What to expect when you're expecting (12 page)

It isn’t necessary to use your first-morning urine, but if you’re testing early (i.e., before your period is due), you’re more likely to get an accurate result if you haven’t peed in the past four hours (because your urine will contain more concentrated levels of hCG).

Watch for the control indicator (ranging from a horizontal or vertical line to a filled-in circle, or a flashing control symbol in the digital tests) to let you know that the test is working.

Look carefully—and before you leap to any conclusions. Any line you see (pink or blue, positive sign, or digital readout), no matter how faint it is (or no matter how faint you feel), means there’s hCG in your system—and a baby likely in your future. Congratulations—you’re pregnant! If the result isn’t positive, and your period still hasn’t arrived, consider waiting a few days and testing again. It may have just been too soon to call.

“The home pregnancy test I just took came back positive. When should I schedule the first visit with my doctor?”

Good prenatal care is one of the most important ingredients in making a healthy baby. So don’t delay. As soon as you suspect you might be pregnant or have a positive home pregnancy test result, call your practitioner to schedule an appointment. Just how soon you’ll be able to come in for that appointment may depend on office traffic and policy. Some practitioners will be able to fit you in right away, while some very busy offices may not be able to accommodate you for several weeks or even longer. At certain practitioners’ offices, it’s actually routine procedure to wait until a woman is six to eight weeks pregnant for that first official prenatal visit, though some offer a “pre-OB” visit to confirm a pregnancy as soon as you suspect you’re expecting (or have the positive HPT results to prove it).

But even if your official prenatal care has to be postponed until midway
through the first trimester, that doesn’t mean you should put off taking care of yourself and your baby. Regardless of when you get in to see your practitioner, start acting pregnant as soon as you see that positive readout on the HPT. You’re probably familiar with many of the basics (take your prenatal vitamins, cut out alcohol and smoking, eat well, and so on), but don’t hesitate to call your practitioner’s office if you have specific questions about how best to get with the pregnancy program. You may even be able to pick up a pregnancy packet ahead of time (many offices provide one, with advice on everything from diet do’s and don’ts to prenatal vitamin recommendations to a list of medications you can safely take) to help fill in some of the blanks.

In a low-risk pregnancy, having the first prenatal visit early on isn’t considered medically necessary, though the wait can be hard to take. If the waiting’s making you unreasonably anxious, or if you feel you may be a high-risk case (because of a history of miscarriages or ectopic pregnancies, for instance), check with the office to see if you can come in earlier. (For more on what to expect from your first prenatal visit, see
page 124
.)

“My practitioner has told me my due date, but how accurate is it?”

Life would be a lot simpler if you could be certain that your due date is actually the day you will deliver, but life isn’t that simple very often. According to most studies, only 1 in 20 babies is actually born on his or her due date. Because a normal full-term pregnancy can last anywhere from 38 to 42 weeks, most are born within two weeks either way of that date—which keeps most parents guessing right up to delivery day.

That’s why the medical term for “due date” is EDD, or
estimated
date of delivery. The date your practitioner gives you is only an educated estimate. It is usually calculated this way: Subtract three months from the first day of your last menstrual period (LMP), then add seven days—that’s your due date. For example, say your last period began on April 11. Count backward three months, which gets you to January, and then add seven days. Your due date would be January 18.

This dating system works well for women who have a fairly regular menstrual cycle. But if your cycle is irregular, the system may not work for you at all. Say you typically get your period every six to seven weeks and you haven’t had one in three months. On testing, you find out you’re pregnant. When did you conceive? Because a reliable EDD is important, you and your practitioner will have to try to come up with one. Even if you can’t pinpoint conception or aren’t sure when you last ovulated, there are clues that can help.

The very first clue is the size of your uterus, which will be noted when your initial internal pregnancy examination is performed. It should conform to your suspected stage of pregnancy. The second clue will be an early ultrasound that can more accurately date the pregnancy. (Note that not all women get an early ultrasound. Some practitioners perform them routinely, but others will only recommend one if your periods are irregular, if you have a history of miscarriages or pregnancy complications, or if the estimated due date can’t be determined based on your LMP and physical exam). Later on, there are other milestones that will confirm your date: the first time the fetal heartbeat
is heard (at about 9 to 12 weeks with a Doppler), when the first flutter of life is felt (at about 16 to 22 weeks), and the height of the fundus (the top of the uterus) at each visit (for example, it will reach the navel at about week 20). These clues will be helpful but still not definitive. Only your baby knows for sure when his or her birth date will be … and baby’s not telling.

Choosing and Working with Your Practitioner

We all know it takes two to conceive a baby, but it takes a minimum of three—mother, father, and at least one health-care professional—to make that transition from fertilized egg to delivered infant a safe and successful one. Assuming you and your spouse have already taken care of conception, the next challenge you both face is selecting that third member of your pregnancy team and making sure it’s a selection you can live with—and labor with. (Of course, you can make this selection even before you conceive.)

Where to begin your search for the perfect practitioner to help guide you through your pregnancy and beyond? First, you’ll have to give some thought to what kind of medical credentials would best meet your needs.

The obstetrician.
Are you looking for a practitioner who is trained to handle every conceivable medical aspect of pregnancy, labor, delivery, and the postpartum period—from the most obvious question to the most obscure complication? Then you’ll want to look to an obstetrician-gynecologist. Ob-gyns not only provide complete obstetrical care, they can also take care of all your nonpregnancy female health needs (Pap smears, contraception, breast exams, and so on). Some also offer general medical care and thus can act as your primary physician as well.

If yours is a high-risk pregnancy, you will very likely need and want to seek out an ob-gyn. You may even want to find a specialist’s specialist, an obstetrician who specializes in high-risk pregnancies and is certified in maternal-fetal medicine. Even if your pregnancy looks pretty routine, you may still want to select an obstetrician for your care—more than 90 percent of women do. If you’ve been seeing an ob-gyn you like, respect, and feel comfortable with for your gynecological care, there may be no reason to switch now that you’re pregnant. If you haven’t been seeing an ob-gyn, or you’re not sure the one you’ve been seeing is the practitioner you want to spend your pregnancy with, it’s time to start shopping around.

The family physician.
Like the general practitioner of years ago, today’s family physician (FP) provides one-stop medical service. Unlike the obstetrician, who has had postmedical school training in women’s reproductive and general health only, the FP has had training in primary care, maternal care, and pediatric care after receiving an MD. If you decide on an FP, he or she can serve as your internist, obstetrician-gynecologist, and, when the time comes, pediatrician. Ideally, an FP will become familiar with the dynamics of your family and will be interested in all aspects of your health, not just your obstetric ones. If complications occur, an FP may send you to an obstetrician but remain involved in your care for comforting continuity.

Birthing Choices

From start (when to conceive) to finish (how to deliver), pregnancy these days is full of personal choices. When it comes to birthing that baby, the array of options is dizzying, even in a hospital setting. Leave the hospital and there’s yet more to select from.

Though your delivery preferences shouldn’t be your only criteria in picking a practitioner, they should certainly be on the table. The following are among those birthing options that you can consider these days. Ask your potential candidates about their feelings on any of these—or any others—that appeal to you (keeping in mind that no firm birthing decisions can be made until further into your pregnancy, and many can’t be finalized until the delivery itself):

Birthing rooms.
The availability of birthing rooms in most hospitals makes it possible for you to stay in the same bed from labor through recovery (instead of laboring in one room and then being wheeled into a delivery room when you’re ready to push), sometimes even for your entire hospital stay, and for your baby to remain at your side from birth on. Best of all, birthing rooms are cozy and comfy.

Some birthing rooms are used just for labor, delivery, and recovery (LDRs). If you’re in an LDR, you (and your baby, if he or she is rooming in) will be moved from the birthing room to a postpartum room after an hour or so of largely uninterrupted family togetherness. If you’re lucky enough to be in a hospital that offers LDRP (labor, delivery, recovery, postpartum) rooms, you won’t have to do any moving at all. You and baby—and in some cases, dad and even siblings—will be able to stay put from check-in to check-out.

Most birthing rooms boast an “at-home-in-the-hospital” look, with soft lighting, rocking chairs, pretty wallpaper, soothing pictures on the wall, curtains on the windows, and beds that look more as if they came out of a showroom than a hospital supply catalog. Though the rooms are thoroughly equipped for low-risk births and even unexpected emergencies, medical equipment is usually stowed out of sight behind the doors of armoires and other bedroom-type cabinetry. The back of the birthing bed can be raised to support the mom in a squatting or semi-squatting position (a squatting bar can often be attached if desired), and the foot of the bed snaps off to make way for the birthing attendants. After delivery, a change of linens, a few flipped switches, and presto, you’re back in bed. Many hospitals and birthing centers also offer showers and/or whirlpool tubs in or adjacent to the birthing rooms, both of which can offer hydrotherapy relief during labor. Tubs for water birth are also available in some birthing centers and hospitals. (See
page 24
for more on water birth.) Many birthing rooms have sofas for your support team and/or other guests to hang out on—and sometimes even a pullout for your coach to spend the night on.