It is important to have checkups during pregnancy. This regular care can help keep you and your baby healthy, spot problems if they occur, and prevent problems during delivery. Typically, routine checkups occur:
- Once each month for weeks 4 -28
- Twice a month for weeks 28 – 36
- Weekly for weeks 36 to birth
Women with a high-risk pregnancy need to see their doctors more often.
You should schedule your first prenatal visit as soon as you find you are pregnant. During this first visit, your doctor will perform a full physical exam, take your blood for lab tests, and calculate your due date. Your doctor might also do breast exam, a pelvic exam and check your uterus, and do a Pap test. During this first visit, your doctor will ask you lot of questions about your lifestyle, relationship, and health habits. It is important to be honest with your doctor. You will also have the opportunity to ask questions as well. Take this time with your doctor to educate yourself about your pregnancy.
During the first prenatal visit, your doctor will also test your blood to check for:
- Your blood type and Rh factor
- Infections, such as toxoplasmosis and sexually transmitted diseases (STDs)
- Signs that you are immune to rubella (German measles) and chicken pox
Throughout your pregnancy, your doctor or midwife may suggest other tests and screening to check on the health of you and your baby. Some of these tests like, screening for gestational diabetes and HIV are recommended for all women. Other tests might be offered based on your age, personal or family health history, ethnic background or results of other routine tests. Always talk with your doctor or midwife to decide which test(s) you will need.
First Trimester Prenatal Tests
Several prenatal tests may happen in the first trimester.
Cell-free fetal DNA testing (also known as noninvasive prenatal screening or testing). This tests your blood for your baby’s DNA to see if they may have certain genetic conditions, like Down syndrome. This test is done after 10 weeks of pregnancy. Your doctor or midwife may recommend the test is an ultrasound shows that your baby may have a birth defect of if you have already had a baby with a birth defect. It is not recommended for women who are not likely to have a baby with a birth defect or who are pregnant with more than one baby. It is called noninvasive because it is done with a blood test. If you have the test done, your doctor or midwife may recommend that you have an invasive test, like amniocentesis, to confirm the results.
Chorionic villus sampling (CVS). This test checks tissue from the placenta to see if a baby has a genetic condition, like Down syndrome. CVS is done at 10-13 weeks of pregnancy. Your doctor or midwife may want you to have CVS is you are older than 35, if genetic conditions runs in your family, or if the first-trimester screening shows that your baby is at increased risk for birth defects.
Cystic fibrosis carrier screening. This will test to see if you have the gene that causes cystic fibrosis (CF). CF is a disease that affects breathing and digestion. If you and your partner have the gene, you can pass CF to your baby. You and your partner can have this test any time before or during your pregnancy.
Early ultrasound (first-trimester ultrasound). This ultrasound makes sure that you are pregnant. It also helps your doctor or midwife figure out our due date. An ultrasound uses sound waves and a computer screen to show a picture of your baby inside the womb.
First-trimester screening. This tests usually done at 11-14 week of pregnancy and is used to see if your baby may be at risk for some birth defects, like Down syndrome and heart defects. The first-trimester screening can also tell if you are pregnant with more than one baby. This test involves both a blood test and an ultrasound exam called nuchal translucency screening. The blood test measures the levels of certain substances in the mother’s blood. The ultrasound exam measure the thickness at the back of the baby’ neck. This information combined with the mother’s age, will help your doctor or midwife decide if your baby is at risk of birth defects.
Second Trimester Prenatal Tests
As you move further along in your pregnancy, your doctor or midwife will talk to you about these prenatal tests:
Amniocentesis (amnio). Tests the amniotic fluid (“water”) from around your baby to see if they have any genetic conditions. Amniocentesis is usually done at 15-20 weeks of pregnancy and is offered to you if you received an abnormal result on a first trimester screening test or if you are a higher risk of having a baby with a genetic birth defect.
If you and your doctor have decided that you need an amnio test what can you expect? This test can be done at a clinic or hospital. First, your doctor uses ultrasound to find a pocket of amniotic fluid that is safely away from the baby and the placenta. Next, the doctor uses a thin, long needle to draw out a small amount of amniotic fluid and cells from the sac surrounding the baby. The sample is sent to a lab for testing.
Problems after amniocentesis are rare, but may occur. It is up to you to decide if you want to have this test done. According to the Centers for Disease Control and Prevention (CDC), the rate of miscarriage due to amnio is 1 in 200 to 400 (or .25 to .5 of one percent). The risk of miscarriage goes down if the test is done later in pregnancy. There is also a very low risk of infection in the uterus after the test (about 1 in 1,000). Rarely, the needle may touch the baby during the test, but it is usually harmless. Your doctor will use an ultrasound during the test to avoid the baby.
|Avoid Keepsake Ultrasounds You might think a keepsake ultrasound is a must-have for you scrapbook. But, doctors advise against ultrasound when there is no medical need to do so. Some companies sell “keepsake” ultrasound videos and images. Although ultrasound is considered safe for medical purposes, exposure to ultrasound energy for a keepsake video or image may put you and your unborn baby at risk. Do not take that chance.|
Ultrasound. An ultrasound can be performed at any point during your pregnancy, but are not considered a routine test. Most women will have a standard ultrasound exam between 18-20 weeks to look for signs or problems with the baby’s organs and body systems and confirm the age of the baby and proper growth. You might also be able to tell the sex of your baby.
Ultrasounds use sound waves to create a “picture” of your baby. With a standard ultrasound, a gel is spread on your stomach. A special tool is moved over your belly, which allows your doctor and you to view your baby on a monitor.
Glucose screening. This screening is one that all pregnant women who are 26-28 weeks pregnant should get. It determines your risk of gestational diabetes. Your doctor or midwife will have your drink a sugary drink. A blood sample is taken one hour later to look for high blood sugar levels. If you your levels are high, your doctor will give you a glucose tolerance test to detect gestational diabetes. In this test, your doctor will tell you what to eat a few days before the test. Then, you cannot eat or drink anything but sips of water for 14 hours before the test. Your blood is drawn to test you “fasting blood glucose level.” Then, you will drink a sugary drink. Your blood will be tested every hour for three hours to see how well your body processes sugar.
Kick count. Healthy babies are usually active. Unborn babies sleep for short period of time, but most of the time they will kick, roll, twist, and turn. Counting your baby’s movements is a way to tell how your baby is doing. A healthy baby usually moves at least 10 times in 2 hours.
Doctors and midwives usually recommend that you begin counting your baby’s movements around 28 weeks of pregnancy. This will help you to notice if your baby is moving less than normal, which could be a sign that your baby is in distress and needs a doctor’s care. An easy way to do this is the “count-to-10” approach. Count your baby’s movements in the evening – the time of day they are most active. Lie down if you have trouble feeling your baby move. Most women count 10 movements within about 20 minutes. But it is rare for a woman to count less than 10 movements within two hours at times when your baby is active. Count your baby’s movements everyday so you know what is normal for you. Call you doctor or midwife if you count less than 10 movements within two hours or if you notice your baby is moving less than normal. If you baby is not moving at all, call your doctor or midwife right away.
Download our “Baby Activity Record” to start counting your baby’s movements.
Third Trimester Prenatal Tests
In your last trimester, your doctor or midwife will test for group B strep (GBS). GBS is an infection you can pass to your baby during birth that cause pneumonia or a serious infection. The test checks cells from your vaginal and rectum to be tested.
Be an active participant in your prenatal care. If your doctor or midwife suggests certain prenatal tests, do not be afraid to ask many questions. Learn about the test, why your doctor is suggesting it for you, and what the test results could mean can help you cope with any worries or fears you might have. Keep in mind that screening tests do not diagnose problems. They evaluate risk. So if a screening test comes baby abnormal, this does not mean there is a problem with your baby. More information is needed. Your doctor can explain what test results mean and possible next steps.