Pre-Natal Care at Doctor Mack's Office

Congratulations on your pregnancy. We would like to let you know what to expect at each pregnancy related visit to our office. We’d also like to explain to you which tests may be necessary and/or recommended according to your particular situation.

Over the course of your pregnancy you can expect monthly visits until you reach 30 weeks. The visits become bi-monthly between 30 and 36 weeks. And for the final month of your pregnancy you can expect to be seen once a week.

After your baby is born we will check you briefly 2 weeks post-partum if you had a Cesarean section and at 6 weeks post-partum we do the final peri-natal care visit for all new moms.

VISIT 1: Between approximately 6 weeks and 8 weeks:

We will review your health history including that of your family and where significant, the health history of the father of the baby and that of his family.

You can expect a complete exam and a pap smear if you are due for your next one prior to your 6 wk post-partum visit. We may also check for GC and Chlamydia.

At each visit we’ll measure your blood pressure and check your urine for glucose and protein as well.

At this visit and every subsequent visit, feel free to ask whatever questions you have. You may want to write them down as they come up to help you remember them when you come in for your visits.

Labs: A complete battery of pre-natal tests will be ordered for you to have taken at the lab. These include complete blood count, syphilis test, blood type and Rh factor, antibody titer, Rubella titer, Hepatitis B and C screens, HIV screen and a urinalysis. Other tests may be included if indicated for your personal situation.

Procedures: At this visit or within a week of this visit you will have an ultrasound. The ultrasound done at this time will allow us to determine most accurately, the due date of the baby. You can also expect to see the heart beating.

(The sex of the baby and other details are not seen until your later ultrasound performed between 20 to 22 weeks)

At this visit we will make certain that you start pre-natal vitamins, if you haven’t already done so. It is important to have adequate amounts of folic acid, iron and calcium throughout your pregnancy as well as plenty of protein and adequate calories. We have included some guidelines for you in the packet. The packet also includes a booklet on pre-natal testing for birth defects. The AFP test is recommended under age 35. If you are a woman 35 or older at the expected birth of your child, you’ll receive a booklet discussing pre-natal test options including amniocentesis and Chorionic Villus Sampling..

VISIT 2: Between approximately 9 and 12 wks.

We’ll ask you about any symptoms you may be experiencing./p>

We’ll also discuss the AFP test if you are under age 35. And give you the lab slip to have the blood drawn between 15 and 20 weeks. Ideally it should be drawn between 16 and 17 weeks.

If you are 35 or older you may have already had the CVS or decided on the amniocentesis. Each of these tests is time sensitive, so be certain to inform yourself about them very early in your pregnancy.

We will check your blood pressure, and test your urine as at every visit.

We will listen for the fetal heart tones with the Doppler.

After we address any concerns that you may have, you’ll be scheduled to return 4 weeks later.

VISIT 3: Between approximately 13 and 16 wks.

We will review any concerns you may have. The order form for the AFP test will be given to you if not done so previously.

Your blood pressure and urine will be checked.

We’ll listen with the Doppler for the fetal heart sounds.

Again, assuming all is ok; another appointment will be made in 4 wks.

If your next visit is for your ultra-sound visit, you may want to bring in a blank video cassette. Dr Mack will tape the ultra-sound for you.

VISIT 4: Between approximately 17 and 22 wks.

By now you should begin to feel “fluttering” of your fetus. It will gradually become a regular sensation usually starting around 20 wks or so. This is when we begin to measure the size of your uterus.

From here on until close to your due date, the uterus grows about 1 cm. a week.

If the size and dates don’t match closely, we will order extra tests to ascertain that everything is normal for you and your baby.

If this is not yet your ultrasound visit i.e. before 20 wks, then this will be  a routine pre-natal visit for you.

If this is your ultrasound visit you may want to be accompanied by the father of the baby or another family member to enjoy this special opportunity.

You will more than likely find out the sex of the baby if you choose to as well as see the face, abdomen, arms, hands, legs and feet.

VISIT 5: Between 21 and 25 wks.

If you have had your ultra-sound last visit, this will be a routine exam. It will include blood pressure evaluation and urine screening as per earlier visits. We will also measure the uterine size for appropriate growth.

If this is your ultra-sound visit, please see the Visit 4 description.

If you will be 28 wks at your next visit, then we will give you a lab slip to have a blood glucose level and a hemoglobin level drawn. Also if your blood is Rh negative, a Rhogam shot will be ordered at 28 weeks if indicated.

VISIT 6: Between 26 and 30 wks.

Again expect all of the routine evaluations as during the earlier visits.

At this visit we will either review the results of your blood tests, or order them if you have not yet reached 28 wks.

This is the point in your pregnancy when your iron level will reach its lowest point and therefore we will be able to treat you appropriately if you have become anemic.

Excess blood sugar or diabetes of pregnancy is unfortunately a common though not “normal” finding. If the blood glucose levels are not in the normal range, we will order a 3 hr glucose tolerance test and if appropriate, refer you for care with the nutritionist.

You should now notice fetal movement throughout the day. If you are concerned that the baby may not be moving, you can do b>kick counts. The best time is in the evening. If the baby moves, or ‘kicks’ 4 or more times within 1 hr. that is normal.

VISIT 7: Between 30 and 32 wks.

This should be a routine check, including blood pressure and urinalysis. Again any problems will be discussed./p>

If you have a specific birth plan or will be having a repeat Caesarean section, now you will begin planning that with Dr. Mack.

If you are opting for a tubal sterilization, then you should sign the consent papers by 30 wks.

You should also pick up a pre-registration pamphlet upon leaving the office. After filling it out you may either deliver it in person to the registration desk at Washington Hospital or mail it in to them at the address given on the form.

VISIT 8: Between 32 and 34 wks.

At this visit, along with your blood pressure and urinalysis we will also perform a strep culture of the vagina. If this test is positive, i.e. if you have Group B strep in the vagina, you will be given antibiotics while you are in labor in order to prevent passing it on to your baby.

We will also measure the uterus, listen to the heart tones and abdominally check for the baby’s position.

VISIT 9: Between 34 and 36 wk.

This visit will be yet another routine visit. Your blood pressure will again be checked and a routine urinalysis will be performed. The baby’s heart beat and position will be checked.

Your baby should continue to move, though the movements may feel more like “rolling” movements rather than “kicks” as in the last trimester.

If your baby moves less than b>4 times in 1 hr., you should eat something and drink cold water or juice, lie down and do kick counts as previously mentioned. If there are not 4 movements within 1 hr., call us. You will need to be monitored with an NST. This is a test to check for normal fetal heart tones and movements.

If you did not receive a strep-screen last visit it will be obtained today.

If you haven’t already pre-registered for the hospital be sure to do so ASAP.

VISITS 10, 11and 12:  Between 37 and 40 wks.

These will be weekly visits. In addition to the routine procedures, from 38 to 40 wks., we will check your cervix to evaluate the progress of the cervical changes and the dropping of the baby’s head into the birth canal.

At these visits we will ascertain the position of your baby as well. If your baby is breech i.e. head up vs head down, Dr. Mack may discuss a procedure called version whereby in the hospital under ultrasound he may try to position the baby correctly. In the event that your baby remains breech, he or she will need to be delivered by cesarean section.

40+ wks

If you pass your due date, you will be seen twice a week and undergo bi-weekly non-stress tests. These are performed at the hospital to monitor your baby’s heart rate and movements.

If you do not deliver within a week after your due date you may need to have your labor induced. Possibly, if your cervix isn’t ripe or your baby is not in position, you may be a candidate for a Cesarean Section.

Either of these options will be discussed as necessary with Dr. Mack.

Post-partum Visits:

If you had a Cesarean delivery, we will see you 2 wks post-partum for an incision check.

At 6 wks post-partum we will see you for a full pelvic exam. At this visit contraception may be discussed along with any other concerns you may have.