After you decide that you’re 100 percent positive that you want to conceive, you should schedule a pre-pregnancy appointment with your healthcare provider. This doctor’s appointment is also called a preconception checkup, and it’s a smart move for any woman – especially those who have underlying health problems or a family history of obstetrical complications.
You can schedule this preconception checkup with your regular gynecologist or family doctor. This is also a good time to start looking around for an OB/GYN, certified nurse-midwife, or another prenatal practitioner. You may want to schedule your pre-pregnancy appointment with this doctor.
What Happens at a Pre-Pregnancy Appointment?
During a preconception checkup, the OB/GYN or other qualified healthcare provider will review your health history; conduct a Pap examination; ask you for a urine sample to check for urinary tract infections; and he or she may draw blood for blood work.
At this visit, you should come prepared to answer a long line of questions about your overall health and lifestyle. You will have to answer questions to the following topics:
* Gynecological History – The practitioner will ask about your menstrual cycles, how regular they are, how many days they last, and the date of your last period. You’ll also have to provide information about birth control methods you use. He or she will give you guidance on stopping birth control.
You will also discuss any sexually transmitted diseases (herpes, Chlamydia, gonorrhea, HPV, syphilis, etc.) you have presently, or you’ve had in the past. Some STDS are “silent,” which means you won’t have any symptoms now, but they can be problematic in pregnancy. If your partner or significant other has a history of having multiple sexual partners, you’ll want to get an STD screening to be on the safe side. You will also want to get tested for HIV.
* Obstetrical History – If you have been pregnant in the past, you’ll want to discuss this experience with your doctor. Be prepared to talk about any pregnancy complications you may have experienced in the past, such as preterm birth, miscarriage, stillbirths, ectopic pregnancies, abortions, gestational diabetes, etc. If you’ve given birth before, your doctor will also need to know how you delivered your child (vaginally, with the help of vacuum extraction or forceps, or a cesarean section). If you experienced any postpartum complications, bring up this too.
* Medical History – Your doctor will ask about any pre-existing medical conditions you may have, including high blood pressure, diabetes, asthma, and other illnesses. These conditions can affect your pregnancy, so you’ll want to have them controlled prior to conceiving. Your doctor may also give you advice on how to manage these health problems during pregnancy, or he or she may refer you to a specialist to help.
If you’ve had surgeries in the past or you’ve been hospitalized before, this is something you need to bring up at this appointment. You need to also bring up any allergies you may have.
* Current Medications – At this preconception checkup, you should bring a list of prescription and over-the-counter medications that you’re currently taking. Some medicines aren’t safe during pregnancy, so your doctor needs to know this information beforehand. He or she may give you alternatives medicines that are safer during pregnancy.
You should also discuss any vitamins, herbs, or nutritional supplements that you’re taking. Your healthcare provider will recommend that you start taking at least 400 micrograms of folic acid each day. This is a good time to discuss with your doctor his or her recommendations for prenatal vitamins.
* Family Medical History – Be prepared to discuss your family’s health history. Tell your doctor if there’s a family history of diabetes, twins or multiples, mental retardation, congenital birth defects, anemia, high blood pressure, deafness, blindness, or any other health conditions that run in your family.
* Vaccination History – The healthcare provider will ask about which vaccinations you’ve had, so you should bring an immunization record, if you have it. If you don’t know whether you have immunity to rubella (German measles), you will be tested. Most Americans receive the MMR (measles-mumps-rubella) vaccine during childhood, but it is important to double-check your immunity for this disease. Infection of rubella (also called the German measles) in early pregnancy can have devastating effects on your developing baby, including miscarriage and birth defects.
Similarly, if you can’t remember whether you had chicken pox as a child, you may be tested for immunity. Chicken pox may sound harmless, but it can cause birth defects and other complications in pregnancy.
At this visit, you may need to get a tetanus booster shot, if it’s been over ten years since your last shot.
* Emotional History – Although it may be uncomfortable to discuss your mental health history at your preconception checkup, it’s an important part of your future prenatal care. If you’ve ever suffered from eating disorders, depression, or any other emotional illness, your healthcare provider needs to be aware of this to ensure that you get the best care possible during your pregnancy. If you’re currently taking any antidepressants or any psychiatric medication, you need to tell your doctor. He or she may need to switch you to another medication during pregnancy.
* Abusive Relationships – A good healthcare provider should ask about any history of domestic violence or abuse. Keep in mind that abuse comes in many forms, including physical abuse (slapping, hitting, kicking, etc.) and emotional abuse (threats, constant putdowns, degrading you, etc.). Admitting to a professional that you’re in an abusive relationship can be embarrassing, but it’s very important that you let your doctor know. Abuse often gets worse during pregnancy, and abusive partners will become abusive parents once your child is born. Your doctor should be able to give you resources to help – including domestic violence hotlines, safe havens, legal and social services.
* Lifestyle Factors – At your preconception checkup, your doctor will ask about any bad habits you or your partner may have, such as smoking, drinking alcohol, and using recreational drugs. Your healthcare provider will urge you to stop these habits before you get pregnant.
If you don’t exercise regularly, your doctor may recommend that you start a fitness program now. For women who are either underweight or overweight, your doctor will help you find a plan to attain a healthy weight before you get pregnant.
* Your Diet – Your eating habits are crucial to your baby’s health during pregnancy, so you should be prepared to discuss your diet with your doctor at your pre-pregnancy appointment. Your doctor will ask you how much caffeine you consume, what types of food you eat, and your regular alcohol consumption. He or she will recommend that you eat a healthy, well-balanced diet. You may also be asked to start taking prenatal vitamins with at least 400 micrograms of folic acid.
* Genetic Screening – If you or your partner has a family history of genetic disease, if you’re over 35, or if you’ve had recurrent miscarriages, you may be referred to a genetic counselor to get screened. Genetic screening will help you discover your likelihood of having a child with a genetic defect, and you will get the chance to discuss your options with a professional.
After your doctor finishes asking you his or her questions, it’s your turn to talk about any questions or worries you may have. Don’t be embarrassed to ask anything; your healthcare provider has heard it all before.
Examinations at Your Preconception Checkup
At your preconception checkup, you’ll have to undergo a gynecological exam, in which the doctor will examine your genital area for any signs of an infection or sexual transmitted disease. Your vagina and cervix will be examined as well.
If you haven’t had a Pap smear within the last year, you’ll have one at this visit. The purpose of this Pap smear is to check for any abnormal cell changes or cancer. He or she may also take a cell culture to check for Chlamydia and gonorrhea. Be sure to mention any abnormal vaginal discharge or itching you may be experiencing. Your doctor will want to take a culture for vaginal infections, too. After the Pap smear, your doctor will examine your ovaries, uterus, and cervix for any problems.
Urine Tests and Blood Tests at Your Preconception Checkup
During your pre-pregnancy checkup, you will be asked to give a urine sample. The healthcare team will check your urine for any signs of a urinary tract infection (UTI). If you do have a UTI, your doctor will prescribe antibiotics to clear it up. Sometimes, your urine may contain sugar. In this case, you will be asked to take a glucose tolerance test to check for diabetes.
In addition to the urine test, you will be asked to give blood at your preconception checkup. Your doctor may check for your white blood cell count; hemoglobin (HGB) and hematocrit (HCT) counts; your Rh factor (most people are Rh positive, but if you’re RH negative, this can complicate your pregnancy); and your immunity to rubella and chicken pox. You may also get tested for HIV, syphilis and other STDs.