Newly pregnant and wondering what happens at your first medical appointment? Here’s Seven Starling's overview of the key health info, screenings, questions to ask, and planning tips we find most helpful for your first prenatal health care visit. Whether you just found out you're pregnant or have been trying to conceive, here you are in your first trimester - congratulations! Early prenatal care is essential - read on for what to expect of your first prenatal appointment and how to plan for the smoothest experience.
Scheduling Your First Prenatal Visit
- When to Get Prenatal Care
- Prenatal Care Options
Preparing for Your Visit
- Your Key Health Info
- Family & Partner Health Histories
- Questions for Your Provider
First Prenatal Appointment Expectations
- Confirming & Dating Pregnancy
- Physical Exams & Lab Tests
- Discussing Pregnancy Health, Safety and Goals
Scheduling your first prenatal visit
Early access to prenatal health care is one of the best measures for supporting pregnancy health and the well-being of expectant individuals and families. Medical care from a skilled maternal health professional can help you to move through pregnancy safely, getting treatment if any complications arise, receiving care and tips for common discomforts and symptoms, and planning for your whole family’s health as you anticipate life with a newborn and postpartum recovery.
When should I start prenatal care?
Whether someone has been trying to conceive or experiences an unplanned pregnancy, it usually takes some time for the signs and symptoms of pregnancy to show up, and about two weeks (or longer) from the time of conception for a pregnancy test to show an accurate result.
Once you feel confident that you are pregnant, it is a good idea to contact your prenatal health care provider. This may or may not be the primary care provider you see for your general health, and it may require you to set up a new patient appointment if you are seeing a new practitioner. Options and timing will vary a bit with insurance, the area you live in and the facilities near you, but you’ll want to see a medical professional quickly so that your pregnancy can be confirmed with a blood test - then you will be eligible for the next steps in prenatal care that insurance only covers with a medical pregnancy confirmation.
What are my prenatal care options?
If you aren’t already an established patient with a medical health care practitioner who serves pregnant and birthing people, you may have some options about what type of professional you work with. You may also be able to switch providers if you find that you and your current team are not on the same page, or you discover a practice that feels more aligned with your goals and needs. In the United States, depending on your existing health, the status of your pregnancy, and where you live, you may be able to see these types of providers for your care:
- A certified professional midwife (CPM) who works in a birth center, private practice, or serves healthy, low-risk clients in their home.
- A certified nurse midwife (CNM), who works in a birth center, private practice or hospital setting and may or may not choose to work with certain clients at their home.
- An obstetrician (OB), who may also be a gynecologist (GYN) and may work in a private practice or be part of a larger medical group, usually serving clients in the clinical and hospital settings. They may specialize in high-risk fetal-maternal medicine or have other specific training.
- In some states, other care providers such as family physicians or nurse practitioners may oversee someone’s prenatal care.
Although both are primary medical care providers for pregnancy, midwives and OB/GYNs have different specializations and work with clients in different risk groups, so your health and how your pregnancy unfolds may determine the most appropriate care for you. Generally, you can expect to see your provider more frequently as pregnancy continues, and certain universal screenings will be given at certain stages of pregnancy. There are other considerations of care approach, structure of the care relationship, and cost that may also influence what type of provider you choose for your prenatal health care experience.
Preparing for your first prenatal visit
Whether you have been preparing for pregnancy or not, the first prenatal visit can feel like a big event! It marks the official start of your prenatal care journey and may make this pregnancy feel more “official”. It may also stir up anxious feelings, especially if you have any health concerns, feel nervous discussing your personal health with medical staff, or weren’t expecting to be pregnant at this time. Whatever your situation, there are some things you can do to prepare for your first visit that will help you to make the most of your time there and establish the team dynamic that will shape your care in the coming weeks.
Key health information
In order to best serve your health and that of your future child, your prenatal health care provider will want to learn about your health history. This helps you collaborate together in making informed decisions about your care, noting any risk factors, understanding unique preferences and concerns you may have, and making any necessary changes to your plan, your medications, or other health factors that will benefit you and your pregnancy.
Usually the first appointment will include a full intake process, but if you know what to expect, you can prepare by making a copy of your health records, writing down any current considerations you want to discuss, and making note of the following to the best of your ability beforehand:
- Your personal medical history - this includes any hospitalizations, illnesses, chronic or current conditions, including allergies and sensitivities.
- Your mental health history - this includes any clinically diagnosed illnesses such as depressions, any medication or treatment history associated with your mental health, or any significant non-medical mental health experiences you feel are relevant.
- Your gynecological/pregnancy history - this will include any previous pregnancies, any kinds of surgeries or hospitalizations, and also:
- The date of your last menstrual period (an accurate LMP helps estimate due dates)
- Birth control methods used recently and in the past
- Any history of abortions and/or miscarriages
- Any exposure to STI’s, STD’s, chronic illness or other health complications related to your genital and reproductive health
- Prescriptions, medications, supplements you use on a regular basis or for acute conditions should be reported, as some are safe during pregnancy, others are not, and still others might be safe at some stages and not at others, including breastfeeding.
- Personal use and/or exposure to drugs, toxins, environmental hazards and common substances such as caffeine, tobacco smoke, and over the-counter-pain medication.
Family history for you and partner
While a pregnant person and their health are central to any decision making or considerations for the duration of pregnancy care, their family history and that of their partner may come into play in the pregnancy itself or in the health of the baby. Some family histories will indicate a high risk for a genetic condition or illness, so ideally, if someone has the opportunity to plan for pregnancy, they can explore options for carrier screening ahead of time.
If you are living with and/or planning to co-parent with your baby’s other biological parent, their immediate health might influence your day-to-day interactions and mutual well-being - and by extension, your baby’s well-being. While this other adult’s physiology is not your own, and your physical health is the most direct determinant of your baby’s health, your shared lifestyle and exposure to potential risks will determine your long-term satisfaction and safety. Consider if any current or chronic health issues, physical or psychological, may benefit from treatment or additional consideration in your family’s optimal experience of pregnancy and life with a newborn.
Some general health histories are helpful to know for both biological parents, and if you have any of this information for grandparents, siblings or other close direct relatives, even better.
- History of having children with genetic anomalies impacting physical or cognitive function
- Prevalence and types of cancer
- Genetic conditions such as sickle-cell anemia or Tay-Sachs disease
- Challenges with substance abuse, alcoholism, etc.
- Mental health challenges (depression, bi-polar disease, schizophrenia, etc.)
Exploring your family histories can be difficult - it can also be a lot of fun, and an opportunity to learn more about your lineage or connect over shared excitement for the future. If this preparation for your first prenatal visit brings up questions or concerns about you or your partner’s health, it’s worth discussing with someone who can support you, whether that is a medical professional or a doula or counselor, in getting answers, accessing care, or making changes as needed.
Questions for your provider
There are many questions that might come up over the course of a full-term pregnancy, which lasts about 40 weeks. Here are just a few that you might ask in the early stages of your care - both to plan for realistic expectations of next steps, and also to assess if your current prenatal health care provider is the right fit for your family’s care and birth preferences.
Questions about your plan of care
- When will my next prenatal visit be scheduled?
- What type of testing do you recommend and when are they to be done? Can you provide me with a printed list or schedule? (This way you can reference and research before your visits).
- How often will we see each other, and will it be in-person each time?
- If everything keeps going the way it has been, how often will you….
- ….want to do a cervical exam?
- ….want to perform an ultrasound?
- ….need to do blood work?
- Are there particular appointments that I need to prepare for in a special way?
- Are there certain appointments that you think my partner or support person should definitely be present for?
- Is there anyone else in this practice that I will be meeting or working with regularly for my care?
- Do you recommend any alternative therapies, lifestyle tools or holistic methods? Do you have any referrals for acupuncture, massage therapy, physical therapy, etc?
Questions about off-hours medical support
- How do I reach you if I have a concern or question in between appointments?
- Is there a nurse line that I can call if I have urgent questions?
- If I experience bleeding or cramping, do I call you or your nurse?
- What do you consider an emergency?
- How do I access you once I’m actually in labor? Will you be on call for me?
Questions about pregnancy safety and lifestyle
- Will I need to change my habits regarding sex?
- What are your recommendations for exercise during pregnancy?
- Do you have any guidance to offer around my prenatal nutrition?
- I have concerns about _____________________ - do you have any resources or can you refer me to someone who can help me? (Ex: Quitting tobacco)
Questions about labor, delivery and postpartum
- What are your thoughts on laboring without medication or intervention? Do you think I am a good candidate for natural childbirth?
- Do you have experience supporting ________________________? (Ex: unmedicated labor, twins, VBAC, breech babies, etc.)
- What is your policy on labor induction? Do you have a preferred procedure or medication?
- What is your induction rate? What is your Cesarean section rate?
- What situations would warrant a Cesarean section in your practice?
- What situations would warrant an episiotomy?
- How long past an expected due date are you generally comfortable with someone going?
- What are your expectations about when someone comes in during labor?
- Do you offer any remote labor support while I am still at home?
- What are your thoughts on working with a doula?
- What is your perspective on postpartum recovery?
- How do you support lactation success and postpartum healing during our time together?
What happens at a typical first prenatal visit
The first prenatal visit includes a lot of foundational information to the continued care you will receive through your pregnancy. Along with the in-depth discussion and intake information we reviewed above, a number of physiological assessments are usually performed to get baseline information on your health, your pregnancy’s status, and potential risk factors to monitor or follow up on.
Pregnancy confirmation and estimated due dates
Even if you used an at-home pregnancy test and peed on a stick, you will likely be asked to provide a urine sample. This is the easiest way to confirm pregnancy, and may be followed up by a blood serum confirmation, along with other labs drawn that are described below. As you may have figured out before now, dating pregnancy and estimating due dates are rarely accomplished with 100% accuracy, but your prenatal care provider may be able to help you make a good guesstimate using:
- the date of your last menstrual period
- the typical length of your menstrual cycle
- when you think you may have conceived
- when you first tested positive for pregnancy
- your urine sample and the hormone levels measured in it
- your blood sample and the hormone levels measured in it
- an early pregnancy ultrasound to assess embryonic development
A physical exam
Depending on when you last had a general health check-up, some of these may not be necessary, but in general your prenatal health care provider will want to document all of your vital signs and do some reproduction-specific screening.
- Blood pressure, oxygenation levels, height, and weight
- Breast exam of the nipple, areola, breast tissue and underarm tissue
- Pelvic exam using a speculum in the vagina
- Pap smear (a culture taken and looked at under a microscope to see changes in the cells of the cervix)
- Possible abdominal or transvaginal ultrasound
Prenatal tests and screenings
In addition to the tests done to confirm your pregnancy and check on the immediate health of you and your baby, you will likely be asked to give a blood sample so that labwork can be done to test for certain features of your blood health during pregnancy, potential for carrying genetic conditions or disease that could impact you or your baby, and other tests based on specific risk factors unique to the health or family history you shared.
Most of these tests are primarily for baseline information - if something comes up in a screen that indicates any further action, your provider should discuss the test results with you and your options for next steps, if any are recommended. Lab work done in the first visit or at another appointment in early pregnancy may include tests for:
- Hemoglobin/ hematocrit levels (related to red blood cell health)
- Blood sugar (glucose levels) (also tested again later in pregnancy)
- Rh Factor and blood type (rescreened at 26-28 weeks if Rh negative)
- Varicella or history of chickenpox, rubella, and hepatitis vaccine
- Screens for Cystic Fibrosis; Tay Sach’s disease; Sickle Cell anemia
- Hepatitis B surface antigen
- HIV test, STD testing
- Specific tests for patients with higher risk, such as tuberculosis and Hepatitis C
Discussing prenatal health goals and concerns
There is a lot to cover in the first prenatal visit and it may not be possible to ask all of the questions listed above, but your prenatal health care provider should definitely make time to address your most pressing concerns and help you make realistic plans to meet your pregnancy health goals. Along with discussions of your current health and what to expect of your prenatal care, your provider will likely want to go over some things to avoid while pregnant to protect your health and your baby’s development.
Provider style, conversational manner, and the amount of time you will have to discuss these topics will vary greatly, which is why we recommend that you:
- Write down your most important questions ahead of time.
- Discuss your main concerns and goals with your partner or primary support team so that you are both on the same page about what to prioritize in this discussion.
- Write down or highlight the questions that you didn’t have time for or want to follow up on at another time.
Realistically, however, even in a short appointment, your prenatal health care will at the very least discuss or provide materials on:
- Recommendations concerning dental care while pregnant
- Daily exposures to avoid, such as cat litter, raw meat, and certain fish
- Fevers in pregnancy, over the counter-pain medication safety, and other medications
- Environmental hazards (may be specific to workplace or geographic location)
- Travel limitations (may vary at different stages of pregnancy)
- Miscarriage precautions (also see our review of pregnancy symptoms including concerning ones)
- Prenatal vitamins, supplementing with folic acid to prevent developmental problems, supplements, herbs safe in pregnancy, etc.
Your care provider will also likely have some opinions about weight gain during pregnancy, exercise, movement, nutrition and general health. They may reference their medical concerns, tools like the BMI calculator, and your health history in their assessment. Sometimes these conversations are helpful, but as most physicians are not specialists in nutrition or movement, and both topics are frequently misunderstood and can be very personal, if you find the conversation brings up confusion, more questions, or doubt, it may be worth doing more research, discussing further, or consulting with a professional nutritionist or someone else who has insight into nourishment and exercise during pregnancy.
The goal of this initial appointment is to get you and your care team on track for the remainder of your prenatal health care, support you in making healthy decisions for you and your growing baby, and to take action on any risks or concerns that can be addressed at home or through treatment. Let your first prenatal visit be a starting point for informed, collaborative care with your prenatal providers, and know that social support, ongoing education and comprehensive planning tips like these are all available at Seven Starling, from conception to toddlerhood.