The anticipation of the first OB visit is a combination of excitement, hope, and nervousness all rolled into one ball of emotions. And that’s just how I feel as the doctor. For the new parents, it’s even more of a mixed bag as you add uncertainty, with a little surrealism and disbelief.
The goals of the first visit are to confirm the status of the pregnancy, assess and develop a plan to care for any preexisting medical conditions of the mother and to develop a plan to optimize the outcome of the current pregnancy.
This visit is typically scheduled any time after six (6) weeks and preferably from 7-8 weeks of the pregnancy. This works out to most moms missing the period and checking a home pregnancy test around 4-5 weeks (from first day of her last period) and then being scheduled to be seen in 1-2 weeks. Six (6) weeks is the earliest that I would expect to see a baby with a heartbeat on ultrasound. It’s best to call with the first sign of pregnancy as, based on history, we may need to do lab work ahead or want to see you sooner.
First, when you arrive, you will review a detailed questionnaire about personal and family history related to medical conditions and potential genetic conditions or areas of concern. One of our staff will then check a set of vital signs and confirm a pregnancy test in the office. Our staff member will then review the history with you as we help set up the prenatal record. This record allows a consolidated and trackable view for me and any other caregivers you may need during your pregnancy including labor and delivery – ultrasonographers, dieticians, lactation and other consultants. This form is fairly standard throughout the country and can serve as your passport of sorts if you need care while traveling or if life leads to a move during the course of care. A member of our staff will also give you our new mom packet which contains lots of other important pieces of information.
Second, you will be moved to a room for ultrasound evaluation. While we have an awesome ultrasound technician in the office, I like to do this first ultrasound myself. This is probably the most important ultrasound of the pregnancy as I am looking for baby viability, location, number and heartbeat as well as evaluating the maternal anatomy for any cysts or masses. This helps me nail down a fixed due date that will not change as the pregnancy progresses. It’s worth noting that this is often done via an internal vaginal ultrasound in the first trimester. While there is a little pressure involved, it’s very temporary and really makes the difference in image quality and in what I can see. During the first trimester, the baby is well protected inside the bony pelvis and is difficult to evaluate abdominally. After the first visit or outside the first trimester, an ultrasound on your abdomen will usually suffice.
After the ultrasound I will review the prenatal record with you and we will discuss plan of care for any preexisting or anticipated high risk conditions. This is also the time where we can evaluate and treat for any other concerns such as nausea and vomiting as well as answer any questions you may have.
You will then move to the front desk where my staff will help answer questions about cost of pregnancy based on your insurance coverage and can help set up any plans for your convenience. Our staff will also schedule your next visit, which is typically in a month in a normal low risk pregnancy.
Finally, we will send you to the lab for blood work. This ranges from the basic standard Texas OB lab panel, which includes cbc, blood type and screen, rubella immune status, a urine culture as well as the mandated infection screening labs of HIV, syphilis and hepatitis B. I may add additional labs to the order depending on areas of concern based on your history and physical. Typically we get these labs back in 2-3days and you should receive an email notifying you that the results with my comments are available in your portal.
In conclusion, the first visit sets a solid foundation for the start of the prenatal journey. We look forward to seeing you soon.
Kyle P. McMorries, MD, FACOG