First Trimester
(The first 12 weeks)

What to expect at the first visit: 

• Please complete the genetics questionnaire and the prenatal record for Good Samaritan Hospital prior to your appointment and bring them with you.  You can obtain these two forms on the website or ask them to be sent to you when you schedule your first appointment. The forms ask about your prior history and family history.  This is a good time to ask family members your own background.
• A due date will be determined as well as an estimate of how many weeks pregnant you are to date.  It is helpful if you know the first day of your last menstrual period (LMP) or when you ovulated.  By tradition, the pregnancy starts week 1 at the beginning of your LMP and starts week 3 when you ovulate and become pregnant.  A “9 month” pregnancy lasts 40 weeks.
• During the appointment, the paperwork you have completed will be reviewed.  A complete history and physical exam will be performed including a pap smear if you have not had a recent examination.
• Certain genetic diseases can be diagnosed early in pregnancy.  These include cystic fibrosis, muscular dystrophy, Tay-Sachs and sickle cell disease.  If you or the father of the baby is of Jewish descent, you may be screened for carrying Tay-Sachs.  If you are of African-American descent, you may be screened for carrying sickle cell disease.
• You may be given prenatal vitamin samples.  We recommend that you take prenatal vitamins or folic acid (.4 mg to 1.0 mg) daily during at least the first trimester.  If you have a preferance, please let the nurse know and a prescription can be written.  Most non-prescription (OTC or over-the-counter) vitamins have similar formulations and may be less expensive than the prescription vitamins.
• You will have an opportunity to meet with the financial counselor during this visit.  She will call your insurance company with you to determine your level of benefits and complete a financial agreement.
• Please feel free to ask any questions during any of your visits.  We recommend that you write them down so that you do not forget any of your concerns and all of your questions can be answered.  Between appointments, you may call during office hours and leave non-urgent questions on the voice mail.  Your calls will be returned.

What to expect at your second visit:           

• Please sign up for birthing classes early in your pregnancy. You may not be able to take it at the time of your choice if you wait until the third trimester to register. Register at Los Olivos (extension 209), CBE@aol.com, or at Good Samaritan Hospital (559-BABY).  Good Samaritan hospital also offers classes on breast-feeding, infant CPR and sibling classes if you are interested.
• Please read the information about the AFP test or the genetic amniocentesis (if you are over 35).  You will be asked at your second visit if you would like either of these procedures.
• During your second and subsequent visits, you will be asked to give a urine specimen, which is tested for protein (seen in pregnancy-induced hypertension) and glucose (screening for gestational diabetes).  Your weight and blood pressure will be recorded.  We will listen for fetal heart tones and answer questions.  As your pregnancy progresses, the uterine or fundal height will be checked and other tests may be ordered.

The Second Trimester
(12-28 weeks)

 Between 16-20 weeks:

• Your physician may request an ultrasound to check the fetus for size, gestational age, placement of the placenta, position of the baby and number of fetuses.  The ultrasound creates an image of the fetus from sound waves.  Our sonographer in Suite 5 does most ultrasounds.  It is your decision to find out the gender of your baby.  If you wish to know, please let the ultrasound technologist know.  Unfortunately, there is no guarantee of the fetal sex based on the ultrasound alone (a genetic amniocentesis would be necessary).
• Your physician will measure your fundal height (the top of your uterus) every visit after 20 weeks to ensure that your uterus is growing appropriately.  The top of the uterus is at the umbilicus at 20 weeks. Usually, the fundal height is close (plus or minus 2 centimeters) to your gestational age in weeks.

Between 24-28 weeks:

• We recommend a one-hour glucola test to check for gestational diabetes.  Gestational diabetes occurs when your placenta makes a hormone that causes your body to become resistant to your own natural insulin.  When this occurs, the level of glucose or sugar in your blood stream becomes elevated which can cause problems for the fetus.  Your blood is drawn one hour after you drink a sugary solution called Glucola.  There is no need to fast for the test.  If your blood sugar level is normal, no further testing is needed.  If the sugar level is elevated, a full three-hour glucose tolerance test is necessary.

• If your one-hour test shows that you need to take the 3-hour test, we ask that you make an appointment at the lab for the test.  A laboratory slip will be left at the front desk or an order will be faxed to the laboratory of your choice.  Once you have made the appointment, you need to follow a special diet for the 3 days prior to the glucose tolerance test.  You may have nothing to eat or drink other than water for the 12 hours before your appointment.
• If you have gestational diabetes as determined by the test, you will be referred to a special program that helps you with your diet so that your sugar levels remain normal throughout the remainder of your pregnancy. 
• Your blood count is repeated to check for anemia.
• If your blood type is Rh negative and your partner has Rh-positive blood type or is unknown, you receive a shot of Rhogam at 28 weeks to protect your baby.  If this applies to you, it will be discussed in more detail with you.

What is happening to me?

You may be experiencing:

• A linea nigra (a dark line running down your abdomen) forms
• At 18-20 weeks, you will usually begin to feel "Quickening" or fetal movements
• Nasal congestion/Nose bleeds
• Bleeding gums
• Increased appetite
• Mild swelling of hands and feet
• Lower abdominal aches/Backaches
• Constipation
• Leg cramps

What is happening to my baby?
4th month (14-18 weeks):

• Your baby's heartbeat may now be audible with the use of a stethoscope
• Eyelids, eyebrows, eyelashes, nails and hair are formed
• Your baby is developing reflexes, such as sucking and swallowing
• Tooth buds appear
• The fingers and toes are well-defined
• By the end of this month your baby is about 6 inches long

5th month (19-23 weeks):

• A soft, downy "lanugo" (fine hair) covers your baby's body
• Hair begins to grow on its head
• A protective vernix (cheese-like) coating covers the fetus
• Your baby now weighs about one pound and measures nearly 10 inches long

6th month (24-28 weeks):

• Your baby's essential organs are formed
• He/She weighs 1-2 lbs. and is about 12 inches long
• The eyes begin to open, fingerprints form
• Your baby grows quickly from now until birth
• The organs are developing further
• The skin is wrinkled and covered with fine hair
• The fetus moves, kicks, sleeps and wakes
• The fetus can  swallow and hear
• The urinary system is working

The Third Trimester
(28 weeks – term) 

After 28 weeks:

• A fetal kick count form is included to be used if your physician requests this of you. 
• Take a tour of the hospital, Good Samaritan, and turn in the registration form.  You can also FAX the registration form to the hospital admissions department (559-2661) or turn it in to your nurse at Los Olivos.  Please keep a copy of the completed form.

• Choose a pediatrician.  Our community is fortunate to have excellent pediatricians.  Ask your friends or your physician for recommendations.  The pediatrician is the person with whom to discuss nursing, formula, and circumcision.  If you wish to interview pediatricians, this should be done early in the third trimester.  A list of some of the community pediatricians is included.
• Make sure that Los Olivos and the hospital both have your correct insurance information.  If you have any financial obligations to Los Olivos, these should be finalized by 26 weeks of your pregnancy.

Examinations:

• Your physician may check your cervix for dilation and/or softening during the last month of your pregnancy.  A vaginal culture for beta-streptococcus is usually taken.

• You will be monitored for pre-eclampsia (Toxemia or pregnancy-induced-hypertension PIH) during the third trimester.  Signs of pre-eclampsia include: increased blood pressure, right upper quadrant abdominal pain, protein in your urine, severe headaches, significant swelling of your hands, feet or face.

Signs of labor:

• Contractions – during the last weeks of pregnancy, you may experience uterine contractions.  These Braxton-Hicks contractions serve as warm-up exercises for the uterine muscle.  Labor contractions are different.  They are more regular in timing and stronger in intensity, frequency and duration.  Labor contractions do not go away when you lie down or rest.
• Rupture of membranes – Either a gush of fluid or a slow leaking of fluid may occur when the amniotic sack ruptures.  This occurs before labor begins about 15% of the time. The fluid is usually clear and odorless. 
• Bloody show – A small amount of bleeding is commonly seen after an exam in the office or just prior to the onset of labor.  This may or may not contain the mucous plug.  Unfortunately, neither the passage of blood or the mucous plug will predict when labor will begin. It is not necessary to call the doctor if you have bloody show or lose your mucous plug.

Birth plans:
Most patients attend prenatal classes. After you complete your classes, ask your nurse or doctor about any questions that arise. The philosophy of the physicians at Los Olivos is one of non-intervention in low risk pregnancies.  Pain medications and anesthesia are usually available if requested. A written birth plan is not necessary.  Please see “At the hospital” on page 14.

What is happening to me?
You may be experiencing:

• Abdominal pains/Braxton-Hicks contractions
• Shortness of breath
• Stronger fetal activity/larger movements
• Difficulty sleeping
• Swelling of hands, feet
• Itchy abdomen
• Frequent urination
• Colostrum/leaking breasts
• Increasing back and leg aches
• Hemorrhoids
• Increased vaginal discharge
• Navel sticking out
• Cervix changes

7th month (29-32 weeks):

• This is a period of extreme growth and maturation for your baby
• By the end of this month fat begins to deposit on your baby
• Your baby can suck its thumb, hiccup, cry, and can taste sweet or sour
• He/She can respond to stimuli (pain, light and sound)
• The placental functions begin to diminish
• The volume of amniotic fluid lessens
• Your baby is about 14 inches long

8th month (32-36 weeks):

• Your baby is starting to see and hear as the brain matures
• Excluding the lungs, most systems are well-developed
• By the end of this month, your baby is about 18 inches long and weighs about 5 pounds

9th month (37-40 weeks):

• The lungs are maturing this month
• The baby adds about ˝ pound growth per week
• Your baby may weigh nearly 7 lbs. and be about 18-20 inches
• He/She kicks and stretches as it gets bigger and there is less room
• Fine body hair disappears
• Bones harden, but bones of the head are soft and flexible for delivery
• The fetus settles into a position for birth

Full term: approximately 20 inches long and six to nine pounds.