The goal of prenatal visits is to see how you and your pregnancy are doing and to provide you with information to help keep you and your baby healthy. Your doctor will

• check your weight, blood pressure, and urine;
• measure your abdomen; check the position of your baby;
• listen to your baby's heartbeat;
• perform other exams and order tests, as appropriate;

and closely monitor any complications you have or develop and intervene if necessary.

Depending on the visit, you may also learn about warning signs to watch for, receive counseling on lifestyle issues, such as the importance of good nutrition and avoiding tobacco, alcohol, and drugs, or discuss the pros and cons of optional tests that you may want to consider.

Pregnancy is timed from the first day of your last period and is represented by weeks from that point onwards. Your estimated due date is at the 40 week mark, but "term pregnancy" is from 37 to 41 weeks and this is when the majority of women deliver. As well, pregnancy is divided up into trimesters:

• The first trimester goes until 12 weeks
• The second trimester goes from 13 to 27 weeks
• The third trimester goes from 28 weeks until 42 weeks

You'll see a lot of your obstetrician during your pregnancy. Most pregnant women have between 10 and 15 prenatal visits.That's why it's so important to choose someone you like and trust.

Typically, a mom-to-be will visit her doctor every four weeks during the first and second trimesters, once every two weeks after 28 weeks, then weekly from 36 weeks until the baby is born. If you've had any medical problems in the past or develop any new problems during this pregnancy, you may need additional prenatal visits.

Bloodwork called a ‘prenatal panel‘ is done in the first or second trimester of all pregnancies and includes your blood type, a check for anemia, and also hepatitis B and HIV testing. Further labwork is done around 26 to 28 weeks to screen for gestational diabetes (diabetes of pregnancy) and recheck for anemia. If you are Rh negative, an additional blood test called an antibody screen is done at the same time. Learn more about routine tests in pregnancy.

An ultrasound is done between 18 to 20 weeks to ensure baby is growing properly and to complete a checklist on baby's well being. This ultrasound cannot tell us everything about your baby but is usually an enjoyable experience and if you wish, the technician can usually tell you if you are having a boy or a girl. Other ultrasounds maybe be done before or after this ultrasound depending on how you and your baby are doing and which optional tests you wish to pursue.

Around 35 to 36 weeks, your obstetrician will usually check your cervix and at that time do a routine swab for Group B Strep. Learn more about Group B Streptococcus.

You can decide whether or not to do labwork to see if you carry the gene for cystic fibrosis. Learn more about cystic fibrosis carrier testing.

To see if you are at increased risk for having a baby with Down's Syndrome or Trisomy 18 (similar condition to Down's syndrome but even more severe condition) you can opt to do additional testing. You could do an ultrasound and labwork around 11 to 14 weeks (‘Firstscreen‘, sometimes called "Ultrascreen") or just do labwork between 15 and 20 weeks ("Quad Marker" testing). These screening tests are non-invasive. They do not pose a risk to your pregnancy.

To see if you at increased risk for having a baby with Spina Bifida or other forms of Neural Tube Defects, you can opt to do additional screening labwork between 15 and 20 weeks. If you have already done the 'Firstscreen', then this a single additional lab test. If you are doing the "Quad Marker" testing, then testing for Spina Bifida and other forms of Neural Tube Defects is already included. If your test comes back with an elevated risk, then particular attention will be paid to the evaluation of your baby's spine and skull on your 18 to 20 week ultrasound.

For women who will be over 35 at delivery or have a personal or family history of certain genetic problems, other initial options for further genetic testing are chorionic villus sampling (CVS) which usually occurs around 10 to 14 weeks and amniocentesis (amnio) which is usually around 15 to 20 weeks. CVS and amnio are called ‘invasive‘ tests as they do carry a very small risk of miscarriage.

For more information, ACOG provides pamphlets on Screening for Birth Defects and Diagnosing Birth Defects.

Many women look forward to their prenatal appointments but are disappointed to find that, with the exception of the first visit, they're in and out of the office in a short time. A quick visit is usually a sign that everything is progressing normally. If you feel like you don't have enough time to voice your concerns, though, take these steps before your next appointment:

• Write down your concerns and bring the list to each appointment so you can run through it with your provider. And if anything else is bothering you, speak up. Your practitioner will gladly take the time to discuss and explain anything that may be of concern to you.
• Ask the staff about the administrative issues. Save your questions about things like insurance and directions to the hospital for the office staff so your provider has more time to answer your important questions.
• Be open-minded. When talking with your doctor, you should feel comfortable speaking freely, but remember to listen, too. And keep in mind that some days are busier than others. That doesn't mean your provider doesn't have to answer your questions, but sometimes a discussion can be continued at the next visit if it's a really busy day or he or she needs to head to the hospital to deliver a baby.

Taking prenatal classes and breastfeeding classes are optional but strongly recommended for first time moms. Other classes to consider taking are Infant CPR and Boot Camp for Dads. Consider calling to signing up for these classes during the middle of your second trimester and try to have them completed by mid third trimester.

Our affiliated hospitals, Good Samaritan Hospital and St. Vincent Medical Center, offer prenatal classes via their Patient Education Departments.

Any vaginal bleeding should be reported, although spotting at various times is fairly common. Cramping, intermittent low backache or low abdominal pressure, or a gush of fluid from your vagina should be reported as well as signs of infection such as fever, vomiting, or burning with urination. Complications of pregnancy can also begin with severe headache, visual disturbances, sudden weight gain, or abdominal pain. You should be feeling fetal movements by 22 weeks; report any sudden decreases in your baby's movements or activity level after 28 weeks. Early detection and treatment of problems will help both you and your baby to continue a safe pregnancy.

Labor at full-term is characterized rhythmic menstrual-like cramps or contractions that gradually become stronger and closer together. Contractions are usually strong enough to interrupt your ability to walk or talk. Sometimes this process can occur more quickly, especially if you have had a baby before. Most women go to the hospital when the contractions are every five minutes or more often, but if the pain is getting unbearable or if you have had a baby before, you may want to head to the hospital earlier.
Premature labor (prior to full-term) can be completely painless and might only feel like a rhythmic tightening of the uterus or mild pressure and should be reported to the office immediately.

Sometimes the first event marking the onset of labor is leakage of the bag of water and this may occur without any contractions. If you are over 36 weeks and think your bag of water is broken and leaking, please call the office — if it is after hours, you may consider proceeding directly to the hospital.

Be sure to call if you experience any bleeding as this could be a sign of a problem. Do not confuse a jelly-like colored discharge with bleeding as this may be the ‘mucous plug’ or ‘bloody show’ neither of which carries significance at term.

Some women in labor do not have these classic signs, as there is great variability in the labor process. Please always call if you have concerns or questions.

Check with your insurance carrier to determine whether you are able to deliver at Good Samaritan Hospital or St Vincent Medical Center. Even if your insurance carrier has a preferential hospital, you may be able to deliver at the other hospital for a different out-of-pocket cost or by a ‘rate-match‘ - be sure to speak to your obstetrician if this is something you would like to investigate.

To register at the hospital, you can fill in the Registration Form found in the hospital package given to you at your first prenatal visit and mail it into the hospital. If you wish to deliver at St. Vincent Medical Center, you can go online and register. Consider registering at the hospital in mid to late second trimester - you will find it more convenient to be pre-registered by the time you need to go the hospital for a pregnancy concern or for your delivery.

You may choose a pediatrician or family doctor to look after your newborn. If your baby's doctor does not have privileges at the hospital you are going to deliver at, then your baby will be looked after by one of the on-call pediatricians while in the hospital. You can ask friends, family, and/or your obstetrician for suggestions on local baby doctors. Confirm with your pediatrician or family doctor that they are accepting new babies and your insurance to ensure that they are able to look after your baby. If you wish, you may at times be able to interview a pediatrician before you chose them to look after your baby - if possible, coordinate this well before your due date.

Ideally, you should identify who your baby's doctor is going to be before you deliver. If necessary, start looking around by mid second trimester.

For yourself

• Bathrobe, nightgown, slippers, and a couple of pairs of socks
• Nursing bra, breast pads, and maternity underwear
• Toiletries: Toothbrush, toothpaste, hairbrush/comb, lip balm, deodorant, face cream,
  body lotion, cosmetics, hair bands/scrunchies, contact lens supplies, etc.
• Reading materials and eyeglasses
• Address book and prepaid phone card or cell phone
• Camera and extra film, memory cards and batteries
• Going-home outfit. Bring something roomy and easy to get into — perhaps an outfit you wore at or near the end of pregnancy.

For your partner/labor coach

• Basic toiletries, such as a toothbrush, toothpaste, shampoo, deodorant
• Change of clothes
• Some snacks and something to read

For your baby

• Infant car seat
• One to three outfits (baby's first picture, going-home outfit, etc.)
• One to two blankets
• Pair of socks or booties

Infant car seats are required by law. Please be prepared to transport your newborn home from the hospital in a safety device.

The postpartum period begins immediately after the birth of your child and extends for the next 6 weeks. During this time your body, including your hormone levels and uterine size, returns to pre-pregnancy conditions.

Your obstetrician will tell you when you need to return for a checkup. For a normal delivery, it is usually 6 weeks. If you had a C-section, your provider will want to see you 1 to 2 weeks after the birth of your baby and again at 6 weeks after the birth. A follow-up appointment may be scheduled sooner if there were any problems during your pregnancy. At these visits, the progress of your postpartum recovery will be checked and options regarding for contraception may be reviewed.

When you go home after delivery, try to get extra rest and avoid fatigue. However, with caring for and feeding a new baby, there is not much time to rest. Get help from friends and family with household chores so you will have extra time to care for the baby and yourself. Because you must feed the baby day and night, you may need to change your sleeping schedule to get enough rest. Try to sleep while the baby sleeps. Morning and afternoon naps can be very helpful.

If you had a normal delivery without any problems, you can resume most of your normal activities right away. You should still take it easy and avoid heavy lifting, vacuuming, and a lot of stair climbing for the first couple of weeks. If you have had a Cesarean section (C-section), you will need to avoid heavy lifting for 6 weeks and you should not drive a car until you are confident you can hit the brake firmly and without hesitation (usually about two weeks) and are no longer taking narcotic medication.

Lochia, or menstrual bleeding after birth, normally will last between 2 and 6 weeks with it gradually tapering to a dark pink staining. Bleeding is rarely heavier than a heavy period. If you notice any large clots or heavier bleeding, you may be doing too much and need to slow down. If the bleeding continues to be heavy, please call us as the uterus may not have the tone it should, may have an infection or may contain a piece of placenta that did not expel itself. You may also notice a distinct smell; don't be concerned unless you have other symptoms like elevated temperature or abdominal pain. You should use pads for the first 6 weeks, not tampons, so that you do not increase your risk of infection.

If you bottle-feeding your baby, you may start having menstrual periods 3 to 10 weeks after delivery. If you are breast-feeding, there is no specific time when your periods will start again. It may not happen until after the first 6 months of breast-feeding, but it could happen earlier. Some women do not get their period again until they stop breast-feeding.

If you delivered the baby normally through the birth canal, pain in the area between your rectum and vagina is common. To relieve the pain and prevent infection, you can sit in a warm bath, put cold packs on the area, or put warm water on the area with a squirt bottle or sponge. It is also important to wipe yourself from the front to back after a bowel movement to prevent infection. If sitting is uncomfortable, you may want to buy a doughnut-shaped pillow at your local drugstore to help ease the pressure when sitting. For pain relief after a vaginal delivery or cesarean section, you may take ibuprofen along with any prescription pain medication you were given upon discharge.

In addition to heavy bleeding, call us if you are experiencing burning with urination, increasing pain, temperature over 100.4°F, depression for more than 2 to 3 days, or incisional redness or tenderness.

Breast milk usually comes in about 2 to 4 days after your delivery. This may make your breasts very large, hard, and sore. This will get better once you start a breastfeeding routine. If you are not breastfeeding, your breasts may become large and painful while you are waiting for your milk to dry out and you may benefit from wearing a well-fitting support bra and putting ice packs on your breasts. Breastfeeding is recommended and both our affiliated hospitals have lactation consultants available to assist with questions. Breast pumps may be useful, especially for the working mother or premature infant. If breastfeeding is not chosen, or discontinued, we recommend using an iron-fortified formula.

Sore nipples may be relieved with ice packs and regular feeding from both breasts. Avoid prolonged feeding sessions and ensure a good latch. Keep your nipples as dry as possible between feedings. Apply ointment (such as bagbalm, cool tea bags, vaseline, and A&D) to any cracks. Blocked ducts are usually felt as a hard, firm mass without a fever. Gentle massage, hot packs, and frequent feeding from both breasts are the best relief. Mastitis, or breast infection, causes a red, warm and painful mass associated with a temperature over 100.5°F. Should this develop, contact our office immediately. The usual treatment is antibiotics and hot packs. Avoid massage but do continue to breastfeed to decrease the chance of an abscess developing.

Weaning can be accomplished at any time. Planning ahead is helpful, beginning with a gradual decrease in the length and number of feedings. Avoid hot showers or any stimulation to the breast area that would encourage milk production. Continue to wear a good support bra, apply ice and bind the breasts tightly. Medication is not recommended to stop breast milk. You may use ibuprofen to decrease discomfort.

Many physical and emotional changes happen when you are pregnant and after you give birth. These changes can leave you feeling sad, anxious, afraid, or confused. These feelings are called the "baby blues" and usually start right after the baby is born and go away within a week. However, for some women, these feelings do not go away and they may get worse - when this happens it is called postpartum depression. Postpartum depression occurs in about 10% of all postpartum women and can start right after the baby is born or begin weeks later. Women who are at most risk of postpartum depression include first time moms, women with prior history of depression, and those women with less support. Postpartum depression can be a serious problem and needs treatment involving counseling, anticipatory guidance, support from others, and possibly antidepressant therapy. If you are feeling depressed, let your obstetrician know.

During birth, you lose about 12 to 14 pounds. However, this may still leave some weight to lose, depending on how much weight you gained during pregnancy. Losing this weight takes time. It takes most moms 8 to 12 months to return to their normal weight. Losing the weight slowly is healthy and natural. The key is to eat healthy and exercise. After the first few months of eating right and exercising, you can begin a healthy weight-loss program if necessary. If you are breast-feeding, you should make sure you are still eating at least 1800 calories a day. Because breastfeeding uses a lot of calories, it usually helps women lose their pregnancy weight. Exercise is one of the best ways to lose weight, get more energy, relieve stress, and get back into shape. Unless you had a C-section, difficult birth, or other pregnancy problem, you can usually start exercising as soon as you feel up to it. If you have had a C-section, you can usually start exercising after 6 weeks. Walking and gentle stretching and strengthening exercises are the best exercises to start with.

You should not resume intercourse until 6 weeks after you deliver, as this is the time it takes for your uterus to return to normal size. It is normal to feel uncomfortable at first when you start having sex again after childbirth.

Talk to your obstetrician about methods of birth control you can use after the birth of your baby. The method that may be best for you depends on the type of delivery you had, how you are recovering, and if you are breastfeeding. Learn about your postpartum contraceptive options during your pregnancy. These options include but are not limited to birth control pills, condoms, IUDs (Mirena and ParaGard), and vaginal contraceptive ring (NuvaRing). Most of these are safe even if breastfeeding.