What Is Obstetrics?
Obstetrics is a branch of my practice that deals with pregnancy itself and taking care of women during their pregnancy.
What To Expect At A First Obstetrical Appointment?
A patient who has a missed period and thinks she may be pregnant is brought into the office for an appointment.
The first part of that appointment is discussing the patient’s history, similar to my approach with gynecology exams.
Some questions that are covered are specifically related to the patient’s periods, such as:
- When was the last menstrual period?
- Are the periods typically regular or irregular (how far apart are your periods usually)?
- Has there been a positive pregnancy test at home? If so, when?
I also want to talk about any issues that the patient may be worried about, such as pain, bleeding, or very commonly, nausea.
Cramping, Bleeding, and Other Common Concerns
Almost every woman early in pregnancy will have some degree of cramping.
So if a woman has a positive pregnancy test and some cramping, I certainly want to know about that, but I don’t want them to be overly worried or overly concerned because that’s a very common thing.
In addition, about 40% of women early in pregnancy will have some bleeding.
Again, that’s something I would like to know about and I will want to discuss. However, if there is some bleeding early in pregnancy, it doesn’t mean there’s going to be a problem.
Incorporating An Annual Exam
When a woman comes in for this OB appointment, if they are due for their annual exam, we wil go ahead and take care of that at that point. This gives us a good baseline exam, to make sure they are healthy from a general women’s health standpoint.
Getting An Ultrasound
A majority of the time when I see patients for their first obstetrical visit we will perform an ultrasound to address the viability of the baby. It
We can also address any issues that the patient may be worried about, such as pain, bleeding, or other issues.
Blood Work
On this first OB visit, we will also draw a basic pregnancy blood panel.
What To Expect On Follow Up OB Appointments?
The visits after the first OB appointment become a little simpler as we don’t need to repeat the full exam or draw blood with every subsequent visit.
At that point, if things are going well and seem to be uncomplicated, I will start having a patient come in about every four weeks.
When the patient comes in for every four weeks for OB appointments, there
- Making sure vital signs are stable
- Following the patient’s weight
- Listing for a baby’s heartbeat
A large part of that visit is intended simply to talk to the patient and to answer her questions.
I also will try and educate her about what’s going on during the pregnancy at this point at any given gestational age.
Fetal Anatomic Survey
Somewhere between 18 and 20 weeks is when we will do an additional ultrasound. This is called our fetal anatomic survey.
This is a higher level ultrasound, where we’re looking at all the baby’s anatomy and getting multiple measurements.
We’re making sure the baby is growing well, and making sure the baby is looking healthy from an anatomic perspective.
Importantly to patients, this is when we will determine the baby’s gender as well.
Glucola Test
Around 24 weeks is when I will have the patient come in and do their Glucola test.
This is done to make sure their body is processing glucose normally and that they do not have gestational diabetes.
Third Trimester OB Appointments
Around 28 weeks into the pregnancy is when I start having patients come in more often.
In a pregnancy that doesn’t seem to have complications, I usually have patients come in about every three weeks, starting at 28 weeks, until 35 or 36 weeks.
I will see patients more often than that if need be based on their particular situation and if there are any complications we’re following.
Tdap Immunization
Tdap immunization is recommended around the
The purpose of this is to immunize not only mom but the baby against whooping cough or pertussis.
It is now recommended by the CDC a woman should get a Tdap shot every time she’s pregnant, even if it’s year after year.
The Final Weeks Of Pregnancy
During this last month of pregnancy, I have patients come in every week, just to make sure they’re doing well, to answer their questions, and listen for the baby’s heartbeat.
These are usually fairly simple visits.
Additionally, my office will ensure that we pre-admit her to the hospital, have her ready for labor, and make sure she knows when to come into the hospital for labor.
Group B Strep Culture
I will obtain a Group B Strep culture for each patient around 35 weeks.
Group B step is a bacteria that 25% of adults carry as a natural part of their skin flora. It doesn’t mean much for adults, but it can, rarely, make babies sick.
Moms that are carriers, will receive antibiotics while they’re in labor and we watch their babies in the hospital, for 48 hours after birth instead of only 24.
For the moms that are carriers, I will give them antibiotics while they’re in labor and we watch their babies in the hospital, for 48 hours instead of 24.
How long should a pregnancy last?
While it is considered normal and labeled as full term to deliver anytime after 37 weeks, a woman’s due date is based on a full 40 weeks from the first day of her last period.
The number of weeks from the first day of the last period is what is also known as Gestational Age.
Make Sure The Baby Is Moving Well
In these final weeks, I always tell women, “Make sure your baby’s moving well. Make sure you’re getting 10 movements of some kind, within an hour’s time, twice a day.”
When Is It Time To Go Into The Hospital For Labor?
I also tell patients that when they’re contracting quite painfully and the contractions are 5 to 10 minutes apart for an hour, that’s when to head on into the hospital to see if you’re in labor.
Certainly, if the water breaks or a woman thinks her water is broken, that is another indication to go into labor delivery to see if it’s time to have the baby.
Common Pregnancy Questions
How Long Should A Pregnancy Last?
It’s considered normal and
The due date is based on 40 weeks.
What Is Gestational Age?
A woman’s due date is based on 40 weeks from the first day of her last period, which is called gestational age.
When Can I Have My Baby?
I will often be asked “can you induce me? And when?”
It is very legitimate and safe to do an elective induction of labor after 39 weeks if a woman’s cervix is starting to dilate and her cervix becomes what we call favorable.
Elective induction of labor, or choosing a date to have labor initiated, is a legitimate option after 39wk with a favorable cervix.
This is done at the patients request and per her desires, not for the convenience of a physician.
Regarding the question “how long can I wait for natural labor without being induced?”, the studies are showing us that somewhere around 41 weeks, the risk of the baby is starting to increase.
Somewhere between 41 and 42 weeks I will recommend what’s called a post-date induction for the safety of the baby.