What to Expect When You're Expecting

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What to Expect When You're Expecting

The first prenatal visit is the most comprehensive of all the prenatal visits. (See the Appendix for an explanation of the procedures and tests performed.) A complete medical history will be taken, and certain tests an procedures will be performed only at this exam. One practitioner's routine may vary slightly from another's. In general, the examination will include:

Confirmation of Your Pregnancy.

Your practitioner will want to check the following: the pregnancy symptoms you are experiencing; the date of your last normal menstrual period, to determine your estimated date of delivery (EDD), or due date (see page 6); your cervix and uterus, for signs and approximate age of the pregnancy. If there's any question, a pregnancy test may be ordered if you haven't already had one.

A Complete History.

To give you the best care, your practitioner will want to know a great deal about you. Come prepared by checking home records and refreshing your memory, as necessary, on the following: your personal medical history (chronic illness, previous major illness or surgery, medications you are presently taking or have taken since conception, known allergies, including drug allergies); your family medical history (genetic disorders and chronic illnesses); your social history (age, occupation, and habits, such as smoking, drinking, exercising, diet); your gynecological and obstetrical history (age at first menstrual period, usual length of menstrual cycle, duration and regularity of menstrual periods, past abortions, miscarriages, and live births; course of past pregnancies, labors and deliveries); and factors in your personal life that might affect your pregnancy.

A Complete Physical Examination.

This may include: assessment of your general health through examination of heart, lungs, breasts, abdomen; measurement of your blood pressure to serve as a baseline reading for comparison at subsequent visits; notation of your height and weight, usual and present; inspection of extremities for varicose veins and edema (swelling from excess fluid in tissues) to serve as a baseline for comparison at subsequent visits; inspection and palpation of external genitalia; internal examination of your vagina and cervix (with a speculum in place); examination of your pelvic organs bimanually (with one hand in the vagina and one on the abdomen) and also through the rectum and vagina; assessment of the size and shape of your bony pelvis.

A Battery of Tests.

Some tests are routine for every pregnant woman; some are routine in some areas of the country or with some practitioners, and not others; some are performed only when circumstances warrant. The most common prenatal tests include:

• A blood test to determine blood type and check for anemia.
• Urinalysis to screen for sugar, protein, white blood cells, blood, and bacteria.
• Blood screens to determine immunity to such diseases as rubella.
• Tests to disclose the presence of such infections as syphilis, gonorrhea, hepatitis, chlamydia, and in some cases, AIDS).
• Genetic tests for sickle-cell anemia or Tay-Sachs disease.
• A Pap smear for the detection of cervical cancer.
• A gestational diabetic screening test to check for any tendency toward diabetes, particularly for women who have previously had an excessively large baby or gained excessive weight with an earlier pregnancy.

Come prepared with a list of questions, problems, and symptoms you would like to talk about. This is also a good time to bring up any special concerns that weren't addressed at an earlier consultation.

What You May Look Like

By the end of the first month, your baby is a tiny, tadpole-like embryo, smaller than a grain of rice. In the next two weeks, the neural tube (which becomes the brain and spinal cord), heart digestive tract, sensory organs, an arm and leg buds will begin to form.

What You Might Be Feeling

You may experience all of these symptoms at one time or another, or only one or two.

Phycically:

• Absence of menstruation (though you may stain slightly when your period would have been expected or when the fertilized egg implants in the uterus)
• Fatigue and sleepiness
• Frequent urination
• Nausea, with or without vomiting, and/or excessive salivation (ptyalism)
• Heartburn, indigestion, flatulence, bloating
• Food aversions and cravings
• Breast changes (most pronounced in women who have breast changes prior to menstruation): fullness, heaviness, tenderness, tingling; darkening of the areola (the pigmented area surrounding the nipple). Sweat glands in the areola become prominent (Montgomery's tubercles), looking like large goose bumps; a network of bluish lines appear under the skin as blood supply to the breasts increases (though these lines may not appear until later)

• Instability comparable to premenstrual syndrome, which may include irritability, mood swings, irrationality, weepiness
• Misgivings, fear, joy, elation
• any or all of these

Fatigue

"I'm tired all the time. I'm worried that I won't be able to continue working."

It would be surprising if you weren't tired. In some ways, your pregnant body is working harder even when you're resting than a nonpregnant body is when mountain-climbing; you just can't see its efforts. For one thing, it's manufacturing your baby's life-support system, the placenta, which won't be completed until the end of the first trimester. For another, it's adjusting to the many other physical and emotional demands of pregnancy, which are considerable. Once your body has adjusted and the placenta is complete (around the fourth month), you should have more energy. Until then, you may need to work fewer hours or take a few days off if you're really dragging. But if your pregnancy continues normally, there is absolutely no reason why you shouldn't stay at your job (assuming your doctor hasn't restricted your activity and/or the work isn't overly strenuous or hazardous; see page 72). Most pregnant women are happier and less anxious if they keep busy.

Since your fatigue is legitimate, don't fight it. Consider it a sensible signal from your body that you need more rest. That, of course, is more easily suggested than done. But it's worth a try.

Baby Yourself.

If you're a first-time expectant mother, enjoy what will probably be your last chance for a long while to focus on taking care of yourself without feeling guilty. If you already have one or more children at home, you will have to divide your focus. But either way, this is not a time to strive for Super-Mom-to-Be status. Getting adequate rest is more important than keeping your house white-glove-test clean or serving dinners worthy of four-star ratings. Keep evenings free of unessential activities. Spend them off your feet when you can, reading, watching TV, or scouring baby-name books. If you have older children, read to them, play quiet games with them, or watch classic children's videos with them rather than traipsing off to the playground. (Fatigue may be more pronounced when there are older children at home, simply because there are so many more physical demands and so much less time to rest. On the other hand, it may be less noticed, since a mother of young children is usually accustomed to exhaustion and/or too busy to mind.)

And don't wait until nightfall to take it easy

• if you can afford the luxury of an afternoon nap, by all means indulge. If you can't sleep, lie down with a good book. A nap at the office isn't a reasonable goal, of course, unless you have a flexible schedule and access to a comfortable sofa, but putting your feet up at your desk or on the sofa in the ladies room during breaks and lunch hours may be. (If you choose to rest at lunch hour, don't forget to eat, too.) Napping when you're mothering may also be difficult, but if you can time your rest with the children's nap-time (if they still nap), you may be able to get away with it
• assuming you can tolerate the unwashed dishes and the dust balls under the bed.

Accept your mother-in-law's offer to vacuum and dust the house when she's visiting. Let your dad take the older kids to the zoo on Sunday. Enlist your husband for chores like laundry and marketing.

Get an Hour or Two More Sleep Each Night.

Skip the 11 o'clock news and turn in earlier; ask your husband to fix breakfast so you can turn out later.

Be Sure That Your Diet Isn't Deficient.

First-trimester fatigue is often aggravated by a deficiency in iron, protein, or just plain calories. Double-check to make certain you're filling all of your requirements (see the Best-Odds Diet, page 80). And no matter how tired you're feeling, don't be tempted to rev up your body with caffeine and candy bars, and cake. It won't be fooled for long, and after the temporary lift, your blood sugar will plummet, leaving you more fatigued than ever.

Check Your Environment.

Inadequate lighting, poor air quality ("sick building" syndrome), or excessive noise in your home or workplace can contribute to fatigue. Be alert to these problems and try to get them corrected.

Take a Hike.

Or a slow jog. Or a stroll to the grocery store. Or the time to do a pregnancy exercise routine. Paradoxically, fatigue can he heightened by too much rest and not enough activity. But don't overdo the exercise. Stop before that exercise high dissolves into a low, and be sure to follow the precautionary guidelines on page 195.

Though fatigue will probably ease up by month four, you can expect it to return in the last trimester -probably as nature's way of preparing you for the long sleepless nights once the baby has arrived.

When fatigue is severe, especially if it is accompanied by fainting, pallor, breathlessness, and/or palpitations, it's wise to report it to your practitioner...