Pregnant women may see their HCP more times during pregnancy than at any other point in their otherwise healthy lives.
The Bottom Line

Prenatal care involves all aspects of monitoring and improving the health of both mother and baby during pregnancy, and is critical to ensuring a positive pregnancy outcome.

For women in the United States, prenatal care can look different for each woman depending on socioeconomic status, insurance coverage, access to medical care, and comfort with physicians and physical exams.

The timing of appointments, volume of appointments in large practices, and the length of time of each appointment can also vary and may have a major impact on a woman’s ability to care for herself and her baby.

Most appointment schedules resemble four-week intervals from the start of pregnancy to about week 32, followed by appointments every two weeks, and then every week beginning at 36 weeks.

It is important that women find a provider (OB/GYN, midwife) they feel safe and comfortable with. Women must trust their HCP, feel relaxed enough to ask questions, and comfortable enough to describe their symptoms or concerns.

Jump to:
Share on:

Background

Women may see their physician more times during pregnancy that at any other point in their otherwise healthy lives.

An estimate from 2001 indicated there were approximately 50 million prenatal visits. The median was 12.3 visits per pregnancy, and many women had 17 or more visits.

Women’s experiences and overall satisfaction with their prenatal care can dramatically differ. Women need to find a provider who treats them respectfully, provides adequate, accurate, and up-to-date information, individualized care, is available for questions, and provides a feeling of inclusivity and safety.

Comfort with an HCP is important, as prenatal care is critical in the avoidance of serious and possible life-threatening complications. In a study of almost 29 million births, the risk for preterm birth, stillbirth, early and late neonatal death, and infant death rose with decreasing prenatal care.

Photo by Hush Naidoo on Unsplash

Appointment Schedule

A quick note about trimesters: Although appointments are mostly based upon week of gestation, trimester timing may also play a role, especially for screening tests. However, trimesters are not consistently defined (although sources differ by only a week or two):

The American College of Obstetricians and Gynecologists (ACOG) indicates the second trimester begins at 14 weeks, and the third trimester begins at 28 weeks.

However, according to a popular and often-cited obstetric textbook (2016), the second trimester starts from week 15 through 28, and the third trimester extends from 29 weeks through 42 weeks.

Some online sources indicate the second trimester begins at 13 or 14 weeks, and the third trimester begins at 27 or 28 weeks. This variance is likely highly dependent on whether the source of the information includes 40 or 42 weeks of gestation.

Most often, a woman will see her HCP once or twice in early pregnancy (between 6 and 8 weeks).

The purpose of early prenatal care is to determine the baseline health of the mother, due date, number of fetuses, and to identify an individualized plan of care for the entirety of gestation and at least the first 6 weeks postpartum. This also includes emotional, social, and psychological support. Some women with bleeding, abdominal pain, or inconclusive ultrasound results may have more visits in the first trimester.

Almost all women will have a first trimester screening and ultrasound scan between 12 and 14 weeks.  Appointments usually follow a 4-week schedule thereafter, until 32 weeks, in which appointments are generally scheduled 2 weeks apart, and then 1 week apart beginning at 36 weeks.

For example, an average schedule may look like:

  • 6 to 8 weeks

  • 12 weeks

  • 16 weeks

  • 20 weeks

  • 24 weeks

  • 28 weeks

  • 32 weeks

  • 34 weeks

  • 36 weeks

  • 37 weeks

  • 38 weeks

  • 39 weeks

  • 40 weeks

  • 41 weeks (if necessary)

  • 42 weeks (if necessary)

Appointment intervals may be closer together in women with complications or those who are considered high-risk; women may also see their HCP in-between these appointments if they need to be seen for any unexpected issue or concern.

Women should talk to their HCP about their risk factors for Nausea and Vomiting of Pregnancy.

As Nausea and Vomiting of Pregnancy (NVP) can begin as early as 4 to 5 weeks of pregnancy, and women may not see their HCP until 6 to 8 weeks, it is important that women discuss their risk factors and current symptoms with their HCP at their first appointment.

Women also need to call before their first appointment if they are experiencing severe – even moderate – NVP. Research indicates that early intervention and management (not always medication) by an HCP can help women better control their symptoms and prevent nausea/vomiting from becoming intolerable or leading to complications.

If women wait until their symptoms are too severe (8 to 10 weeks), management methods may be less effective.

There are many symptoms and conditions that arise during pregnancy that can concern women or cause significant anxiety. With appointments 4 weeks apart, some women may call for an earlier appointment, while others will wait until their next scheduled exam. It is possible this extra timing – especially with certain symptoms – may not be advised, and women should always feel comfortable calling their HCP in-between appointments when they have questions/concerns.

Interestingly, in at least one study, more than 50% of the study participants felt that some gaps between visits were too long.

Further, outside of major “milestone” appointments (ultrasound scans, screening tests), typical return visits may only last 10 to 15 minutes and may not be enough time for women to explain how certain symptoms are affecting their lives, how they are managing stress and anxiety, or even ask general questions.

Although appointment time may be brief, it is recommended that women tell their HCP all symptoms they are experiencing, so HCPs can make earlier diagnoses of pregnancy-specific and non-obstetric conditions. Specifically, women need to tell their HCP anytime they have:

Medical History

Women can do their best to prepare for the first appointment by having a full understanding or documentation of their medical history, especially their obstetric history (number of prior pregnancies, deliveries, delivery method, infant weight).  Women are almost always requested to fill out several questionnaires in their early appointments (see Resources).

A full and complete medical history helps HCPs to:

  • Determine a woman’s health risks during pregnancy

  • Determine whether the woman receives routine or high-risk care

  • Assess any possible complications that occurred in prior pregnancies

  • Help prevent teratogenic exposure by determining current medication use

  • Counsel women regarding any current or past drug, alcohol, or tobacco use

This history will also include past surgical history, vaccinations, chronic conditions, social history, drug allergies, and gynecological history, to include:

  • Cycle (period) history

  • Last pap smear (and results)

  • Birth control history

  • Procedure history (such as a D&C)

  • Infections

  • Fibroids

  • Ovarian cysts

Family history is also critical. According to the U.S. National Library of Medicine, a full and proper family history includes three generations of relatives, including children, brothers and sisters, parents, aunts and uncles, nieces and nephews, grandparents, and cousins.

Genes play a major role in pregnancy and fetal growth and development. Understanding medical problems or conditions on both the paternal and maternal sides of the family can offer possible clues regarding certain medical conditions or complications that can run in families and potentially affect a pregnancy.

Women should not hesitate to answer their HCP’s questions fully and ask the HCP for clarification if they do not understand a question. Women should also understand that medical information is private and protected under federal law in the United States (Health Insurance Portability and Accountability Act (HIPAA)).

Further, women can speak to their HCP/nurse alone, without their partner or other family member. HCPs should also inquire during the first appointment whether the woman is a victim of sexual assault or domestic violence (see Resources).

Screening Tools/Tests

At every appointment, HCPs will generally check/request:

Blood pressure

Fundal height:

Fundal height measurement – distance from the top of the uterus (fundus) to the pubic bone (symphysis) – is a physical exam method that can be used to estimate gestational age and screen for fetal growth restriction. Fundal height is most accurately measured after 20 weeks, with a non-elastic tape measure, and an empty bladder.

Fundal height measured is a somewhat antiquated technique, used mostly prior to the advent of routine ultrasound.  When using fundal height, each 1 centimeter (cm) increment corresponds to one week of gestation. A difference of two to three weeks or two to three cm in either direction is considered normal (32 cm would be equal to 29 to 35 weeks of pregnancy).

An HCP measures fundal height.

Fetal heart rate

Doppler ultrasound is used to easily detect fetal heart tones; because the fetus moves freely in amniotic fluid, the site on the maternal abdomen where fetal heart sounds can be heard best varies, and some HCPs may need a minute or so to find it.

Weight

Women can discuss with their HCP how often they are comfortable with this; women can also inform their HCP that although they will step on the scale, they do not want to hear the number; the HCP can inform the woman only if her weight gain becomes a concern.

Urine tests

Some practices may request a urine test at every appointment, while others may take just one (first appointment) or once every trimester – unless there is a specific concern for proteinuria or a possible urinary tract infection.

Blood work/tests

Blood work requests change based on stage of pregnancy, but can include: antibody screenings, Rh status, blood counts, blood typing, infection (sexually transmitted infections (STIs), Hepatitis B), nutrient levels, and hormone levels (read Fear of Needles).

Swab tests may also be performed to check for some infections (Group B strep, STIs, influenza, coronavirus, strep A) that can affect a pregnancy or treatment plan.

Ultrasound

Women in large practices may receive an ultrasound at every appointment; the average practice offers at least two – one between 12 and 14 weeks and another between 18 and 22 weeks. Some women may also receive a very early “dating” ultrasound, between 6 and 10 weeks of pregnancy, as well as a final ultrasound near term to check the baby’s position and/or amniotic fluid levels.

Pelvic Exam/Pap Smear

Although at least one pelvic exam may occur during prenatal care, they do not occur at every appointment, and only if a woman consents. The most likely time for a pelvic exam is during the first appointment.

A pelvic (internal) exam consists of:

  • An assessment of the vulva

  • Visualization of the vagina and cervix (with a speculum)

  • Physical assessment of the internal organs (ovaries, uterus) with a gloved hand (two fingers in the vagina while the HCP’s other hand palpates the abdomen)

The pelvic exam may also include a Papanicolaou (pap) smear if one was previously not collected within the last 12 months.

However, since general recommendations for pap smears are once every 3 years, a pap smear is not always necessary during pregnancy, and some women have concerns regarding possible bleeding or miscarriage. Further, pregnancy can make it harder to get accurate results.

It is likely that an HCP will wait until after pregnancy to conduct a pap smear, even if a woman is “due” for a screening. However, in women with prior abnormal results, an HCP may determine that during pregnancy may be the best option, as early diagnosis of possible malignant cells enables more effective treatment of the disease.

Additionally, a pap smear during pregnancy may also be a viable option for women who have difficulty seeing or following-up with their gynecologist outside of pregnancy.

Action

Women should read Health Care Providers for a better understanding of the different types of HCPs (and practices) they may see during their appointments. The Birth Plan page also offers additional information.

It is very important that women find an HCP/practice that makes them comfortable; it is recommended women see their HCP at least once every few weeks. Therefore, women must trust their HCP, feel relaxed enough to ask questions, and comfortable enough to describe their symptoms or concerns.

In addition, women/their partners should always speak up, ask for clarification, and make sure they leave every appointment understanding any situation or instruction necessary.

Women can perform an Internet search for HCPs in their area, read their biographies, and ask friends for recommendations. Women should also be wary of Internet reviews, however. Although these can be valuable at times, women who generally have positive experiences may not feel the need to leave a review, therefore these can be slightly skewed.

Note: For women who are very nervous about screening tests (needles) and pregnancy itself (fear of childbirth), women should also make sure to find an HCP who helps them overcome these concerns and empathizes with their fears.

Partner/Support

Partners should attend as many prenatal appointments with the pregnant woman as often as they can.

Partners can also improve the overall experience by:

  • Being engaged and asking questions

  • Asking questions or expressing concerns the pregnant woman may be too shy to ask herself

  • Specifically asking the HCP what they can do for the pregnant woman based on her current health status/stage of pregnancy

  • Better understanding the management of any potential condition she may have or symptoms she may be experiencing (such as nausea and vomiting of pregnancy, gestational diabetes, swelling, or headaches)

  • Learning warning signs/symptoms the pregnant woman may exhibit that could indicate a complication (preeclampsia, dehydration, deep vein thrombosis)

Almost all the pages on this site have a Partners/Support section near the bottom of each page that directly indicates a potential role for partners, family members, and friends regarding that topic during pregnancy.

Resources

Health Information Privacy; HIPAA (U.S. Department of Health and Human Services)

An example of an obstetric Patient History Questionnaire can be viewed here. (UCLA Health System)

If a pregnant woman has experienced domestic violence or sexual assault, there are numerous resources available to obtain immediate, safe, and discreet medical attention or law enforcement assistance.

Women can:

Additional resources include:

Sexual Assault: Committee Opinion 777 (American College of Obstetricians and Gynecologists; April 2019)

References

Test ToolTip

    Sign up to read 3 pages for free or subscribe now for full site access.