Trimester by Trimester

	First Trimester (0-12 weeks)
Initial Prenatal Visit	During your first visit you will meet with your obstetrician, nurse practitioner, or nurse-midwife. This is a great time to begin developing a relationship with your provider. Feel free to ask questions especially concerning good nutrition, safe exercise, and enjoying your pregnancy.
Assessments	You will have a comprehensive physical assessment including detailed medical, reproductive health, and family health histories. Your weight will be checked along with a vital sign assessment, urine dipstick for glucose, albumin, and ketones, and an abdominal measurement (fundal height).
Medications	Your provider may recommend prenatal vitamins according to your needs. You will want to avoid taking any medications or herbs (prescribed or over-the-counter) that have not been approved by your obstetrician or midwife.
Diagnostic Tests	At this visit, laboratory testing including blood work will be done to obtain baseline information on your general health.
Procedures	Your provider may schedule an ultrasound to check on fetal size and development.
Teaching and Learning	Read about your pregnancy. Ask your OB/midwife or friends about resources on pregnancy, your developing baby, and your newborn. See suggested readings in Chapter Two for our recommendations.
Fetal Development	Embryo size doubles between nine and twelve weeks. All major organs are forming, but they are not fully developed yet. Eyes and ears are growing. The heart is beating strongly. At 12 weeks your baby is 2.5 inches long and weighs about 0.64 ounces. The head is becoming more rounded and the face is completely formed. Toes and fingers are formed and nails are beginning to grow. The baby may be very active, but you cannot feel movement yet. Male and female genitalia are recognizable by 12 weeks
	Second Trimester (12-24 weeks)
Prenatal Visit	You will be visiting your OB/midwife monthly or more frequently depending on your needs. Ask any questions you may have.
Assessments	At these visits you will have a weight check, vital sign assessment, urine dipstick for glucose, albumin, and ketones, abdominal measurement (fundal height), and a fetal heart check.
Medications	Continue taking your prenatal vitamins. Anemia during pregnancy is common. Your obstetrician or midwife may order iron supplements.
Diagnostic Tests	Your health care provider may order the Quad screen, a simple blood test. Other laboratory testing may also be ordered such as a complete blood count to test for the presence of anemia.
Procedures	Amniocentesis may be performed based on many factors, please discuss with your health care provider.
Teaching and Learning	Sign up for childbirth classes and other classes that are of interest to you, such as breastfeeding, baby care, infant CPR. See Chapter Two to find available classes. Read about labor and childbirth. Ask your OB/midwife about their particular philosophies regarding labor and birth. Explore Birth Plan information in this chapter.
Fetal Development	At 16 weeks your baby is about 6.3 inches long and weighs .08 pounds. It is kicking and moving about frequently. You may be feeling the baby moving. If this is your first baby, you are likely to feel the first movements a bit later. At 20 weeks the baby is swimming in a large amount of amniotic fluid growing rapidly, both in length and weight and is now 9.8 inches long and weighs about .75 pounds. The baby is very active. You will probably notice that there are times when your baby seems to be asleep and other times when he’s moving a lot. At 24 weeks your baby is about 12.5 inches long and weighs 1 pound, 1.6 ounces. You may feel different parts of the baby’s body through your abdominal wall. Your uterine muscle is stretching and you may feel occasional pain along the sides of your abdomen (round ligament pain). The top of your uterus (the fundus) reaches to just above your navel.
Reminder	Submit all pre-registration forms to Newton-Wellesley Hospital. This includes: Parent Worksheet for Birth Certificates, Maternity Pre-Admission Form, and Healthcare Proxy. For more information about your hospital stay, see Chapter Four.
	Third Trimester (24 weeks - birth)
Prenatal Visit	You will be visiting your OB/midwife more frequently now. Beginning at about 28 weeks you will have appointments every two weeks and then weekly from 36 weeks until delivery. Don’t forget to ask any questions you may have concerning labor, birth, your hospital stay in the mother-baby unit, and going home.
Assessments	At these visits you will have a weight check, vital sign assessment, urine dipstick for glucose, albumin, and ketones, abdominal measurement (fundal height), and a fetal heart check. You may have a pelvic examination as you get closer to your due date.
Medications	Continue taking your prenatal vitamins. Anemia during pregnancy is common. Your obstetrician or midwife may order iron supplements.
Diagnostic Tests	Your healthcare provider may order a glucose tolerance test. Depending on these results, a 3-hour glucose tolerance test may be ordered. A swab of the vagina may be done between 35 and 37 weeks to test for the presence of Group B Streptococcus (GBS). GBS is a bacteria that occurs in 15% to 30% of women. If you test positive for GBS, you may be given antibiotics during your labor. Other laboratory testing may also be ordered such as a complete blood count to test for the presence of anemia.
Procedures	A non-stress test (NST) is sometimes ordered by your obstetrician or midwife to check on fetal well-being. A biophysical profile (BPP) may also be ordered. This test involves an ultrasound assessment of fetal well-being. Ultrasound or amniocentesis may also be ordered to check fetal well-being or maturity.
Teaching and Learning	Read about baby care. Talk with your caregiver as you choose whether to breastfeed or bottle-feed. Based on your breast exam you may be encouraged to consult a lactation specialist prior to the birth of your baby. Finish all childbirth, breastfeeding, baby care, and other classes sooner rather than later. Babies have their own time schedules and sometimes may arrive early. Read about labor and childbirth and develop your birth plan. See the Birth Plan Worksheet  At 30 weeks your baby’s weight is now about 3 pounds, 11 ounces and measures about 15.8 inches in length. You may be feeling pressure on your diaphragm, stomach, and intestines as your uterus and baby grow.
Fetal Development	At 36 weeks, the baby is almost fully mature and is now about 19.7 inches long and weighs anywhere from 5 pounds, 8 ounces to 9 pounds, 14 ounces. The baby may descend into your pelvis (engagement) preparing for birth. Once the baby has engaged, you may find that your breathing becomes easier and the pressure on your diaphragm is less. Your baby is putting on weight at a rate of almost 8 ounces per week until delivery. When the baby is awake, his eyes are open and he can differentiate between light and dark. Labor may start at any time now. Do not worry if your baby is not born exactly on his due date. The due date is only an estimate. Only 5 % of babies are born exactly on their due dates. The long-awaited day is near and soon you will be holding your baby in your arms.
Birth Plan	It is best to complete your Birth Plan by the 32nd week of your pregnancy. A Birth Plan Worksheet can be found in the back pocket of this manual. Discuss your expectations with your physician/midwife. If you choose to complete a written birth plan, bring it with you to the hospital and pack extra copies to give to the staff caring for you. During your hospital stay, your nurse will check with you to assure that your needs and expectations are being met.
Care Conference	If you have any questions about your upcoming hospitalization, special needs, or concerns related to the plan of care for your labor and birth, you can arrange a Care Conference by calling our Maternity Clinical Nurse Specialist: Carolyn Mirando, MSN, 617-243-6106.
Car Seat Inspection	Schedule a car seat inspection. Many inspection stations have limited hours or require an appointment. Contact your local Police Department or visit www.nhtsa.gov or www.seatcheck.org for a listing of local inspection stations.
	What is a quad marker screening? The quad marker screen, previously called the triple marker screen, is a blood test that provides a woman and her health care provider with useful information about her pregnancy. The test predicts the likelihood of a certain problem occurring. It does not diagnose the problem. The quad marker screen determines if a woman is at a higher or lower risk of carrying a fetus with a birth defect. The test can only be performed during the 15th and 20th week of pregnancy. During the quad marker screen, a sample of blood is taken and substances in the blood sample are measured to screen for: problems in brain and spinal cord development (neural tube defects); and genetic disorders such as Down Syndrome (a chromosomal abnormality). What is amniocentesis? This is a procedure in which a small sample of amniotic fluid is drawn out of the uterus through a needle inserted in a pregnant woman’s abdomen. The fluid is then analyzed to detect genetic abnormalities in the fetus or to determine the gender of the fetus.