Set up your first prenatal care visit as soon as you know you are pregnant. For now through the seventh month, you'll be seeing your provider on a monthly basis (unless you are considered high risk, in which case you may have more frequent appointments). If you're seeing a new doctor or midwife, expect your initial visit to be a bit longer than subsequent checkups since you'll be asked to fill out medical history forms and insurance paperwork. Some providers will send you these materials in advance so you can complete them at home. If you still haven't chosen a provider, now is the time to do so.

Your provider will ask plenty of questions about your health history and the pregnancy symptoms you have been experiencing. Make sure that you take advantage of this initial appointment to ask about issues that are on your mind as well. In addition to this interview time, you will undergo a thorough physical examination, give a urine sample (the first of many), and have blood drawn for routine lab work. If you haven't had a Pap smear within the last year, your provider may also take a vaginal swab of cells scraped from your cervix for this purpose. (For a detailed look at diagnostic and screening tests in pregnancy, go to Chapter 5.)

Your provider will probably supply you with educational brochures and pamphlets on prenatal care, nutrition, office policies, and other important issues. There will be a lot of new information to absorb, so don't feel as though you have to study everything on the spot. However, do take everything home so you can read and refer to it later. Start a folder or notebook for keeping pregnancy information together, and store it near your bed or other favorite reading and relaxation spot for easy access. Add a pad of paper to your pregnancy portfolio so you can jot down any questions for your provider.

Confirming Your Pregnancy

Today's home pregnancy tests are highly sensitive (many claim a 99 percent or higher accuracy rate), and provide many women with a convenient and private way to confirm their pregnancy. However, juggling sticks, strips, and tiny plastic cups while trying to decode the magic answer window does leave some room for operator error.

If your provider hasn't yet officially confirmed your pregnancy with a lab test, he will do so now at this first visit, typically with a urine test, although a blood (or serum) test may be used. The pregnancy test measures the amount of hCG in your system. Urine tests detect levels anywhere from 15 to 50 milli-international units per milliliter (mIU/mL) and up, depending on the test used, while the more sensitive serum tests can detect levels as low as 5 to 10 mIU/mL. Blood tests may be performed in cases where a urine test is negative but pregnancy is still suspected (usually in the early weeks of pregnancy), or when an abnormal pregnancy may be suspected.

Estimating Your Due Date

Although pregnancy lasts approximately 280 days or about nine calendar months, your estimated date of delivery (or EDD) is based on a ten lunar month pregnancy. Each month is four seven-day weeks. Why lunar months instead of following a good old-fashioned calendar? Lunar months are based on a twenty-eight-day menstrual cycle, which is considered the average cycle length.

It's important to remember that most providers determine gestational age (how far along you are) from the first day of your last menstrual period (called LMP). This means that you are officially two weeks pregnant at the moment of conception. How's that for an existential twist? Of course, if your cycle is longer or shorter than twenty-eight days or if you have an irregular menstrual period, some mathematic gymnastics are required. In addition, if you're hazy on the date of your LMP, the EDD could be harder to pinpoint.

Because this is all so confusing, your provider probably makes good use of the printed EDD charts in her office. However, if you do have a regular twenty-eight-day cycle, you can figure out your own EDD by taking the date of your last period, counting three months back, and then adding seven days. For example, if your last period began on September 1, you would go back through August, July, and into June. Then add seven days to come up with an estimated due date of (the following) June 8. An alternate method is to count 280 days (forty weeks) from the first day of your last period. (See Appendix D for an estimated due date chart.)

Prenatal Vitamins

Although some experts question whether you need to supplement a well-balanced diet with a vitamin and mineral dosage, most practitioners feel that a daily prenatal vitamin can't hurt, and in many cases will benefit you and your developing fetus. A basic prenatal vitamin contains vitamins A, D, E, C, B1, B2, B6, B12, calcium, copper, iron, magnesium, zinc, and folic acid (other vitamins and minerals may be included). It is recommended that you take a minimum daily dose of 400 mcg of folic acid, plus other essential nutrients such as iron and calcium, to prevent neural tube defects in the first trimester. Some women find prenatal vitamins, which are the rough equivalent of a horse pill, tough to swallow (literally). And if you're experiencing morning sickness, you may find them hard to keep down. Try experimenting with different brands and formulations — there are chewable and flavored versions of prenatal vitamins now on the market. Your provider probably has a roomful of vitamin samples for the asking, so request some freebies if they aren't offered.

Learning the Ropes

At each appointment you'll provide a urine sample, have a weigh-in, and get your blood pressure taken. Other diagnostic and screening tests may also be administered throughout pregnancy. (For more on these, look ahead to Chapter 5.) Once you're in the examining room, you may or may not have to disrobe depending on your provider's policy and how far along you are. For your first prenatal visit you will probably don a gown for a full physical exam. Later, some providers will simply have you move your clothing aside for a quick belly check and measure, while others prefer a more thorough examination (for example, checking your heart rate, examining your feet for any swelling).

When to Call the Doctor, Day or Night

At your first appointment, your provider may discuss how patient phone calls are handled both during the day and after-hours. Frequently, obstetrical practices use a triage system where the receptionist or intake coordinator answers and prioritizes calls and has a nurse, midwife, or physician return them in order of urgency. If your doctor is in the office and you feel more comfortable speaking with her directly (and don't mind waiting a little longer for your answer, if necessary), be sure to make your preference known when you call.

Usually an answering service will pick up after-hours calls and will page the doctor or midwife on duty, who will then return your call. In most group practices, providers usually take turns covering nights and weekends, so you will get a call back from the on-call practitioner. If you aren't given any guidelines for reaching staff after-hours, make sure you ask.

Call your doctor immediately if you experience any of the following symptoms:

Abdominal pain and/or cramping

Fluid or blood leaking from the vagina

Abnormal vaginal discharge (for example, foul-smelling, green, or yellow)

Painful urination

Severe headache

Impaired vision (for example, spots, blurring)

Fever over 101°F

Chills

Excessive swelling of face and/or body

Severe and unrelenting vomiting and/or diarrhea

You should also become familiar with the signs of preterm labor (covered in Appendix A). Some women hesitate to pick up the phone for fear they're being oversensitive or a hypochondriac. While a good dose of common sense should be used in contacting your doctor after-hours (for example, a call regarding the pros and cons of epidurals is probably not a good idea at 3 A.M. — unless you're in labor, of course), in most cases “better safe than sorry” applies. Remember, your provider works for you, and you're heading up this pregnancy team. Learn to trust your instincts. If something just doesn't feel right to you, make the call.