Antenatal visits, either to the clinic or the doctor’s surgery usually take place at four-week intervals up to twenty-eight weeks of the pregnancy and, after that, at two-week intervals up to thirty-six weeks and then weekly. If complications develop, more frequent visits will be needed.
At each visit, weight, blood pressure and urine tests will be repeated and a simple examination made of the enlarging uterus. This is done by the doctor (or midwife) feeling the uterus to determine how much it has enlarged in size since the previous visit. He will also be able to feel the baby inside the uterus to check that it is growing normally.
The presentation of the baby, that is which part is coming first, is only important after about thirty-four weeks. By this time the head should have settled down into the lower part of the uterus. The crown of the head is called the vertex, hence this is known as vertex presentation. If the buttocks of the baby presents, this is called a breech presentation. It is diagnosed by feeling the hard round baby’s head in the upper part of the uterus.
Breech presentation is common up to thirty-four weeks, but after that time is uncommon. Attempts are usually made to turn the baby round to the correct head-down vertex position. The abdominal examination will be completed by the doctor or midwife placing a fetal stethoscope over the lower part of the uterus in order to listen to the baby’s heart beat.
Using the simple traditional trumpet-like fetal stethoscope, the heart cannot be heard before twenty-four weeks. With the aid of an ultrasound stethoscope, the heart can be heard as soon as the uterus is large enough to be felt in the lower part of the abdomen, usually about twelve weeks. Although listening to the baby’s heart is a traditional part of the antenatal visit, it only confirms what the woman herself already knows from feeling the baby’s movements-that her baby is alive and well!
For a woman who has already had a baby and knows what to expect movements of the baby are usually first felt between sixteen and eighteen weeks. For a woman who is pregnant for the first time, twenty weeks is more common. There is a considerable normal variation, however, and movements may be felt earlier or later in some individuals.
Movements are a good indication of a baby’s well-being and, tiresome though they may be at night, hearty kicks and thumps indicate a vigorous baby. The pattern of fetal movements may change during pregnancy and it may be more active at some times than at others. In general, provided the baby has a spell of good activity two or three times a day, all is well.
If a baby, which has been very active, becomes much less so over a period of one or two days, this fact should be reported to the doctor or midwife so that a check can be made to see that all continues well. Please note, one or two days, not one or two hours, of inactivity. The baby will often sleep inside the uterus for several hours at a time.
REPEAT ANTENATAL VISITS – TESTS
Unless the expectant mother is anaemic, no further blood tests will be needed after the first antenatal visit, until about thirty weeks. A haemoglobin estimation will be needed at this time to cheek on possible anaemia. In the case ofnegative women, the blood sample will also be examined to see if any rhesus antibodies are developing.
As the baby’s well-being depends on the placenta, and as the placenta produceswhich can be measured in the woman’s blood or urine, hormone tests are often carried out to confirm that the placenta is functioning normally and keeping the baby properly supplied with oxygen and nourishment. If there is any doubt, following a simple abdominal examination at the clinic, that the is not growing as it should, these tests are done as a precautionary measure.
A number of tests are needed at weekly intervals for any conclusions to be reached. The fact that the doctor decides to have them done should not be a cause for anxiety. They are part of the antenatal system of checks to confirm that all is going well and to detect any possible complications long before the baby suffers any harm.
Different hospitals do different tests, but the common hormones to be measured are oestriol, which comes from both baby and placenta and is measured most often in a complete twenty-four hour specimen of urine from the mother, and human placental lactogen (H.P.L.) which comes from the placenta alone and is measured in a sample of the mother’s blood. [I X-rays are rarely needed in mid-pregnancy except, occasionally, to diagnose twins or to confirm a breech presentation. Ultrasound is increasingly preferred to X-rays for this purpose.
DON’T BE AFRAID TO ASK
At all, take the opportunity to tell the doctor or midwife about any unusual symptoms or discomforts, and ask about any aspect of pregnancy that is worrying you. It is a good idea to jot questions down on a piece of paper as they arise and take the paper with you to the clinic. This avoids the “I know there was something else I wanted to ask you, doctor, but l can’t remember what it is’ situation. Be persistent! The doctor or midwife should be able to answer your questions and allay your worries.
Politely, but firmly, refuse to be fobbed off with any answers that you do not understand or that do not relieve your anxiety. Antenatal visits are a time to get to know the doctors and midwives and to build up a confident bridge of understanding which will stand you in good stead in labor.