Your Guide to Prenatal Visits

Regular prenatal visits help monitor your health and your baby's growth and development throughout pregnancy.

For most uncomplicated pregnancies, appointments are generally scheduled:

• Until 28 weeks: Every 4 weeks
• 28–36 weeks: Every 2 weeks
• After 36 weeks: Every week until delivery

During these appointments, we discuss how you're feeling, check your blood pressure, assess your baby's growth and well-being, and address your questions or concerns.

Your appointment schedule may vary depending on your medical history, pregnancy needs, and any additional monitoring recommended by your healthcare team.

Prenatal Vitamin Options & Recommendations

Taking a prenatal vitamin before and during pregnancy helps support your nutritional needs and your baby's development. Look for a prenatal vitamin that provides adequate folic acid, iron, iodine, and other essential nutrients.

Not all prenatal vitamins contain the same ingredients. For example, some gummy prenatal vitamins do not contain iron, so it's important to review the supplement label and discuss your individual nutritional needs with your healthcare provider.

Prenatal Vitamin Options

• One A Day Prenatal Multivitamin with Folic Acid, Iron & DHA
• One A Day Prenatal Gummies with Folic Acid, DHA & Iodine (Iron-Free)
• Amazon Basics Prenatal & DHA Gummies

These are examples of available prenatal vitamins, not a requirement to purchase a particular brand. Supplement formulations may change, so always check the current product label.

Affiliate disclosure: As an Amazon Associate I earn from qualifying purchases. I may receive a commission when you purchase through these links, at no additional cost to you.

Your first prenatal appointment is an important opportunity for us to get to know each other, review your health history, and develop a personalized plan for your pregnancy.

What to Expect at Your First Visit

Medical History and Physical Assessment

We will review your medical and surgical history, previous pregnancies, medications, allergies, family history, and any concerns you may have. Your visit will also include a physical assessment, blood pressure measurement, and discussion of your overall health.

Initial Prenatal Laboratory Testing

Routine prenatal laboratory testing generally includes:

• Complete blood count (CBC) to evaluate for anemia and other blood-related concerns.
• Blood type, Rh factor, and antibody screening.
• Screening for HIV, syphilis, hepatitis B, and hepatitis C.
• Rubella immunity testing.
• Urine culture to screen for bacteria in the urine, even when symptoms are absent.
• Screening for chlamydia and gonorrhea based on age and individual risk factors.

Additional testing may be recommended based on your medical history, previous pregnancies, or other risk factors.

Early Pregnancy Ultrasound

An ultrasound may be performed or ordered to:

• Confirm the location of the pregnancy.
• Evaluate fetal cardiac activity when appropriate for gestational age.
• Estimate your due date.
• Determine whether you are carrying one baby or multiples.

The timing and need for ultrasound examinations depend on your individual pregnancy.

Genetic Screening and Counseling

We will also discuss available prenatal genetic screening and diagnostic testing options. These are personal decisions, and you will have the opportunity to ask questions before choosing whether to proceed.

A Note About Ultrasounds

Ultrasounds are medical examinations used to evaluate your pregnancy and your baby's development. A detailed anatomy ultrasound is generally performed between 18 and 22 weeks.

Additional ultrasounds may be recommended when clinically indicated. Not every pregnancy requires the same number of ultrasound examinations.

My goal is to help you feel informed, supported, and comfortable asking questions throughout your pregnancy.

During this stage of pregnancy, we focus on your baby's development, review prenatal screening options, and prepare for your detailed anatomy ultrasound.

Prenatal Genetic Screening

Prenatal screening tests can help identify whether your pregnancy has an increased chance of certain genetic conditions. These tests are optional and do not provide a definitive diagnosis.

Noninvasive Prenatal Testing (NIPT)

NIPT, also called cell-free DNA (cfDNA) screening, is a blood test that can be performed beginning at approximately 10 weeks of pregnancy.

It screens for certain chromosomal conditions, including:

• Trisomy 21 (Down syndrome)
• Trisomy 18 (Edwards syndrome)
• Trisomy 13 (Patau syndrome)

Examples of NIPT tests include:

• Natera: Panorama
• MaternitT21

Maternal Serum Screening

Other screening options include second-trimester maternal serum screening, such as the quad screen. These tests estimate the chance of certain chromosomal conditions and may also screen for open neural tube defects.

Maternal serum alpha-fetoprotein (MSAFP) screening is another option for assessing the chance of open neural tube defects, including spina bifida.

NIPT does not screen for open neural tube defects.

Understanding Your Results

A positive screening result does not necessarily mean your baby has a genetic condition. Additional counseling, detailed ultrasound evaluation, and diagnostic testing, such as chorionic villus sampling (CVS) or amniocentesis, may be offered when appropriate.

You may also be referred to Maternal-Fetal Medicine (MFM) or a genetic counselor.

Anatomy Ultrasound (18–22 Weeks)

A detailed anatomy ultrasound is generally performed between 18 and 22 weeks of pregnancy.

This examination evaluates your baby's anatomy, including the brain, spine, heart, kidneys, abdomen, and extremities. It also assesses the placenta and other important aspects of the pregnancy.

Although the baby's sex may sometimes be identified during the examination, the primary purpose is to evaluate fetal anatomy and development.

Remember: Every pregnancy is unique. We'll discuss your screening options together so you can make informed decisions that align with your preferences and needs.

Between 24 and 28 weeks of pregnancy, several important tests help monitor your health and identify conditions that may develop during pregnancy.

Gestational Diabetes Screening

Most pregnant patients are screened for gestational diabetes during this time.

The most common initial screening test is the 1-hour glucose challenge test:

• You will drink a sweet beverage containing 50 grams of glucose.
• Your blood will be drawn one hour later to measure your blood sugar level.
• Fasting is generally not required for this screening test.
• Follow any specific instructions provided by your healthcare team or laboratory.

If your screening result is elevated, you may need a follow-up 3-hour oral glucose tolerance test to determine whether you have gestational diabetes.

The 3-hour test generally requires fasting beforehand. Your healthcare team will provide preparation instructions.

Anemia Screening

A repeat complete blood count (CBC) is generally performed during this stage of pregnancy to check for anemia.

Anemia can develop as your pregnancy progresses because your body's iron requirements increase.

Additional Prenatal Care

Depending on your blood type, medical history, and previous testing, additional care may include:

• Repeat antibody screening and Rh immune globulin (RhIg) administration at approximately 28 weeks if you are Rh-negative and it is indicated.
• Repeat infectious disease screening as recommended.
• Discussion of fetal movement, warning signs, and preparation for the third trimester.

Depending on your blood type, medical history, and previous testing, additional care may include:

• RhoGAM Injection (Rh Immune Globulin): If you have Rh-negative blood and your body has not developed antibodies against Rh-positive blood, you may receive a RhoGAM injection at approximately 28 weeks of pregnancy.
  RhoGAM helps prevent your immune system from developing antibodies that could affect your baby or future pregnancies if your baby has Rh-positive blood.
  Another dose may be needed after delivery if your baby is Rh-positive. RhoGAM may also be recommended at other times during pregnancy, such as after certain bleeding episodes or procedures.

Every pregnancy is different, and additional testing may be recommended based on your individual needs.

As you enter your third trimester, your prenatal appointments become more frequent, and preparations for your baby's arrival should be well underway!

During these visits, we continue monitoring your health and your baby's growth and well-being. We will also discuss your birth preferences, labor and delivery plans, and postpartum care.

What to Expect During Your Visits

• Check your blood pressure and discuss any new symptoms or concerns.
• Monitor your baby's growth and heart rate.
• Discuss your baby's movements and when to report changes.
• Review warning signs of preterm labor and preeclampsia.
• Discuss labor, delivery, pain management options, breastfeeding, and newborn care.

Repeat Laboratory Screening

Some laboratory tests may be repeated during the third trimester, including:

• Syphilis screening: Repeat testing is recommended during the third trimester and may be required based on state guidelines and individual risk factors.
• HIV screening: Repeat testing may be recommended depending on your individual risk factors and applicable screening guidelines.
• Other sexually transmitted infection (STI) screening: Additional testing may be recommended based on your history or risk factors.

Recommended Vaccinations During Pregnancy

Certain vaccines are recommended during pregnancy to help protect both you and your baby from serious infections.

Tdap Vaccine (27–36 Weeks)

The Tdap vaccine protects against tetanus, diphtheria, and pertussis (whooping cough).

• Recommended during every pregnancy, preferably early in the 27–36-week window.
• Helps your body produce protective antibodies that pass to your baby before birth.
• Provides important protection against whooping cough during your baby's first months of life.

Even if you've received Tdap in the past, another dose is recommended during each pregnancy.

Maternal RSV Vaccine (32–36 Weeks, During RSV Season)

Respiratory syncytial virus (RSV) can cause serious respiratory illness in newborns and young infants.

• Pfizer's Abrysvo is the maternal RSV vaccine recommended during pregnancy.
• It is generally administered between 32 weeks 0 days and 36 weeks 6 days, during September through January in most of the continental United States.
• Maternal vaccination helps protect your baby from severe RSV illness during the first months of life.

Most babies need either protection through maternal RSV vaccination or an RSV antibody injection after birth, rather than both.

If you received a maternal RSV vaccine during a previous pregnancy, another dose is not currently recommended. Your baby may instead receive RSV antibody protection after birth.

Influenza (Flu) Vaccine

The flu vaccine is recommended during pregnancy during influenza season.

• It may be given during any trimester.
• Helps reduce your risk of serious flu-related illness.
• Also provides protection for your baby during the first months of life.

COVID-19 Vaccine

COVID-19 vaccination is also recommended under current CDC guidance. We can review the most recent recommendations, your vaccination history, and any questions you may have during your prenatal visit.

Your Baby's Movements

As your pregnancy progresses, you'll become familiar with your baby's usual movement patterns.

Contact your healthcare team promptly if you notice decreased movement or a significant change in your baby's usual activity.

Do not wait until your next prenatal appointment to report decreased fetal movement.

Preparing for Labor and Delivery

During your third trimester, we'll discuss:

• Signs of labor and when to contact your healthcare team.
• Your preferences for labor and delivery.
• Pain management options.
• Breastfeeding and infant feeding.
• Postpartum recovery and emotional well-being.
• Choosing a healthcare provider for your newborn.

My goal is to help you feel informed, supported, and prepared as you approach the arrival of your baby.

Pregnancy Vaccination Resources

• Pregnancy and Vaccines — English (CDC)
• Vacunas antes, durante y después del embarazo — Español (CDC)

These resources provide general education. Your prenatal care and vaccination recommendations will be individualized based on your medical history and current clinical guidance

Although I provide comprehensive prenatal care, I do not personally attend deliveries.

Before 36 weeks of pregnancy, I coordinate the transfer of your obstetric care to your preferred delivering provider. The timing of this transition is individualized based on your pregnancy, medical needs, and the requirements of your delivering provider.

We will discuss your delivery preferences and make arrangements for a smooth transition of care. I will help coordinate the transfer of your prenatal records, laboratory results, ultrasound reports, and other relevant information through appropriate clinical channels.

Your delivering provider will continue your prenatal care, help you prepare for labor and delivery, and provide instructions about when to contact the hospital.

My goal is to walk with you throughout your prenatal journey and ensure you feel informed, supported, and confident as you transition to your delivering team.

You're getting closer to meeting your baby! During these final weeks, prenatal care focuses on monitoring your health, checking your baby's well-being, and preparing for a safe transition to your delivering provider.

Group B Streptococcus (GBS) Screening — 36–37 Weeks

Between 36 weeks 0 days and 37 weeks 6 days, most pregnant patients are screened for Group B Streptococcus (GBS).

GBS is a common bacterium that can naturally live in the digestive and genital tracts. Many people carry GBS without symptoms.

What to Expect

• Screening involves a simple swab of the lower vagina and rectum.
• The test identifies whether GBS bacteria are present.
• Having GBS does not mean you have a sexually transmitted infection.

What Happens if Your GBS Test Is Positive?

If your screening is positive, you will generally receive antibiotics through an IV during labor to help protect your newborn from serious GBS infection.

Antibiotics are not routinely needed before labor or after delivery solely because of a positive GBS screening result.

IMPORTANT: Tell your healthcare provider if you have a penicillin allergy. This information helps your delivering team select the appropriate antibiotic.

Learn More About GBS

• Group B Strep — English (CDC)
• Estreptococo del grupo B — Español (CDC)

Additional Infection Screening

Depending on your medical history, previous testing, and individual risk factors, additional screening for sexually transmitted infections may be recommended during the final weeks of pregnancy.

Your Baby's Position

During late prenatal visits, we assess whether your baby is head-down (vertex) or in another position, such as breech.

An ultrasound may be recommended if your baby's position is uncertain.

If your baby is breech, I will help coordinate further evaluation and delivery planning with your delivering provider.

Cervical Examinations

As you approach your due date, we may discuss whether a cervical examination would be helpful.

A cervical examination can assess:

• Dilation: How open your cervix is.
• Effacement: How thin your cervix has become.
• Station: How far your baby's presenting part has moved into your pelvis.

Cervical examinations cannot reliably predict exactly when labor will begin.

Mild spotting or mucus discharge may occur afterward because the cervix becomes more sensitive during pregnancy.

Sexual Activity During Late Pregnancy

For most people with uncomplicated pregnancies, sexual intercourse is generally safe throughout pregnancy, including the final weeks, as long as you feel comfortable.

Mild spotting or mucus discharge may occur afterward because the cervix has an increased blood supply.

However, avoid intercourse if your water has broken or your healthcare provider has advised against it because of a pregnancy complication.

Contact your healthcare team if you experience heavy bleeding, persistent pain, leaking fluid, or other concerning symptoms.

Signs of Labor and When to Seek Care

As your due date approaches, you may notice:

• Regular contractions that become stronger, longer, and closer together.
• Increasing pelvic pressure or lower back discomfort.
• Loss of your mucus plug or blood-tinged mucus.
• Your water breaking, which may feel like a gush or a continuous trickle of fluid.

Your delivering provider and hospital will give you specific instructions about when to call or come in for evaluation.

If you believe you are in labor or your water has broken, contact your delivering provider or labor and delivery unit rather than waiting for your next prenatal appointment.

Seek immediate medical evaluation for decreased fetal movement, heavy vaginal bleeding, severe headache, vision changes, or other concerning symptoms.

Approaching Your Due Date

If labor has not started by your due date, your delivering provider will discuss appropriate monitoring and delivery options, including whether induction of labor may be recommended.

Remember: My role is to walk with you through your prenatal journey, provide education and individualized care, and help ensure a smooth transition to the provider who will attend your delivery.