Pregnancy for doctors and patients is separated into trimesters of First ( zero to 13 weeks), Second (13 to 28 weeks), and Third ( 28 to 40 weeks) because each trimester offers it’s own unique challenges, fun, and worry.

 

FIRST TRIMESTER

I, generally, start your prenatal care at 8 to 11 weeks of pregnancy. If you are a new patient this is what I call the “Biochemistry of Pregnancy.” We will talk about antenatal testing that is offered for you or your partner, such as genetic mutations like Cystic Fibrosis, Fragile X, Spinal Muscular Atrophy (SMA). You do State of California blood work such as your blood type ; It never changes but they want it done every pregnancy:( .You are offered testing for the health and genetic make-up of your baby, meaning Maternal Serum Alpha Fetoprotein aka MSAFP, Nucelotide Peptide Testing aka NIPT (this is the early blood test that tells YOU gender, and me Trisomy 21,18,13 risks) as well as invasive testing such as Chorionic Villous Sampling aka CVS or Amniocentesis. AM I RIGHT!!! BIOCHEMISTRY TO THE MAX!

Finally, if you want to, we can do an Transvaginal ultrasound to determine if you have one or 2 babies, where they are in the uterus, how fast the heart is beating, and the really fun stuff, if it wiggles:) We will confirm your due date aka EDC (Estimated Date of Confinement). I will then prescribe you prenatal vitamins with DHA, or manage your pregnancy malaise (see handout Options for Malaise of Pregnancy) and send you off to a Perinatologist for all of your subsequent ultrasounds.

You will make appointments to see me every 4 weeks, and since the pregnancy is 40 weeks, we have plenty of time to cover all the bases of preparing your body, your family, and your spirit before you bring a baby home. I love lists! Bring them in to every visit.

Preconception also known as before you get pregnant can get rid of almost all of the BIOCHEMISTRY of PREGNANCY by getting done your Counsyl (Counsyl.com Universal Plus Fragile X) testing and Starting Folic Acid (in your prenatal vitamins) 4 months before pregnancy to prevent fetal neural tube defects.

Additionally, the first visit physical exam and history can be done before pregnancy also.

 

SECOND TRIMESTER

15 to 18 weeks – this visit has you finish your fetal testing with a State of California MSAFP test. You can read through the brochure and decline it, if you wish. Hopefully, by now you will notice that you feel, and think more clearly. Your malaise is easing up, and our conversations are less of a fog. From now on your exam is simple, wight check, blood pressure, urine check (not for infection unless you tell us you have symptoms) for protein. I’ll measure the size of your baby with a tape measure.

They call this a Fundal Height, which is the top of your uterus, noted by Hippocrates in 300 BC. Even in the 21st Century it correlates very nicely with gestational age ; so the fundal height matches your gestational age: 16 weeks,16 centimeters. Isn’t that cool ! Then the fetal heart rate. Because most sites you guys read ( I don’t read them, you tell me) say your baby starts moving now.

This visit is still full of worry because you don’t feel your baby move, or it happened once (that’s what happened to me.) About 4 days before this visit you get anxious and have nightmares or super weird dreams. The heart rate with a doppler is very reassuring. It pounds, and you can feel it with your physical being. I lay it on your upper abdomen and lay your hands and your partner or parents hand on it to enjoy that beautiful sound and you begin to feel that it’s real. I tend to talk to your baby at all the visits. I just love it.

Because you’re baby is getting bigger now, and starting to lay down more bone. I will start to supplement you with Calcium and Vitamin D3. (Separate handout)- this visit has you finish your fetal testing with a State of California MSAFP test. You can read through the brochure and decline it, if you wish.

Hopefully, by now you will notice that you feel, and think more clearly. Your malaise is easing up, and our conversations are less of a fog. From now on your exam is simple, wight check, blood pressure, urine check (not for infection unless you tell us you have symptoms) for protein. I’ll measure the size of your baby with a tape measure.

They call this a Fundal Height, which is the top of your uterus, noted by Hippocrates in 300 BC. Even in the 21st Century it correlates very nicely with gestational age ; so the fundal height matches your gestational age: 16 weeks,16 centimeters. Isn’t that cool ! Then the fetal heart rate. Because most sites you guys read ( I don’t read them, you tell me) say your baby starts moving now.

This visit is still full of worry because you don’t feel your baby move, or it happened once (that’s what happened to me.) About 4 days before this visit you get anxious and have nightmares or super weird dreams. The heart rate with a doppler is very reassuring. It pounds, and you can feel it with your physical being. I lay it on your upper abdomen and lay your hands and your partner or parents hand on it to enjoy that beautiful sound and you begin to feel that it’s real. I tend to talk to your baby at all the visits. I just love it.

Because you’re baby is getting bigger now, and starting to lay down more bone. I will start to supplement you with Calcium and Vitamin D3. (Separate handout) 20 to 23 weeks – I call this the BABY MOON, fun month. All the biochemistry and scary perinatology visits are over. You have popped! Everyone knows you are NOT FAT, you are pregnant. It’s a beautiful state of being that you only experience a few times in your life.

Take the interval 4 weeks to just enjoy being pregnant. Throw away all the negative thoughts that people can’t stop themselves from saying “You’re too small, you’re too big, are you sure it’s not twins, you’re not eating enough.” Most of the time you handle the comments all day without an issue but at night when you try to sleep, they come creeping back. So purposely try to get them out of your head. I will notify you if you are “too big or too small” and we will talk about nutrition every visit. Try not to do any “Homework,” meaning specifically, no classes, hospital tour, registration at the hospital (unless you feel it will decrease your anxiety. ) Just enjoy being out of the Biochemistry of pregnancy……..Please…… it’s once in a LIFETIME 🙂

24 to 28 weeks – Now is where the Homework begins. I will give you a folder with information about the Classes I recommend and the numbers to call for them, Stem Cell Collection, Registration at Tarzana Hospital, Breastfeeding resources, Pediatrician recommendations, Labor Doulas, Placental Encapsulation, getting help if your having twins.

Also you will do the glucose test. This is a drink of 50 grams of glucola, you drink it within 5 minutes.Then have nothing to eat or drink or chew (gum) for 1 hour. It is a timed test and should be drawn fro blood within 5 minutes of you finishing the drink. There are alternates to the glucose drink, just ask. Also with this blood draw we are checking for anemia, thyroid, and vitamin D3 levels. We will add anything you may need for a medical condition to alleviate too many blood draws.

28 to 32 weeks – Many people choose a 3D ultrasound at this time to get a good picture of your baby. You will do this with a separate company or a perinatologist. If you have a medical reason for checking the growth of your baby or we are following your for a medical condition that could effect your baby then I will send you to a perinatologist for this follow up ultrasound. You may decline these ultrasounds if you choose.

 

THIRD TRIMESTER

At 32 weeks I will give you a prescription, ACOG informational handout on TDAP (Whooping Cough) vaccination. This is an ideal time to get it because , if you are a breastfeeding mom, the baby will get the most antibodies against whooping cough through your breastmilk in those first 6 weeks of life when they are vulnerable. Even if you are not breastfeeding babies can be vulnerable to Whooping Cough so TDAP is recommended.

I will also give you a Breastpump prescription. Your insurance company should give you a free one. I prefer the Medela Double breast Pump-in-Style. (Insert click to handout).

We discuss what is going on in your classes, what are your fears, helpful information, clarifications of terms learned. I call it your pregnancy homework.

After 32 weeks – Your visits will be scheduled for 35 weeks, 37 weeks, then every week after that until you deliver.