Routine Prenatal Care by Trimester

Let’s talk about routine prenatal care you’ll be offered throughout pregnancy. The infographic below contains a list of prenatal exams, tests, and more. It also shows in which trimester(s) to expect each one. Read on for more detail about these routine prenatal care options.

Weight Check

Trimester 1️⃣ 2️⃣ 3️⃣

At your first prenatal appointment, it is routine for your weight to be checked. Your provider will also get your height, calculate your BMI, and establish a reference point for tracking pregnancy weight gain.

It’s then routine for your weight to be checked at each subsequent appointment. The general recommendation is to gain between 25 and 35 pounds throughout pregnancy, though your provider will let you know if they recommend gaining more or less than this. The purpose of stepping on the scale each visit is to monitor the amount of weight gain (or loss).

Gaining too little weight increases the likelihood of:

• A baby being born too early (before 37 weeks of pregnancy)
• Having a baby with low birthweight (less than 5 lbs., 8 oz.)

Gaining too much weight increases the likelihood of:

• A baby being born too early (before 37 weeks of pregnancy)
• A baby being born large (greater than 8 lbs., 13 oz.), which increases certain risks during and after birth
• Needing a cesarean birth
• Health issues for baby at birth and later in life
• Having a harder time losing the weight postpartum, increasing the risk of certain health conditions

Check out my blog post below for more on this topic:

🧭 Embracing Changes in Weight From Pregnancy to Postpartum

Blood Pressure Check

Trimester 1️⃣ 2️⃣ 3️⃣

Your blood pressure will be checked at each prenatal visit. This is to monitor for hypertensive disorders, like chronic hypertension, gestational hypertension, and preeclampsia. High blood pressure can cause complications, so it’s important to be aware if it’s an issue and get any necessary treatment.

Less than 120/ 80 mm is considered normal when it comes to blood pressure. If your blood pressure is above this level, you can have your care provider take it again. Consistent higher readings could be a concern, and your care provider will counsel you on any next steps.

Blood pressure could also be too low. This would be anything 90/ 60 mm or less.

Risk Factors for Preeclampsia and Low-Dose Aspirin

If you have certain risk factors, taking low dose aspirin during pregnancy (at the direction of your care provider) can help reduce your risk of preeclampsia.

Preeclampsia is a type of high blood pressure that can happen in the second half of pregnancy and the postpartum period. This is a serious condition, and knowing the signs and symptoms is important when you’re pregnant. Learn more about it below:

🔗 Preeclampsia | March of Dimes

Check out the resource below for more information on risk factors for preeclampsia and what to do if you are at risk. This resource can be a helpful conversation starter when asking your care provider about getting screened. Consider bringing this up at your first prenatal appointment.

🔗 Low Dose Big Benefits | March of Dimes

Pelvic and Breast Exam

Trimester 1️⃣

At your first prenatal visit, your care provider will perform a pelvic and breast exam.

A plastic or metal speculum is inserted and then adjusted to open up the vaginal walls so that your vagina and cervix can be visually examined. Your care provider will also insert two gloved fingers into your vagina to check your pelvic organs. At the same time, they will use their other hand to press on your lower abdomen. 

If you are due for a Pap smear or HPV testing, this will be done at this time, as well. Testing for chlamydia and gonorrhea may also be a routine part of this exam, but you can always ask for this testing if it’s not offered.

The purpose of the breast exam, beyond checking for lumps, is to determine in advance if there could be any issues with breastfeeding or chest feeding.

Pay attention to how these sensitive exams are performed, because it can give you some valuable insight on your choice of care provider. This exam can feel invasive and uncomfortable for some people. The way a healthcare provider conducts a pelvic and breast exam can reflect their level of professionalism, empathy, and respect for your autonomy and dignity as a patient. A compassionate and skilled care provider will ask for your consent, prioritize your comfort, communicate clearly throughout the procedure, and ensure that you feel respected and supported. Anything less is a red flag.

Urine Test

Trimester 1️⃣ 2️⃣ 3️⃣

At your first prenatal appointment, your care provider will ask for a urine sample. They will send you into the bathroom with a sterile cup. They’ll ask you to collect a clean urine sample in the cup and should let you know where to place the cup when you’re done.

Your care provider may ask for a urine sample at all subsequent prenatal appointments or at least periodically through pregnancy.

They’ll use your urine sample to test for the following:

• Bladder infection
• Kidney infection
• Diabetes
• Preeclampsia (later on in pregnancy)
• Dehydration

Your care provider can also use your urine sample to test for chlamydia and gonorrhea.

Blood Work

Trimester 1️⃣

You will likely have blood work done at (or after) your first prenatal visit that could include the following tests:

• Complete blood count (CBC)
• Blood type, Rh factor, and antibody screen
• Syphilis, HIV, and hepatitis
• Chlamydia and gonorrhea
• Tuberculosis
• Immunity to rubella

Specifics will vary from person to person, depending on risk factors. Results of your blood work can help guide your care and any treatment that’s necessary.

Immunizations

Trimester 1️⃣ 2️⃣ 3️⃣

During pregnancy, it’s recommend to get the following vaccines:

• Flu (ideally by the end of October)
• COVID-19 at any point and based on current recommendations
• Tdap (during the third trimester of EACH pregnancy to help protect your newborn from whooping cough)
• Pfizer RSV (if you are 32-36 weeks pregnant from September to January; there is also an alternative option to give your baby an injection called nirsevimab after birth)

Getting these vaccines during pregnancy allows you to pass on some antibodies to your baby. This helps to protect your baby from these illnesses before they can get their own vaccines.

Talk to your care provider about your options and about what to do if you’re not up-to-date on any other vaccines. There are some that aren’t recommended in pregnancy (like MMR).

It’s ultimately your choice as to which vaccines you choose to receive. It’s important to note that there is a lot of misinformation surrounding this sometimes controversial topic. Reliable information and research evidence is crucial in informing your decisions. Check out the link below for more information:

🔗 Voices for Vaccines

Ultrasound

Trimester 1️⃣ 2️⃣

Depending on the timing, you may have an ultrasound at your first prenatal visit. This can help in confirming a viable pregnancy and establishing a due date. An ultrasound uses sound waves to produce images. Ultrasounds done in very early pregnancy may need to be transvaginal to get a better image. This means a probe is inserted 2-3 inches into the vagina. Near the end of the first trimester, ultrasounds can be performed externally. This means the wand is placed on the outside of the abdomen.

Another ultrasound is performed at around 18-22 weeks of pregnancy. This ultrasound is more detailed and checks your baby’s anatomy (organs and body parts), as well as the placenta, umbilical cord, and amniotic fluid. The sonographer will take measurements of your baby to make sure they are growing appropriately. Your baby’s movements will be checked, as well as their heartbeat. You can usually find out the sex of your baby, if you want, too.

Your care provider may recommend also checking the length of your cervix, via transvaginal ultrasound, especially if you have certain risk factors. A shorter cervix at this point in pregnancy means you are at higher risk for preterm labor.

Fetal Heartbeat Check

Trimester 1️⃣ 2️⃣ 3️⃣

Your care provider will check your baby’s heartbeat at most, if not all, prenatal care appointments. During the first trimester (at around the six week mark), your baby’s heartbeat can first be detected on an ultrasound. 

Starting at around twelve weeks, your care provider will check your baby’s heartbeat at each prenatal appointment. Typically, this is done with a fetal Doppler. This hand-held device uses ultrasound technology to listen to your baby’s heartbeat. They are checking number of beats per minute to make sure it falls within a normal range, which varies by gestational age. You may also hear a “whooshing” sound, which is the sound of blood flow in the placenta.

It can sometimes be challenging to hear the heartbeat in earlier pregnancy. If your care provider is unable to find it, an ultrasound can be done instead. 

There are other options for checking fetal heartbeat that are less commonly used, like:

• Stethoscope
• Fetoscope
• Pinard horn

Prenatal Genetic Testing

Trimester 1️⃣ 2️⃣

Prenatal genetic testing can give you more information about whether or not your baby could have a genetic disorder. Some genetic disorders are caused by missing or extra chromosomes. Other are caused by mutations or changes in genes.

Prenatal genetic testing is optional, and there are both screening and diagnostic tests. Screening tests don’t give definitive answers but provide information as to how likely it is that your baby has a genetic disorder. This information can help you decide whether or not to have any diagnostic testing done. While diagnostic tests can tell you with certainty whether or not your baby has a genetic disorder, they are more invasive and carry additional risk. Diagnostic tests include:

• Amniocentesis 
• Chorionic villus sampling

Here’s a link to a chart that shows your different options for prenatal genetic testing and when in pregnancy they are done. There are also links to FAQs on both prenatal screening and diagnostic testing if you look in the top right corner of the chart.

🔗 Prenatal Genetic Testing Chart | ACOG

Fundal Height Measurement

Trimester 2️⃣ 3️⃣

Starting around 20 weeks, your care provider will measure the distance from your pubic bone to the fundus (or top of the uterus). This is to check how your baby is growing. At 20 weeks, the distance should be about 20 cm. At 25 weeks, 25 cm.

If this measurement is not what’s expected, ultrasound can be used to figure out why. It could mean your baby is growing slower than expected or is larger than expected. It could also mean you have too much or too little amniotic fluid.

The image below illustrates fundal height throughout pregnancy. It also shows how this measurement can actually decrease (which is normal) at the very end of pregnancy, if your baby starts to settle down further in the pelvis.

Screening for Gestational Diabetes

Trimester 2️⃣

Between weeks 24 and 28 of pregnancy, your care provider will recommend that you are screened for gestational diabetes, which is diabetes that develops during pregnancy. You’ll be asked to drink a glucose drink (typically called Glucola), which contains 50 grams of glucose, within a five-minute period of time. Often, you’ll be sent home with this drink at an earlier appointment, along with instructions on when to drink it. An hour after finishing the drink, your blood sugar will be tested. If you fall outside of the normal range, additional testing will be needed to diagnose gestational diabetes.

Also, you may be tested earlier in pregnancy, as well, if you are at high risk of developing gestational diabetes.

It’s important to know if you have this, so that it can be managed and treated to avoid complications.

Alternative Options

Not everyone is thrilled with drinking the glucose drink. If you have concerns, talk to your care provider about alternative options. Please be aware that we don’t have enough research on the alternatives to know if they are as accurate in screening and diagnosing gestational diabetes. Here are some options to explore, if you are interested:

• Fasting 
• At-home monitoring
• Fresh Test

Using candy or food in place of the glucose drink is sometimes recommended (usually by those that are not healthcare professionals). You may hear to try fruit juice, jelly beans, or even pancakes with maple syrup. The problem is that some of these foods include fats, protein, or other types of sugar that can affect the test results, which are based on taking 50 grams of glucose. These other methods have not been validated and could cause a missed diagnosis.

Group B Strep Test

Trimester 3️⃣

Group B streptococcus (GBS) is a common bacterium found in the genital tract or digestive system of approximately 1 in 4 pregnant people. While GBS is usually harmless to healthy adults, it can pose risks to your baby if exposed during vaginal birth. As a result, routine prenatal care includes testing for GBS during the 36th or 37th week of pregnancy. If GBS is detected, IV antibiotics are typically administered during labor to reduce the risk of transmission to your baby. 

According to an article on Group B Strep from Evidence Based Birth®:

To collect the sample for the culture test, a swab that resembles a long Q-tip will be used. The cotton tip should be inserted first into the vagina (not very far, only about 2 cm or ¾ inch), and then into the rectum (about 1 cm or ½ inch, through the anal sphincter).

You will likely be given instructions and sent to the bathroom to perform this swab on yourself during your prenatal visit.

Here are some important facts about Group B strep:

• If not treated, there is a 1-2% chance your newborn will develop early onset GBS disease in their first week of life, which can be serious and often requires a NICU stay
• IV antibiotics reduce, but don’t completely eliminate, the risk of newborns developing early onset GBS disease

Talk to your care provider about alternative options if you have concerns about receiving IV antibiotics in labor.

Cervical Exam

Trimester 3️⃣

In the final weeks of pregnancy, your provider may offer to check your cervix during your routine prenatal visits to see if any changes are starting to happen. While some people might find this information interesting, the current status of your cervix can’t tell you when you will go into labor. It’s possible your cervix will start to change at the end of pregnancy in preparation of labor. It’s also possible that your cervix doesn’t change until labor begins. It is up to you whether or not to have a cervical check done.

💡 Tip: If you know you don’t want a cervical exam at the end of pregnancy, you don’t have to get undressed during your prenatal care appointments while waiting for your care provider. This can help to communicate that you are not interested.

If you are needing to make decisions regarding induction of labor, however, this information can be helpful. There are a variety of induction methods. Effectiveness and availability vary based on what’s going on with the cervix.

It’s important to understand that routine care is often presented as required. It’s not always clear that you can say no or that other options may be available. You can always ask questions, find out about alternative options, and refuse care. It can be helpful to understand why certain exams and tests are routine and recommended as part of your decision-making process.