The “Normal” Pregnancy

Unless you're under the care of a midwife who visits you at home, getting pregnant begins a series of visits to the obstetrician's office. It's a period of time in which the types and frequency of visits are as varied as the doctors who attend the deliveries.

In this respect, the entire prenatal course is punctuated by a doctor's care plan that he has developed over the years and then which is fine-tuned to the unique presentation of your pregnancy.

There are two types of prenatal populations: Those pregnancies where everything is perfect; and the rest of us!

Either you’re normal or you’re not. Even the smallest concerns will warrant the melodramatic “high-risk” label so as to watch suspect conditions more closely.

We have to concentrate our attentions according to relative scales, and to this end we like to think that there are the normal and the high-risk pregnancies. These two groups are the most generalized divisions of surveillance for an obstetrician watching a pregnancy. “Normal” and “high-risk”, these are designations in that if there's any problem at all, a doctor will consider the patient and pregnancy high-risk.

In a normal pregnancy you can expect to see your obstetrician every three to four weeks in the beginning. Visits will become more frequent as your pregnancy advances until you begin having weekly visits during "countdown time" in your last month.

During pregnancy you can expect there to be a trigger-edge to reconsidering you "high risk" should any issues out of the "normal" develop. These include, high blood pressure, spilling protein in the urine, fetal growth abnormalities, abnormal ultrasound, and any number of things will justify moving you from the normal to the high risk. Of course, that's what obstetrics is all about—knowing which patients need extra care.

First Trimester

Until the completion of the first twelve weeks of pregnancy (ten weeks after conception), known collectively as the first trimester, your prenatal care will be primarily documentation of a healthy pregnancy, the general medical considerations as they pertain to your pregnancy, and addressing any questions you may have. Since pregnancy is a natural process, there usually aren’t any extraordinary measures taken to watch you, beyond “checking in” for your weight, blood pressure, and dip-stick tests, which look for illnesses that give themselves away by spilling warnings into your urine.

In fact, it’s hard to hear the fetal heart beat with a Doppler before 10 weeks, so a lot of this “documentation of a healthy pregnancy” consists of nothing more than a documentation of exclusions: no vaginal bleeding, no unusual vaginal discharges, no fevers, no unusual pain, and no troubling medical peculiarities. At many of these early visits, you will likely deal with physician extenders (nurse practitioners, etc.) since a lot of what is done is recording an interval history since your last visit and marking down mere measurements of the weight, blood pressure, and urinalysis.

An ultrasound can give your doctor the opportunity to peak in at a very early time, but because of the early gestation, even those measurements are limited. With many managed care insurance companies authorizing only one ultrasound per pregnancy, your doctor may want to wait a bit so as to get the most information from the one ultrasound.

The first trimester is also a clearinghouse of sorts to separate normal from high risk patients. For this reason, everyone initially undergoes an evaluation that consists of a physical exam and laboratory investigations (cultures and blood work). The first trimester will usually label you with something early if you’re going to end up in the high risk category later on. (Remember, the high risk club has very lax membership criteria, so don’t flip out.)

The initial work-up in normal pregnancy is a careful history and a thorough exam that includes vaginal cultures for STDs, a Pap smear, and a determination to see if the uterine size is appropriate for the gestational age (the result of which may prompt an ultrasound). Blood work will check for anemia, syphilis, hepatitis (disease or carrier), HIV (AIDS virus), blood type, immunity to Rubella, and perhaps immunity to Toxoplasmosis or Chicken Pox. Racial genetic concerns are addressed, like Sickle Cell and Tay-Sachs. Sensitivity to the risk of miscarriage is heightened during the first trimester.

You will be appraised of the protocols unique to your doctor and given instructions, precautions, and prenatal vitamins, among other things. The real hubbub of the first trimester is vigilance over miscarriage. The first 12 weeks of pregnancy is the time when miscarriage is most likely and up to 20 percent of diagnosed pregnancies end up miscarrying due to genetic mishaps at conception.

But assuming all is well and normal and in every way unsuspicious, you can expect your normal pregnancy to involve monthly visits that will continue usually until the end of your second trimester (24 weeks).