Doctors Appointments During Pregnancy

Until the beginning of the twentieth century, unless complications developed, a pregnant woman did not make any doctors appointments during pregnancy until she went into labor. The idea of antenatal care arose from the realization that many complications could be prevented if mothers-to-be were seen and examined throughout pregnancy. Modern antenatal care starts early and aims not only at preventing complications, but also at keeping the mother-to-be fit and happy. Today she can approach labor with the quiet confidence that comes from proper antenatal care and a knowledge of what will happen to her in labor and who will be looking after her. With this understanding of what is happening during pregnancy, women are better equipped to take care of their health and that of their unborn child. Since knowledge relieves many of the common anxieties, it is very important that during the antenatal period the mother-to-be comes to understand the processes of pregnancy and labor.
 

Attendance at antenatal clinics
 

Regular antenatal examinations are the cornerstone of modern obstetric care, so regular visits to the antenatal clinic, however boring or tedious they may seem, are vital to the expectant mother's and baby's well-being. If the mother-to-be is unable to keep a particular appointment, she should tell the doctor or midwife so that an alternative appointment can be arranged. Failure to do this is not only unfair to the doctor or midwife, but to the baby and the mother-to-be herself.
 

As soon as a woman thinks she may be pregnant she should consult her doctor and have the pregnancy confirmed. This will normally be two to three weeks after the first period is missed, i.e. six to seven weeks after the last menstrual period. Once pregnancy has been diagnosed, an appointment should be made for the first proper antenatal visit. In most cases this will involve a trip to the hospital booking ante-natal clinic. This usually takes place ten to twelve weeks after the last menstrual period. Women who feel well in early pregnancy often postpone the first visit to the doctor, but this is misguided.
 

The First Visit

A simple examination in early pregnancy is very helpful in detecting complications and establishing that the foetus is developing normally.  The first visit to the antenatal clinic is an exciting, event for every pregnant woman it is exciting because having succeeded in becoming pregnant she will be anxious to be reassured that all is well and that she has nothing to fear in the six months or so that follow.

 

During this visit, questions on her health, menstrual cycle, contraceptive practice and family history will usually be asked. The woman’s height and weight are recorded. A urine sample is examined for sugar and albumin and, if the latter is present, the urine is examined in detail for evidence of infection or kidney disease. An ultrasonographic examination will usually be conducted.


The following blood tests may also be conducted:
Haemoglobin
V.D.R.L (the Veneral Disease Research Laboratory Test for syphilis
Blood Group and Rhesus Factor
Rubella Immunity status

 

Subsequent Visits

Visits to the clinic or the doctor's surgery usually take place at four-week intervals up to twenty eight weeks of the pregnancy and, after that, at two-week intervals up to thirty-six weeks and then weekly. If complications develop, more frequent visits will be needed.  At each visit, weight, blood pressure and urine tests will be repeated and a simple examination made of the enlarging uterus. This is done by the doctor (or midwife) feeling the uterus to determine how much it has enlarged in size since the previous visit. He will also be able to feel the baby inside the uterus to check that it is growing normally. The abdominal examination will be completed by the doctor or midwife placing a foetal stethoscope over the lower part of the uterus in order to listen to the baby's heart beat. Using the simple traditional trumpet-like foetal stethoscope, the heart cannot be heard before twenty-four weeks. With the aid of an ultrasound stethoscope, the heart can be heard as soon as the uterus is large enough to be felt in the lower part of the abdomen, usually about twelve weeks. Although listening to the baby's heart is a traditional part of the ante-natal visit, it only confirms what the woman herself already knows from feeling the baby's movements—that her baby is alive and well!

 

Fetal movements would be felt by the mother at around 16 to 20 weeks. The doctor will check the position of the baby from the 30th week onwards. By the 34th week, the head should have settled down into the lower part of the uterus. The crown of the head is called the vertex, hence this is known as vertex presentation. The doctor may choose to turn the baby around to the correct head-down vertex position at this time if he is lying with his buttocks toward the mother’s pelvis (a breech presentation). It is diagnosed by feeling the hard round baby's head in the upper part of the uterus. Breech presentation is common up to thirty-four weeks, but after that time is uncommon. Normally, at the 36th week, a pelvic examination is performed to assess the roominess of the bony pelvis.

There are other tests that may be conducted, such as the measurement of alpha-fetoprotein (if the risk of neural tube defect is high), amniocentesis and others if there are good reasons to do so.

 

The Last Antenatal Visit
 

By the time thirty-six weeks have elapsed from the last menstrual period, the mother-to-be will have come to understand the meaning of the phrase `Heavy with child' ! The last four weeks of pregnancy are often an uncomfortable time and apprehension about labor will often increase as the expected date of delivery draws near. Late pregnancy is a time to strive for a tranquil existence. Cut routine jobs down to a minimum and rest. During the last few antenatal visits, greater attention will be paid to excessive weight gain, swelling of the legs and hands, protein in the urine or a raised blood pressure, since these signs are a warning of toxaemia. At the same time, the presentation of the baby is carefully checked to ensure that the head is properly down in the lower part of the uterus—vertex presentation.
 

As well as checking the presentation, the doctor will want to check as far as possible that the head of the baby will pass through the mother's pelvis. The pelvis has an inlet, a cavity and an outlet. The inlet is the narrowest part of the pelvis so that if the baby's head will go through the pelvis inlet it will usually go through the cavity and emerge at the outlet.
 

At about thirty-six weeks, in the case of a woman having her first baby, the head passes through the inlet and into the pelvis to become engaged. The mother-to-be will notice less pressure in the upper part of the abdomen. There is no need for anxiety if your baby's head has not engaged by thirty-seven weeks. In the first place, engagement of the head at this time usually only occurs with the first baby and, even then, not invariably. With second and subsequent babies, engagement occurs later and may not take place until labor has actually begun.
 

When the head is not engaged, the doctor may carry out a simple test in which he presses gently down on the baby's head to see if it will go into the pelvis. The head that is not engaged when the mother-to-be lies down often becomes so when she sits or stands up. This is because gravity pulls the baby's head down in the direction to which the uterine contractions will make it go when labor starts.
 

If there is any doubt about the presentation or about the ability of the foetus to pass through the pelvis, the doctor will carry out a vaginal examination. This will enable him to feel the baby's head and to confirm that it will crime down into the pelvis when the-mother-to-be sits up or when gentle abdominal pressure is exerted on it.
 

Occasionally, in cases of real doubt, an X-ray may be ordered so that the exact size of the pelvis be measured. As a result of these examinations, will usually be clear that there is not likely to any problem about the foetus passing through pelvis and delivering normally.

 

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