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Overview

Midwives and OBGYNs are experts in prenatal care, pregnancy, and birth. They are trained to identify risks, and their goal is to keep you and your baby healthy. In total, you can expect to have around 14 appointments with your midwife or OBGYN leading up to your labor. Some of those appointments can be as short as 15 minutes or less. This episode/article has 5 tips to make the most out of the limited time you have with your doctor or midwife leading up to your birth.

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You see a midwife or OBGYN because they are the expert in prenatal care, pregnancy, and birth. They are trained to identify risks, and their goal is to keep you and your baby healthy. I hope you find a care provider that you trust and feel confident that they will support the birth you want. You can show up to each appointment unprepared and entirely rely on your provider. You can also do a little bit of homework before each appointment, so you know what to expect, and you are prepared. The difference between these two options is what role you want to play in your prenatal care.

Frequency of appointments

Whether a doctor or a midwife is seeing you, your visits follow a typical schedule. Your first appointment is around week 8, or later if you did not realize you were pregnant early on. For the first and second trimesters, your visits are every four weeks. Starting in the third trimester, at week 29, you will have an appointment every other week. For the last month or so of your pregnancy, beginning in week 36, you see your care provider weekly. In total, you can expect to have around 14 appointments throughout your entire pregnancy.

In a study of over 7,000 uncomplicated term births, researchers looked at the number of prenatal appointments compared to outcomes. Of this group, 30% had more than ten appointments, and this group was more likely to undergo an induction and have a cesarean. They also found that an increased number of appointments did not improve neonatal outcomes.

A Cochrane Review found that reducing the number of prenatal visits is associated with an increase in perinatal mortality in low‐ and middle‐income settings. In lower-income countries, the number of prenatal visits is already relatively low, around five or less. They did not find statistical differences in outcomes in higher-income countries. They also found that women in all settings were less satisfied with fewer visits and perceived the gap between visits as too long. This last point is often not addressed in research. Your experience matters, and how you feel about the level of care and support you receive is important.

#1 Logistics to Know From the Start

There are some key things you want to at the start of working with your doctor or midwife, so your expectations are clear.

Before Your First Appointment

As soon as you realize you are pregnant or suspect you may be pregnant, try to make a note of when you started your last menstrual period. Your doctor or midwife will ask for this date to help determine your due date. Your entire prenatal care revolves around your due date, and the more accurate it is, the better. If you are not pregnant yet and trying to conceive, start keeping track of your menstrual cycles now. If you are already pregnant, try to recall the date of your last period as best as you can. The more time that passes, the harder this is to recall.

The period between finding out you are pregnant, and your first prenatal appointment can feel like an eternity. The best things you can do are start taking a high-quality prenatal vitamin, focus on eating healthy whole foods, stay hydrated, get plenty of sleep, and be mindful of caffeine and alcohol.

Work with Administrative Staff

To maximize the time with your doctor or midwife, you want to take care of any administrative tasks outside of that time. If there is someone else in the office, like a nurse or an administrative person, who can answer your question or get you the information you need, go to them first. This would include anything about scheduling appointments, insurance coverage, or billing questions. You should be able to tackle these items over the phone, so you do not need to deal with it during an appointment or unnecessarily involve your doctor or midwife. You can also request any paperwork you need to complete ahead of time. This is especially applicable before your first appointment when you need to complete a full medical history and give them all of your information. This also minimizes the amount of time you are spending in the waiting room.

The Length of Appointments

For the majority of expecting mothers in high-income countries, you have 14 appointments or less. To put that into more context, let’s take a look at the average length of an appointment. This tends to vary significantly based on your care provider. Typically, with an OBGYN, your first appointment is the longest and can be up to an hour. After that, appointments are only about 15 minutes. That means you are spending only about 4 hours and 15 minutes with your doctor leading up to your birth. Different care settings may have longer appointment times. Birth centers or independent midwives tend to allocate more time available for each appointment. You may also have the opportunity for group appointments or a centering pregnancy model for appointments, usually around 60-90 minutes. While these appointments are longer, you are sharing the time with other expecting mothers.

Get Clear on How Long Your Appointments Are

You should know how long you can expect an appointment to last. This helps you and your partner or another support person attending to plan your schedule. This also lets you know how much time you will have to tackle any questions or topics you want to discuss. If you feel like you need more time during an appointment, please ask for it. If you prefer longer appointments in general, ask if there is a better time to schedule them, so your doctor or midwife is not rushed.

You also want to know how to get in touch with your care provider or ask questions in between appointments. If you are concerned about something or do not want to wait until your next appointment, you should be able to call or email with a question.

Appointments and COVID-19

COVID-19 has created some new policies and procedures for prenatal care. You may have fewer personal appointments or meet with your doctor or midwife virtually. If you are going in for an appointment, please ask for any specifics you should know ahead of time. It will help you to know if you need to wear a mask, if you need to call ahead before entering the office, and whether they allow your partner or a support person to accompany you.

I am a huge advocate of involving your partner in your prenatal care and ideally attending all of your prenatal appointments. Hopefully, if you do not have a partner, you have a friend or family member who can step in to be there for you. There are many benefits of having your partner join you for appointments. It allows them to ask questions and get educated about pregnancy and birth. It can help them feel more connected and excited about having a baby. Plus, they can help advocate for you. Due to COVID-19, many care providers request that you do not bring anyone with you to appointments. If you have an in-person appointment alone, you can always get your partner on speakerphone or FaceTime to be there. It isn’t the same as having them in the room, but it is better than nothing.

If you have a virtual appointment, please include your partner. Different providers are using different platforms, and if you are using a new platform that you have not used before, please log in a few minutes early to test your audio and video. If your partner or a support person will be joining you from another location, ask if they can use the same link or if they need their own.

#2 Expect the Routine Items

After your first appointment, there are some routine procedures you can expect at every appointment. Knowing what to expect will have you going into your appointment better prepared.

You will likely step on a scale to take your weight. The average woman gains between 25 to 35 pounds throughout pregnancy. This is based on being average weight before getting pregnant. Generally, if you are underweight, you should gain 28 to 40 pounds. If you are overweight, you may only need to gain 15 to 25 pounds. In general, you should gain about 2 to 4 pounds during the first trimester. Then about a pound a week for the remainder of your pregnancy.

You can expect to have your blood pressure taken at each visit. Your provider takes your blood pressure to monitor you for preeclampsia. They will also listen to your baby’s heartbeat. Your doctor or midwife can hear your baby’s heartbeat with an ultrasound, a Doppler, or a stethoscope as you get further along.

In the second half of your pregnancy, your doctor or midwife will also measure the distance between the top of your pelvic bone to the top of your uterus (called a fundus). After about week 24, the length in centimeters will roughly match up to the number of weeks along you are. It is not uncommon to measure a week off, so don’t stress if the measurement doesn’t line up exactly.

At each appointment, there should be time to ask how you feel, educate you about any symptoms you are experiencing, and time for you to ask questions.

#3 Know What is Coming Up at Your Next Appointment

After the routine procedures, some additional tests or procedures will occur at specific times throughout your pregnancy. Many expecting parents walk into a prenatal appointment to learn that they are taking one of many tests or that your care provider is recommending a procedure. If you have a heads up that you will have the option to do a particular test at your next appointment, have a procedure done, or get a vaccine, you can get informed and be prepared.

Tests

At several appointments throughout your pregnancy, you will likely have some type of test. The most basic tests are from urine or blood samples. Urine samples are collected several times during your pregnancy. Your care provider uses these to test for a variety of things. Sugar in your urine can be an indication of gestational diabetes. The presence of protein can indicate a urinary tract infection, kidney damage, or some other disorders. You will also most likely encounter a few blood tests. Blood samples check things like your blood type, whether you have any infections or diseases, or whether you are at risk for anemia.

There are many additional tests you can opt into that can take place anywhere between 10 to 36 weeks. The timing varies depending on the test. Tests are either noninvasive or invasive prenatal tests. These include tests like the cell-free DNA or NIPT, ultrasounds, gestational diabetes testing, and group B strep. With all of these tests, you have some options regarding whether you want to opt into the test and how it is performed. Many expecting mothers show up to a prenatal appointment and learn they are taking some type of test at that time. If you know ahead of time that at your next appointment, you have the option to get a specific test, you will be much better prepared.

Vaccines

The vaccines that are recommended by the American College of Obstetricians and Gynecologists during pregnancy are the flu vaccine and Tdap. I encourage you to talk to your doctor or midwife about the timing of vaccines.

Some expecting mothers and care providers may choose to avoid a flu shot during the first trimester because this period is critical to development. The Centers for Disease Control says that you can get a flu shot during any trimester. One study showed that the influenza vaccination at any time during the second and third trimester of pregnancy, but at least 15 days before delivery, creates passive immunity.

Tdap stands for Tetanus, Diptheria, and Pertussis (aka whooping cough). The Tdap vaccine is recommended for all pregnant women during each pregnancy. It is given via intramuscular injection in your upper arm in the third trimester. Typically this is given between 27-36 weeks. This time frame provides you with adequate time to produce antibodies and pass them to your baby before birth.

Procedures

It is helpful to know what procedures are coming up ahead of time. If you know you are getting an ultrasound, you may choose to wear pants and a shirt rather than a dress. If your care provider will offer the opportunity for an invasive procedure like a vaginal exam or to sweep your membranes to induce labor, you may want to educate yourself about your options ahead of time.

At the end of each appointment, ask what you can expect at the next appointment. You can also always call the office and ask someone ahead of time. The alternative is that you are put on the spot to opt into something. It is a lot easier to make informed decisions when you are not pressured and have the time and the space to explore your options and think through what is best for you and your baby. If you are looking for information on a particular subject, chances are there is an episode of the Pregnancy Podcast that dives into the evidence on it.

#4 Understand Informed Consent

Every OBGYN and midwife vary on the amount of time they will spend with you at each appointment and how much time and education they commit to giving proper informed consent. I hope you are working with someone thoughtful and considerate about informing you of all of the evidence, pros, cons, and your options available. Unfortunately, not everyone gets this high level of care, and to be educated, you may need to do some homework on your end.

If your OBGYN or midwife puts you on the spot for something and you are not ready to make a decision right then and there, ask for more time. You can also request to have a few days or a week and offer to make a follow-up appointment to tackle it. Please do not feel intimidated or pressured into anything that you are not comfortable with or on board with.

Organizations within the birth community have guidelines on informed consent. The American College of Obstetricians and Gynecologists’ opinion acknowledges that there are practical difficulties with ensuring the kind of communication necessary for informed consent. The first limitation they address is the limitation of time, which plays a significant role in this. It is difficult to take the time needed to discuss procedures at length when you are limited to 15 minutes or less for an appointment.

The North American Registry of Midwives outlines the components of informed consent as Shared Decision Making and Informed Consent. I like their emphasis on shared decision making because that is what your prenatal care is. You are working with your doctor or midwife to make shared decisions. This is a two-way street.

My interpretation of true informed consent means that you fully understand the procedure, intervention, or treatment, that you are made aware of all of the risks and benefits, and that you have the choice to opt-in or opt-out. The last part of that is tricky. The truth is that you can opt-out of anything. This includes ultrasounds, vaginal exams, the glucose tolerance test, genetic testing, testing for GBS. For a doctor or midwife to truly give you a choice can be tough because they, and the entities like hospitals they work for, have policies about what is “required” and routine. I know from even my personal experience that it doesn’t always feel like you have a choice. It is so important that you know you do have choices. You always have a choice, and that is a critical component of true informed consent.

#5 Ask Questions

Your meetings with your doctor or midwife are an excellent opportunity to ask questions. There is no such thing as a stupid question. In between appointments, keep a list of questions that come up. You can do this on a piece of paper or in a note-taking app on your phone. When you have your next visit, bring your list so you can be sure to get all of your questions answered. If something comes up, you cannot wait until your next visit for please do not hesitate to call or email your doctor or midwife.

Jotting down a few notes during an appointment can go a long way in recalling what you talked about later. Doctors and midwives are medical professionals who use a lot of terms you may not be familiar with. Prepare to take some notes when they answer your questions.

In the event you ask about something and don’t feel like you get a clear answer, ask them to clarify. If you want to know more information, ask them to explain it further. When they give you a yes or no and you want to know why, please ask.

Remember that you are hiring your doctor or midwife. You also can fire them and find another provider if you don’t feel like you are getting the attention or support you need. You can change your care provider if you do not feel like your current one is the right fit. Switching providers is easiest the earlier on you are in your pregnancy. I genuinely hope you find the right provider and that you feel supported during every prenatal appointment.

 

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