What to Expect…at the OB (when you are pregnant)

I remember the first time I went to the OB when I was pregnant with Tera.

I was nervous. Like, sweating, shaking…I had no idea what to expect.

Well, I survived alllllll the visits to the OB with Tera, and then I didn’t go back again until the pregnancy with this little one. Oops.

Anyways, when it came time for my first appointment the second time around, I was all nerves again. I couldn’t remember what had happened at the OB when I went in with Tera.

I figured that there are probably people out there frantically googling what to expect at the OB, so I will simply recount my experiences and hope that it helps someone out there! Please remember that each pregnancy and each practice is different. However, from most people I have talked to, the gist of it is the same.

A little info on the practice I go to: It is a practice of several OB’s and several midwives. They lean towards the “crunchy” approach of pregnancy, labor and delivery and are often the least obtrusive possible, with as little intervention as possible. When making an appointment, I see all of the OB’s/midwives, and the person who is on call at the time of labor is the one who delivers the baby.

Viability Appointment

A few days after my positive pregnancy test, I called my OB practice to make the initial appointment. This appointment usually happens sometime between 9-12 weeks. The receptionist asked me if I would like a viability appointment before that time, and I said yes.

The viability appointment happened at 8.5 weeks. Theo and I took both girls with us. I had to provide insurance, ID and proof of address. We waited in the waiting room for a while, and then the receptionist asked me to go pee in a cup. The cups are provided in the bathroom. After donating my specimen, I return to the waiting room to wait for the nurse/doctor to see me. Finally, it was our turn to go to a room…and wait. For the viability appointment, the nurse took my blood pressure, but that was it. There was no weighing or measuring. Finally, the doctor came and pulled out his ultrasound wand. Now, if you have never been, you need to know that some ultrasounds are abdominal and some are transvaginal. With Tera, I never had a transvaginal ultrasound, but with this baby I did. The doctor explained that it’s easier to get precise measurements with a transvaginal ultrasound, especially early on. I believe if you have a tilted uterus or a “high-risk” pregnancy, the doctor prefers to do transvaginal as well.

Please note: if you go in as early as 8 weeks, there is a chance that the doctor will be unable to find a heartbeat. This does not mean that there is no heartbeat!!! Instead, it means that the baby’s heart hasn’t started beating yet, or is too faint to pick up on the technology. Don’t freak. The purpose of the viability appointment is just as it sounds: to confirm that your pregnancy tests aren’t lying, that the pregnancy is indeed implanted in the right location and that their is a growing fetus inside your womb. That’s it. They may also do a pap smear while they are at it, but this varies depending on the practice that you go to.

First Appointment

The next appointment that I had was around 12 weeks, and was the first official appointment. Again, we waited in the waiting room and I donated a fine specimen, then we waited in the exam room until someone showed up to get the party started. The nurse weighed me, took my blood pressure and asked me how I was feeling. She asked if I had any concerns or questions for the doctor, and gave me a sweet little bag full or reading materials, coupons and advice on making it through morning sickness. Then, a student doctor came in and looked for the heartbeat with the Doppler. It took a very long time for her to find it, and my own heart probably stopped beating for a while. Eventually, she found it and we listened to it for about 15 seconds before she put the Doppler away. And that was the end of the appointment.

Genetic Testing

With our fabulous advancements in medicine have come some really advanced testing options. Something that is becoming more and more popular is the (optional) 12 week genetic screen. This happens through a simple blood test and can assess risks for several genetic diseases. Another option at this time is finding out the gender of the baby through blood test.

A personal note here: We opted out of ALL genetic testing. Frequently, a genetic test is simply assessing the risks of the fetus having a particular disease. It might indicate a possible positive that causes a lot of worry/stress and in the end the fetus does not have any genetic abnormality. Please be aware of this. Theo and I decided early on that we would not abort a baby even if it had no chance of life outside the womb, so that is another reason we opted out. Please also be aware that genetic testing can have risks.

It is important to remember that some women are required to have this testing done. This may be because you have a carrier in your family, or because you have had a previous pregnancy that resulted in a genetic disease. It is not required for all, but may be required for some.

First and Second Trimester Appointments

Appointments happen once a month until the third trimester, and they look very similar to the first appointment. Wait. Pee in cup. Wait. Wait. Weigh, measure, questions. Wait. Heartbeat on the Doppler. Starting around 20 weeks, the doctor/midwife will also start measuring your fundal height at the appointments. You will lay down, pull up your shirt and she will pull our her tape measure and measure your baby bump.

Anatomy Scan

Around 20 weeks, you get to schedule an anatomy scan! The anatomy scan is the ultrasound that typically reveals the gender. But it also much more than that. During this scan, an ultrasound tech will measure almost every inch of the baby, determining that the growth is right on track and that there are no heart problems, brain issues or other organ problems.

At my 20 week scan with Tera, it was simply an anatomy scan. However, with this pregnancy they did an anatomy scan and a transvaginal ultrasound to check the length of my cervix and make sure that it was not dilated. I had been having Braxton Hicks as early as 18 weeks, so they wanted to check to make sure it wasn’t making any progress (it wasn’t), but they said this is a new requirement that they are doing for every woman who has not had two full-term births (I have had one).

I think that it would take a little bit of arguing, but please remember to do your research, and if you don’t feel comfortable with ultrasounds (either abdominal or transvaginal), speak up! Talk it through and remember that you always have rights.

Third Trimester

After 27 weeks, appointments happen bi-weekly, but still continue to look the same (weight, blood pressure, fundal height, questions). At 37 weeks, appointments start to happen weekly and you will begin talking about cervical dilation, effacement and all that jazz. I don’t know from personal experience, but I believe somewhere around full term (37-40+ weeks), you can be checked for dilation.

I denied being checked for dilation throughout my entire pregnancy with Tera. It just sounded uncomfortable, and honestly…I didn’t want to know. I’m glad I did that, and will probably be doing it again with this pregnancy. During my labor, being checked for dilation was the singular most painful moment (of course, labor is really painful…but it was like more pain on top of the bodies natural rhythms of pain, if that makes sense), so I’m not a fan.

Overdue

Once you hit 40 weeks, you will have to go in for a non-stress test at least once a week. They strap you up to some monitors and watch to see if you are having any contractions. It’s completely painless, but it just keeps them in the loop of what your body is doing.

Most practices will not let you go more than 2 weeks overdue. At that point, you will start talking induction. Which is a different post for another time!

Here are some of my tips for your visit to the OB throughout your pregnancy:

• Write down your questions as you think of them. I cannot tell you how many times they asked me if I had questions and I just stared at them like they had three heads. Then, when I returned to the car I suddenly the 700 super important questions that I had wanted to ask. WRITE IT DOWN BEFOREHAND, when you think of the question.
• Don’t be afraid to ask questions. There is no such thing as a stupid question when you are going through something you haven’t gone through before. Don’t be ashamed to ask what a word means or why the doctor would recommend that, or if you can have an alternative. It is your pregnancy and your baby, and you need to be informed!

• Do your own research. Theo’s family currently has three doctors in it. I would trust each one of them with my life and the life of my children. However, when we get together as a family I am amazed that all three doctors can have a totally different opinion on a medical situation. Please, please….do your own research. Your doctor is a human. They will give you the best advice that they have, and they are to be trusted…but their word is not gold. You should be doing your own research on the pros and cons of EVERTHING you are going through (pap smears, ultrasounds, cervical checks, scheduled C-sections).
• Find someone you feel comfortable with. Honestly, I don’t care who my regular doctor is. I just need them to get the job done. But the story is different with an OB-GYN. This person will be seeing you on a fairly regular basis and will be helping you bring your child into the world. It’s an important relationship, and you need to feel comfortable with it. If you don’t feel comfortable with a man being all up in your business (quite literally), then find a female. If you find someone you just don’t like, find someone else (the sooner the better). If you click with someone, go for it!!! With both of my pregnancies, I have been seen by several people within the same practice. I had my favorite picked out by appointment #2, and I preferred to see them each time. When it came time for labor and delivery with Tera, it ended up being someone I had never even met before. Honestly, that didn’t bother me, since it was the nurse who was doing all the labor work. But a lot of women feel really, really strongly about who is in charge during labor and delivery. Don’t hesitate to switch if you don’t feel comfortable.
• Understand your insurance. Raise your hand if you just don’t understand how insurance works in this country. Yeah. With Tera we had a HUGE issue that almost resulted in us having to pay the $20,000 bill out of pocket. No, thank you. And all because we simply hadn’t asked questions such as, “Do you take my insurance?” “What does this cover?” “What does this NOT cover?”. Insurance can be really tricky, especially since maternal health and labor and delivery can be considered something completely separate from “medical needs”. Just make sure to ask the questions, even if it seems stupid or obvious.
• Have a birth plan. I’ve heard some women not recommend a birth plan, and I’m guaranteeing that they are a type B personality. Or maybe a C. Is that even a thing? I don’t know, I wouldn’t associate with them. Just kidding. But really…a birth plan is incredibly helpful, not just for you, but for the professional who is planning on delivering your baby. I recommend having this birth plan ready to go around 35 weeks. You need to communicate how you want to labor, how you want deliver, if you want an epidural, etc. This is important because you and your OB might on completely different pages. I don’t know about you, but I’d rather have that discussion/argument sitting on an exam table at 35 weeks than sitting in a hospital room having a contraction every 3 minutes. Talk it over, work it out.
• Don’t forget to thank them! I know it seems like 98% of your visits to the OB are spent waiting. However, these doctors are doing a fabulous job and most of them absolutely love their job! Don’t forget to tell them thank you!