What to Ask Your OB in Each Trimester

Pregnancy is a great time to focus on your health in general.  Although you are “eating for two,” you actually only need 300 additional calories per day to support your growing baby.  Focusing on a healthy diet of protein, complex carbohydrates, healthy fats, fruits, and vegetables will give your baby a great start.  Exercise is encouraged in pregnancy, and your OB can answer any questions you have about what kind of exercise is safe.  Make sure you start a prenatal vitamin if you hadn’t already been taking one. 

At your first visit, around eight weeks of pregnancy, we recommend a panel of lab tests including a blood count to screen for anemia, testing to screen for infectious diseases such as hepatitis and HIV, screening to ensure you are immune to German measles, and a blood type.  If you have risk factors for high blood pressure or diabetes, additional tests may be ordered.  At your first OB visit, a Pap smear can be done if you are due for testing. 

Whether or not to have genetic testing is a personal decision – these tests are completely optional.  There are two basic types of genetic tests.  The first is aneuploidy screening or noninvasive prenatal testing (also called NIPT, NIPS, or cell free DNA testing).  This is a blood test that screens for chromosomal abnormalities the baby may have, such as Down Syndrome.  It can also determine whether you will be having a boy or a girl.  This is a screening test – if it suggests a problem, further testing would be recommended. 

The other type of genetic testing is carrier screening – this testing looks at your genes to see if you carry genetic mutations you could pass on to your baby.  There are a variety of panels you can choose from, from testing just a few genes to checking several hundred genes. 

Your obstetrician will be able to answer any questions you may have and will help you decide what testing, if any, is right for you. 

In the first trimester, most women see their OB at 8 weeks and 12 weeks.  Women with high-risk pregnancies may have additional visits. 

Pregnant women are at higher risk from respiratory viruses such as influenza and Covid.  If it is flu season, the flu shot is recommended.  Covid boosters are also safe and recommended in pregnancy. 

It’s normal to have questions about what’s typical and what’s not.   While your OB can answer many of these questions at your prenatal visits, if you have concerning symptoms such as bleeding or pain, there is always an OB on call for your practice. 

The most exciting test during this time is the anatomy scan.  This is a comprehensive ultrasound that takes a detailed look at your baby’s development.  Many women have not yet started to feel regular movements at this time, so the ultrasound is a great way for women to be reassured things are going well.  This can also identify any issues that may need to be followed more closely. 

Preparing for childbirth early on can help ease any worries. The Elliot offers a variety of childbirth classes and tours of our labor and delivery unit, so you know what to expect when the time comes. The hospital also offers classes about breastfeeding your baby and infant first aid. 

Recognizing the signs of preterm labor is important, even if everything is going well. Knowing when to seek help can make a big difference.  Your OB will counsel you about what contractions feel like and when you should call the office if you have pain. 

At 28 weeks, you will be screened for gestational diabetes (GDM). GDM affects about 10% of pregnant women, and identifying and managing blood sugars is vital to making sure you and your baby stay healthy.  At 36-38 weeks, you will have a vaginal and rectal test for Group B strep (GBS).  GBS is a bacteria carried by up to 25% of women. It has no symptoms for the pregnant woman but can cause severe infections in newborns.  Women who test positive for GBS will be treated with antibiotics in labor, which markedly decreases the risk that your baby would be infected. 

In most cases we recommend following the 5-1-1 rule for contractions.  If you have contractions every 5 minutes (or more often) that last 1 minute, and this has been going on for 1 hour, you should call your OB. You should also call if you think your water has broken.  Some women, such as women with a planned Cesarean section or vaginal birth after Cesarean (VBAC), may be encouraged to call earlier. 

There are a variety of options for pain relief in labor.  For women hoping to have a more natural labor, you can move around, use the birthing ball or rocking chair, or get in the tub.  Medication options include nitrous oxide (“laughing gas”), IV medication, or an epidural.  You can make the choice that feels right for you. It is best to keep an open mind about your options, as your labor may not go as planned. 

There is very little you actually NEED to bring – comfortable clothes for yourself to wear home, an outfit for your baby, and a car seat.  The hospital will provide a gown for you for labor and postpartum, diapers and wipes for the baby, and basic toiletries.  Many women do bring their personal toiletries, a nursing pillow if they plan to breastfeed, and their own pillow.  You may also want to ensure you have hair ties, chapstick, and possibly a small fan for labor.  Your friends are also a great source to ask what they were most thankful to have had and what they wish they had brought! 

At The Elliot, we respect your feeding choice.  We do encourage women to try breastfeeding, but if it is not right for you, we will support you in bottle feeding your baby.  Your labor and maternity nurses will be able to answer any breastfeeding questions you may have, and if you are nursing, our lactation consultants will be there to help you as well. 

Even if you expect everything to go smoothly, it’s important to know about our NICU services. Elliot Hospital has the only Level III NICU in southern New Hampshire. This means we have a team of experts ready to care for babies born as early as 23 weeks. Knowing this level of care is available can give you peace of mind, no matter what happens.