Dr. Kostant returns to Healthful Woman to talk about the first prenatal visit. In this episode, she explains what patients can expect in their first appointment with a new OB/GYN, when to schedule a prenatal appointment, and more.
The first prenatal visit, which should be 6-10 weeks after the last period (or embryo transfer if this is an IVF pregnancy) is a chance for the provider to get to know the patient. This may include her health history, medical/surgical history, prior pregnancies, etc. The first visit is also a great time for the provider to connect with the patient on a personal level, and review her expectations for the practice, for prenatal care, and for her delivery.
“A lot of people are under the impression that when they come for their first prenatal visit, the first thing we’re going to focus on is this pregnancy…in fact, that’s not our first goal,” explained Dr. Fox. “Our first goal is to get to know the person, and vice versa.”
“One of the things I like to do at the first visit is just start with a simple question, which is ‘How are you feeling?’,” said Dr. Kostant. “Because at the first prenatal visit, often…many women are not feeling well, to be honest. They may be very nauseous, very fatigued.”
After the initial introduction, patients will have an ultrasound prior to or during their first appointment. This first ultrasound confirms the gestational age of the pregnancy and the due date. “The principle is that the early ultrasounds are the most accurate in establishing how far along the pregnancy is,” explained Dr. Fox. “The default is we go by their last period, and then we do an ultrasound, and if the ultrasound is in line with that, we stick with the last period date.” Dating the pregnancy by the last menstrual period is not always accurate if a woman’s periods have been irregular, so the ultrasound can be very helpful in these cases.
If a patient conceived through IVF, her gestational age and due date will already be known based off of the embryo transfer date, but the ultrasound on the first visit is still helpful for making sure the pregnancy is progressing well.
A woman’s first prenatal visit will involve speaking with their provider regarding a lot of health information. The goal of the provider is to gather a comprehensive medical, surgical, and allergy history, as well a prior pregnancy history (if relevant). A complicated medical or past pregnancy history can affect the frequency of visits, ultrasounds, and timing/mode of delivery; at MFM Associates, some patients will be set up for a separate Maternal Fetal Medicine specialist consult.
A general physical examination will also take place. This may include a breast exam and pap smear if the patient has not had a visit with a gynecologist for a check up in a year, or has any new concerns.
Once a provider has gathered all of the health information they need, they will then discuss what the next several weeks may look like-schedule of visits and ultrasounds, how the patient may feel, and how to get in touch with the office if they have any concerns.
In the first trimester, the schedule of visits will also depend on whether or not the patient would like to go ahead with prenatal genetic screening, to check for the risk of Trisomy 21, 18, 13 or other chromosomal abnormalities. “If patients do want to do some type of genetic screening, we’ll probably want them to be back around 9 to 10 weeks,” explained Dr. Kostant, as the blood draws for these tests are usually done at that time. “And if they haven’t even begun to think about that, I’ll just introduce the topic, I’ll give them some basic information.” Meeting with a genetic counselor can be helpful and this can be set up after the first visit.
There are a few precautions in early pregnancy, which should be discussed during this visit. “There’s actually a lot of misconceptions around that area,” said Dr. Kostant. “Sometimes I’ll have patients saying, ‘I heard I can’t do this, this, and this.” Having this discussion is a great opportunity for the patient to gain clarity on any misconceptions and feel confident moving forward. Most women can continue exercising, enjoying their usual foods (if they are not too nauseous) and can continue sexual activity, but there are some exceptions which should be discussed with the provider on the first visit.
The doctors also provide reliable sources of information, where patients can find further information regarding common questions. Even after a face to face discussion, a patient and her partner may come up with more questions and should have resources to review away from the office. The Healthful Woman Podcast, produced by our practice, is one such resource.
Women should begin taking prenatal vitamins before they become pregnant or as soon as they discover that they are pregnant. Prenatal vitamins that contain a minimum of folic acid 400 mcg and DHA are recommended. Dr. Kostant says that women who are too nauseous to tolerate a full prenatal vitamin should at least just take the folic acid alone, as this is usually a smaller pill and easier to tolerate, and then can switch to a complete prenatal vitamin around 12-13 weeks when their nausea hopefully improves.
“The other supplement that we’ve started really recommending for all of our patients is a low-dose aspirin supplement…because it’s a very low-risk intervention [for prevention of preeclampsia]” says Dr. Kostant. This was typically recommended for women who were at particularly high risk for developing preeclampsia, but given its low risk profile, at MFM Associates is recommended to all patient.
Overall, a prenatal visit is a great opportunity to discuss an array of topics regarding pregnancy, as well as for your provider to gather the information needed to provide optimal care. If you are interested in scheduling a prenatal visit with one of our board-certified OBGYNs, please contact our New York City office today.
Maternal Fetal Medicine blogs are intended for educational purposes only and do not replace certified professional care. Medical conditions vary and change frequently. Please ask your doctor any questions you may have regarding your condition to receive a proper diagnosis or risk analysis. Thank you!