The moment you pee on that stick and get a positive pregnancy test result, your whole world changes. You’re probably feeling excited, anxious and even a little bewildered by what to do next. What sorts of tests do you need? What vitamins do you have to take? When will you get to hear your baby’s heartbeat or see that first ultrasound? Well, slow down. The first step is to book time to see a medical professional. Here are some of your options and what to expect at your first prenatal appointment.
Who you see for your prenatal check-ups depends on what type of care you want, where you want to give birth and if you have any health complications to consider. You could call your family doctor first, but you may want to book directly with a midwife or an OB/GYN because they’re often in high demand. (If you plan to see an OB/GYN, you may need to visit your family doctor first for a referral anyway.) Generally, most healthcare practitioners recommend that you book your first prenatal appointment at around eight to 10 weeks.
Once you’ve established your healthcare provider of choice and secured an appointment, what should you prepare? Bring a list of any supplements and medications you’re taking, including their dosages, recommends Beth Murray-Davis, a registered midwife and an associate professor in the midwifery education program at McMaster University in Hamilton. Find out about your family history if you can. Did your mother or grandmother have any risk factors in pregnancy, such as gestational diabetes and hypertension? Does your partner or his family have a history of any genetic disorders? If you’re pregnant with a donated sperm or egg or both, try to gather the donors’ medical history.
If you have a partner, ask them to join you for that first prenatal appointment. “It’s a lot to take in on one visit,” says Susan Thorne, department chief of obstetrics and gynaecology and medical director of the Maternal Newborn Program at Queensway Carleton Hospital in Ottawa. Make note of your concerns and be prepared to jot down any relevant information at your first appointment or keep a running list of questions on your phone.
At your first prenatal appointment, you’ll book some follow-up tests to confirm your pregnancy and your baby’s gestational age, or due date. Your healthcare provider will ask about your last menstrual cycle to help them determine how far along you are. Generally, if your periods are fairly regular and you’re planning to do the first-trimester screening, you may not get an ultrasound until around 11 to 12 weeks, says Thorne. But if you’re unsure or your periods are irregular, you’ll likely get a scan sooner.
Depending on when you have your first ultrasound, you may be able to hear your baby’s heartbeat at your first scan, when you’re at least six to seven weeks. More commonly, your healthcare provider should be able to detect the baby’s heartbeat using a Doppler fetal monitor (a handheld ultrasound device) when you’re 12 weeks along, so you’ll get to hear it for the first time then. (Don’t panic if your doctor can’t find it immediately, says Thorne. If your dates are off by a few days and you’re earlier than 12 weeks or if your bladder is too full, your uterus is tilted or you have a high body mass index, the baby’s heartbeat may not be detectable via the Doppler until 14 weeks or later.)
Your midwife or doctor will measure your progress in pregnancy by gathering baseline information, such as your pre-pregnancy weight, current weight, height and blood pressure. A full physical may not happen at your first prenatal visit due to time constraints, but during the first few appointments, you’ll have a head-to-toe physical, where they’ll check your head, neck, thyroid, heart, lungs, skin and breasts and do a Pap test (an internal swab of your cervical cells to look for cancerous cells) if you are due for one. (The latest recommendation is to have a Pap test every three years, unless you’ve had an abnormal Pap or are at high risk—and, yes, docs recommend doing the test during pregnancy.)
Your doctor or midwife will give you a requisition for comprehensive blood work to assess your complete blood count (red blood cells, white blood cells and platelets, which can indicate anemia or infections) and blood type (in case you are Rh negative, which can affect your pregnancy). You will also have routine public health screenings through blood work for rubella, syphilis, hepatitis B and HIV.
Your healthcare provider may order additional blood work based on your lifestyle and health history, such as checking your chickenpox status and thyroid levels. If you’re a vegetarian, they might check your vitamin B12 levels. If you’ve experienced hypertension in the past, your healthcare provider might want to check your kidney function with a creatinine test. Based on your ethnic background and other risk factors, they may also screen for diseases such as sickle cell disease and thalassemia.
If that wasn’t thorough enough, you’ll get to pee in a cup so that the lab can test for sexually transmitted infections (STIs), such as gonorrhea and chlamydia, and look for anything abnormal in your urine, such as white blood cells, glucose and proteins that can indicate a risk of infection, diabetes or pre-eclampsia. If you have other STIs, such as genital herpes, this is important information to share as it may affect how you deliver (if you have an outbreak near your due date, you may need to have a C-section to protect the baby from infection).
Depending on your province or territory, you may be offered an optional first-trimester screening to determine your risk of having a baby with Down syndrome or trisomy 18. This involves a blood test and an ultrasound at around 11 to 14 weeks. Your medical provider will counsel you on the reasons for undergoing this testing. If the initial screening results are positive, if you’ve had a prior pregnancy with a positive first-trimester screening or if you are over 40 when the baby is born, you may want to pursue a newer blood test called non-invasive prenatal testing (NIPT), which can be done as early as nine weeks (and may be covered by your provincial healthcare) and provide more genetic information on your baby’s risk factors. (Some women opt for the NIPT screening, which costs about $700, regardless of whether they are high risk, says Thorne.) When will your next ultrasound be? After the first-trimester screening ultrasound, your next one generally won’t be until 18 to 20 weeks for the anatomy scan.)
Knowing that you will be offered this screening test beforehand can be helpful. “The conversation about screening and genetic risks brings up a lot of things that people might not have thought about before,” says Murray-Davis. “Within couples, in particular, sometimes that may be a discussion they’ve never had.”
Most prenatal healthcare providers will ask some questions about your mental health, both currently and in the past. They’ll want to know about risk factors, such as your history of anxiety, depression, eating disorders, schizophrenia and bipolar disorder. “We want to identify if there is anything in this person’s experience in the past that will affect their care going forward and if any additional supports are needed,” says Murray-Davis. Your healthcare provider will also ask and answer questions about your diet, exercise routine, sexual activity and travel. They’ll talk to you about the importance of taking a prenatal vitamin with folic acid regularly to prevent neural tube defects and counsel you on avoiding certain foods (such as unpasteurized cheeses, deli meats, raw fish and eggs) and drinks (limiting caffeine and avoiding alcohol). If you’re wondering whether you can keep training for that 10K or book a babymoon in a tropical locale, now is the time to ask.
Pack a snack—this isn’t your standard 15-minute doctor’s visit. The first prenatal appointment will be about half an hour with a family doctor or an ob-gyn and around an hour with a midwife (the midwifery model of care generally allows for longer visits).
The standard of care during pregnancy is the same for all healthcare providers. From the beginning of pregnancy until 28 weeks, you’ll have an appointment every four weeks. Starting at 28 weeks, you’ll see your healthcare provider every two weeks and then, at 36 weeks, you’ll check in weekly until your baby is born.
Depending on where you want to give birth and who you’ll be seeing during your pregnancy, you’ll want to discuss a plan for who to call or where to go if you require medical attention. Most doctors and midwives will provide you with contact information if you experience cramping, bleeding or any other signs of concern.
That first appointment can be overwhelming and a little bit intimidating, but once it’s done, you’ll be armed with lots of information to make the best decisions for you and your baby.