Overview

You see a midwife or OBGYN because they are the experts in prenatal care, pregnancy, and birth. They are trained to identify risks, ensure you and your baby are healthy, and assist you in navigating pregnancy and childbirth. In the nine months you are pregnant, you can expect to have around 14 prenatal appointments. Each appointment allows your care provider to monitor you and your baby, administer tests, and perform procedures. These visits are your opportunity to discuss your symptoms and prenatal care options, plan for birth, and ask questions. There is so much to cover in each of these visits, some of which can be as short as 15 minutes or less. Learning some basic information and applying simple practices will allow you to prepare for your prenatal appointments and make the most out of your limited time with your doctor or midwife.

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Prenatal Appointment Schedule

Your prenatal visits with a doctor or a midwife follow a typical schedule. Your first appointment is around week eight or later if you did not realize you were pregnant right away. 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 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.

The Length of Appointments

The length of each prenatal appointment can vary significantly by 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 or less. That means you are spending only about 4 hours and 15 minutes with your doctor leading up to your birth. Different care settings or providers may have longer appointment times. Birth centers or independent midwives tend to allocate more time 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 share the time with other expecting mothers.

Making the Most Out of Your Appointments

The quality of appointments is more important than the quantity of time you spend with your doctor or midwife. 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 increased 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 care and support you receive is important.

The reality is that you have limited face time with your doctor or midwife. Let’s talk about some tips to maximize your prenatal appointments and how to take advantage of your time with your doctor or midwife.

#1 Logistics to Know from the Start

You want to know some key things at the start of working with your doctor or midwife, so your expectations are clear, and you can prepare accordingly.

Before Your First Appointment

If you are not pregnant yet and trying to conceive, start keeping track of your menstrual cycles. 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. The more time that passes, the harder it is to recall. Your doctor or midwife will ask for this date to help determine your due date. Your entire prenatal care revolves around your due date; the more accurate it is, the better.

Request any onboarding or new patient paperwork to complete before your first appointment. Filling out this paperwork ahead of time will allow you to take your time providing your complete medical history and minimize the amount of time you spend in the waiting room.

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 that time. If a nurse or an administrative person can answer your question or get you the information you need, contact them first. This includes 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 them during an appointment or unnecessarily involve your doctor or midwife. Save your time with your care provider for the topics only they can advise you on.

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 need more time during an appointment, please ask for it. If you prefer longer appointments, 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 contact your care provider or ask questions 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.

Involve Your Partner or a Support Person

You can and should have someone accompany you to your appointments. I greatly advocate 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. If your partner cannot be there in person, they can always join via Facetime, video chat, or be on speakerphone. If any complications come up throughout prenatal care or you get unfavorable test results back, those appointments can be challenging to go through alone. Please encourage your partner to attend as many appointments as possible.

If your partner can only attend some appointments, a few are more eventful than others. The first appointment is when a doctor or midwife confirms the pregnancy and sets expectations. The other eventful appointment is the anatomy scan ultrasound. This happens at about the halfway point. In the last month of your pregnancy, appointments are weekly, and there is more conversation around birth, which can be beneficial for your partner to hear.

#2 Expect the Routine Items

Knowing what to expect will help you go into your appointment better prepared. There are some routine procedures you can expect at every appointment.

You will 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, you should gain 28 to 40 pounds if you are underweight. You may only need to gain 15 to 25 pounds if you are overweight. 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 hypertension and preeclampsia. They will also listen to your baby’s heartbeat. Your care provider can hear the heartbeat with an ultrasound, a Doppler, or a stethoscope.

In the second half of your pregnancy, your doctor or midwife will also measure the distance between the top of your pelvic bone and 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 you are. It is not uncommon to measure a week off, so don’t stress if the measurement doesn’t line up exactly. 

#3 Know What is Coming Up at Your Next Appointment

After the routine procedures you can expect at almost every appointment, 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 their care provider is recommending a procedure. If you have a heads up that at your next appointment, you will have the option to do a particular test, undergo a procedure, or get a vaccine, you can educate yourself and be prepared.

An easy way to stay on top of what is coming up at each prenatal appointment is to listen to the 40 Weeks Podcast. In about six minutes, you can learn how your baby is growing, what is happening in your body, what to expect at your upcoming prenatal appointments, and a tip for dads and partners.

Tests

You will likely have some type of test at several appointments throughout your pregnancy. 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 other disorders. You will also most likely encounter a few blood tests. Blood samples check your blood type and whether you have any infections or diseases or 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. These include tests like cell-free DNA or NIPT, ultrasounds, gestational diabetes testing, and group B strep. With each of these tests, you have options regarding whether you want to opt into the test and how it is performed.

If you educate yourself about an upcoming test, you will be prepared to discuss it with your provider and make an informed choice.

Vaccines

The vaccines your care provider will likely recommend during pregnancy include the flu vaccine, Tdap, COVID-19, and RSV.

The COVID-19 and influenza vaccines are available in any trimester. Some expecting mothers and care providers may avoid vaccines during the first trimester because this period is critical to development. If you decline the flu or COVID-19 vaccine in the first trimester, your doctor or midwife will likely offer or suggest these vaccines in the second trimester. See this episode for more information on the COVID-19 vaccine during pregnancy. This article examines the evidence on the flu vaccine for the current flu season.

In the United States, the CDC and ACOG recommend the TDap vaccine in your third trimester between 27-36 weeks. The antibodies your body creates are highest two weeks after you receive the vaccine. The goal of having the vaccine by week 36 is to pass antibodies to your baby before they are born. Tdap provides immunity for tetanus, diphtheria, and pertussis (whooping cough). Sifting through the vaccine evidence can be challenging, especially during pregnancy. This episode dives deep into the evidence on the Tdap vaccine.

In 2023, the American College of Obstetricians and Gynecologists began recommending a single dose of Pfizer’s RSV vaccine (Abrysvo) for pregnant individuals between 32 0/7 and 36 6/7 weeks of gestation, using seasonal administration. For most of the United States, RSV season occurs from September through January. If you are 32-37 weeks, sometime during September through January, your care provider will recommend the RSV vaccine. The goal of the RSV vaccine during pregnancy is to pass antibodies to your baby to prevent RSV lower respiratory tract infection in infants. Stay tuned for a future episode digging into the research on this vaccine. In the meantime, you can read the package insert here.

Procedures

Some procedures will be offered at appointments, and knowing they are coming up ahead of time will be helpful. 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 you are unprepared for. It is much 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 its evidence.

#4 Understand Informed Consent

Proper informed consent means that you fully understand the procedure, intervention, or treatment, are made aware of all of the risks and benefits, and can opt in or opt-out. The last part of that is tricky. The truth is that you can opt out of anything. For a doctor or midwife to honestly give you a choice can be challenging because they, and the entities like hospitals they work for, have policies about what is required and routine. While it may not always feel like it, you always have a choice, which is crucial to true informed consent.

Numerous constraints can make it challenging for care providers to give proper informed consent. Limited time during a prenatal appointment or in labor can make it difficult to discuss procedures at length. How knowledgeable your care provider is about particular topics can affect their ability to assist you in navigating interventions. If your care provider is not consistently educating themselves, there may be areas where they do not have the most up-to-date information. While every procedure should come with informed consent, many care providers gloss over procedures they consider routine.

All of these constraints can make it challenging for doctors and midwives to provide proper informed consent for everything with every patient. Some care providers prioritize true informed consent more than others. If you ever need more information, please advocate for yourself and ask questions. You can also request to have a few days or a week and offer to make a follow-up appointment. Please do not feel intimidated or pressured into anything you are uncomfortable with.

#5 Ask Questions

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 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 and you cannot wait until your next visit, please 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 many terms you may not be familiar with. If you are asking questions, be prepared to take some notes when they answer.

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

Remember that you hire 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 your current one is the right fit. Switching providers is easiest the earlier you are in your pregnancy. I hope you find the right provider and feel supported during every prenatal appointment.

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