10 Things to Expect at Your Initial OB Appointment

So, you’ve found out that you are pregnant, congratulations!!!

Maybe you missed your menstrual cycle, or you’re feeling nauseous, or maybe you and your spouse have been intentionally trying to conceive. For whatever reason, you decided to take a urine pregnancy test (or two) and the test is positive! Congratulations mama bear, you are bearing new life within you!

Now you may be asking yourself a few questions, starting with, how accurate is this at home test? Should I take another one? Should I schedule a doctors appointment for a blood test to confirm? The truth is the accuracy of over counter urine pregnancy tests has drastically improved since their inception. Nowadays, these tests boast of 98-99% accuracy if they are taken a few days after a missed menstrual cycle. The accuracy is slightly lower if you haven’t yet missed your cycle. So, it doesn’t hurt to take an extra at home urine test a few days after your cycle should have started.

You can read more about period health and tracking your menstrual cycle in future posts. But for now let’s talk about what to expect at your first prenatal appointment!

1. Your initial appointment may not be scheduled until the end of your first trimester.

Now that you’re pregnant, you may feel a mix of emotions: excitement, anxiety, anticipation. First things first, it’s time to call your obstetrician or midwife to schedule your initial appointment. For women without any chronic medical conditions or have low risk of complications, most clinics will have a woman schedule their initial appointment for later in the first trimester (between 8-12 weeks gestation).

When you call, they will tell you to start taking a prenatal vitamin immediately. Which if you have already read this post you are a step ahead of the game! Waiting for your appointment can seem like forever (at least it did for me). But the time will quickly fly by!

Some insurance companies require a referral from your Primary Care Provider to see a specialist. You can call the phone number on the back of your insurance card to ask them if its required. Or you can schedule your initial OB visit and they will let you know if you need a referral. If you don’t have a provider picked out, read here for my top 5 tips to picking your pregnancy provider.

Since you may not have your initial OB appointment until the end of your first trimester, one important thing to do as soon as you find out you are pregnant is to find your main resource on “what to expect”.

If you and your spouse were actively trying to get pregnant, you’ve probably already picked out your pregnancy guide. But if not, now is the time! There are many options to choose from, from the classic “What to Expect When You’re Expecting”, to newer takes like “Natural Mama’s Guide to Pregnancy”. You can ask a trusted person what book they used, browse your local bookstore or do some research online before purchasing your guide.

If you are not a book person, there are also apps and podcasts that can provide guidance on what to expect. Try not to become overwhelmed with all of the options out there. Find what works best for you, and if you buy a book or app that you don’t find helpful, don’t be afraid to change it up. Whatever resource you choose, read through the first few chapters before your initial OB visit to get a general guide on things to expect, things to do and things to avoid until you can meet with your pregnancy provider.

2. Prepare to talk about insurance.

In the United States, the estimated cost of delivering a baby in a hospital was $18,865 for insured patients with the average out of pocket cost of $2854.¹ If you do not have insurance, many hospitals offer a discounted price for self-pay patients. Self-pay patients should call multiple local hospitals to compare pricing before deciding where to deliver. If you are interested in having a midwife deliver your baby at a birthing center, contact that center directly to ask them their prices and what that price includes. Usually, prenatal care, labor care, and postpartum visits are covered in the overall fee. But, bloodwork and ultrasounds are billed separately.

In the USA, if you do not have health insurance, you may qualify for Medicaid or other state funded programs which can cover prenatal care, newborn visits and postpartum healthcare for moms. Please talk to your healthcare provider to learn about the resources in your area.

3. Get ready to answer a lot of medical history questions.

Women with chronic (particularly uncontrolled) pre-pregnancy conditions have a higher risk of complicated pregnancies. For this reason, your doctor or midwife will ask many questions at your initial visit to evaluate your risk factors. Among the many questions they will ask:

• Do you have any personal medical conditions?
• Are you taking any medications or supplements? (this includes vitamins or herbal remedies)
• Do you have any allergies, specifically to medications?
• Have you ever had any surgeries or surgery complications?
• Do you smoke, drink alcohol or use tobacco products?
• Have you had any previous pregnancies? If so, were there any pregnancy complications? How were your babies delivered?
• What chronic medical conditions run in your family? Any cancers? Any pregnancy complications?

They will also ask questions about your sexual history. You may be wondering if these questions are important or if medical professionals are just being nosy. You can read more about the questions that are asked and why in this post.

4. Your OB will order a pelvic ultrasound to see how far along you are.

Your OB may have the equipment to do a quick pelvic ultrasound in the clinic to “date” your pregnancy (determine how far along you are). However, if your clinic doesn’t have the ability to do the ultrasound during your initial appointment, your provider will order an ultrasound to be done at a later time. You can read more about what to expect at your initial ultrasound here.

5. You will have a full panel of bloodwork drawn.

There are a lot of factors to monitor in pregnant mommas for her safety and baby’s. Blood tests will rule out any infectious diseases that could be passed on to baby. They also establish a record of baseline results for mom. Labs can also help diagnose any conditions that may need to be treated or monitored throughout pregnancy. A more detailed discussion of the bloodwork ordered and why can be found in this post.

6. You will be offered a pap smear.

If you are over age 21, you will be asked when your last pap smear was done. If you have not had one within the recommended time frame (1-5 years depending on your age and previous test results), they will offer to do one at this visit. You may have heard from some women that they experienced miscarriages after pap smears during pregnancy. At this time, medical literature does not show any concrete link between pap smears performed during pregnancy and miscarriage. But, as they say the absence of evidence is not evidence of absence. In other words, we can’t say 100% that there is or isn’t a link.

If you are concerned, please discuss this with your pregnancy provider. They will be able to discuss your individual level of cervical cancer risk as well as the possible benefits of screening. They should also discuss whether or not you would want to do any further tests or procedures while you are pregnant if you were to have a positive screening test. Remember, you are the patient and you are your best advocate. You have the right to ask any questions you may have in order to give informed consent. And if you do not feel comfortable you have the right to decline or defer any tests or procedures until after delivery.

7. You will be counseled on any chronic conditions.

If you have any chronic conditions or take any medications, your doctor or midwife will go through your medication list to make sure everything is safe for pregnancy. They may also recommend changing certain medications that could have harmful effects to your baby or add certain medications depending on your lab results or pre-pregnancy conditions. If you have a lot of risk factors for pregnancy complications, you may be referred to a maternal fetal medicine specialist. MFM physicians are OB/GYNs who pursue additional years of training in managing complex pregnancy cases.

8. Be ready to talk about unhealthy habits.

In the USA, 41.6% of pregnancies are a surprise!² If you have been trying to conceive, you may have already read this post on things to do before getting pregnant. But if this baby is a surprise, you may not have been as prepared. It’s never too late! Now is the time to make informed choices to keep you and baby healthy.

If you do smoke, drink alcohol, or use recreational drugs, your pregnancy provider will take this opportunity to advise you to quit. The first trimester is when baby’s organs develop and when most malformations, although rare, would occur. So it is important to avoid anything that can disrupt normal development as soon as you find out you are pregnant.

There are many programs and treatment options to help moms with substance use disorders (including opioid addiction) quit during pregnancy. If you need help, please discuss this with your pregnancy provider. It may feel uncomfortable to bring up, but your healthcare provider isn’t asking questions to be judgmental, but to help both momma and baby to be as healthy as possible.

9. You will receive education on the common side effects of pregnancy and remedies.

You may already be experiencing some of the side effects of pregnancy. At your initial appointment, your provider will discuss what side effects you are having and offer safe treatment options. Most clinics also provide a handout with common side effects and safe solutions that you can always refer back to.

10. Expect to talk about abnormal symptoms to watch for and when to call to the clinic.

During the first trimester of pregnancy, many women experience common symptoms such as nausea, vomiting, constipation or heartburn. But, it is important to know which pregnancy symptoms are normal and which are abnormal so you can receive speedy care. Some of the symptoms you may call your clinic for include: burning with urination, vaginal bleeding, or severe nausea and vomiting. Your doctor may also recommend calling if you are hospitalized or go to the ER for any reason. Consult with your doctor or midwife for a more comprehensive list of things to watch for.