What to know about your first prenatal appointment

When should I schedule my first prenatal visit?

Right after you receive a positive home pregnancy test, book an appointment with your obstetrician, family physician, or midwife. Depending on your practice, advanced practice providers, such as nurse practitioners and physician assistants may also handle your first prenatal visit.

If you haven't yet chosen a healthcare provider to care for you during your pregnancy, it's still important to see someone now to start your prenatal care. You can always switch to another provider later.

When will my first OB appointment be?

Many healthcare providers will schedule your first visit for when you're about 8 weeks pregnant. Some will see you sooner, particularly if you have an existing health condition, had problems with a pregnancy in the past, or are having new or severe symptoms such as vaginal bleeding or abdominal pain.

If you're taking any medications or think you may have been exposed to a hazardous substance, speak with your provider as soon as possible.

What happens at the first prenatal visit?

This will probably be the longest of your prenatal appointments unless you encounter problems with your pregnancy along the way. At this and all future visits, don't be afraid to raise any issues you've been wondering about. If questions come up between checkups, it may help to keep a running list.

Here is what your provider will likely do during the first prenatal visit.

Take your health history. Your provider will ask several questions about your gynecological health, personal medical history, and lifestyle habits. Topics commonly covered include:

• Whether your menstrual cycles are regular and how long they tend to last
• The first day of your last period (to determine your due date)
• Symptoms or problems you've noticed since your last period, whether they’re related to pregnancy or not
• Current or past gynecological conditions, including sexually transmitted infections
• Details about previous pregnancies
• Current or past diseases and conditions
• Past surgeries or hospitalizations
• Mental health difficulties and diagnoses
• Whether you are being or have been abused, or have another situation that could affect your safety or emotional well-being
• Smoking, drinking, and drug use
• Medications, supplements, vitamins, and herbal drugs you take
• Drug allergies

Your healthcare provider will also ask about your family medical history. Many genetic issues and birth defects are at least partly hereditary, so learning about your family history helps your medical team keep an eye out for potential issues. Let your provider know whether a relative in either family has a chromosomal or genetic disorder, had developmental delays, or was born with a structural birth defect. Also important to mention: potential exposure to toxins, especially if you live or work near toxic materials.

Check you out and run some tests. You can expect a number of standard exams and tests at your first prenatal visit. Some healthcare providers will do an ultrasound. But if you don't have any medical problems or concerns, it may not be part of the routine. Here's what's typical:

• A thorough physical exam
• A pelvic exam, including a Pap smear (unless you've had one recently) to check for infections such as chlamydia and gonorrhea or abnormal cells that could indicate cervical cancer
• A urine sample to test for urinary tract infections and other conditions

Your provider will also order blood tests to:

• Identify your blood type and Rh status
• Look for anemia
• Check for HIV, syphilis, hepatitis B and, in certain cases, hepatitis C
• Determine immunity to rubella (German measles) and chickenpox

Discuss any high-risk pregnancy concerns: Many people are considered to have high-risk pregnancies. That means there is a higher-than-average chance of health issues during pregnancy, in labor, and at birth. High-risk groups include those who:

• Become pregnant for the first time at age 35 or older
• Become pregnant for the first time before age 18
• Are having multiple babies
• Have certain medical issues that develop during pregnancy, such as preeclampsia and gestational diabetes
• Have certain pre-existing health problems, such as high blood pressure, thyroid disease, or type 1 or type 2 diabetes

While many potential troubles are treatable or temporary, some can be dangerous to both parent and baby. As a result, high-risk pregnancies need extra care. Your provider can talk to you about the risks at your first visit and throughout your journey.

Explain your options for prenatal genetic testing. Your provider will offer you various screening tests that can give you information about your baby's risk for birth defects and chromosomal conditions like Down syndrome.

You'll also be offered noninvasive prenatal testing (NIPT), also called cell-free fetal DNA testing. Performed at 9 weeks of pregnancy or later, it's used to examine the little bits of your baby's DNA present in your blood.

Another test that will be offered is a first trimester screen, also called a first-trimester combined test. Typically done between weeks 11 and 13, it consists of a blood test and a type of ultrasound called a nuchal translucency.

Finally, if you're high-risk, there is the option of invasive genetic diagnostic tests that can tell you for sure whether your baby has Down syndrome or certain other problems. These tests include chorionic villus sampling (CVS), generally performed at 10 to 13 weeks, and amniocentesis, usually done at 16 to 20 weeks.

CVS and amniocentesis are invasive and may carry a small risk of miscarriage, so women who choose to have these procedures are usually those with a higher risk for genetic and chromosomal problems. Some moms-to-be choose to wait for the results of screening tests before deciding whether to have one of these diagnostic tests.

You may also be given the option of a carrier screening if you haven't had one already. It's a simple blood or saliva test done to see whether your baby is at risk for any of 100 genetic disorders such as cystic fibrosis, sickle cell disease, thalassemia, and Tay-Sachs disease.

For more information, your provider can refer you to a genetic counselor.

Counsel you and let you know what's ahead. Your provider should advise you about eating well, foods to avoid, weight gain, and prenatal vitamins. You'll also hear about the common discomforts of early pregnancy and be warned about symptoms that require immediate attention.

Your emotional health is very important. Your provider may screen you for signs of depression during pregnancy. But don't wait to be asked. If you're feeling depressed or anxious, let your provider know so you can be referred to someone who can help.

The dangers of smoking, drinking alcohol, using drugs, and taking certain medications will be a topic of discussion, as well. If you need help quitting smoking or any other substance, your provider can recommend a program or counselor.

Other topics include the do's and don'ts of exercise, travel, and sex during pregnancy; environmental and occupational hazards that can affect your baby; and how to avoid certain infections, such as toxoplasmosis. Your doctor will also discuss recommended vaccinations, like the flu shot and the COVID-19 vaccine.

Is there anything I can do to prepare for my first pregnancy appointment?

To help ensure your visit goes as smoothly as possible, try taking the following steps.

Review your medical history. Brush up on your health status so you can better answer questions. This includes information about your:

• Overall physical and mental health
• Current and past diseases, conditions and other health issues
• Current medications, including prescriptions, supplements, vitamins and herbal supplements and teas
• Fertility and pregnancy history
• Family medical history
• Partner's medical history

If possible, bring documentation along, such as immunization records or a list of your medications. You may even want to tote a baggie containing the medications themselves.

Take your partner, a family member or friend. Another person can write down notes, ask questions, and provide emotional support during this information-dense first visit.

Get there on time or a little early. This can be helpful for filling out forms and reviewing your insurance status. Make sure to bring your insurance information and cash or a credit card for any necessary co-pays. And of course, follow all office COVID-19 policies regarding your arrival, check-in, and clinic visit.

What questions should I ask at the first prenatal visit?

Just as your provider will ask you questions at your first prenatal visit, it's a good idea to come prepared with a list of questions for your provider. Ask anything—don't be shy. Again, try to keep a running list in the weeks before the appointment, so nothing important slips your mind.

Here are some questions to consider if your provider doesn't bring up the topic first.

• How much weight gain is healthy for me? The first prenatal visit is a great opportunity to learn about how your body will change. It's also a good time to ask about nutrition, including which foods to prioritize in your diet.
• What are the foods I should avoid? Raw fish and unpasteurized cheeses are long-established no-no's for pregnant people, but ask your provider for a full list of what to skip, since the accepted wisdom has changed over the years. Inquire about caffeine and alcohol as well. Coffee is typically alright in limited doses, but no amount of alcohol is considered safe when you're having a baby.
• Are prenatal supplements a good choice for me? Your provider will likely recommend a prenatal vitamin containing folic acid and iron, both of which are needed more during pregnancy.
• Can I exercise? What about sex? With some exceptions, both are usually okay when you're pregnant. They are important to discuss, however, since certain conditions may complicate matters.
• Should I continue to work? If you have a physically or emotionally demanding job, you may want to ask how you can ease the effects on your body and mind.
• Is travel okay? While planes, trains and automobiles are typically safe well into pregnancy, people with particular complications may need to limit or avoid traveling.
• Which medications are alright to take? Ask about your current prescriptions, herbal products, teas, supplements, and any over-the-counter drugs you may use, such as pain relievers and cold medicines. Non-steroidal inflammatory drugs (NSAIDs) like ibuprofen and naproxen are not recommended, for example.
• What are common symptoms of pregnancy? Your provider can tell you what to expect and how to cope. Remember to ask what symptoms are uncommon, too—what red flags should you watch for?
• What should I do in an emergency? Find out who to contact and where to go if you begin to experience new, unusual, severe, or long-lasting symptoms.
• Who will treat me over the course of my pregnancy? If you provider is part of a group practice, you may see other members of the group during appointments. They may even deliver your baby.
• Do you recommend taking prenatal classes? Whether they're in a hospital, at a university, online, or somewhere else, prenatal classes can be invaluable learning experiences for parents-to-be. Though Lamaze childbirth classes are probably the best-known, you can find courses in everything from stress management to good nutrition and even breastfeeding.

Last but not least, ask about your next visit and schedule the appointment before leaving the office. Until your 28^th week of pregnancy, you will likely see someone every four weeks or so. You may also want to ask whether future visits will be in-person or virtual. Certain practices offer virtual visits for low-risk patients, those who's doctors aren't close in proximity, or even higher-risk patients that need to be evaluated more often.