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Prenatal Care: Mapping Your 40 Weeks

By Helen M Hurst DNP, RNC-OB, APRN-CNM

Prenatal Care: Mapping Your 40 Weeks

Mapping Your 40 Weeks of Prenatal Care

Regular prenatal care and mapping your 40 weeks is important for you and your baby to have the healthiest pregnancy and birth possible. At each visit, your healthcare provider checks the health and progress of your pregnancy for both you and your baby; you get your questions answered.

You’ll likely have 10-12 prenatal care visits during which you’ll learn about any risks that could affect your pregnancy, watch how your baby is growing, get screened for any medical issues that could arise such as gestational diabetes or high blood pressure(preeclampsia), and plan for baby’s birth. Your healthcare provider will also calculate your estimated due date, which will be set at 40 completed weeks from the first day of your last menstrual period.

Hearing baby’s heart beat at each visit is exciting; second only to seeing baby via ultrasound. Many women and their partners feel like they bond with their babies when they can hear his or her heartbeat and see baby in the womb.

Prenatal Care Schedule

Call your healthcare provider when you first become pregnant but don’t be surprised if they don’t schedule your first prenatal visit until you’re 7-8 weeks along. You’ll get that first visit earlier, though, if you have had issues in previous pregnancies, such as previous preterm labor or repeat miscarriages, or if you have an existing health problem like high blood pressure or diabetes. If you’re unsure of the first day of your last menstrual period, your provider may want to see you earlier to get a more accurate estimate of baby’s gestational age by ultrasound.

Whether you choose to have individual or group care, such as Centering Pregnancy, your prenatal visits will be scheduled:

  • Up to 28 weeks: monthly
  • 28-36 weeks: every 2 weeks
  • 36 weeks-birth: weekly

If you choose group prenatal care, you’ll receive the same care at each visit. Bring your partner to each prenatal care visit, as possible, so that together, you can both learn about baby’s growth and development and make decisions about your care.

Nothing is more important than your health and baby’s health. Keep all of your prenatal care appointments, and jot a list of questions on your mobile that you’d like to ask your healthcare provider so that you don’t forget to ask about all of your concerns. Encourage your partner to do the same; it’s a great way for him or her to be involved in your prenatal care.

Your 40 Weeks: Each Prenatal Care Visit

 

WeeksHow often?Your VisitTestsDiscussion with your Healthcare Provider
**Routine checks at all subsequent visits: Vital signs (blood pressure, pulse, breathing), weight, baby’s heart rate, uterine size, urine dipstick for protein and glucose (sugar)

***A vaginal/cervical exam may be done anytime preterm labor is suspected.

Up to 28 weeksMonthlyFirst Visit 7-8 weeks

·       Health history

·       Family and personal medical, genetic history

·       Pregnancy history to identify any risk factors

·       Complete physical examination

·       Lifestyle assessment (tobacco, alcohol, drugs, intimate partner violence, depression/mental health issues, stress)

·       Determine estimated due date

·       Review vaccinations; recommendations if any are needed (e.g. flu in flu season)

·       Discuss current medications (prescription, over-the counter, supplements)

·       Receive prescriptions/recommendations for prenatal vitamins, iron supplements (if needed)

 

 

·       Blood and urine: blood type, protein or glucose (sugar) in your urine

·       Pap smear

·       Vaginal and cervical cultures to check for sexually transmitted infections(STIs)

·       Gestational diabetes screening, if high risk

·       Ultrasound, if unsure of last period and physical exam raises gestational age questions

·       Other blood tests for anemia, rubella immunity, STIs, inherited disorders

 

·       Your/your partner’s questions or concerns about your physical and emotional health, your baby, diet, physical activity, sexual activity; anything else that concerns you

·       Normal pregnancy discomforts; how to manage (e.g. nausea, vomiting, frequent urination, breast tenderness, tiredness, headaches)

·       Signs and symptoms of spontaneous miscarriage

·       Your plans/desires for birth including where you want to birth (e.g., hospital, birth center). Where your provider practices will limit your choices

·       When to call your healthcare provider

 

10-12 weeks

·       Routine checks **

·       Listen for baby’s heart rate

·       Review lab results

·       Assess for any new symptoms, medications or lifestyle changes

 

·       Genetic screening and counseling; usually offered in 1st trimester regardless of risk status·       Your/your partner’s questions or concerns

·       Normal pregnancy discomforts; how to manage

·       Signs and symptoms of spontaneous miscarriage

·       When to call your healthcare provider

·       Importance of breastfeeding

 

16 weeks

·       Routine checks **

 

·       Genetic screening tests (MSAFP/multiple marker screening)

·       Explanation of MSAFP checking for neural tube defects and multiple markers screening for NTD and trisomy

·       Your/your partner’s questions or concerns

·       Normal pregnancy discomforts; how to manage

·       Signs and symptoms of spontaneous miscarriage

·       When to call your healthcare provider

20 weeks

·       Routine checks **

·       Discuss any previous test results

·       Assess for any new symptoms, medications or lifestyle changes

·       Depression/anxiety and intimate partner violence screening

 

 

·       Ultrasound to look at fetal anatomy (brain, heart, lungs, spine, hands and feet, face, sex)

If you don’t want to know your baby’s sex ask them not to tell you before the ultrasound starts

 

·       Questions or concerns of you or your partner

·       Discuss genetic screening results

·       Review of normal discomforts of pregnancy and how to manage them (e.g. constipation, tiredness)

·       Review signs and symptoms of preterm labor

·       Potential pregnancy complications and their signs and symptoms: preeclampsia, embolism and post-partum hemorrhage

·       When to call your healthcare provider

28-36 weeksEvery 2 weeks·       Routine checks **

·       Depression/anxiety and intimate partner violence screening as needed

·       Review fetal movements

·       Assess for any signs and symptoms of preterm labor

·       Assess for any new symptoms, medications or lifestyle changes

 

·       Glucose screening for gestational diabetes

·       Repeat blood work

·       Hematocrit and hemoglobin, to check for anemia

·       Antibody screen (if RH-blood type)

·       Administration of RH Immunglobulin (if RH negative and antibody screen negative)

·       TDap vaccination at between 27 and 36 weeks

·       Your/your partner’s questions or concerns

·       Normal pregnancy discomforts; how to manage (e.g. constipation, heartburn, difficulty sleeping, frequent urination, changes in vaginal discharge)

·       Signs and symptoms of preterm labor

·       Lab results, as needed

·       When to call your healthcare provider

·       Potential pregnancy complications and their signs and symptoms: preeclampsia, embolism and post-partum hemorrhage

·       Childbirth, breastfeeding and other prenatal classes

·       Options for baby’s healthcare provider

·       Normal fetal movement, kick counts

·       Birth plans and labor expectations, including your provider’s recommendations about waiting for labor versus induction if all is healthy, including if you go past your due date

·       Postpartum contraception

 

36 weeks to birthWeekly·       Routine checks **

·       Assess for any new symptoms, medications or lifestyle changes

·       Review fetal movements

·       Assess for any signs of labor

·       Results of GBS and other tests

·       If GBS positive, discuss management during labor

·       Vaginal examination, as needed, to check for cervical change if you’re having contractions

 

 

·       Screening for GBS (group beta strep)

·       Repeat screening cervical and vaginal cultures (gonorrhea and chlamydia) if high risk for STIs

·       Blood tests (if high risk for certain STIs)

·       Your/your partner’s questions or concerns

·       Normal pregnancy discomforts; how to manage (e.g. shortness of breath, frequent urination, heartburn, constipation, Braxton-Hicks contractions, backache, difficulty sleeping)

·       Preterm labor signs and symptoms

·       True labor signs and symptoms

·       Potential pregnancy complications and their signs and symptoms: preeclampsia, embolism and post-partum hemorrhage

·       Birth plans

·       Postpartum support at home

·       When to call your healthcare provider

After 40 weeksTwice a week or more often·       Routine checks **

·       Assess for any new symptoms, medications or lifestyle changes

·       Assess for any signs of labor

·       Review fetal movements

·       Vaginal examination to check for cervical effacement and/or dilation

 

One or a combination of the following:

·       Non-stress test

·       Contraction stress test

·       Ultrasound (biophysical profile)

·       Your/your partner’s questions or concerns

·       Review of normal discomforts of pregnancy and how to manage them (e.g. frequent urination, heartburn, constipation, Braxton-Hicks contractions, backache, difficulty sleeping)

·       Labor signs and symptoms

·       Potential pregnancy complications and their signs and symptoms: preeclampsia, embolism and post-partum hemorrhage

·       When to call your healthcare provider

 

Helen M Hurst DNP, RNC-OB, APRN-CNM, is a midwife and expert advisor to Healthy Mom&Baby.


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