What to expect when you're expecting (48 page)

One practitioner’s routine may vary slightly from another’s. In general, the exam will include:

Confirmation of your pregnancy.
Your practitioner will check the following: the pregnancy symptoms you are experiencing; the date of your LMP to determine your estimated date of delivery (EDD), or due date (see
page 20
); your cervix and uterus for signs and approximate age of the pregnancy. A pregnancy test (urine and blood) will most likely be performed. Many practitioners also do an early ultrasound, which is the most accurate way of dating a pregnancy.

A complete history.
To give you the best care possible, your practitioner will want to know a lot about you. Come prepared by checking records at home or calling your primary care doctor to refresh your memory on the following: your personal medical history (chronic illness, previous major illness or surgery, known allergies, including drug allergies); nutritional supplements (vitamins, minerals, herbal, and so on) or medications (over-the-counter, prescription) you are presently taking or have taken since conception; your family medical history (genetic disorders, chronic diseases, unusual pregnancy outcomes); your gynecological history (age at first period, usual length of your cycle, duration and regularity of periods); your obstetrical history (past live births, miscarriages, abortions), as well as the course of past pregnancies, labors, and deliveries. Your practitioner will also ask questions about your social history (such as your age and occupation) and about your lifestyle habits (what you typically eat, whether you exercise, drink, smoke, or use recreational drugs) and other factors in your personal life that might affect your pregnancy (information about the baby’s father, information on your ethnicity).

A complete physical examination.
This may include assessment of your general health through examination of heart, lungs, breasts, abdomen; measurement of your blood pressure to serve as a baseline reading for comparison at future visits; notation of your height and your weight (prepregnancy and present, if they’re already different); a look at your arms and legs for varicose veins and swelling to serve as a baseline for comparison at future visits; examination of external genitalia and of your vagina and cervix (with a speculum in place, as when you get a Pap smear); examination of your pelvic organs bimanually (with one hand in the vagina and one on the abdomen) and also possibly through the rectum and vagina; assessment of the size and shape of the bony pelvis (through which your baby will eventually try to exit).

The Wholly Healthy Pregnancy

Not surprisingly, getting regular medical care in the form of prenatal visits makes a big difference in the outcome of your pregnancy. Women who see a practitioner regularly during pregnancy have healthier babies, and they are less likely to deliver prematurely and to have other serious pregnancy- related problems.

But though your health care should begin with your belly when you’re expecting, it shouldn’t end there. It’ll probably be easy to remember to see your prenatal practitioner regularly (it’s worth it just to hear the baby’s heartbeat!), but will you remember to take care of the rest of you, even the less apparently pregnant parts?

To keep yourself wholly healthy during your whole nine months, stay on top of all your health care maintenance. Pay a visit to your dentist for a cleaning and a checkup; most dental work, particularly the preventive kind, can be done safely during pregnancy and may actually prevent pregnancy complications. Check in with your internist, family physician, or specialist if you have any chronic conditions or other medical problems that will need monitoring (make sure your pregnancy practitioner’s in the loop about other care you’re receiving). And see your allergist, if necessary. You probably won’t begin a course of allergy shots now, but you may need to look into different treatment options now that you’re breathing for two.

If new medical problems come up while you’re expecting, don’t ignore them, even if you’re already in over your head with pregnancy-related symptoms. Check any issue out (even ones that seem relatively innocuous—a persistent sore throat or a chronic headache) with an appropriate physician. Your baby needs a wholly healthy mother.

A battery of tests.
Some tests are routine for every pregnant woman; some are routine in some areas of the country, or with some practitioners and not others; some are performed only when circumstances warrant. The most common prenatal tests given at the first visit include:

Urinalysis to screen for glucose (sugar), protein, white blood cells, blood, and bacteria.

A blood test to determine blood type and Rh status, hCG levels, and to check for anemia and possibly for vitamin D deficiency.

Blood screens to determine antibody titer (levels) and immunity to such diseases as rubella.

Tests to disclose the presence of infections such as syphilis, gonorrhea, hepatitis B, chlamydia, and HIV.

A Pap smear for the detection of abnormal cervical cells.

Depending on your particular situation, and if appropriate, you may also receive:

Genetic tests for cystic fibrosis, sickle
cell anemia, Tay-Sachs, or other genetic diseases.

A blood sugar level test to check for any tendency toward diabetes, especially if you have a family history of diabetes, have high blood pressure, have previously had an excessively large baby or one with birth defects, or gained excessive weight with an earlier pregnancy. (All women receive a glucose screening test for gestational diabetes at around 28 weeks; see
page 297
.)

An opportunity for discussion.
Here’s the time to bring out that list of questions and concerns.

“When should we tell friends and family that we are expecting?”

This is one question only you can answer. Some expectant parents can’t wait to tell everyone they know (not to mention a fair number of strangers) the good news. Others tell only selectively at first, starting with those nearest and dearest (close relatives and friends, perhaps), and waiting until their condition is obvious before making the pregnancy common knowledge. Still others decide they’d rather put off issuing any announcements until the first trimester has been successfully completed or until prenatal testing has been finished up.

For the Other Pregnant Half

There isn’t a page in this book that isn’t intended for both expectant mothers and fathers. As a father-to-be, you’ll gain plenty of insight into the pregnancy experience (as well as make some sense out of those crazy symptoms your spouse has been complaining about) by reading along with her, month by month. But because you’re likely to have some questions and concerns that are uniquely yours, there’s a chapter dedicated to you—the other pregnant half. See Chapter 19: Fathers Are Expectant, Too.

So talk it over, and do what feels most comfortable. Just remember: In spreading the good news, don’t forget to take the time to savor it as a twosome.