What to Expect During Your Prenatal Doctor’s Appointments

A lot happens over the course of a pregnancy. The journey from conception to birth (and before and after, of course) can be a whirlwind of emotions, information, questions, excitement, anticipation, and confusion.

While prenatal care does involve many visits to the doctor or midwife, most of these visits are brief, and it can feel like a fair amount of pressure to make sure you’re getting all of your questions answered in a short amount of time. On the other hand, if you don’t have any specific questions prepared, you may feel like you’re not making the most of your time.

With my patients, I like to frame each visit with big-picture things that I think they should know about the stage of pregnancy they’re in and ask if they have any questions. For those who prefer to prepare and come to their visit with a list of questions, I am happy to answer each of them as best as I can either before or after I review what I want them to know and expect.

This article is meant to be an overview of prenatal care and to help you get organized before your visits, whether you’re planning out your questions months in advance or are pulling it up in the waiting room before your visit begins. Of course, every pregnancy is different, so it’s not a comprehensive checklist — if there are other things that come up during your pregnancy that you have questions about, please raise them with your provider.

Note: I am dividing the pregnancy into trimesters, as that is a common colloquial designation, but in practice, doctors typically use weeks, not trimesters or months.

First trimester

Your first trimester begins at conception and ends at 13 weeks and 6 days.

This is usually a very action-packed trimester. It starts with finding out you are pregnant by either missing a period, having a positive home pregnancy test, or in a blood test or potentially an ultrasound.

You’ll also encounter many milestones during the first trimester. At the beginning of pregnancy, the embryo is smaller than a grain of rice. By the end of the first trimester, it is typically the size of an adult thumb and nearly all organs have been formed. This is also the time when we determine if the pregnancy is viable and, if so, whether it is a singleton pregnancy or perhaps twins. You’ll go through genetic screening for you and your baby, start (or continue) a prenatal vitamin or folic acid, and have your first exams at your provider’s office.

What to expect at your visits

The first visit happens at different times in different practices but could be anywhere from 6 to 11 weeks from your last period.

At your first visit, expect someone to ask you about your medical history, any prior pregnancies, prior surgeries, medications you take, and a whole host of questions all about you. Usually you will have a physical examination and potentially an ultrasound. Blood is usually drawn, mostly for routine screening. Ideally you will get a sense of the makeup of the practice you are seeing, what to expect for visit frequency, how to reach a provider in off hours, and the like. They will also go over “dos and don’ts” in pregnancy.

Later in the first trimester, you will likely be offered options for genetic screening to identify the risk of your baby having a genetic condition. Almost everyone has some symptoms of pregnancy (fatigue, nausea, vomiting, frequent urination, enlarged or sore breasts), and if any of them are severe, your provider will go over options for alleviating them. Most often, the symptom people want to address is nausea or vomiting. Sometimes there are only one or two visits in this time frame. For people with more symptoms or health issues, or concerns such as bleeding and pain, there may be many more visits.

Questions to ask your provider

Are there doctors or midwives (or both) at your practice?
How many of you deliver?
Where will I deliver my baby?
How do I reach someone if I have questions during the day?
How do I reach someone at night or on the weekends?
How often will I be seen in the office?
Will I always see the same provider, or will that rotate?
What kinds of genetic screenings do you offer for me and my partner?
What kinds of genetic screenings do you offer for the baby?

Also, if you have any specific concerns about your past medical history, pregnancy history, or family history, now is a great time to ask your provider.

Second trimester

Your second trimester begins at 14 weeks and goes until 27 weeks and 6 days.

The second trimester tends to be people’s “easiest” trimester, at least physically. Often, most of the first-trimester symptoms have improved and it is prior to the baby and uterus getting large enough to cause physical symptoms (there are exceptions to all of this, of course). Usually you will begin to “show” sometime in the second trimester, but the exact time varies considerably. While the fetus is moving from very early on in the first trimester, most people do not feel fetal movements until sometime between 16 and 24 weeks. This also varies considerably.

By the end of the second trimester, the fetus is usually over 1 pound and, if born, there is a chance of survival (the gestational age where a fetus can survive after birth starts around 23 weeks, where the survival is very low, to 28 weeks, where with good neonatal care the chance of survival is very high).

What to expect at your visits

During this trimester, visits are usually spaced out to about once a month, unless there are other reasons to have more frequent visits.

For people who did not gain much weight in the first trimester, typically it starts picking up in the second trimester. During this trimester, usually you will undergo an ultrasound examining the size and anatomy of the fetus. This ultrasound has many names: detailed ultrasound, anatomy ultrasound, level 2 ultrasound, and comprehensive ultrasound. All of these mean the same thing: a head-to-toe assessment of the fetus examining as much as possible in terms of fetal size, the structure of the major organs, the location of the placenta, the amniotic fluid volume, and sometimes the length of the cervix by vaginal ultrasound. The ultrasound usually takes 30 to 60 minutes.

If you were planning invasive genetic testing, it is usually done by chorionic villus sampling (CVS) in the beginning of the second trimester (12 weeks) or by amniocentesis around 16 weeks. There is also usually screening for a fetal condition called spina bifida. This is either done with a blood test around 15 weeks (MSAFP, or maternal serum AFP) or by ultrasound evaluation of the fetal spine.

At the end of the second trimester, at 24 to 28 weeks, usually you will be screened for gestational diabetes. This typically involves having you drink a solution with 50 grams of glucose and then having your blood drawn one hour later. If that result is normal, you are done. If it is abnormal, then you get scheduled for a longer test that involves coming in fasting, requires four blood draws, and takes three hours. If that three-hour test is normal, you are usually done. If it is abnormal, you would be diagnosed with gestational diabetes. Often an anemia test happens at the same time, though this can vary depending on the practice.

Questions to ask your provider

How will you screen for spina bifida: blood work or ultrasound?
Where will I be having my detailed anatomical ultrasound and who will be interpreting it?
Where would I get invasive/diagnostic genetic testing, such as CVS or amniocentesis, if I am interested in that?
When will I be screened for gestational diabetes? If I do get diagnosed with gestational diabetes, who will manage that?

Third trimester

Your third trimester begins at 28 weeks until you deliver.

The baby is growing significantly during the third trimester; by the end of the third trimester, the baby is growing about a pound every two to three weeks. Typically between 24 and 28 weeks, you will start to feel the baby move every day, although this can happen even sooner. Toward the end of pregnancy, it is normal to start to have irregular contractions. These can start days or weeks (or months!) before labor.

What to expect at your visits

Visits in the third trimester become more frequent, usually weekly by about 36 weeks and sometimes even twice weekly after your due date.

At each visit, you will likely have your blood pressure checked (screening for preeclampsia), give a urine sample (screening for preeclampsia), be asked about fetal movements (fetal well-being), have your weight checked, have the size of your uterus felt (fetal growth), asked about symptoms such as bleeding and contractions (labor), and potentially have one or more ultrasounds.

In terms of tests, usually there are few until close to delivery, when we perform a routine vaginal culture for group B strep, and sometimes another set of blood work. We start to talk about your plans for delivery and after delivery. In the final few weeks, you may have routine vaginal exams to assess if your cervix is dilated or not. If you approach or go past your due date, you may have additional testing such as ultrasound or non-stress tests, and your provider may start discussing induction of labor as an option for you. If there was a reason a cesarean delivery was recommended, your provider will have discussed this with you as well.

Questions to ask your provider

Who do I call if I think I may be in labor?
Where do I go to deliver? How do I get there? What is the visitor policy?
At what point do you start doing cervical exams routinely?
Do you routinely recommend delivery by a certain week of pregnancy? Meaning, at what point do you routinely recommend induction if it hasn’t happened spontaneously?
How do you decide if I would need a C-section?

If you have birth preferences (aka a “birth plan”), now is also a good time to discuss this with your provider in advance.

Closing thoughts

There’s value in having an understanding of what happens during prenatal care, and doing your own research to prepare for your visits helps make the most of your time. Remember: No matter how quick these visits may feel, it is your time. If you’re confused about anything, ask your provider for clarification. Ideally you’re leaving feeling more informed, confident, and at ease than when you went in.