Now that you tested positive for being pregnant it is time to meet your healthcare provider. Which means it’s testing time!
Did you know that there are different healthcare providers you can go to? Click here to find what your options are.
What to bring to your doctor's appointment
For your appointment with your healthcare provider make sure you bring:
- Insurance card and know what your deductible is. Make sure that the health care provider takes your insurance or you will be out of pocket. You may want to read this before you go into see your doctor or midwife. Here are some interviewing and insurance tips.
- If you are taking medications, bring them in or make a list of names and the amount you are taking for the doctor/ midwife to go over. Some medications can be harmful to a growing embryo or fetus. If you don't want to wait check out The InfantRisk Center (headed by Dr. Thomas Hale in the US). They have a phone helpline (1-806-352-2519) and additional information on medication use during pregnancy and breastfeeding.
- A list of question you would like to ask them. Make sure you get your questions answered so you feel good when you walk out of their office. Here is a list of questions you can ask.
- You will be asked about your health history and your family history so be prepared to discuss it. Bring any RELEVANT medical history that you feel cannot be explained verbally. The most helpful option is simply being thorough and concise on the medical history form. And when the healthcare provider reviews it, he/she will ask for more information if necessary and the proper release forms will be signed to obtain those specific records.
- Know when your last period was.
- Make sure you understand what informed consent is. Click here to learn what it means.
During the visit your health care provider may:
- Perform a physical exam: you’ll be weighed and your blood pressure, heart, lungs, and breasts will be examined.
- Perform a pelvic exam: examine your abdomen and the height and size of your uterus, check your ovaries etc.
- Give an ultrasound to listen for the heartbeat.
- Go over your medical history.
- Discuss various tests your healthcare provider may recommend such as: ultrasound, chronic villus sampling, amniocentesis, AFP and a prenatal genetic screening in order to detect genetic issues.
- Take a blood test and a urine sample. This is called the Prenatal Panel. The test checks your blood count, blood type, RH Factor, Rubella antibodies, Hepatitis B, Syphilis, Chlamydia, Gonorrhea, HIV, and possibly your Vitamin D levels.
FYI - it's a really good idea to ask your healthcare provider to check:
- Your Vitamin D levels if they don't automatically test for it.
- Your blood sugar levels now rather than wait for the glucose tolerance test at 24 - 28 weeks. You may have blood sugar issues and not even know it. The test is called a Hemoglobin A1C. It measures your average blood sugar levels over 2 - 3 months. Basically the test will tell your healthcare provider if your are pre-diabetes or diabetic. Which means that you will have to exercise and be very careful regarding your diet. Gestational diabetes is no joke.
- If you are vegetarian, vegan, had gastric bypass surgery or have digestive issues of any kind, ask your doctor to test your serum B12 levels as well as urinary MMA levels. Optimal serum B12 levels should be 1000 pg/ml or greater.
- Did you know that there are some women who lack an enzyme that allows them to metabolize folic acid and may need to take an activated form? I'm one of them! Unless you’ve had testing for this genetic variation in folate metabolism(MTHFR testing) you won’t know if this applies to you. Aviva Rohm, M.D. recommends taking 1 mg (1000 mcg) of active folate daily as this is safe for all pregnant women, and bypasses this enzyme problem. But it’s best to ask your health care provider.
- This is an opportunity to discuss any questions you have. So make sure you ask questions!
Estimating your due date
Due dates.....first of all I want you to understand that a due date is just an estimate of when your baby will be born. Most likely your baby will not be born on the exact due date that your healthcare provider will provide for you. There is a range of time in which most women will go into labor on their own. For first time moms, about half of women will go into labor by 40 weeks and 5 days (or 40 weeks and 3 days if you’ve given birth before), and the other half will go into labor after that.
It's important to ask the following questions to your health care provider regarding your due date;
- What is the estimated date range that I might expect to give birth—not based on Naegele’s rule, but based on more current research about the average length of a pregnancy? Naegele's rule is a standard way of calculating the due date for a pregnancy. The rule estimates the expected date of delivery (EDD) by adding one year, subtracting three months, and adding seven days to the first day of a woman's last menstrual period (LMP).
- Did you use my Last Menstrual Period or an early ultrasound to determine my baby’s gestational age?
- Has my due date been changed in my chart at any point in my pregnancy? If so, why?
What are the various tests?
These tests only tell a woman what her chances are of having a baby with a certain chromosomal or neural tube defects. They do NOT TELL YOU FOR SURE. If you get an abnormal result it is recommended that you get a diagnostic test.
- False negative – the baby has a defect but the test doesn’t catch it.
- False positive – the baby is fine but the test says there is a problem.
Screening Tests look for Down Syndrome, Trisomy 18, neural tube defects (anencephaly and spina bifida), abdominal wall defects (gastroschisis and omphalocele), and Smith-Lemli-Opitz syndrome (SLOS)
Diagnostic tests are offered when:
1.) A mom is older than 35 years old.
2.) A screening test comes back abnormal.
3.) A mom has had a previous baby with a genetic abnormality.
Diagnostic tests are more invasive because they need to get a sample of the baby’s cells. Results some times take more than 2 weeks to get back.
Examples of diagnostic tests:
- Chorionic Villus Sampling (CVS) - a needle is passed through the mom’s abdomen or cervix and a small sample of placental cells are taken and sent to the lab. CVS test is preformed between 10 weeks - 23 weeks and 6 days. The DNA from the baby is examined for chromosomal defects. There is a slight chance of miscarriage ( .7 - 1.3% ) PMID 17766619 This is higher than the rick from an amniocentesis. There is also a chance of limb defect. PMID 1481865, 8333429, 7597654.
- Amniocentesis --- a needle is passed through the mom’s abdomen and a small sample of amniotic fluid is taken and sent t the lab. The Amnio test is preformed during 15 weeks – 20 weeks. The DNA from the baby is examined for chromosomal defects. There is a slight chance of miscarriage. ( .2 - .3% ) PMID 18055749
- Detailed ultrasound exam —This type of ultrasound exam can help explain abnormal screening test results and provide more detailed information.
- Fetal blood sampling —Also known as cordocentesis, this procedure tests for chromosomal defects and other problems. For this test blood is taken from a vein in the umbilical cord. Fetal blood sampling usually is used when the results of amniocentesis, chorionic villus sampling, or ultrasound are unclear.
For more information about the Prenatal Screening Program, Check your State’s Public Health Department for information. Here is California’s website: California Department of Public Health provides information on prenatal screening in many languages. You can download brochures and FAQs from the site.
Testing appointments that need scheduling:
- Make an appointment if you are having a Chorionic Villus Sampling(CVS), a test that can detect Down syndrome and other chromosomal defects. This test is usually preformed between weeks 10 - 14. There are risks with this test.
- Make an appointment if you are having a 1st Trimester Screening. This test is done between 11 – 14 weeks. It checks for your baby’s risk of down syndrome and trisomy 18 ( an extra copy of chromosome 18 ). This test involves taking a blood sample from you and performing a detailed ultra sound called a nuchal translucency. The ultra sound is used to measure the distance from the soft tissue to the skin in the fetus’s neck. Then the results of the blood test and the ultrasound are combined.
It is important for you to ask questions about the tests your healthcare provider is suggesting. Check out my ‘Do You Know About Informed Consent?’ blog!
- Ask what are the benefits and risks of the test?
- Is it necessary in my particular pregnancy?
- What is your particular experience with the test?
- What are the complication rates for this particular test?
- Should I be referred to a fetal-medicine specialist?
- How much will it cost and will it be covered by my insurance?
- What information will the test give?
- When will I hear the results and how reliable will the test be?
- Is there an alternative procedure or test that is safer?
- What complications can I expect?
Communication is important between you and your healthcare provider!!! It is important that you are a participant in your healthcare.
Find out how much your health insurance covers so you do not have any unexpected bills!
What is happening with you?
Testing time can be a little...who am I kidding...extremely nerve racking. It makes you confront concerns about the possibility of having a disabled child and/ or risk of miscarriage. Neither topic is fun to address. But please keep in mind that most babies are born healthy. In fact, 96 to 97 out of every 100 babies born are born healthy.
Your uterus has been quickly growing and will continue to enlarge until your baby is born. Around 12 weeks your uterus has begun to expand past your protective pubic bones. So what does that mean?? You’re beginning to “show”. Be cautious around activities that can cause you to fall on your abdomen. Most healthcare providers recommend you avoid lying on your back around your 2nd trimester because the weight of your fetus (baby) can place too much weight on the venous cava. It is the main vein that carries blood back to the heart from your lower body region. If squashed, it can interfere with optimum circulation and circulation is a pregnancy's best friend! You will want to begin sleeping on your left side. But you can switch from side to side. Just know that the left side allows for maximum blood flow (less pressure on the vena cava) and could reduce swelling in the legs.
Ultra wellness tips for weeks 8 - 13:
- Sign up for my week to week pregnancy guide plus learn how your baby is growing week to week.
- Favor the things that give you peace and minimize the things that don’t.
- Listen to relaxing music, soak in a bath (not to hot), start journal writing, and/or make a gratitude journal. What are you grateful for? Start with 5 things you are grateful for that day or 5 things you are grateful for about your body. Hint+ it is growing your baby+
- Do not feel guilty about taking naps or resting. You need it and so does your baby!
- Open your windows and get fresh air!
- Take a walk and get some Vitamin D from the sun!
- Eat well and drink 2 -3 quarts of water a day!
- Make sure you are eating a healthy diet. This is super important because your baby is made from what you eat!! Literally! So be mindful of what you put into your mouth and body. Check out my blog ‘12 Tips to Eating Well During Pregnancy’. If you want to learn more about prenatal power foods and what will make you and your baby thrive, 12 Days To A Health Pregnancy, Healthy Baby & Beyond - Prenatal Nutrition 101.
- Wondering what you should be avoiding? Check out my blogs
- Attention Moms! Top 12 Things To Avoid While Pregnant.
- Attention Moms! The Yucky Seven NON-FOOD Items Pregnant Women and Kids Should Avoid
- Attention Moms! 8 Environmental Things Children and Pregnant Women Should Avoid
- Make a list of all the things you want to do before the baby comes.
- Start moisturizing your belly, hips and thighs. I love the body oil and lotion by the Honest Company.
Don't forget that I have to check out Tips for Weeks 14 - 22: Second Trimester Decisions
QUESTION: What feelings do genetic testing bring up for you? Are you planning on doing them? Please leave your comment below. I would love to hear your thoughts. If you found this information useful please pass this information on to your friends and loved ones.