Review Your Insurance Policy Regarding Pregnancy Coverage.
Vaccinations Before Pregnancy. It’s best that you receive your vaccinations before you become pregnant. Schedule a preconception exam with your health care team to make sure your “adult” vaccinations are up to date. It is generally advised that you wait one month following any vaccination to become pregnant. Be sure to thoroughly research any vaccination or medication recommended to you during pregnancy. Your health care team may or may not advocate vaccinations during pregnancy.
Congratulations! You have a positive pregnancy test (Weeks 4-5).
Choosing Your Health Care Team. If you have not already done so, start interviewing OBs, Midwives, and other health care professionals. You will want to choose your health care team for your pregnancy and schedule your first prenatal appointment during Weeks 8-12.
hCG and Progesterone Levels. These hormone levels may be checked especially if you have a history of miscarriage. This test may be ordered before your first visit.
Request Estimated Placental Volume (EPV). This measurement will make sure your placenta is the correct size to nourish your baby adequately. Measure at every ultrasound.
Lifestyle Changes. It’s time to make a few changes to your lifestyle if you haven’t already. Avoid seafood high in mercury and enjoy one seafood entrée per week. Begin choosing low-mercury seafood like salmon, which contains omega-3 fatty acids, providing health benefits for you and your baby. Cut out deli meats and foods high in sugar and refined carbohydrates. Remove or limit caffeine. Eliminate smoking, drinking alcohol, and using any and all drugs (over the counter or otherwise). Use the best hygiene possible. Stop changing cat litter pans and cease sharing drinks and food with small children to prevent infections that pose a major risk to pregnant women and their developing babies. The goal is to keep you healthy so your baby will have the best start possible.
Exercise Options. If you already did some kind of exercise prior to becoming pregnant, talk with your health care team to see if you should continue or change you program. If you did not exercise prior to becoming pregnant, now is not the time to begin a vigorous routine. Discuss all exercise options with your health care team.
Your First Prenatal Visit. You will most likely provide your health care team with your complete medical history, a pap smear, a blood test, urine test, and your blood pressure and weight. An ultrasound will confirm your baby’s heartbeat and gestational age according to your baby’s size. Your prenatal protocol will be based on your age, medical data, and any previous pregnancy outcomes. Share any and all concerns, questions, and symptoms during this visit.
Rh Factor, Positive or Negative.
hCG/Progesterone Values, if applicable.
Toxoplasmosis/Cytomegalovirus Screening, if applicable.
Genital Herpes, if applicable.
Urine: Group B Strep (GBS), Positive or Negative.
Urine: Protein, Ketones or Sugar.
Ultrasound: Heart Rate
Ultrasound: Gestational Age and Estimated Due Date.
Ultrasound: Cervix closed.
Ultrasound: Placenta, Posterior or Anterior.
Ultrasound: Note any abnormalities such as Placenta Previa and Tilted Uterus.
Ultrasound: Request Estimated Placental Volume (EPV). This measurement will make sure that your placenta is the correct size to nourish your baby adequately. EPV should be measured at Week 10 and Week 18. Visit My Pregnancy, First Trimester, Week 10 for more information.
Ultrasound: Cord Insertion Site, Central, Marginal or Velamentous.
Begin Your Pregnancy PUR$E. By saving $10 per week, this savings account will allow you to schedule an additional ultrasound that is recommended around Weeks 28-30 in case your insurance company does not cover this expense.
Further Tests. Your health care team will help you to decide which tests are right for you.
If you are over age 35 or have a family history of genetic disorders, discuss with your health care team if you need Chorionic Villus Sampling (CVS). This test is usually done between Weeks 11-13. It is more invasive than a blood test because a sample of the chorionic villus from the placenta is taken, which has potential risks. This testing will reveal genetic disorders such as Tay-Sachs disease, Cystic Fibrosis or a chromosomal abnormality such as Down syndrome.
If you are high risk for genetic disorders or over the age of 35 and choose against CVS, you may want to utilize a new genetic maternity blood test, the MaterniT21™PLUS. This is a simple blood test that can be done as early as Week 10 and may be a good alternative to CVS.
A Nuchal Translucency Screening Test (NTS) can be done between Weeks 11-14 when the skin on the back of your baby’s neck is still transparent. This screening for chromosomal abnormalities gives families important information on potential outcomes as early as possible. First trimester screening results can be combined with second trimester screening results to detect Down syndrome and Trisomy 18. This testing provides an estimate of risk only. A positive result, which indicates an increased risk, does not mean your baby has a problem. Your medical provider will simply measure the thickness of fluid at the back of your baby’s neck during an ultrasound. They can use this information together with two additional tests to provide more accurate results of a possible chromosomal abnormality. Keep in mind, these test results are not guaranteed. They only help give the odds of potential abnormalities that may cause your health care team to monitor your baby more closely, or change your prenatal protocol based on their findings.
The Quad Marker Screen. A blood test performed between Weeks 15-20 to determine if you are at a higher or lower risk of carrying a baby with a birth defect such as Down’s syndrome or an Open Neural Tube Defect (NTD) such as Spina Bifida or Trisomy 18, as well as other vital information about your baby. This test predicts the likelihood of a problem with your baby; it does not diagnose the problem. You will want to discuss with your health care team if this test is the right choice for you.
Be Aware of Your Sleeping Position. Sleeping on your left side may improve blood flow to your baby.
Be Aware of Fetal Hiccups. Your baby may hiccup; learn your baby’s hiccup timetable. Although some babies hiccup until delivery day, by Week 32 hiccups should lessen in frequency and duration. If beyond Week 32, your baby suddenly begins experiencing hiccups, is experiencing hiccups that last longer than 15 minutes, or is having a series of hiccups 3-4 times within 24 hours, ask your health care team to evaluate you as your baby may have umbilical cord issues.
Be Aware ofIntrahepatic Cholestasis(ICP). This isaliver disorder affecting 1-2 women per 1000 that may occur during pregnancy. Itching is the most common symptom.
Research Childcare Facilities.
Recheck EPV at Every Ultrasound.
Preeclampsia. This condition can occur during the last half of your pregnancy and is typically hallmarked by a rise in blood pressure. Protein may be present in your urine. Your health care team should evaluate you at every visit beginning at Week 20 to make sure that you are not exhibiting any signs or symptoms of preeclampsia.
Your 20-Week Ultrasound. This ultrasound examines your baby’s anatomy and his or her uterine environment. Both the umbilical cord and placenta should also be carefully assessed for normal development and position. Recheck EPV. Count ten fingers and ten toes!
Start Your Baby’s Movement Journal. Get to know your baby and start jotting down when he or she begins moving. Knowing your baby’s movement patterns lets you to know that your baby is well and will enable you to easily move into daily Movement Counting beginning around Week 28. Remember, a change in your baby’s movements such as speeding up or slowing down, or changes in sleep-wake cycles can be a sign that your baby is not well. Call your doctor, midwife, or health care team with any questions or concerns, or even better, just head on in for a quick checkup on your baby.
Be Aware of the Symptoms of Preterm Labor. These contractions are different than Braxton Hicks. A few indications of preterm labor are contractions at recurring intervals, four or more contractions per hour that may or may not become stronger, and may include low backaches, spasms or twinges. Other possible signs are alterations in your vaginal secretions such as bleeding, spotting, or water emitting or oozing from your vagina. If you experience any of these symptoms, call your health care team and go to Labor and Delivery (L&D) for further evaluation.
Measure Fundal Height. Fundal height measurements will let you and your health care team know if the placenta is supplying adequate nourishment to your baby. Your fundal height measurement will usually equal your gestational week in this trimester. So if you are at Week 28, your fundal height measures approximately 28 centimeters. Keep in mind, this is not a precise measurement and it is not uncommon to have a fundal height smaller or larger than anticipated. If you’re concerned about an atypical fundal height measurement, an ultrasound or other tests may be recommended to determine the cause.
Cord Blood Stem Cells. Begin to think about what you would like to do with your baby’s cord blood now as your decision must be made prior to delivery day. Stem cells are the building blocks of the body, and have the ability to create our organs, blood, tissue, and the immune system. The youngest, most flexible stem cells in the body come from the umbilical cord. Cord blood stem cells are not embryonic stem cells, so collecting, storing, and using them is not controversial.
Amniotic Fluid, Polyhydramnios and Oligohydramnios. Amniotic fluid (AF) is the watery fluid surrounding your baby inside the amniotic membrane (sac) and is an essential part of pregnancy and fetal development. Too much amniotic fluid, polyhydramnios, or too little amniotic fluid, oligohydramnios, may cause complications. Usually 500-1000 ml of fluid is present during a normal pregnancy. During an ultrasound, if either condition is diagnosed, you will be closely monitored for your baby’s level of mobility.
Decide Where to Deliver Your Baby.
Research Childbirth, Sibling and Infant CPR Classes.
Glucose Challenge Screening. This version of the Glucose Tolerance Test is usually done between Weeks 26-28. You will be screened for Gestational Diabetes, a type of diabetes present only when you are pregnant.
Begin MovementCounting Around Week 28. Since prenatal appointments are not on a daily basis, it is up to you to pay close attention each day to your baby’s movements. By simply counting your baby’s movements, ideally three times a day, this noninvasive, easy and free method allows you to get to know your baby’s movement patterns making sure your baby is well. Visit My Pregnancy, Third Trimester, Week 28 for specific movement counting directions.
Request an Ultrasound. This ultrasound will examine the position of your baby’s umbilical cord and check for the normal development and position of the placenta. Recheck EPV. If your ultrasound is not covered by your insurance company, use your Pregnancy PUR$E towards this test. If you and your health care team determine that your baby should have further monitoring following your ultrasound around Week 28, or you are considered high risk, don’t panic! It is comforting and reassuring to know that your baby is healthy with frequent monitoring. Four main reasons for monitoring your baby are: to ensure that your baby is comfortable in utero, to check that his or her heart rate is normal and steady with no significant deceleration (decels) present, to be sure that your placenta is working properly and not showing signs of aging or failure, and to check for signs of preterm or premature labor.
Ask Your Health Care Team to Look for ALL Potential Cord Problems. A Cord Blood Flow Doppler Test (Cord doppler Test) can be easily performed by a simple push of a button during any ultrasound. This test is preformed to check the blood flow within the umbilical cord. It can be used to detect umbilical cord issues such as a nuchal cord (the cord encircling the baby’s neck), knots, kinks, twisting, torsion, or if a cord is too long or too short. Early detection of all cord issues can allow mom to be monitored more frequently and may help prevent further complications.
Ask Your Health Care Team to Monitor a Nuchal Cord if Present. A nuchal cord is extremely common and most babies can wriggle their way out of one. Still, all nuchal cords have the potential to be problematic. The most important aspect of dealing with any type of umbilical cord issue is to be aware of its presence. So if your baby starts having changes in patterns of movement and heart decelerations when monitored, you may know the probable cause. If your baby does not wriggle out of his or her nuchal cord and it remains in place, discuss with your health care team about the need for closer monitoring, such as frequently scheduled visits at your health care team’s office or at your hospital, ultrasounds (ultrasounds are the only way your baby’s umbilical cord can be seen), BPPs, NSTs, very diligent movement counting, and daily home fetal heart rate monitoring.
Request a Fetal Non-Stress Test (NST) and a Biophysical Profile (BPP).These tests can be done as a one-time occurrence based on symptoms found or as needed. They can also be done regularly for a high-risk patient or even just a worried mom. Don’t be afraid to ask or demand these tests based on your instinct. Mom knows best!
Fetal Non-Stress Test. The first test, a NST, will monitor and evaluate your baby’s heartbeat. This test usually starts in the third trimester (for high-risk moms as early as Week 28) for moms and expected babies who need special care and monitoring. A condition such as diabetes or hypertension, a blood clotting disorder, an amniocentesis follow-up, Intrauterine Growth Restriction (IUGR), carrying a baby who is small or not growing properly, carrying a less active baby, passing your due date or a previous loss usually warrants regular NSTs.
Biophysical Profile.A BPP combines both fetal heart rate monitoring (NST) and a fetal ultrasound. Your baby’s breathing, heart rate, movements, muscle tone and amniotic fluid levels are calculated and scored. This simple combination of testing does not cause any physical danger to you or your baby. A BPP is normally performed after Week 32. It may, however, be considered as early as Weeks 24-26 if your doctor is planning an early delivery. A score of 8-10 is the ultimate goal. A score of 6 or less indicates that you and your baby need further testing or immediate delivery.
Vaccinations at Week 28. Influenza (Inactivated) and Tdap vaccinations may be recommended now; research and discuss receiving them with your health care team. The Tdap vaccine is also suggested for relatives, friends and caregivers who will spend time with your baby.
Request Additional Third Trimester Testing. Around Week 30, speak with your health care team about the possibility of including two NSTs per week and one BPP (one with a Cord Doppler Test) every other week for the remainder of your last trimester. These vital checkups will provide the opportunity to detect any problems, especially with your baby’s lifeline at this time: the placenta and the umbilical cord. No matter how many tests or visits you receive, do not forget to do your movement counting if possible three times a day.
Continue to Monitor Your Baby’s Movements.Your baby’s movements and heart rate will basically stay the same during the last trimester of your pregnancy. All moms need to continue being their baby’s guardian up until delivery day. Remember, a change in your baby’s movements such as speeding up or slowing down, or changes in sleep-wake cycles can be a sign your baby is not well. Call your doctor, midwife, or health care team with any questions or concerns, or even better, just head on in for a quick checkup on your baby. If you are unable to reach your health care team or feel things are more urgent, just go to L&D or the nearest Emergency Room (ER). The L&D nurses are always happy to reassure a worried mom. Always trust your instincts. Continue movement counting preferably three times a day.
Inform Your Insurance Company of Your Expected Baby’s Arrival.
Prepare for Breastfeeding.
Stripping Membranes. Avoid unnecessary, frequent or forceful cervical exams that may push bacteria closer to your baby. It is important that you discuss the benefits and risks of possible methods of induction with your health care team well before your due date. You may not be asked before “stripping” or “sweeping” of your membranes is performed. If you have tested positive for GBS tell your health care team not to strip your membranes.
Get Checked Between Weeks 35-37 for Group B Strep (GBS). If your urine tested negative for GBS early in your pregnancy, get checked now! Rectovaginal swab specimens will be taken and cultured to test for the presence of GBS. This test is extremely important because moms who test positivefor GBS must be given antibiotics during labor to prevent the transmission of this potentially lethal germ to their babies. If you tested positive for GBS early in your pregnancy, your health care team should have already chosen to treat you with antibiotics during labor and may not test you again. Please remind your health care team or nursing staff if you are positive for GBS on delivery day. If your baby develops a fever within the first three months following delivery, have your baby checked in the ER immediately.
Request an Ultrasound. According to Dr. Collins, an ultrasound around Week 36 could detect a potential problem with the umbilical cord or placenta making it a proactive pregnancy tool. The umbilical cord is a definite risk factor during the later part of your pregnancy and could compromise your baby. As mentioned in Week 28, UCAs, including nuchal cords, true knots, twists, torsion, kinks and long or short cords, account for 16 percent of the 26,000 yearly deaths in utero in the USA. That is at least 71 untimely deaths each and every day in our country. Dr. Collins states a UCA is not a “rare condition or event” and should be watched for especially in the last trimester of pregnancy. If you and your health care team determine that your baby should have further monitoring following this ultrasound, it is comforting and reassuring to know that your baby remains healthy with frequent monitoring. Four main reasons for monitoring your baby are: to ensure that your baby is comfortable in utero, to check that his or her heart rate is normal and steady with no significant deceleration (decels) present, to be sure that your placenta is working properly and not showing signs of aging or failure, and to check for signs of preterm or premature labor. Recheck EPV.
Prepare to Introduce Your Baby to Your Pets. Begin preparing your pets to meet the newest addition to your family. Start by letting your pets become familiar now with new scents and the furniture your baby will be using. With no surprises, homecoming introductions will be a success!
Continue to Monitor Your Baby’s Movements. Movements may or may not feel like specific punches and kicks; they can instead feel more like twirls, twists and jiggles. However, please be sure to pay close attention to these movements and always trust your instincts. Continue movement counting as suggested three times a day. You should still feel your baby’s movements every hour and they should not decrease, whatever the number of the kicks or strength of movement. Keep in mind that you are looking for anything different from your baby’s usual and normal routine. If you notice anything out of the ordinary, call your health care team and make a quick trip to L&D to make sure your baby is well.
Be Informed About Meconium. It’s possible that your baby could pass meconium, a solid greenish-brown waste in utero prior to delivery. If your water breaks or you notice a greenish-brown leakage indicating the presence of meconium in your amniotic fluid, call your health care team immediately, and go to L&D.
Your Plan if Your Baby Does Not Arrive by His or Her Due Date. Discuss with your health care team what your plan is ifyour baby does not arrive by his or her due date. If your baby has not arrived on time, please don’t be surprised or upset. You will need to discuss with your health care team when you should expect your baby, or the possibility of planning your baby’s delivery day. Ask, specifically, how long beyond your expected due date you will be allowed to wait if labor does not begin spontaneously? Will special tests be performed? Is an induction feasible? What about scheduling a C-Section? Ask many questions, assess the pros and cons to each option, and then make the best informed decision for you and your baby. Continue movement counting ideally three times a day until delivery day.