nausea and vomiting. 1

You've probably heard pregnancy discussed in terms of months and trimesters (units of about 3 months). Your health care provider and health information might use weeks instead. Here's a chart that can help you understand pregnancy stages in terms of trimesters, months, and weeks.

Because your first visit will be one of your longest, allow plenty of time.

During the visit, you can expect your health care provider to do the following: 1

Answer your questions. This is a great time to ask questions and share any concerns you may have. Keep a running list for your visit.
Check your urine sample for infection and to confirm your pregnancy.
Check your blood pressure, weight, and height.
Calculate your due date based on your last menstrual cycle and ultrasound exam.
Ask about your health, including previous conditions, surgeries, or pregnancies.
Ask about your family health and genetic history.
Ask about your lifestyle, including whether you smoke, drink, or take drugs, and whether you exercise regularly.
Ask about your stress level.
Perform prenatal blood tests to do the following:
Determine your blood type and Rh (Rhesus) factor. Rh factor refers to a protein found on red blood cells. If the mother is Rh negative (lacks the protein) and the father is Rh positive (has the protein), the pregnancy requires a special level of care. 2
Do a blood count (e.g., hemoglobin, hematocrit).
Test for hepatitis B, HIV, rubella, and syphilis.
Do a complete physical exam, including a pelvic exam, and cultures for gonorrhea and chlamydia.
Do a Pap test or test for human papillomavirus (HPV) or both to screen for cervical cancer and infection with HPV, which can increase risk for cervical cancer. The timing of these tests depends on the schedule recommended by your health care provider.
Do an ultrasound test, depending on the week of pregnancy.
Offer genetic testing: screening for Down syndrome and other chromosomal problems, cystic fibrosis, other specialized testing depending on history.

Prenatal Visit Schedule

If your pregnancy is healthy, your health care provider will set up a regular schedule for visits that will probably look about like this: 1

Later Prenatal Visits

As your pregnancy progresses, your prenatal visits will vary greatly. During most visits, you can expect your health care provider to do the following:

Check your blood pressure.
Measure your weight gain.
Measure your abdomen to check your developing infant's growth—"fundal height" (once you begin to "show").
Check the fetal heart rate.
Check your hands and feet for swelling.
Feel your abdomen to find the fetus's position (later in pregnancy).
Do tests, such as blood tests or an ultrasound exam.

Talk to you about your questions or concerns. It's a good idea to write down your questions and bring them with you.

Several of these visits will include special tests to check for gestational diabetes (usually between 24 and 28 weeks) 3 and other conditions, depending on your age and family history.

In addition, the Centers for Disease Control and Prevention and the American Academy of Pediatrics released new vaccine guidelines for 2013 , including a recommendation for pregnant women to receive a booster of whooping cough (pertussis) vaccine. The guidelines recommend the shot be given between 27 and 36 weeks of pregnancy. 4

Centers for Disease Control and Prevention. (2013). Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (TDAP) in pregnant women―Advisory Committee on Immunization Practices (ACIP), 2012. Retrieved September 20, 2013, from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6207a4.htm

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Prenatal care in your first trimester

Trimester means "3 months." A normal pregnancy lasts around 10 months and has 3 trimesters.

The word prenatal means before birth. The first trimester starts when your baby is conceived. It continues through week 14 of your pregnancy. Your health care provider may talk about your pregnancy in weeks, rather than in months or trimesters.

Your First Prenatal Visit

You should schedule your first prenatal visit soon after you learn that you are pregnant. Your doctor or midwife will:

Draw your blood
Perform a full pelvic exam
Do a Pap smear and cultures to look for infections or problems

Your doctor or midwife will listen for your baby's heartbeat, but may not be able to hear it. Most often, the heartbeat cannot be heard or seen on ultrasound until at least 6 to 7 weeks.

During this first visit, your doctor or midwife will ask you questions about:

Your overall health
Any health problems you have
Past pregnancies
Medicines, herbs, or vitamins you take
Whether or not you exercise
Whether you smoke, use tobacco, drink alcohol or take drugs
Whether you or your partner have genetic disorders or health problems that run in your family

You will have many visits to talk about a birthing plan. You can also discuss it with your doctor or midwife at your first visit.

The first visit will also be a good time to talk about:

Eating healthy , exercising, getting adequate sleep, and making lifestyle changes while you are pregnant
Common symptoms during pregnancy such as fatigue, heartburn, and varicose veins
How to manage morning sickness
What to do about vaginal bleeding during early pregnancy
What to expect at each visit

You will also be given prenatal vitamins with iron if you are not already taking them.

Follow-up Prenatal Visits

In your first trimester, you will have a prenatal visit every month. The visits may be quick, but they are still important. It is OK to bring your partner or labor coach with you.

During your visits, your doctor or midwife will:

Check your blood pressure.
Check for fetal heart sounds.
Take a urine sample to test for sugar or protein in your urine. If either of these is found, it could mean that you have gestational diabetes or high blood pressure caused by pregnancy.

At the end of each visit, your doctor or midwife will tell you what changes to expect before your next visit. Tell your doctor if you have any problems or concerns. It is OK to talk about them even if you do not feel that they are important or related to your pregnancy.

At your first visit, your doctor or midwife will draw blood for a group of tests known as the prenatal panel. These tests are done to find problems or infections early in the pregnancy.

This panel of tests includes, but is not limited to:

A complete blood count (CBC)
Blood typing (including Rh screen)
Rubella viral antigen screen (this shows how immune you are to the disease Rubella)
Hepatitis panel (this shows if you are positive for hepatitis A, B, or C)
Syphilis test
HIV test (this test shows if you are positive for the virus that causes AIDS)
Cystic fibrosis screen (this test shows if you are a carrier for cystic fibrosis)
A urine analysis and culture

Ultrasounds

An ultrasound is a simple, painless procedure. A wand that uses sound waves will be placed on your belly. The sound waves will let your doctor or midwife see the baby.

You should have an ultrasound done in the first trimester to get an idea of your due date. The first trimester ultrasound will usually be a vaginal ultrasound.

Genetic Testing

All women are offered genetic testing to screen for birth defects and genetic problems, such as Down syndrome or brain and spinal column defects.

If your doctor thinks that you need any of these tests, talk about which ones will be best for you.
Be sure to ask what the results could mean for you and your baby.
A genetic counselor can help you understand your risks and test results.
There are many options now for genetic testing. Some of these tests carry some risks to your baby, while others do not.

Women who may be at higher risk for these genetic problems include:

Women who have had a fetus with genetic problems in earlier pregnancies
Women, age 35 years or older
Women with a strong family history of inherited birth defects

In one test, your provider can use an ultrasound to measure the back of the baby's neck. This is called nuchal translucency .

A blood test is also done.
Together, these 2 measures will tell if the baby is at risk for having Down syndrome.
If a test called a quadruple screen is done in the second trimester, the results of both tests are more accurate than doing either test alone. This is called integrated screening. If the test is positive, an amniocentesis or cell-free DNA test may be recommended.

Another test, called chorionic villus sampling (CVS) , can detect Down syndrome and other genetic disorders as early as 10 weeks into a pregnancy.

A newer test, called cell free DNA testing, looks for small pieces of your baby's genes in a sample of blood from the mother. This test is newer, but offers a lot of promise for accuracy without risks of miscarriage. It may reduce the need for an amniocentesis, and so is safer for the baby.

There are other tests that may be done in the second trimester .

When to Call the Doctor

Contact your provider if:

You have a significant amount of nausea and vomiting.
You have bleeding or cramping.
You have increased discharge or a discharge with odor.
You have a fever, chills, or pain when passing urine.
You have any questions or concerns about your health or your pregnancy.

Alternative Names

Pregnancy care - first trimester

Gregory KD, Ramos DE, Jauniaux ERM. Preconception and prenatal care. In:.Landon MB, Galan HL, Jauniaux ERM, et al, eds. Gabbe's Obstetrics: Normal and Problem Pregnancies . 7th ed. Philadelphia, PA: Elsevier; 2021:chap 5.

Hobel CJ, Williams J. Antepartum care. In: Hacker N, Gambone JC, Hobel CJ, eds. Hacker & Moore's Essentials of Obstetrics and Gynecology . 6th ed. Philadelphia, PA: Elsevier; 2016:chap 7.

Magowan BA, Owen P, Thomson A. Antenatal and postnatal care. In: Magowan BA, Owen P, Thomson A, eds. Clinical Obstetrics and Gynaecology . 4th ed. Philadelphia, PA: Elsevier; 2019:chap 22.

Symonds I. Early pregnancy care. In: Symonds I, Arulkumaran S, eds. Essential Obstetrics and Gynaecology . 6th ed. Philadelphia, PA: Elsevier; 2020:chap 18.

Williams DE, Pridjian G. Obstetrics. In: Rakel RE, Rakel DP, eds. Textbook of Family Medicine . 9th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 20.

Review Date 4/19/2022

Updated by: John D. Jacobson, MD, Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Prenatal Care Visits

Initiation of care between six and 10 weeks allows for identification of preexisting conditions that negatively affect maternal-fetal outcomes (e.g., diabetes mellitus, hypertension, obesity) 2 ; however, 22% of pregnant patients do not receive care during this time. 2 The COVID-19 pandemic resulted in a reevaluation of the number of physician visits needed, with an emphasis on increased flexibility, allowing for a combination of virtual and in-person visits depending on risk. 3 Table 1 outlines the components of prenatal care. 1 , 4 – 22 Table 2 provides opportunities for educating pregnant patients during prenatal care visits. 6 , 8 , 14 – 19 , 23 – 29

PHYSICAL EXAMINATION

Weight, height, and blood pressure should be measured at the first prenatal visit. Early identification of periodontal disease and treatment decreases adverse pregnancy outcomes. 7 Treatment may be performed in the second trimester, and emergent treatment may be completed at any time during pregnancy. 7 A bimanual pelvic examination has poor predictive value for clinical pelvimetry and screening for disease (i.e., sexually transmitted infections and cancer) but may be used as a diagnostic aid in patients with a discrepancy between uterine size and gestational age, which warrants ultrasonography assessment. 30 A pelvic examination is also useful in a symptomatic patient for evaluating spontaneous labor (e.g., cervical dilation, rupture of amniotic membranes). The clinical breast examination is a diagnostic aid in the symptomatic patient and addresses breastfeeding concerns or barriers but does not demonstrate benefit in patients already receiving screening mammograms and does not decrease mortality. 31 – 33

MATERNAL WEIGHT GAIN AND NUTRITION

A prepregnancy body mass index (BMI) greater than 25 kg per m 2 is associated with preterm delivery, gestational diabetes, gestational hypertension, and preeclampsia. A BMI greater than 30 kg per m 2 is also associated with an increased risk of miscarriage, stillbirth, and obstructive sleep apnea. 6 Prepregnancy BMI informs the timing of fetal surveillance, nutritional counseling, and goals for gestational weight gain. Table 3 lists general dietary guidelines for pregnant people. 8 , 17 , 34 , 35 For Black and Hispanic people, a prepregnancy BMI greater than 25 kg per m 2 and the associated poor outcomes are worse compared with non-Hispanic White people. 36

PARENTAL AGE AT CONCEPTION

Advanced maternal and paternal age (35 years and older) is associated with poor outcomes (i.e., aneuploidy, birth defects, gestational diabetes, hypertension, intrauterine growth restriction [IUGR], miscarriage, and stillbirth). Activities focused on improving perinatal outcomes for this group, such as a detailed fetal anatomic screening on ultrasonography, may decrease morbidity and mortality. 37

PREGNANCY DATING AND ULTRASONOGRAPHY

Accurate gestational age estimation is critical to quality care because it enables more precise timing of interventions (e.g., aspirin for preeclampsia prevention, steroids for fetal lung maturity), screening tests, and delivery. Up to 40% of people estimate their last menstrual period incorrectly; therefore, ultrasonography is recommended if uncertainty exists and for patients with irregular menstrual cycles, irregular bleeding, and discrepancy between uterine size and gestational age. 1 , 38 Ultrasonography before 24 weeks decreases missed multiple gestations and post-term inductions. 39 Although routine third-trimester ultrasonography may increase detection of IUGR, it does not improve outcomes. 40 If malpresentation is suspected on physical examination, confirmation with ultrasonography is recommended. 4

ALLOIMMUNIZATION

For patients who are RhD-negative and carrying a fetus who is RhD-positive, the alloimmunization risk is 1.5% to 2% in the setting of spontaneous abortion and 4% to 5% with dilation and curettage. The risk is decreased by 80% to 90% with anti-D immune globulin. 41 Testing for the ABO blood group and RhD antibodies should be performed early in pregnancy. A 300-mcg dose of anti-D immune globulin is recommended for RhD-negative pregnant patients at 28 weeks and again within 72 hours of delivery if the infant is RhD-positive. 41

Iron deficiency anemia increases the risk of preterm delivery, IUGR, and perinatal depression. The U.S. Preventive Services Task Force found insufficient evidence to assess the benefits and harms of screening for anemia in pregnancy. 42 Screening is recommended by the American College of Obstetricians and Gynecologists early in pregnancy, with iron treatment if deficient. 43 Intravenous iron should be considered for patients who cannot tolerate oral iron or in whom oral iron has been ineffective at correcting the deficiency. 43 Patients with non–iron deficiency anemia, or if iron repletion is ineffective within six weeks, should be referred to a hematologist for further evaluation. Iron supplementation in the first trimester decreases the prevalence of iron deficiency. 43

INHERITED CONDITIONS

Pregnant patients should be counseled and offered aneuploidy (extra or missing chromosomes) screening in early pregnancy, regardless of age. 44 In the United States, 1 in 150 infants has a chromosomal condition, the most common being trisomy 21 (Down syndrome). 44 Table 4 compares screening tests for Down syndrome. 1 , 45 , 46 If a screening test is positive, amniocentesis at 15 weeks or more or chorionic villous sampling between 11 and 13 weeks is recommended. Both procedures have similar rates of fetal loss. 47 At 35 years of age, the risk of Down syndrome (1 in 294 births) is similar to that of fetal loss from amniocentesis. 47 Serum and nuchal translucency testing can screen for other trisomies, including 13 and 18, the protocols for which have lower sensitivities and higher specificities compared with screening protocols for trisomy 21 because they are rarer. 47

Additional genetic screening should be based on maternal and paternal personal and family histories. Race is a social construct, necessitating a shift in genetic risk stratification from race-based to ancestry-based. Sickle cell disease affects up to 100,000 people in the United States, but its inheritance pattern (1:10) is based on people with African ancestry, which includes much of the world. 48 Cystic fibrosis is inherited mainly by people of European ancestry (1:25), but ignoring the possibility of European ancestry in certain racial and ethnic groups results in an underestimation of its prevalence: African (1:61), Hispanic (1:40), and Mediterranean (1:29). 49

NEURAL TUBE DEFECTS

In the United States, neural tube defects affect approximately 2,600 infants per year, with the highest prevalence in Hispanic populations. 35 , 50 All pregnant patients should be counseled and offered screening with maternal serum alpha fetoprotein. 35 Folic acid, 400 to 800 mcg daily, started at least one month before conception and continued until the end of the first trimester, decreases the incidence of neural tube defects by nearly 78%. 35 Patients taking folic acid antagonists (e.g., carbamazepine, methotrexate, trimethoprim) or who have a history of carrying a fetus with a neural tube defect should take 4 mg of folic acid daily, starting at least three months before conception. 35

THYROID DISORDERS

There is no evidence that screening for thyroid disorders improves pregnancy outcomes. Thyroid-stimulating hormone levels should be measured if there is a history of thyroid disease or symptoms of disease. If the level is abnormal, a free thyroxine test helps determine the etiology. 51 Hypothyroidism complicates 1 to 3 per 1,000 pregnancies and increases the risk of fetal loss, preeclampsia, IUGR, and stillbirth. Hyperthyroidism occurs in 2 per 1,000 pregnancies and is associated with miscarriage, preeclampsia, IUGR, preterm delivery, thyroid storm, and congestive heart failure. 51 The effect of subclinical hypothyroidism on a child's neurocognitive development is not well understood, and the effectiveness of treatment with levothyroxine is unproven. 51

CERVICAL CANCER

Intervals for cervical cancer screening are based on patient age, cytology history, and history of the presence of high-risk human papillomavirus (HPV). Routine screening for people at average risk of cervical cancer should begin at 21 years of age. Screening can be performed with either cytology alone every three years, HPV screening alone every five years, or cytology plus HPV screening every five years starting at 25 years of age. Screening is not indicated for people 65 years and older with negative screening in the previous 10 years, and no history of cervical intraepithelial neoplasia grade 2 or higher in the past 25 years. 52 Colposcopy is indicated when the risk of cervical intraepithelial neoplasia grade 3 is greater than 4%. Surveillance of high-grade lesions should be performed every 12 to 24 weeks. 52 , 53 Although colposcopy and cervical biopsy can be safely performed during pregnancy, endocervical sampling should be deferred until postpartum. 53

Infectious Disease

Bacteriuria.

Asymptomatic bacteriuria complicates up to 15% of pregnancies in the United States, 30% of which progress to pyelonephritis if untreated. 54 All pregnant patients should be screened for bacteriuria at the first prenatal visit. 54 A culture from a midstream or clean-catch sample with greater than 100,000 colony-forming units per mL of a single pathogen is considered positive and treated to decrease the risk of pyelonephritis and subsequent preterm delivery. 54

SEXUALLY TRANSMITTED INFECTIONS

Sexually transmitted infections can affect prenatal outcomes. 55 – 57 Table 5 lists routine screening and treatment for sexually transmitted infections in pregnancy. 55 , 56

Rubella immunity screening during the first prenatal visit is recommended. Postpartum vaccination should also be offered if the patient is not immune to prevent congenital rubella syndrome in subsequent pregnancies. 1 , 58 The presence of rubella immunoglobulin G should be interpreted with caution in patients recently migrating from areas where rubella is endemic because this may indicate a recent infection. 58 Rubella is a live vaccine and should not be administered during pregnancy but is safe during lactation after delivery. 59 , 60

Maternal varicella can result in congenital varicella syndrome (i.e., IUGR and limb, ophthalmologic, and neurologic abnormalities) and neonatal varicella; infection can occur from approximately five days before to two days after birth. A negative history of varicella infection or vaccination warrants serologic testing, and if immunoglobulin G is negative, varicella exposure should be avoided. Postpartum vaccination should be offered. 61

Although tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccination is recommended for anyone in close contact with the infant, only antenatal maternal vaccination ensures increased protection against neonatal pertussis. 62 Pregnant patients should receive a Tdap vaccine beginning at 27 weeks to maximize time for passive immunity to the fetus through the placental transfer of maternal antibodies; vaccination is recommended in each subsequent pregnancy. 62

INFLUENZA AND COVID-19

Influenza and COVID-19 infection in pregnancy increase the risk of intensive care unit admission, preterm delivery, stillbirth, and maternal death. 63 , 64 COVID-19 infection almost doubles the risk of developing preeclampsia 64 ; therefore, initiating low-dose aspirin (81 mg daily) starting at 12 weeks should be considered. 5 Pregnant patients and their household contacts should be vaccinated for influenza and COVID-19. 63 , 64

GROUP B STREPTOCOCCUS

In the United States, group B Streptococcus (GBS) is the leading cause of infection in the first three months of life; 25% of all pregnant patients are GBS carriers. 65 , 66 Screening with a vaginal-rectal swab for culture between 36 and 37 weeks is recommended. 67 Intrapartum antibiotic prophylaxis decreases neonatal mortality. Antibiotics are recommended when there is GBS bacteriuria with the current pregnancy, a history of a previous infant affected by GBS (e.g., septicemia, meningitis, pneumonia, death), or unknown GBS status and risk factors (e.g., preterm labor, rupture of membranes more than 18 hours before delivery, GBS in previous pregnancy). 67 Patients with GBS bacteriuria in the current pregnancy are assumed to be colonized and do not need subsequent screening. 67

Social Determinants of Health

Social determinants of health represent up to 80% of the factors that directly affect a person's health. 68 Physicians who provide prenatal care play a critical role in mitigating the burden that social determinants of health play on maternal-child health without compromising the quality of care delivered. 69 An increased burden from social determinants of health increases the risk of depression, anxiety, intimate partner violence, substance use, and food insecurity 70 , 71 ; therefore, universal screening is recommended early in pregnancy.

DEPRESSION AND ANXIETY-RELATED DISORDERS

After the COVID-19 pandemic, rates of perinatal depression and anxiety have increased. People who are non-White, 24 years or younger, or who have 12 years or less of education, lower socioeconomic status, or a history of intimate partner violence or sexual trauma are at higher risk. 11 , 72 , 73 If untreated, depression and anxiety-related disorders increase the risk of preeclampsia, preterm delivery, IUGR, substance use, maternal suicide, infanticide, psychosis, and homicide. 11

INTIMATE PARTNER VIOLENCE

Intimate partner–related homicide is the leading cause of death in the United States in pregnancy. Screening is recommended at the first prenatal visit and once per trimester. 13 Intimate partner violence increases the risk of miscarriage, placental abruption, premature rupture of membranes, IUGR, and preterm delivery. 13 Family physicians should be aware of the signs of intimate partner violence (e.g., frequent sexually transmitted infections, repeated requests for pregnancy tests when pregnancy is not desired, fear of asking a partner to use a condom), the effect of violence on health, and the increased risk of child abuse after delivery. 13

SUBSTANCE USE

Substance use during pregnancy increases the risk of IUGR, preterm delivery, stillbirth, fetal malformations, and maternal death. 74 The use of prescription opioids complicates 7% of pregnancies in the United States; of these, 20% of patients report misuse. 75 Opioid use in pregnancy increased by 131% from 2010 to 2017 in the United States, and the incidence of babies born with withdrawal symptoms in that time increased by 82%. 76 Fetal alcohol exposure is the leading cause of preventable neurodevelopmental disorders in the United States. 14 However, 14% of pregnant patients report current drinking, and 5% report binge drinking in the past 30 days. 77 Exposure to cigarette smoking in utero increases the risk of sudden intrauterine and infant death. 15

FOOD INSECURITY

Maternal food insecurity increases the risk of poor outcomes (e.g., IUGR, preterm delivery, gestational diabetes, hypertension, depression, anxiety). However, few patients disclose this due to concerns about social stigma; therefore, a universal approach to screening is encouraged. The Hunger Vital Sign tool may be used. 12

Complications of Pregnancy

Gestational diabetes.

Gestational diabetes complicates up to 14% of U.S. pregnancies, with up to 67% of patients developing type 2 diabetes later in life. 78 Racial and ethnic minorities are at the highest risk. 79 Gestational diabetes is associated with hypertension, macrosomia, shoulder dystocia, and cesarean deliveries. 80 Screening for undiagnosed type 2 diabetes at the initial prenatal visit is recommended for people at increased risk 80 ( Table 6 5 , 80 ) . Universal screening for gestational diabetes should occur between 24 and 28 weeks with a one-hour (50-g) glucose tolerance test and, if results are abnormal, should be followed by a confirmatory, fasting, three-hour (100-g) test. 80

HYPERTENSION

Blood pressure should be monitored at each prenatal visit, and education should be provided on preeclampsia warning signs. 5 Patients at increased risk of preeclampsia should be screened for thrombocytopenia, transaminitis, and renal insufficiency, including proteinuria, during the first or second trimester and started on prophylactic daily low-dose aspirin (81 mg) between 12 and 16 weeks 5 , 85 ( Table 6 5 , 80 ) . [Updated] Screening for proteinuria in isolation has little predictive value for detecting preeclampsia. 5 Chronic hypertension (hypertension before 20 weeks) is treated to less than 140/90 mm Hg. 81

PRETERM DELIVERY

Preterm delivery (between 20 and 37 weeks) is a significant cause of neonatal morbidity and mortality, complicating 10.5% of U.S. pregnancies. 2 Modifiable risk factors include prepregnancy BMI (less than 18.5 kg per m 2 and greater than 25 kg per m 2 ), substance use, and short interval between pregnancies (i.e., less than 18 months). 82 Several options are available for the prevention of preterm labor in a singleton pregnancy. 82 Patients with a previous preterm delivery before 34 weeks should have a cervical length assessment starting at 16 weeks through 24 weeks. 82 These patients should be treated with progesterone supplementation (vaginal or intramuscular). In the asymptomatic patient with a short cervix and without a history of spontaneous birth before 34 weeks, vaginal progesterone (200 mg) started between 16 and 20 weeks and continued through 36 weeks is recommended. 82

POST-TERM DELIVERY

Stillbirth complicates 3 per 1,000 post-term (42 weeks or greater) pregnancies. 20 Antenatal testing should be initiated at 41 weeks; if the results are not reassuring, induction of labor is recommended. 20 , 21

Cultural Considerations

Maternity care improves outcomes; however, vulnerable populations (i.e., racial, ethnic, and religious minorities) are less likely to engage in care if it is not culturally centered, which acknowledges the effect of culture on health conditions (e.g., depression) and enhances patient-physician trust. 83 Addressing cultural needs (e.g., doula, community health workers, interpreters) throughout pregnancy helps mitigate barriers and improves outcomes.

This article updates previous articles on this topic by Zolotor and Carlough 1 ; Kirkham, et al. 17 ; and Kirkham, et al. 84

Data Sources: A search was completed using the key terms prenatal care, COVID-19, oral health, pelvic examination, prepregnancy body mass index, pregnancy dating and ultrasound, maternal and paternal age and impact on pregnancy outcomes, aneuploidy screening, inheritance patterns of sickle cell disease and cystic fibrosis, anemia, cell-free DNA analysis, thyroid disease, cervical cancer screening, management of abnormal cervical cytology, screening guidelines for sexually transmitted infections in pregnancy, group B Streptococcus screening, social determinants of health and prenatal outcomes, intimate partner violence, polysubstance abuse, food insecurity, maternity care deserts, hypertension in pregnancy, progesterone for preterm birth prevention, post-term delivery, and preconception care. Also searched were PubMed, Essential Evidence Plus, the Cochrane database, U.S. Preventive Services Task Force, American College of Obstetricians and Gynecologists, American Cancer Society, American Family Physician , and reference lists of retrieved articles. Search dates: July 1, 2022; February 19, 2023; and June 16, 2023.

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Grohskopf LA, Blanton LH, Ferdinands JM, et al. Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices – United States, 2022–23 influenza season. MMWR Recomm Rep. 2022;71(1):1-28.

Jamieson DJ, Rasmussen SA. An update on COVID-19 and pregnancy. Am J Obstet Gynecol. 2022;226(2):177-186.

Nanduri SA, Petit S, Smelser C, et al. Epidemiology of invasive early-onset and late-onset group b streptococcal disease in the United States, 2006 to 2015: multistate laboratory and population-based surveillance [published corrections appear in JAMA Pediatr . 2019; 173(3): 296, and JAMA Pediatr . 2019; 173(5): 502]. JAMA Pediatr. 2019;173(3):224-233.

Centers for Disease Control and Prevention. Active bacterial core surveillance (ABCs) report. Emerging infections program network, group B Streptococcus , 2018. May 19, 2020. Accessed October 12, 2022. https://www.cdc.gov/abcs/reports-findings/survreports/gbs18.pdf?CDC_AA_refVal= https%3A%2F%2Fwww.cdc.gov%2Fabcs%2Freports-findings%2Fsurvreports%2Fgbs18.html

Prevention of group b streptococcal early-onset disease in newborns: ACOG committee opinion, no. 797 [published correction appears in Obstet Gynecol . 2020; 135(4): 978–979]. Obstet Gynecol. 2020;135(2):e51-e72.

Institute for Clinical Systems Improvement. Going beyond clinical walls: solving complex problems. October 2014. Accessed October 11, 2022. https://www.icsi.org/wp-content/uploads/2019/08/1.SolvingComplexProblems_BeyondClinicalWalls.pdf

Partin M, Sanchez A, Poulson J, et al. Social inequities between prenatal patients in family medicine and obstetrics and gynecology with similar outcomes. J Am Board Fam Med. 2021;34(1):181-188.

Compton MT, Shim RS. The social determinants of mental health. Focus. 2015;13(4):419-425.

Kuhrau C, Kelly E, DeFranco EA. Social determinants of health associated with intimate partner violence in an urban obstetric population. Am J Obstet Gynecol. 2023;228(1):S110-S111.

Bauman BL, Ko JY, Cox S, et al. Vital signs: postpartum depressive symptoms and provider discussions about perinatal depression - United States, 2018. MMWR Morb Mortal Wkly Rep. 2020;69(19):575-581.

Lombardi BN, Jensen TM, Parisi AB, et al. The relationship between a lifetime history of sexual victimization and perinatal depression: a systematic review and meta-analysis. Trauma Violence Abuse. 2023;24(1):139-155.

Yazdy MM, Desai RJ, Brogly SB. Prescription opioids in pregnancy and birth outcomes. J Pediatr Genet. 2015;4(2):56-70.

Ko JY, D'Angelo DV, Haight SC, et al. Vital signs: prescription opioid pain reliever use during pregnancy–34 U.S. jurisdictions, 2019. MMWR Morb Mortal Wkly Rep. 2020;69(28):897-903.

Hirai AH, Ko JY, Owens PL, et al. Neonatal abstinence syndrome and maternal opioid-related diagnoses in the US, 2010–2017 [published correction appears in JAMA . 2021; 325(22): 2316]. JAMA. 2021;325(2):146-155.

Gosdin LK, Deputy NP, Kim SY, et al. Alcohol consumption and binge drinking during pregnancy among adults aged 18–49 years–United States, 2018–2020 [published correction appears in MMWR Morb Mortal Wkly Rep . 2022; 71(4): 156]. MMWR Morb Mortal Wkly Rep. 2022;71(1):10-13.

Diaz-Santana MV, O'Brien KM, Park YM, et al. Persistence of risk for type 2 diabetes after gestational diabetes mellitus. Diabetes Care. 2022;45(4):864-870.

Bower JK, Butler BN, Bose-Brill S, et al. Racial/ethnic differences in diabetes screening and hyperglycemia among US women after gestational diabetes. Prev Chronic Dis. 2019;16:E145.

American College of Obstetricians and Gynecologists' Committee on Practice Bulletins–Obstetrics. Gestational diabetes mellitus. ACOG practice bulletin, no. 190. Obstet Gynecol. 2018;131(2):e49-E64.

Tita AT, Szychowski JM, Boggess K, et al. Treatment for mild chronic hypertension during pregnancy. N Engl J Med. 2022;386(19):1781-1792.

American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Obstetrics. Prediction and prevention of spontaneous preterm birth. ACOG practice bulletin, no. 234. Obstet Gynecol. 2021;138(2):e65-e90.

Gopalkrishnan N. Cultural diversity and mental health: considerations for policy and practice. Front Public Health. 2018;6:179.

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Roberts JM, King TL, Barton JR, et al. Care plan for individuals at risk for preeclampsia: shared approach to education, strategies for prevention, surveillance, and follow-up. Am J Obstet Gynecol . 2023;229(3):193-213.

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Your first antenatal visit

7-minute read

Antenatal visits check the wellbeing of you and your baby during pregnancy.
During your first visit, your doctor or midwife will check your health.
They will also work out when your baby is due to be born.
During your visit you will learn how to keep healthy during your pregnancy.
Regular antenatal care is likely to positively affect the health of you and your baby.

Antenatal visits check the wellbeing of you and your baby during pregnancy. Antenatal care throughout your pregnancy is likely to positively affect the health of you and your baby.

Your first antenatal care appointment is an important one. During your visit, your doctor or midwife will:

confirm your pregnancy
check your health
give you some information that you will need in the months ahead

You will also be able to talk about the type of care you want during your pregnancy.

When should I make my first appointment?

It’s best to have your first antenatal visit before 10 weeks into your pregnancy. Ideally this will happen when you are about 6 to 8 weeks pregnant. This is because there are lots of things to learn about. Also, some tests are recommended early in your pregnancy.

Your first appointment may be with a midwife or your doctor. It may be at a clinic or hospital — you can choose.

What does an antenatal visit involve?

Taking your medical history.

During the visit, your doctor or midwife will ask about your health. This includes finding out about:

any prior pregnancies
any illnesses or operations you’ve had
what medicines you’re taking, including those from a pharmacy or supermarket
if you have any current health problems
if you are allergic to any medicines

Your doctor or midwife will ask you if you:

drink alcohol
take recreational drugs
are stressed
have any signs of depression or anxiety
about the support you may get from people at home and work

These questions aren’t to judge you. The more your doctor or midwife knows about you, the better they can support you during your pregnancy.

It’s up to you whether you answer these questions. Anything you say will be kept in confidence.

If you are experiencing family violence you should let them know. It’s important to get professional help and they can support you to do this.

Your family medical history

Finding out about the health of your family is also important because it may affect you or your baby. This includes any family history of:

genetic conditions
chronic illnesses such as diabetes

You may wish to do screening tests for certain genetic conditions . You can talk about this with your doctor or midwife.

What tests will I have?

Your doctor or midwife will check your health and measure your:

blood pressure

They may suggest a urine (wee) test to see if you have a urinary tract infection (UTI) or any kidney problems.

You will also be offered a blood test to check your blood group and rhesus factor. They will also check for:

infectious diseases — rubella
sexually transmitted infections (STIs)
bacteria that may affect your baby — group B streptococcus
infections that can be passed on through blood-to-blood contact — hepatitis C and HIV

Some STIs that can affect your pregnancy don’t have any symptoms. It’s possible to have an STI and not know.

Find out more about the check-ups, tests and scans you can have during your antenatal visits.

If you have any questions about these tests, ask your midwife or doctor.

Finding out about your baby

Your doctor or midwife will work out how many weeks you have been pregnant. This will let them work out the due date of your baby.

If you’re not sure when your last period was, they may book a dating scan . This is an ultrasound that will help figure out which week of pregnancy you are in.

Tests are available to check for some problems that may affect your baby. You don’t have to have these tests — it’s up to you. Your midwife or doctor will tell you about the tests and how much they will cost.

Discussing your antenatal care options

During your first appointment, your midwife or doctor will give you information about antenatal care. They will talk with you about which model of care you would like for your pregnancy and birth. You'll be able to discuss:

who will be your main maternity carer
where you would like to receive your antenatal care
how many antenatal visits you will have and when
where you would like to give birth
where to find local antenatal classes or education sessions

How can I have a healthy pregnancy?

Your midwife or doctor will talk to you about keeping healthy during your pregnancy. They will also ensure you have good support and care.

This may cover:

help to stop smoking or stop drinking alcohol (if needed)
advice about healthy eating , exercise and weight gain
advice on which vitamins and minerals you should take during pregnancy
referrals to support services if you need them

They will answer questions about any issues that worry or concern you.

If this is your first pregnancy, The Australian Pregnancy Care Guidelines advise you have 10 antenatal care visits. If there are complications with your pregnancy, you may need to have more visits.

If you’ve been pregnant before, The Australian Pregnancy Care Guidelines advise you have 7 antenatal care visits. Again, if you have any complications with your pregnancy, you may need more visits.

Speak to a maternal child health nurse

Call Pregnancy, Birth and Baby to speak to a maternal child health nurse on 1800 882 436 or video call . Available 7am to midnight (AET), 7 days a week.

Learn more here about the development and quality assurance of healthdirect content .

Last reviewed: November 2022

Questions to ask your doctor about tests and scans

Checkups, tests and scans available during your pregnancy

Antenatal classes

Antenatal care during your pregnancy

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Antenatal Care

Need more information?

Antenatal Care during Pregnancy

Once you are pregnant, your first antenatal appointment will ideally take place when you are about 6 to 8 weeks pregnant.

Read more on RANZCOG - Royal Australian and New Zealand College of Obstetricians and Gynaecologists website

Antenatal care includes several checkups, tests and scans, some of which are offered to women as a normal part of antenatal care in Australia.

Preconception & Early Pregnancy

There are many different types of antenatal care and birth options in Australia.

Birthing services in Central Australia | NT.GOV.AU

Antenatal care, midwife services, labour and birth, lactation consultant, childbirth education and support for Central Australia.

What does your GP do in pregnancy care?

Your doctor, or GP, is likely to be the first health professional you see when you’re pregnant. Read more about how GPs help with your antenatal care.

Pregnancy at week 7

Your baby is now about 1cm long and if you haven’t seen your doctor yet, now is a good time to start your antenatal care.

Being pregnant after 40

Being pregnant is an exciting time. But when you’re over the age of 40, there are a few extra things you need to think about.

Pregnancy and birth care options - Better Health Channel

Pregnant women in Victoria can choose who will care for them during their pregnancy, where they would like to give birth and how they would like to deliver their baby.

Read more on Better Health Channel website

Maternity care in Australia

If you are pregnant or planning a pregnancy, find out what care, support and services may be available to you in Australia.

Pregnancy, Birth and Baby is not responsible for the content and advertising on the external website you are now entering.

Call us and speak to a Maternal Child Health Nurse for personal advice and guidance.

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Trigger Warning, Emergency room visit??

Nursery Theme Ideas

Pregnancy cravings, moms weigh various birthing options, prepping the nursery get inspired, help keep our community safe, to create a safe place, please, on our end, we will, about what to expect, popular articles, tools & registry.

“He’s wonderful. I actually met him and went out with him three-and-a-half years ago,” she said on the “Bitch Bible” podcast in May. “Some of my friends call it a boomerang where you go out the first time, the timing wasn’t right, and then they come back around, so that’s basically what happened.”

She further explained, “We met and we hit it off, went on some dates. He was trying to figure out his career moves, and it was just bad timing for him. It was also just the holidays, bad timing for me. I was in a weird place at that time, and so he broke things off with me.”

The two ended up reconnecting in December 2023 when he reached out to her after her ex-fiancé, Carl Radke, ended their engagement in August.

“First of all, I put him on ice for a month. He reached out in mid-December, and I was like, ‘Hm, he made me wait three years, I’m gonna make him wait a month.’ So I reached back out in January, and I was like, ‘Alright, coffee.’ We wound up at lunch, and it felt like that lunch we went on was almost like catching up on the last three years of our lives,” she gushed.

Hubbard has kept details of her beau under wraps, but she previously told Page Six in February that she wasn’t interested in dating anymore reality TV stars.

“I think I’m good on the reality TV boys for now,” she told us at the time. “I’m good. I’m definitely good.”

The Bravolebrity later appeared on “Watch What Happens Live” in March where she told host Andy Cohen that she’s “having fun” dating.

“I’m dating, I’m having fun, I’m really busy, I have a lot of projects, I just bought a house in Nashville,” she shared.

Hubbard had previously been vocal about her desire to become a mom and froze her eggs in May 2022.

“It was very special, because the day of my retrieval happened to be Mother’s Day. It was like one of those serendipitous moments where you sit back, and you’re like, ‘Wow, I really did this,’” Hubbard told Page Six at the time.

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Just a few months before she went through the egg retrieval process, Hubbard revealed that she got pregnant with “Winter House” co-star Jason Cameron, but sadly suffered a miscarriage.

She added that she has “always wanted to have a family,” so she wanted to “have a backup plan.”

“I would have absolutely had this child,” she said. “That was cool to feel that. I never thought that it would happen like that for me. It’s something I’ve always wanted my entire life, to have a family.”

Radke, 39, called off their engagement in August 2023 –– just a few months before they were set to say “I do” in November.

Their relationship woes have since been playing out on the current season of “Summer House.” Most recently, Hubbard had a difficult conversation with Radke over him struggling to determine his career.

“Something that turns me on is when my man is out there, like, crushing life,” Hubbard told Radke during the April 18 episode.

When Radke asked if that included him, she told him, “No.”

The former couple also got into arguments after Hubbard questioned Radke’s sobriety –– despite Radke being sober since January 2021.

“Summer House” star Lindsay Hubbard is pregnant.

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Gypsy Rose Blanchard is pregnant, expecting 1st child with Ken Urker

Gypsy Rose Blanchard is pregnant.

The author and reality TV star, 32, who spent eight years in prison for her role in the 2015 murder of her allegedly abusive mother , Clauddine “Dee Dee” Blanchard, announced July 9 in a YouTube video that she and boyfriend Ken Urker were expecting their first child.

She also shared photos from a photoshoot with Urker on her Instagram page.

In her video, titled “I’m Pregnant, My Journey So Far,” Gypsy Rose Blanchard revealed she was 11 weeks pregnant and was due in January 2025.

“This was not planned at all. This was completely unexpected, but we’re both very excited to take on this new journey of parenthood,” Blanchard said in the video, which she also excerpted on TikTok.

Blanchard, who was released from prison in December 2023 , addressed concerns.

“I know that there are going to be people who feel like I’m not ready to be a mother," she said. Her response? "I don’t know if anyone’s really ready to be a mother.”

“I just want to be a good mother for my child. I want to be everything my mother wasn’t,” she said.

Blanchard is believed to have been a victim of Munchausen syndrome by proxy, a psychological disorder in which a caretaker makes someone ill or creates the illusion of them being ill in order to receive attention.

Dee Dee Blanchard, Gypsy Rose Blanchard's mother, “was convinced Gypsy suffered from a wide range of health issues,” according to Ozarks First .

While on the stand during her trial, Gypsy Rose Blanchard described how her mother sought medical attention for her throughout her life to treat her for various conditions — including leukemia and muscular dystrophy — which she actually never had.

Gypsy Rose Blanchard detailed how she was forced to use both a wheelchair and an oxygen tank although she required neither, according to the Springfield News-Leader .

She also admitted on the stand that she arranged for then-boyfriend Nicholas Godejohn to kill her mother, according to Ozarks First.

Godejohn was convicted of first-degree murder and sentenced to life in prison after first pleading not guilty to stabbing Dee Dee Blanchard to death in her bedroom. He is currently serving a life sentence with no chance of parole at the Potosi Correctional Center, according to The Springfield News-Leader .

Blanchard met Urker after he wrote her a “letter of support” while she was in prison in 2017, she told E! News in 2019. Urker proposed to Blanchard while she was still behind bars in 2018.

The two later parted ways in 2019. Blanchard went on to marry another man, Ryan Anderson, in a prison wedding ceremony in 2022.

Blanchard b egan spending time with Urker again earlier this year following her split with Anderson. In an interview with TODAY.com earlier this year , Anderson said he felt "blindsided" by the breakup.

“I’m just experiencing things as they come. I’m still in reflection and processing mode,” he says. “A lot has happened. It’s hard to wrap my head around a lot of things that have happened because I mean, when I say I’m blindsided, I really am blindsided about how fast things progressed.”

Blanchard confirmed to People in May that she and Urker were back together , saying for the first time in her life, she’s “doing something that makes me happy — I’m prioritizing me.”

In her video announcement about her pregnancy, Blanchard said Urker has been supportive of her as she experiences pregnancy "mood swings."

"I have experienced crazy mood swings. Poor Ken. Like, Poor Ken," she said, adding, that she becomes irritated with Urker even if he just "breathes wrong."

"He's been very gracious about it. He's been very forgiving about it," she added.

Blanchard also mentioned dealing with some fatigue, but said in general, her pregnancy "has been a breeze" and noted that her baby-on-the-way was healthy.

Blanchard told viewers that her pregnancy has brought her peace of mind. "I feel a shift in myself. When I found I was pregnant, none of anything else mattered," she said. "The drama, the social media, the feud between creator and me and all of that drama, just all faded. It didn't matter anymore."

"All that matters is making sure that I'm healthy, the baby is healthy, my relationship with Ken is healthy and we are moving forward in a positive way," she added.

In her first interview after announcing the news, Blanchard explained how learned she was pregnant. She took a pregnancy test at her father Rod and stepmother Kristy's home. "Girl, you're pregnant," she recalled Kristy telling her.

Blanchard said she was surprised because she had recently been to the doctor about trouble ovulating, and had ruled out pregnancy.

“I literally had taken that out of my mind as a possibility,” she told People. Her reaction? "My dad is going to kill me!”

Based on People's interview, though, her family is supporting her.

"It’s such a blessing and it’s still unreal. They will be great parents and cherish every minute of it,” Blanchard's stepmother Kristy said. “When they hold their baby for the first time, they won’t be able to imagine their life without their child. Everything just melts away, even when she gets a lot of hate about it.”

TODAY.com has reached out to Blanchard for comment.

Gina Vivinetto is a writer for TODAY.com.

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Andy & Barbara Gessner College of Nursing

Undergraduate Programs

Traditional bsn.

The Traditional BSN Track is designed for University of Houston students who want to apply to the nursing major beginning their junior year to become a registered nurse (RN). The freshman and sophomore years will be at the University of Houston. After gaining admission in the nursing program, the junior and senior years will be taught face-to-face at the University of Houston Katy location.

Second Degree BSN

The Second Degree BSN track is offered face-to-face at the University of Houston at Sugar Land. Admission to this fast track is every Spring semester. It is twelve months long, intensive and full-time for people holding bachelor’s or master’s degrees in other fields who want to become registered nurses (RNs). This accelerated track is designed to facilitate a career change for the more mature and experienced student.

The RN to BSN track is offered at the University of Houston at Sugar Land, University of Houston at Katy, and face-to-face/web-enhanced classes or hybrid/online. This program is specifically for working registered nurses who have completed their associate degree and subsequent RN licensure to advance their professional qualifications while continuing to live and work within the Sugar Land and greater Houston communities.

Conversations with students: End Goals as a Nurse

Open access
Published: 09 July 2024

The association of travel burden with prenatal care utilization, what happens after provider-selection

Songyuan Deng 1 ,
Yuche Chen 2 &
Kevin J. Bennett 1

BMC Health Services Research volume 24 , Article number: 781 ( 2024 ) Cite this article

63 Accesses

Metrics details

Birthing people in the United States face numerous challenges when accessing adequate prenatal care (PNC), with transportation being a significant obstacle. Nevertheless, previous studies that relied solely on the distance to the nearest provider cannot differentiate the effects of travel burden on provider selection and care utilization. These may exaggerate the degree of inequality in access and fail to capture perceived travel burden. This study investigated whether travel distances to the initially visited provider, to the predominant PNC provider, and perceived travel burden (measured by the travel disadvantage index (TDI)) are associated with PNC utilization.

A retrospective cohort of people with live births were identified from South Carolina Medicaid claims files in 2015–2018. Travel distances were calculated using Google Maps. The estimated TDI was derived from local pilot survey data. PNC utilization was measured by PNC initiation and frequency. Repeated measure logistic regression test was utilized for categorical variables and one-way repeated measures ANOVA for continuous variables. Unadjusted and adjusted ordinal logistic regressions with repeated measure were utilized to examine the association of travel burdens with PNC usage.

For 25,801 pregnancies among those continuously enrolled in Medicaid, birthing people traveled an average of 24.9 and 24.2 miles to their initial and predominant provider, respectively, with an average TDI of -11.4 (SD, 8.5). Of these pregnancies, 60% initiated PNC in the first trimester, with an average of 8 total visits. Compared to the specialties of initial providers, predominant providers were more likely to be OBGYN-related specialists (81.6% vs. 87.9%, p < .001) and midwives (3.5% vs. 4.3%, p < .001). Multiple regression analysis revealed that every doubling of travel distance was associated with less likelihood to initiate timely PNC (OR: 0.95, p < .001) and a lower visit frequency (OR: 0.85, p < .001), and every doubling of TDI was associated with less likelihood to initiate timely PNC (OR: 0.94, p = .04).

Conclusions

Findings suggest that the association between travel burden and PNC utilization was statistically significant but of limited practical significance.

Peer Review reports

Introduction

Prenatal care (PNC) can prevent or reduce the incidence of adverse birth outcomes by providing pregnancy-related information on nutrition, fetal development, and delivery [ 1 , 2 , 3 ]. Adequate PNC is associated with up to a 75% reduction in maternal mortality rates [ 4 , 5 ], while inadequate PNC is associated with elevated perinatal mortality rates [ 6 ]. For high-risk pregnancies, it is recommended that birthing people initiate PNC earlier and attend more PNC visits [ 7 ]. Unfortunately, approximately 1.6% of birthing people in the United States receive no prenatal care, while an additional 15.0% receive inadequate PNC [ 8 ].

Birthing people in underserved areas encounter various obstacles when accessing adequate PNC, [ 9 ] with transportation being the most significant one [ 10 , 11 , 12 , 13 ]. Most studies have assessed the distance from a birthing person’s residence to the nearest delivery site or PNC provider. However, this strategy raises several concerns, primarily the two-step nature of seeking perinatal care. For most patients, a physicians’ referral network provides available options for subsequent care. Among those options, patients may choose a provider considering factors such as travel distance or insurance (the first step of provider selection), and then receive care from that provider (the second step of care utilization) [ 14 ]. Travel burden may impact patients’ behavior differently in both choosing a provider and care utilization.

The second concern is that relying solely on the distance to the nearest provider may exaggerate the degree of inequality in access [ 15 ]. The two-step process, provider selection and care utilization, is dynamic but not static; experience, knowledge, and referrals from the last and current providers will contribute to the provider-selection of the next visit. Even if birthing people initially visit the nearest provider, patients also bypass these nearby providers to seek care at a more distant PNC provider due to higher medical needs, availability/accessibility of providers, or personal preferences [ 14 , 16 ]. Over the course of the pregnancy, PNC providers who provide the most services to patients become the predominant PNC source, despite the distance [ 17 ].

The distances to all available PNC providers play a crucial role in initial provider selection, and influence the subsequent choice of a referral provider as well [ 18 ]. One study found that a birthing individual would typically bypass more than 90 closer providers to receive PNC from their predominant PNC provider [ 14 ]. Therefore, whether travel burden is still associated with PNC utilization remains unknown after the provider selection process, and may only impact the behavior of receiving care differently between the initial and predominant providers. This study aims to answer whether travel burden to the initial or predominant PNC provider is associated with PNC initiation and frequency.

Travel burden is a metric that has been quantified by objective metrics, including travel distance, travel time, travel cost, and availability of transportation options in previous studies [ 14 , 19 ]. Subjective opinions related to transportation can also influence people’s travel behavior and their assessment of travel burdens [ 20 , 21 ]. Additionally, high-risk populations perceive a greater transportation burden compared to their counterparts [ 22 ]. In these studies, the measures of perceived travel burden encompass not only transportation expenses and accessibility but also safety concerns and other barriers [ 20 ]. Even with similar travel distances and mobility options, a birthing individual with comorbidities, including but not limited to morning sickness, severe anemia, cardiac and respiratory diseases, and bone fractures, may perceive their travel burden for PNC differently from those without. Access to other general healthcare facilities, such as laboratories and pharmacies, is also crucial for medical management and thus should be included in the assessments of overall travel burden. However, no prior study has investigated the effect of a patient’s perceived travel burden on PNC utilization.

South Carolina offers a good context to explore these questions, given its higher poverty rates and uninsured rates compared to the national average [ 23 ]. Medicaid beneficiaries may also have greater travel-related needs to access PNC [ 24 ] Using South Carolina Medicaid claims data related to live births from 2015 to 2018, this study aims to investigate whether travel distances to the initially visited and the predominant PNC provider are associated with timely PNC initiation and PNC frequency, given the selection of PNC providers; and examine whether patients’ perceived travel burden is associated with these two utilization measures.

Data (claims and enrollment) including live births covered by Medicaid in South Carolina facilities during 2015–2018 were acquired. Medicaid enrollment files supplied pertinent administrative information for all birthing people enrolled in Medicaid. The claims data furnished information regarding PNC use and associated diagnoses. Exemption was granted by the Institutional Review Board at the authors’ institution due to the secondary analysis of de-identifiable administrative data.

During 2015–2018, 108,441 live births occurred among birthing people enrolled in Medicaid in South Carolina. PNC services provided by providers were identified using Current Procedural Terminology (CPT) codes, Healthcare Common Procedure Coding System (HCPCS) codes, and ICD-9/10-CM codes. Based on the timeline of all PNC visits for a pregnancy, both the initial PNC provider and the predominant PNC provider (the provider who billed for a majority of PNC services) were identified [ 25 ]. Discontinuous enrollment in Medicaid could lead to missed visits and bias the identification of the predominant PNC provider. Therefore, only pregnancies with full coverage during the pregnancy until delivery were included in this study, resulting in a final sample of 30,020 pregnancies: 25,801 with PNC services and 4,219 without. (Appendix Figure A ).

Travel burden was assessed using two measures: travel distance and perceived travel burden (also referred to as the transportation disadvantages index, TDI) [ 20 ]. Travel distance was measured as the road distance between the centroid of a patient’s area (e.g. ZCTA) to the centroid of healthcare provider’s ZCTA(?). For pregnancies with at least one PNC service and an identifiable predominant PNC provider, the actual road distance was computed from the centroid of the zip code tabulation area (ZCTA) of the birthing individual’s residence to the centroid of the provider’s ZCTA using Google Maps. If both ZCTAs were the same, the estimated radius was assigned as the average travel distance within the ZCTA, employing values from the 2010 Census ZCTA area [ 26 ] with the function: \(A=\pi {r}^{2}\) .

The TDI is an index that estimates an individual’s perceptions of burden when accessing necessary opportunities using various modes of transportation. The index was calculated using survey data from a representative sample of South Carolina residents in a previous study [ 27 ]. A negative TDI score indicates a higher level of perceived difficulty, correlating with greater distances traveled. The TDI utilized residents’ perceptions of the ease of travel, their capacity to travel, and their perceptions of travel safety. Individual-level travel disadvantage indices were converted into a population-weighted index at each ZCTA based on socio-demographic characteristics within the ZCTA. If a ZCTA has a high TDI, individuals residing in that area are likely to perceive greater difficulty in traveling to different places [ 20 ].

Two ordinal measures were employed to assess PNC utilization: PNC initiation for receiving the first PNC care after selecting the initial provider (the first, second or third trimesters) and PNC frequency for receiving PNC care throughout the pregnancy after selecting the predominant provider (more, adequate and less). PNC frequency was categorized into three levels: more than adequate (> 14 visits); adequate (9–14 visits); and less than adequate (1–8 visits) [ 28 , 29 ].

Covariates (Appendix Table A ) included socio-demographics of birthing people (age and race, dual eligibility for Medicaid and Medicare), medical needs (number of pregnancy-related conditions, number of other conditions, repeated pregnancy, age-adjusted Charlson Comorbidity Index (ACCI) [ 30 ]), specialty of the initially visited and the predominant PNC provider (specialists, midwife, nurse, primary care physician, other specialties, and organizations), and ZCTA characteristics (rurality, provider population density, uninsured rates, median income, birth rates, percentage of birthing persons with a high school degree, prevalence of birthing people using tobacco, prevalence of birthing people with obesity prior pregnancy, percentage of birthing people with less than 5 PNC visits). Rurality was defined as rural or urban [ 31 ] using 2010 rural-urban commuting area (RUCA) codes (1.0–3.0, 4.1, 5.1, 7.1, 8.1, and 10.1 as urban, and the rest as rural). To estimate the provider population density, two types of providers were used: registered PNC providers using state licensure data and identified predominant PNC providers using Medicaid claims data. The South Carolina licensure data 2013–2019 were used to estimate the annual number of active PNC providers within each ZCTA, calculated as the total number of active days divided by 365. Specialties with following abbreviations were included: OCC (Critical Care Medicine for Obstetrics & Gynecology), GO (Gynecological Oncology), OBG (Obstetrics & Gynecology), OBS (Obstetrics), GYN (Gynecology), MFM (Maternal fetal Medicine), NEO (Neo-Natal), and NPM (Neonatal-Perinatal Medicine). For each ZCTA, providers within a 24-minute driving distance were aggregated and divided by the birthing people population aged 15–50 in the corresponding year. Other ZCTA level information was acquired from the South Carolina SCAN project.

Characteristics of birthing people and providers were summarized using univariate and bivariate analysis. Comparisons were drawn between pregnancies with PNC and those without, and between initial and predominant providers [ 15 ]. Repeated measure logistic regression was utilized for categorical variables and one-way repeated measures ANOVA for continuous variables to account for those who had multiple pregnancies in the time period. Analyses were conducted using the GENMOD and MIXED procedures. Unadjusted and adjusted ordinal logistic regressions with repeated measure were employed to examine the association of travel burdens with PNC utilization. For interpretation purposes, both travel distance and TDI were subjected to a log-2 transformation in regression analysis, as the results can be explained for any doubled change in travel distance or TDI. Odds ratios with the corresponding 95% confidence interval were reported. Subgroup analysis was conducted for patients’ rural or urban residence. In approximately 3.5% of the sampled pregnancies, birthing people travelled more than 112 miles, covering almost the entire state, to obtain their PNC. Sensitivity analysis was conducted by excluding those who travelled more than 112 miles. Collinearity was checked with Variance Inflation Factor (VIF) and none of the interested independent variables had a VIF higher than 2. All analyses were performed using SAS software version 9.4 (SAS Institute Inc., Cary, NC) at the significance level of 95%.

Table 1 summarizes the characteristics of those included in the study, both with and without PNC. Out of the total sample size, 4,219 (14.1%) did not receive any PNC visits, and 5.8% were on their second pregnancy. The average age of the participants was 25 years old, with the majority being Black or White. Additionally, 9.0% of the birthing people resided in rural ZCTAs.

Table 1 presents comparisons between birthing people with and without PNC visits. Compared to those without any PNC visits, those with at least one PNC visit were younger (26.9 vs. 25.0 years, p < .001), more likely to be White (34.6% vs. 41.3%, p < .001) or Black minority (39.9% vs. 49.1, p < .001), less likely to be a non-Black racial minority (15.7% vs. 4.8%, p < .001) or of unknown race (9.8% vs. 4.9%, p < .001), more likely to reside in a rural area (6.9% vs. 9.0%, p < .001), and less likely to have no pregnancy-related complications (52.4% vs. 30.0%, p < .001) or no other complications (76.6% vs. 56.0%, p < .001). There was a significant but slight difference in TDI scores, -11.4 and − 11.9 (standard deviation, 8.5 and 8.4, respectively, p = .04), between those with and without any PNC, respectively.

Regarding provider population density, birthing people who received any PNC showed no significant difference in the densities of registered PNC providers (8.9 vs. 9.6, p = .14) but significantly lower densities of identified predominant PNC providers (7.6 vs. 8.3, p < .01), compared to those without any PNC visit. Only 8.3% of birthing people without any PNC visit had an unknown ACCI (Table 1 ).

Among pregnancies where birthing people had any PNC, 60.4% initiated PNC in the first trimester. The average number of PNC visits was 8.1 and birthing people received fewer than 9 PNC visits for 52% of included pregnancies (Table 1 ).

Table 2 summaries the characteristics of both initial and predominant providers. Pregnant people travelled a longer distance to initial providers than to predominant providers (24.9 vs. 24.2 miles, p < .001). A change in specialty occurred from the initial PNC provider to the predominant PNC provider; birthing people were more likely to initiate PNC with primary care physicians (9.4% vs. 4.5%, p < .001), organizations (2.7% vs. 0.9%, p < .001) and providers with other specialties (0.8% vs. 0.3%, p < .001) and then shift to an obstetric-gynecologist (81.6% vs. 87.9%, p < .001) or a midwife (3.5% vs. 4.3%, p < .001) for most of their PNC.

Table 3 presents all odds ratios (ORs) and 95% confidence intervals from ordinal logistic regressions using repeated measures. A doubled travel distance was associated with delayed initiation and lower frequency in both the unadjusted (OR: 0.98, 95% CI: 0.96-1.00, p = .04; OR: 0.97, 95% CI: 0.95–0.99, p = .009; initiation and frequency, respectively) and adjusted models (OR: 0.95, 95% CI: 0.93–0.97, p < .001; OR: 0.95, 95% CI: 0.93–0.97, p < .001; initiation and frequency, respectively). A higher perceived travel burden, defined as a doubled TDI, was associated with delayed PNC initiation in both unadjusted (OR: 0.94, 95% CI: 0.89–0.99, p = .02) and adjusted (OR: 0.94, 95% CI: 0.88-1.00, p = .04) models. A higher perceived travel burden was not significantly associated with PNC frequency in both models.

Table 4 summarizes the results of subgroup analysis by rurality. For rural populations, a doubled travel distance was associated only with delayed initiation (OR 0.86, 95% CI: 0.79–0.93, p < .001), and TDI was not associated with either outcome. On the contrary, for urban populations travel distance did not differ from the entire study population, yet TDI was associated with both outcomes (OR: 0.91, 95% CI: 0.83–0.90, p = .04; OR: 0.90, 95% CI: 0.82–0.98, p = .02; initiation and frequency, respectively).

Travel pattern was plotted (figure not provided) and it was identified that some birthing people travelled almost across the whole state, covering more than 112 miles. Due to the limited detection of telehealth, a sensitivity analysis was conducted by excluding those who travelled more than 112 miles. The sample size for PNC initiation was reduced from 25,801 to 24,889 (excluding 912 with more than 112 miles to the initial provider) and for PNC frequency, it was reduced from 25,801 to 24,996 (excluding 805 with more than 112 miles to the predominant provider). The results were consistent with the prior model results, except for slight changes in coefficients.

This study found that the negative effect sizes of travel burdens on PNC utilization were statistically significant but practically small after the provider-selection process, among South Carolina Medicaid enrolled birthing people. The probabilities for earlier PNC initiation and frequency would decrease slightly if travel distance doubled, and the probabilities for earlier PNC initiation would decrease slightly if TDI doubled.

This study is one in a series focusing on the association between travel burden and PNC utilization. The travel burden played a more significant role in provider-selection than in receiving care. A previous study found that travel distances to all available predominant PNC providers played a significant role in provider selection. Birthing people were 14 times more likely to choose a nearer provider (within 26 miles) than those located 26–81 miles away, and 14 ~ 16 times more likely to avoid providers located further away (beyond 81 miles) [ 18 ]. Given the selected PNC provider, however, this study found a small effect size on the association between travel distance and receiving PNC services. A birthing individual in this study would only be 5% less likely to initiate PNC in an earlier trimester if the travel distance to the first visited PNC provider was doubled, compared to another birthing individual when other covariates were controlled for. Similarly, a birthing individual would be only 5% less likely to have a higher level of PNC frequency if the travel distance to the predominant PNC provider doubled, compared to another birthing individual when other covariates were controlled for. This finding indicates that resources allocated to address travel burden during receiving care would not be efficient without considering provider-selection.

To address these issues of travel burden on PNC utilization, providers and policymakers should consider evidence during both provider-selection and receiving care. The results of this study suggest that for birthing people with varying travel burdens, if they visited the same provider, there would be only a minor difference in receiving PNC. The substantial differences in the effect sizes of travel burden highlight the importance of travel distance in the provider-selection process. Therefore, policy implications should consider the provider-selection process as a major factor in PNC. Building a referral network can be one solution; peer referral networks, in particular, could play a significant role in provider-selection, [ 14 , 32 ] as evidenced by a previous study that found the number of connections with other peers was a significant predictor of being selected by patients [ 18 ].

Another implication is the impact of recent closure of obstetric units [ 33 , 34 , 35 ] on the provider-selection process. Those closures have already added to, and will continue to add, more travel burden to affected birthing people. This study provides evidence that future studies should investigate how that closure impact birthing people’s provider-selection process rather than directly examining PNC utilizations.

To authors’ knowledge, this is the first study examining the association between travel burden to the visited providers and subsequent PNC utilization. Unlike prior studies that used travel distance to the nearest available provider to examine the impact on PNC utilization, this study applied travel distance to both the initially visited and predominant PNC providers. The rationale behind this choice is that using the travel distance to the nearest available but not necessarily visited provider would overstate the access disparity between different groups with different access to PNC [ 15 ]. Consequently, the results of this study cannot be directly compared to those of previous studies.

The inclusion of the concept of perceived travel burden represents an innovative aspect of this study, as its comprehensive exploration has been relatively lacking in prior literature. Prior research has primarily focused on objective transportation metrics and their impacts on healthcare services, such as travel distance or time to healthcare facilities, and the frequency of public transit service. However, these objective transportation metrics may not accurately capture individuals’ realized ability to travel, and their perception of travel difficulties based on their socioeconomic status. For instance, a person with a lower income may perceive transportation costs differently compared to those with higher incomes. Apart from the direct impacts of perceived travel burden on healthcare facilities, indirect effects are also important through nutrition intake and physical exercise. Nutrition education, micro-nutrient supplementation and access to fresh food are promising factors that could prevent adverse birth outcomes and enhance fetal health [ 36 ]. Furthermore, physical activity has been identified as a protective factor for adverse maternal and birth outcomes [ 37 , 38 ]. However, many communities are not safe for residents to travel without a vehicle [ 39 , 40 ]. Therefore, limited access to nutrient and fresh food and safety concerns for physical exercise may increase the prevalence of pregnant comorbidities, leading to increased PNC needs.

Thus, in this study, we have adopted a perceived travel difficulty index and investigate its effects on PNC utilization. This travel difficulty index includes measures of travel difficulty for both private and public transportation travel. For each travel mode, it integrated aspects of opportunity accessibility, safety concerns, cost, and abilities, through both the direct and indirect pathways, to assess travelers’ objective feelings of travel difficulties based on their social-demographic status. This is the first study investigating the association between perceived travel burden and PNC utilization.

Our results indicate a significant disparity in the perception of travel difficulty between patients who received PNC visits and those who did not. Specifically, patients who did not attend PNC visits reported encountering significantly greater travel difficulties compared to those who did. Our results also reveal that after accounting for chronic comorbidities and pregnancy-related complications, the travel disadvantage index exhibited a connection with slightly delayed PNC initiation. However, no observed correlation was found between the travel disadvantage index and the frequency of PNC visits, taking into consideration the healthcare provider that was visited. This finding aligns with the conceptual process during pregnancy, where birthing people who perceive a high travel burden may delay initiating PNC but ultimately overcome it due to the recognized benefits for both maternal and neonatal health.

The different nature of objective travel distance and subjective TDI was also evident in our subgroup analysis. For rural subjects, only objective travel distance was associated with late initiation of PNC; for the urban subjects, while both measures were barriers for PNC utilization, TDI presented a larger effect size than travel distance.

The study is subject to several limitations. First, it is important to note that the calculation of perceived travel burden is based on findings from an initial pilot survey characterized by a limited sample size. To enhance the robustness of our analysis and findings, it is worth noting that the research team is currently conducting a follow-up survey with a significantly larger sample size. The expected increase in sample size is anticipated to contribute to more robust analyses and conclusive outcomes. Ideally, the implementation of regular surveys over a specific period would be optimal, as this would continually update our understanding of the perceived travel burden among the local populace. Finally, an overall travel burden metric that integrates both objective and subjective measures would be valuable to explore.

Using data before 2014, a previous study reported that approximately 60% of American birthing people experienced a change in insurance status, transitioning from one insurance to another and potentially being uninsured for at least one month during pregnancy [ 41 ]. The total number of PNC visits is crucial for determining both PNC initiation and PNC frequency. Without complete visit information, the estimated PNC initiation and frequency could be biased. To avoid this bias, this study only included pregnancies with continuous Medicaid enrollment. However, by doing so, the study sample does not fully represent all South Carolina Medicaid beneficiaries, nor does it reflect others without Medicaid. The likelihood of timely PNC initiation in the first trimester for this study was 60.4%, which was lower than the 72.0% for the South Carolina general public and 68.1% for Americans enrolled in Medicaid in 2016 [ 8 ]. This lower initiation rate could be partly attributed to the representativeness of the sample. While the generalizability was limited by the sample characteristics, additional research should be conducted using claims from different payers and for other geographic locations.

Telehealth may introduce bias to these estimates. Some birthing people sought PNC at a greater distance from their residential ZCTAs yet had a delivery site that was in or nearer to the residential ZCTAs. These PNC encounters may have been due to travel or the use of telehealth. In 2011, the absolute rates of telehealth utilization were between 0.09% among Medicaid beneficiaries [ 42 ]. South Carolina initiated a demonstration project for obstetric-gynecologic telehealth in July 2014 [ 43 ]. However, this study confirmed only one tele-PNC visit for one live birth using the HCPCS modifiers (“GT”), and thus, it was unable to confirm or deny if these were telehealth visits. The impact of telehealth on these estimates remains unknown. To mitigate this impact, the sensitivity analysis excluded those who traveled more than 112 miles, and the main results remained consistent.

This study assigned an estimated radius to approximately 16% of pregnancies with any PNC, representing the travel distance where the residential ZCTA of birthing individuals matched that of PNC providers’ ZCTA. Computing this radius relied on two assumptions. Firstly, it assumed that the ZCTA is nearly round. Second, it presumed that the provider is positioned at the center of this round, with all patients situated on its edge. Consequently, this approach led to an underestimated variation in travel distances for this population, and thus, the results of travel distances were underestimated. Future studies that utilize actual addresses of patients and providers can circumvent this limitation.

In studies that examine travel burdens on healthcare utilization, selection bias is a concern. Patients who travel a long distance to visit their providers may not be sensitive to travel burdens. Our measure of TDI showed that perceived travel burden was almost the same for patients who travelled more than 24 miles or 24 miles or less. (data not shown) That result suggests the possible selection bias was not evident in the current study. Furthermore, the results of the sensitivity analysis showed that the main results remained consistent, after excluding those who travelled more than 112 miles.

In conclusion, this study found that the travel burden, measured by travel distance to visited providers and the perceived travel difficulty index, was statistically associated with PNC utilization in South Carolina birthing people with full enrollment during their pregnancy. However, the effect sizes were practically small for receiving care after provider-selection. Further studies are necessary to validate this conclusion, and priority should be given to exploring the association between travel burden and the provider-selection process. Policymakers should concentrate on the role of travel burden in the provider-selection process, such as providers’ referral network, to address the issue of PNC access rather than addressing it after provider-selection.

Data availability

The South Carolina Medicaid data that support the findings of this study are available from South Carolina Revenue and Fiscal Affairs Office, but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. The primary survey data for constructing travel disadvantage index is owned by Yuche Chen. It is available upon request to the corresponding author. Software programs are available upon request to the corresponding author through email: [email protected].

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Acknowledgements

We would like to acknowledge support from the South Carolina Revenue and Fiscal Affairs Office by approving and providing us the free access to South Carolina Medicaid Claims data. That support made this study possible. We also appreciate a person for collecting 2010 Census South Carolina ZCTA area.

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Deng, S., Chen, Y. & Bennett, K.J. The association of travel burden with prenatal care utilization, what happens after provider-selection. BMC Health Serv Res 24 , 781 (2024). https://doi.org/10.1186/s12913-024-11249-9

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As nursing professionals, understanding and addressing these changes is essential in providing comprehensive care during pregnancy. The first prenatal visit holds immense significance as it sets the foundation for a successful pregnancy journey, ensuring optimal maternal and fetal well-being through early detection, education, and tailored care ...
Prenatal care: Initial assessment
The three main components of prenatal care are: risk assessment, health promotion and education, and therapeutic intervention [ 1 ]. High-quality prenatal care can prevent or lead to timely recognition and treatment of maternal and fetal complications. Complications of pregnancy and childbirth are the leading cause of morbidity and mortality in ...
Prenatal care: 1st trimester visits
Prenatal care: 1st trimester visits. Pregnancy and prenatal care go hand in hand. During the first trimester, prenatal care includes blood tests, a physical exam, conversations about lifestyle and more. By Mayo Clinic Staff. Prenatal care is an important part of a healthy pregnancy. Whether you choose a family physician, obstetrician, midwife ...
What To Expect at Your First Prenatal Visit
Your first pregnancy visit will probably include questions about family history, a pelvic exam, blood tests and a calculation of your due date ... We talked with certified nurse midwife Kellann ...
First Prenatal Visit: What to Expect at First Pregnancy Appointment
The most common tests at your first prenatal visit will likely include: [3] Urine test. Your urine may be checked for protein, glucose (sugar), white blood cells, blood and bacteria. Bloodwork. A sample of your blood will be used to determine blood type and Rh status and check for anemia. Trusted Source Mayo Clinic Rh factor blood test See All ...
What Happens at Your First Prenatal Appointment
Be prepared to get a lot of information during that first visit. It is meant to orient you and your family with your pregnancy and your care team. "Typically, we start with an intake to get to know you and review your past medical, surgical and obstetrical history," Power said. During your first appointment you'll also receive a physical ...
What to Expect at Your First Prenatal Visit
The first prenatal visit probably will be the longest of your pregnancy. It will include a complete physical exam, including pelvic and breast exams. Your blood pressure and weight will be recorded at this and future visits. A urine sample will be taken so that your provider can check for signs of infection and dehydration and levels of protein ...
Your first prenatal visit: what to expect & questions to ask
Here are some tips to prepare for your initial prenatal visit: Know the date of the first day of your last menstrual period. If you know the date your baby was conceived, bring that information, too. Jot down notes about your physical and mental health history, as well as that of your family. Bring a list of your medications, immunization ...
Prenatal Care in Your First Trimester
Your first prenatal visit. This first visit will probably be the longest, because there's a lot to cover! To make sure you and your baby are off to a healthy start, we'll: Give you a physical exam, including a breast exam, pelvic exam, and a Pap test, if you're due for one. Perform an ultrasound, often vaginal, to see how far along you ...
What happens during prenatal visits?
Your first prenatal visit will probably be scheduled sometime after your eighth week of pregnancy. Most health care providers won't schedule a visit any earlier unless you have a medical condition, have had problems with a pregnancy in the past, or have symptoms such as spotting or bleeding, stomach pain, or severe nausea and vomiting. 1 You've probably heard pregnancy discussed in terms of ...
1st Trimester: 1st Prenatal Visit
1st Trimester: 1st Prenatal Visit. It's the first doctor visit of your pregnancy. Congratulations! During this visit, your doctor will check your overall health and determine your due date. They ...
What to expect before, during and after your first prenatal appointment
The nurse will work with the patient to schedule their first in-person appointment. We typically schedule the first in-person prenatal appointment approximately 10 weeks after the first day of a patient's last period. To schedule your first prenatal appointment, or request an initial phone call, call the location you'd like to visit.
How to prepare for your first prenatal visit:
2. Write down your questions. It's hard to remember everything. So, it's a good idea to write down your questions and bring them with you to your first appointment. Check out our suggested list of questions here. 3. Take a prenatal vitamin. There are many good options for over-the-counter prenatal vitamins.
What to expect at your first prenatal appointment
The first ultrasound. Many people look forward to their first ultrasound, which usually happens at the initial prenatal visit. This ultrasound gives you the opportunity to hear your baby's heartbeat. It'll be fast — about 100 to 160 beats per minute! An ultrasound gives your clinician a better idea about your due date.
Prenatal care in your first trimester
Your First Prenatal Visit. You should schedule your first prenatal visit soon after you learn that you are pregnant. Your doctor or midwife will: Draw your blood. Perform a full pelvic exam. Do a Pap smear and cultures to look for infections or problems. Your doctor or midwife will listen for your baby's heartbeat, but may not be able to hear it.
Prenatal care in your first trimester
Your First Prenatal Visit. You should schedule your first prenatal visit soon after you learn that you are pregnant. Your doctor or midwife will: Draw your blood. Perform a full pelvic exam. Do a Pap smear and cultures to look for infections or problems. Your doctor or midwife will listen for your baby's heartbeat, but may not be able to hear it.
The First Trimester
The first prenatal visit is also an opportunity to ask any questions or discuss any concerns that you may have about your pregnancy. The First Trimester: What to Expect. A healthy first trimester is crucial to the normal development of the fetus. You may not be showing much on the outside yet, but on the inside, all of the major body organs and ...
What Happens at a Prenatal Care Check-Up Appointment?
During prenatal care visits, your doctor, nurse, or midwife may: update your medical history. check your urine. check your weight and blood pressure. check for swelling. feel your belly to check the position of your fetus. measure the growth of your belly. listen to the fetal heartbeat. give you any genetic testing you decide to do.
FAQ About Your First Prenatal Visit
The first prenatal check-up is usually scheduled around week eight of pregnancy, or, at least, ideally before week 10. It's a good idea to schedule your first prenatal appointment once you get a positive pregnancy test. The first prenatal visit is significant because getting prenatal care on time is a vital step in a healthy pregnancy.
Pregnancy: First Prenatal Visit
Overview. Your first prenatal visit will probably be the longest visit you'll have. Your doctor or midwife will take your medical history and do a complete physical exam. You may also have some tests. This will provide information that can be used to check for any problems as your pregnancy progresses.
Prenatal Care: An Evidence-Based Approach
Screening is recommended at the first prenatal visit and once per trimester. 13 Intimate partner violence increases the risk of miscarriage, placental abruption, premature rupture of membranes ...
Pregnancy appointment timeline: How often to see your OB
After your first appointment, your prenatal visits will start to fall into a pattern. At every visit, your care team will ask about how you're feeling and check a few key things: the growth of your baby and uterus, your weight and your blood pressure. And starting around 10-12 weeks into your pregnancy, you'll get to hear your little one ...
Your first antenatal visit
Antenatal visits check the wellbeing of you and your baby during pregnancy. During your first visit, your doctor or midwife will check your health. ... Speak to a maternal child health nurse. Call Pregnancy, Birth and Baby to speak to a maternal child health nurse on 1800 882 436 or video call. Available 7am to midnight (AET), 7 days a week.
How to stay sane before first prenatal visit
Hi All - first time future mom here. I've tested positive (multiple tests) and am at about 4 weeks and 2 days. I experienced extreme nausea yesterday and have had sensitive breasts, but my symptoms disappeared overnight.My first appointment is not until the 8 week mark. Should I be concerned at this...
Trigger Warning, Emergency room visit??
31 years old, first pregnancy, 6 weeks 4 days. All day today, I have been so nauseated. no vomiting, just nauseous. A few hours ago, I started having severe lower abdominal pains, which I recognized as trapped gas pains. I can feel/hear the gas moving, and I am passing gas. The pain is excruciating....
'Summer House' star Lindsay Hubbard pregnant, expecting first baby with
In March, Hubbard confirmed that she was "dating" and "having fun." David Becker/Bravo. She further explained, "We met and we hit it off, went on some dates.
Woman With No Baby Bump Shares Pregnancy Photos
Salazar's doctor told her not to worry — pregnancy is different for everyone and taller women (Salazar is 5'9) may appear less pregnant than their shorter counterparts.
Gypsy Rose Blanchard Is Pregnant: What She's Said So Far
Gypsy Rose Blanchard is pregnant, expecting first child with boyfriend Ken Urker. Here's everything she has shared about the child, her pregnancy, if it's a boy or girl and more.
Undergraduate Programs
The Traditional BSN Track is designed for University of Houston students who want to apply to the nursing major beginning their junior year to become a registered nurse (RN). The freshman and sophomore years will be at the University of Houston. After gaining admission in the nursing program, the ...
The association of travel burden with prenatal care utilization, what
Prenatal care (PNC) can prevent or reduce the incidence of adverse birth outcomes by providing pregnancy-related information on nutrition, fetal development, and delivery [1,2,3].Adequate PNC is associated with up to a 75% reduction in maternal mortality rates [4, 5], while inadequate PNC is associated with elevated perinatal mortality rates [].For high-risk pregnancies, it is recommended that ...