So you think you may be pregnant. Perhaps you have been preparing for this for a while. Or maybe it’s unexpected. In any case, you are likely to have a lot of questions.
Here are answers to some of the questions most frequently asked by those who are just embarking on this journey. The answers come from Jane Owen, DO, an obstetrician-gynecologist at The Mount Sinai Hospital and an Assistant Professor in the Raquel and Jaime Gilinski Department of Obstetrics, Gynecology and Reproductive Science at the Icahn School of Medicine at Mount Sinai.
Are there signs of pregnancy other than a missed period?
Early symptoms of pregnancy can vary from individual to individual. Fatigue, nausea, vomiting, sensitivity to distinctive odors, or breast sensitivity are some common symptoms that may occur. If someone is trying to get pregnant, they’re usually really in tune with their body and may notice these early signs of pregnancy. If someone’s on birth control who is not looking to get pregnant and becomes pregnant, they may notice fatigue or feeling out of sorts. Some people don’t have regular cycles, so a missed period may not be the first indication of pregnancy. Some people feel nauseous, some will vomit when they’re around food that has a distinctive smell. It varies from individual to individual.
Jane Owen, DO
When should I take a home pregnancy test?
You should take a home pregnancy test if you’re trying to get pregnant or think you’re pregnant. Normally you would take a test about 11 days after conception. So when does a conception occur? That’s based on your last menstrual period. Ovulation typically occurs at day 14 of your menstrual cycle. Day one is when you begin the cycle, which is the first day you have any bleeding, spotting, or pink-tinged discharge. A urine test can determine a pregnancy after 11 days. A more sensitive hCG blood test can determine pregnancy earlier than that.
How accurate are home pregnancy tests?
Home pregnancy tests are about 90 percent accurate, which means it is possible to get a false positive, which can be upsetting. Some can have a positive test and then have a normal period. A lot of my patients will take a series of pregnancy tests. A positive pregnancy test is just the beginning, and then we need to conduct an exam to find out exactly what’s going on with that pregnancy.
When should I see my OBGYN if I think I am pregnant?
For a normal pregnancy with prenatal care, you should see your gynecologist at seven to eight weeks of pregnancy. Your initial evaluation will involve an ultrasound to evaluate for the presence of the gestational sac and fetal heart rate; to confirm the estimated due date; to scan for anatomic issues, such as any small pooling of blood, also known as hematomas; and to determine multiple gestation, meaning if it is twins. Some patients like to come earlier if they have any spotting or cramping, which can happen early in pregnancy.
What can I expect at my first doctor’s visit?
Your first visit is called your pregnancy confirmation visit. We start by taking a thorough history from you. We will ask about prior pregnancies, prior deliveries, medical problems, and surgical issues. Then you’ll be brought into the gynecology evaluation room. Usually I start off with a transvaginal ultrasound because that’s going to give me the most information about your pregnancy. The ultrasound will help us with dating, or determining how far along you are in the pregnancy. A lot of people are not sure, especially if you have an irregular cycle. If you need a Pap smear or a vaginal culture, we will also collect those samples at the initial visit. We will also perform an exam to check your anatomy. Then I walk patients through the schedule of visits. We usually see a patient about 13 times, maybe more depending on if the pregnancy is more complicated. Finally, we will do a series of blood tests, including genetic testing to check for the risk of some conditions such as sickle cell disease or cystic fibrosis. Your first doctor visit will be pretty long, especially here at Mount Sinai. We follow best practices, which means we’ve looked at all the requirements that you need for your prenatal care, and we’ve chosen what we consider to be the most important to get the most information. Not too much, not too little.
What happens next?
At 10 weeks we will perform a non-invasive prenatal screening, which is a blood test. This test allows us to assess the baby’s risk for a genetic disorder, such as Trisomy 13 or Trisomy 21 (also known as Down syndrome). We also have the technology to tell, if a patient wants to know, the baby’s gender. We can do the ultrasounds right here in our office, and then the provider is able to discuss the results with patients right away. We do a nuchal translucency test at 12 weeks, an ultrasound that checks the space behind the baby’s neck, which can inform about the risk for disorders such as Trisomy 21. At 16 weeks we do an hour-long anatomy scan, mostly focusing on neural tube defects such as spinal bifida. At 24 weeks I like to go over the delivery plan with the patient and discuss postpartum expectations and plans, including breastfeeding. If desired, we provide breast pump prescriptions at this time, as most insurance plans will cover this service. At 28 weeks, we screen for gestational diabetes and offer the Tdap vaccine (Tetanus, Diphtheria, Pertussis). Starting at 35 weeks, we see pregnant patients every week up until delivery.
What are some of the best pregnancy apps?
There are many apps available. One of the apps that I recommend is BabyCenter, which gives patients good advice on what to expect during each stage of pregnancy and how the baby is growing and developing. Pregnancy is a time when you’re in training and preparing for delivering a healthy baby. A lot of my patients like exercise apps, and the Juna app is a good exercise app. The only problem with some of the apps is because they require your information for use, you’ll likely receive emails and advertisements from them.
How do I find the right doctor to deliver my baby?
The most important decision is probably choosing where to go for your prenatal care. You want a doctor who you can communicate with, who doesn’t intimidate you, who really listens to your needs, and who’s flexible, because things change with your prenatal care. You want to feel like you can talk to your OBGYN because it’s a long relationship. And you want to be in a place where you know you’ll have a safe delivery. Often my patients will check other options, and then we welcome them back if they want to come back. It takes a while for you to know exactly what you want with your prenatal care. You’ll know. Trust your gut. Just because someone recommends a prenatal care provider to you doesn’t mean that you’re going to click with that person. Everyone remembers their delivery story, and they remember their prenatal care. They remember everything. So you want to have a really good relationship with your OBGYN and the hospital. Each patient should feel special.
Any other tips?
There are many things you can do to optimize your pregnancy, to stay as healthy as possible. Make sure you’re eating a healthy diet, that you’re getting enough rest. I look at prenatal care as a way to help patients learn about themselves, such as their family history. For example, if we diagnose gestational diabetes—or diabetes that occurs during pregnancy—we may need to adjust your diet. It is important to be open to realizing more about your health. Many people don’t go to the doctor until they’re pregnant. And then they’re seeing us so frequently that we pick up a lot of issues that patients never were aware of.