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General overview of prenatal care

Shieva Ghofrany: [00:00:00] Hi tribe. Do you guys know what happens like during a typical pregnancy? I decided that I was sitting here doing a video that I'm gonna release tomorrow talking about my pregnancy kit, but I realized I think a lot of you guys, if you're not yet pregnant or if you're really early pregnant, you don't actually know what just happens during a typical pregnancy. 

So I am gonna talk about that really quickly before I go have dinner with my family. So here's what happens. You find out you're pregnant, we're going down to like the granular nuggets. , you pee on your stick, you find out you're pregnant, what should you do? Well, you should call your doctor's office, not if it's the middle of the night, wait till the next morning and schedule an appointment. 

They'll ask you when your last period was, and that's because they're trying to calculate when you are close to seven to eight weeks from the first day of your last period, and that's when they're gonna have you come in, because that's when the ultrasound will be able to see that little flickering, which makes it so happy. 

And that's the sign that there is a viable pregnancy in your. Now what if you have [00:01:00] pain on one side or the other, or bleeding or spotting? Then you should tell your practice because they're likely gonna have you come in earlier. Cuz they wanna rule out an ectopic pregnancy, which is where a pregnancy can be outside of the uterus. 

Okay? So let's assume that doesn't happen. You go for your first visit at seven to eight weeks, they do an ultrasound, they measure the. Crown rump length, which is that little beam that looks so cute with a little flickering and they decide, yep, you're as pregnant as we thought you were. Sometimes they adjust the date. 

There's different rules as to when they adjust the date and why they adjusted the date based on the measurement. Um, and then they'll talk to you about the pregnancy schedule, as I call it, right? So typical pregnancy schedule is gonna be that you go see your doctor every four weeks till 28 weeks, then every two. 

after 28 weeks and then every week after 36 weeks. What I usually say to my patients when I go through that is, you don't have to remember this, we're gonna tell you when to come next time, but just so you know, the overview, so that first visit, let's just say, is eight weeks. At that visit, like I said, they document the [00:02:00] heartbeat and they confirm your due date. 

They may or may not send you for all the routine blood work, which is like. Hiv, hepatitis, blood count, blood type, syphilis, rubella, immune status. These are standard things throughout the country that states require us to do because the pediatricians need to know these things because any of those things might be a reason for us to either treat you during pregnancy or know what to do with the baby when the baby's born. 

Sometimes, like in our practice, we don't send the patients for that first trimester ultrasound. I call, I mean, first trimester blood work. We don't send them for that at the eight week visit. And that's because many of our patients wanna do the N I P T non-invasive prenatal test, otherwise known as cell-free D n A, um, because that test is the one that can tell us what the chromosomes of the baby are. 

Yeah, it's a blood test that actually checks the circulating DNA of the baby, little snippets of it, and it can. If the baby has things like Down Syndrome and if the baby is a boy or a girl, that blood test can be done really after eight or nine weeks, [00:03:00] but it sometimes doesn't have enough of the dna, so we tend to wait until 10 weeks. 

Other practices might be different, and we try to just conglomerate and say, come back at 10 weeks to do the blood tests for all the routine stuff. And the N I P T test. So again, eight-ish weeks, you do your first ultrasound, ten-ish weeks. You will do all your first trimester blood tests, plus the non-invasive prenatal blood test, twelve-ish weeks. 

You do a fancy ultrasound called the nucle translucency, and that's the thickness behind the baby's neck that they measure on an ultrasound. That can give us data with regard to whether or not the baby has things like cardiac defects or abdominal wall defects, and back in the day before the N I P T, or if your insurance doesn't cover it, then that blood, that thickness test will be coupled with different blood tests to tell us what the risk of things like Down Syndrome are. 

You also might get some anatomy looked at during that ultrasound, just depending on the practice that you go to. We send our patients to the perinatologist, which is considered the [00:04:00] high risk obstetric doctor, not because our patients are high risk necessarily, some are, some are not, but because that's the doctor whose offices have the fancier ultrasounds than what we have. 

So we leave it to them to do that 12 week ultrasound. After the 12 week visit again, you'll be going every four weeks. So let's say you came at eight weeks to see us, then typically you get seen at 12 weeks, 16 weeks, 20 weeks. Around that 18 to 20 week mark, you would have another ultrasound to look at all of the anatomy to make sure that the head and the heart and the kidneys and the lungs and. 

Femur and all the different bones and structures and organs are there. They're in the right size, the right shape, the right quantity, um, because that can give us an indication if the baby has any kind of concerns or birth defects or anything. They'll also look at your placenta and they'll look at your cervix to make sure there's no concern for things like preterm labor. 

Again, that's at 18 to 20 weeks. You'll come in at about 24 ish weeks for a visit. Where we just listen with the Doppler and check your blood pressure and urine dip. There's my dog. And then [00:05:00] 26 to 28 weeks where we do the glucose visit, I call it, and that's where you will drink. 50 grams of sugar in a bottle and that will tell us what the risk of diabetes. 

We check every pregnant woman for gestational diabetes, which is diabetes. That comes about just during the pregnancy. So you'll drink that bottle and an hour later you'll get your blood drawn. Some doctor's offices do it in the office, some send you to the lab, you'll talk to your doctor about it. So, and in our. 

We do it in our office, but we're limited by what your insurance will cover because the lab in our office is our hospital's lab. It's not ours. Not every insurance covers it, so sometimes we have to send you down the street to the commercial lab, thank you to your insurance companies. It's so annoying. 

But again, that's at 26 to 28 weeks. So we check for diabetes, we check again for anemia, and we talk about birthing. Checking, checking. I mean, I'm picking a pediatrician whether or not you wanna do cord blood banking for stem cells. Whether or not you wanna take a C P R class, we make sure that your blood [00:06:00] type, so are you a, B, or O, we don't care so much about that, but we care if you are negative or positive, something called RH negative or positive. 

And if you're RH negative, you'll get a shot of a medicine called Roho Gamma, 28 weeks. So these are all things we talk about and we remind you to get your whooping cough vaccine. The T. The tetanus, diptheria, pertussis vaccine, which is for whooping cough that's recommended to all pregnant women. After 27 weeks after that visit, you start coming every two weeks. 

And that's because in theory, towards that third trimester, your blood pressure can go up. And so we really wanna make sure that's okay and other things can happen with the baby. Is your baby getting too big? Is your baby not growing enough? So that's why we wanna check in periodically every two weeks, and then after 36 weeks, you start coming every week. 

And that's because. . Now your blood pressure might go up even more, and these are the times where you're getting closer to maybe going into labor at 36 weeks. You have a quick perineal culture. I don't really wanna say vaginal, but it checks a little bit in your vagina and a little bit near your rectum. 

And your perineum. It's a [00:07:00] Q-tip swab that checks for the beta strep bacteria. There's no speculum involved, so don't worry. And that's done again at 36. . Our practice happens to do it. We do it or our nurses do it, but some practices actually have you self-administer, so that's something that you can do easily in the bathroom and they'll teach you how to do that. 

And then you go to see your doctor every week. Some doctor's offices will check your cervix every week. We happen not to do it every week because it's not gonna change our management. Even if I check your cervix, it doesn't help me D tell you when you're gonna go into labor. If you're gonna go into labor within the next couple days. 

and frankly, it's really uncomfortable, so I discourage checking every week, but some people like to get checked every week, and some doctors like to do it, so you'll talk to your doctor and help decide. Then once you get closer to that 38 to 41 week stretch, you and your doctor will have decisions to make, whether or not you need to be induced because of things like blood pressure or diabetes, or growth issues with the baby, or fluid issues with the baby. 

Whether or not you can go until the farthest, your practice might let you go. In our practice, we let people go anywhere from seven to 12, seven to 10 days past their [00:08:00] due date. Some practices, let them go a little bit farther. Some practices automatically induce at 39 weeks and there's different data to support all of those practices. 

So there's no one right way you and your practice should discuss what they do and what their philosophy is. So that's an overview of the whole practice. Um, you might be offered nowadays telehealth visits, which I'm gonna talk about again tomorrow. You might see different practitioners despite seeing your own practice all the time. 

For example, if you have diabetes, you might be sent to a diabetes counseling office. You might be sent to the perinatal office for certain ultrasounds. If you are having any other concerns, your doctor might have to send you to an endocrinologist, for example. So throughout your pregnancy, They get a lot of attention. 

It's really important that you feel like you are comfortable with your doctor, and I'm glad that, I think in America for the most part, we actually have doctors who are pretty engaged, but we also know that prenatal care comes at a financial cost to the country, and doctors are increasingly squeezed and not necessarily able to answer all the questions that patients want. 

So patients tend to go to the. , [00:09:00] which can be good and bad because sometimes the internet is giving you a lot of great information and comfort. There's so many OBGYNs now that are on, um, Instagram and Facebook and TikTok to educate you guys, but there's also a lot of information that I think just increases anxiety. 

So just be cautious. Where you go, who you look at, what you watch. Okay. All right. So that was an overview. I hope that helps. I just figured it was good to kind of give you guys a little spiel of what I give my patients. I'm sure your doctors have done the same thing and um, I am just grateful to you guys. 

You guys are a great, great audience. I get so many good dms. I don't even get to read the majority of them, but the ones that I do read are super, um, supportive and thankful, so I appreciate it. Okay, have a great night. Bye.