Pregnant or planning? Congratulations on your journey to parenthood! A lot of people are unsure about what to expect at their first prenatal appointment. Some are expecting an ultrasound or perhaps to hear the baby’s heartbeat. Others bring their whole excited family expecting a grand event, only to be disappointed with an hour wait and a rushed appointment. So let’s discuss what actually happens at your first prenatal appointment.
If you have gone to a doctor to confirm your pregnancy you likely took a urine test and /or did bloodwork to confirm the pregnancy. From there you may follow up with your family doctor until your primary maternity care providers takes over. If you have chosen midwifery care you do not need a referral from a doctor, you can simply go online and fill out the intake form or call the clinic. Midwives will usually first see their clients early in the first trimester.
If you have an obstetrician (OB) you likely won’t have your first appointment until the second trimester. Your family doctor will provide your obstetrical care until that time. Therefore your family doctor will manage your initial care and then transfer your records to the OB when they take over your care.
So what happens at your first appointment?
At your intake appointment your antenatal forms will be completed. This includes an obstetrical and medical history as well as a brief physical exam. What’s important to know is that you will be asked personal questions like have you had any miscarriages or abortions, have you had any sexually transmitted infections and do you experience violence in your home? Being honest is important as the answers to these questions may require certain care considerations. So if you’re bringing someone to your appointment you need to be comfortable answering these questions in front of them or be comfortable enough to ask them to step out during this part of the appointment.
You might not hear the baby’s heartbeat
It can be difficult to hear the fetal heartbeat with a doppler during early pregnancy. Therefore, if you are less than 10 weeks pregnant at your first appointment you will likely need to wait until a future appointment to hear your baby’s heartbeat. Don’t be disappointed or worried if there is an unsuccessful attempt at hearing the heartbeat because it is completely normal not to hear it yet. If your provider does ultrasounds in the appointment room you may get a chance to hear the heartbeat during that first appointment, depending on how far along you are at the time.
A prenatal physical exam is typically brief. Usually your midwife or doctor will listen to your heart and lungs, check your pulses and reflexes and assess your abdomen (ie check how your baby bump is coming along). You will be asked general questions about your health and discuss medications. It is important to list all medications, pills, herbs and supplements you take, even if you don’t think they’re important. If you have specific questions about certain supplements it would be best to bring them with you to the appointment so your provider has the full details.
Genetic testing, ultrasounds and bloodwork
Another important part of your initial prenatal appointment is discussing upcoming testing. Usually, you will be asked to do a urine sample at the office so try not to pee right before your appointment, if possible. This sample is used to test for infections. You will likely get requisitions for bloodwork, genetic testing and ultrasounds. All of these tests are optional, although they may not be presented that way. All pregnant people in Ontario are offered genetic screening. The standard test offered is called the first trimester screen (FTS). This test uses a combination of ultrasound and bloodwork to identify if there is a risk of your baby having trisomy 21 (Down Syndrome) or trisomy 18. This is a screening test, it is not diagnostic. That means the test will not tell you whether or not your baby has one of these conditions, it will tell you the risk of your baby having those conditions. This test needs to be done between 11 and 14 weeks and requires you to do the bloodwork and ultrasound on the same day. Often you can pair your prenatal bloodwork with this screening test if you plan to do both sets of testing. The ultrasound needed for the FTS can also be your dating ultrasound (an ultrasound that establishes the gestational age of the pregnancy and your due date).
If you have questions about these standard tests please ask your midwife or doctor and do your own research. It is best to have your questions ready before the appointment so that you can ask while you are there discussing the topic.
Often newly pregnant people come to their first appointment with an exhaustive list of questions only to be rushed in and out having barely scratched the surface. Midwifery intake appointments tend to be 30-60 minutes long and offer ample opportunities for questions. Informed choice is a core principle of midwifery care and therefore giving information and answering questions is a significant part of each appointment. Obstetricians usually have shorter appointments that last 15 minutes or less. Try to have your questions written down and keep them concise to increase the likelihood of getting them answered. Regardless of your maternity care provider there may not be time to answer all of your questions in one appointment so try to prioritize.
It’s your choice
There is a lot of information to exchange at your first prenatal appointment so don’t be disappointed if it’s not a very social visit. However, you should have a sense of your midwife or doctor and learn about the course of care they provide. You will likely leave with requisitions, hospital registration forms and an understanding of who to contact in case of emergency. Remember that (in most cases) you can choose your primary maternity care provider. Although your family doctor may send a referral to a certain care provider you can still do your own research and if you find someone you prefer, you can choose to change providers. You will need to contact your family doctor to transfer your records and referral to the new midwife or OB. Once care is confirmed with the new provider you should contact the previous office to let them know you’ve switched providers. This is best done early in your pregnancy so choosing a care provider should be one of the first things on your to-do list.
Those are the main things that will be covered during your initial prenatal appointment. In some cases you may do this once with your family doctor and again with your primary maternity care provider. We hope this information leaves you more informed about what’s to come. If you still have questions, feel free to leave them in the comments or contact us.