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9 Questions You Must Ask At Your First Prenatal Visit

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First Prenatal visit questions

 

These nine questions you must ask at your first prenatal visit are based on our clinical experience. The information we will be sharing is based on women who have gone through the entire childbirth process. From their first prenatal visit until the time they returned home from the hospital with their newborn child.

9 Must Ask Questions at Your First Prenatal Visit

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These questions are intended to initiate a conversation with your prenatal care provider and are not all-inclusive. There are many other very important questions you will have based on your particular desires and expectations.

These 9 questions you must ask at your first prenatal visit are very important.  You want to be aware of any fundamental differences you might have with your health care provider.  It is comforting to know the answers to these questions as you move forward with your prenatal care.

Keep in mind that you will be seeing your healthcare provider for prenatal and postpartum care. This care will span over a year, so you want to be sure you share the same beliefs and philosophies about pregnancy.

  • At your first prenatal visit, your medical history and physical exam will impact your medical care as your pregnancy advances.
  • Be proactive and ask the questions you feel you must ask at your first prenatal visit. The initial prenatal visit is your opportunity to address any concerns you feel you might have later in your pregnancy.
  • Write down the questions you want to be sure you ask at your first prenatal visit. It is very common to forget questions because of the sheer volume of information gathered at your first visit.
  • The initial visit is the best time to ask questions since you have not yet established a healthcare relationship with your provider. You will be most comfortable discussing what is on your mind about the management of your prenatal care, labor, and delivery.

prenatal counseling

(Couple at a prenatal visit.)

9 Questions You Must Ask At Your First Prenatal Visit

1. Who will deliver my baby when I go into labor?

Every women’s health medical practice caring for prenatal patients has a labor and delivery schedule arranged months in advance. This schedule indicates what medical group provider, will be managing labor patients in labor and delivery 24/7/365. This schedule is usually made 3 to 6 months in advance, to avoid any scheduling conflicts.

There are also medical practices that have doctors who only cover patients in labor and delivery. These physicians are called laborists. This role was created to improve the continuity of care for patients in the hospital.

When you go into labor, you will be managed by the doctor covering labor and delivery based on the call schedule discussed above. It is not physically possible nor safe for one doctor to cover labor and delivery 24 hours a day, every day. 

There are a few clinical situations where you will be more likely to be delivered by your doctor:

  • If you are having an induction, your doctor may schedule it when on call at the hospital.
  • Scheduled repeat cesarean section.

 

2. If I require urgent care during my pregnancy, where will I be seen and who will evaluate me if my provider is not available?

The answer to this question differs a great deal from one medical practice to another. Before you choose a provider, you will want to find out how the medical practice cares for patients when the office is closed and what facilities (if any) are available when it comes to managing problems after office hours.

Questions that will help determine who will manage your care after hours are the following:

  1. What is the size of the medical practice? (How many doctors in the medical group?)
  2. Does the medical practice operate as an independent group of physicians who deliver at one hospital?
  3. Is the practice part of a larger network that delivers their patients at one hospital or different hospitals
  4. Does the medical practice have an urgent-care facility to evaluate labor patients before sending patients to the hospital?
  5. Is your doctor part of a managed care organization. A medical practice such as Kaiser Permanente has urgent care facilities to evaluate patients after office hours.
  6. How many doctors in the medical practice manage labor patients in the hospital. Once you know the answers to the questions noted above, you will have a far better idea of how you will be managed for non-scheduled medical visits.

    Pro Tip:
    Since you may be managed by another doctor in your medical group, it is a good idea to schedule a prenatal visit with each of the doctors in the practice that may cover your labor and delivery. This will ensure that you will have at least meet the doctor delivering your baby before the onset of labor.

 

3. Do the providers in your practice manage labor from home or is there always one provider present at the hospital?

There are very few practices that cover labor and delivery from home.

This was done years ago; however, now that most medical practices have three or more doctors, the number of patients managed in a particular practice results in at least one patient always being in labor, and the safety of covering labor patients from home can result in many problems.

Some medical practices and hospitals now employ laborists.

These doctors are trained solely to manage laboring patients. It is important to note that these doctors have received training in both obstetrics and gynecology, before deciding to focus on labor and delivery management.

 

4. How is anesthesia coverage managed at the hospital affiliated with your medical practice?

It is important to know how the anesthesia department covers patients in labor at the facility where you plan to deliver.

This is important to know even if you are not planning on using pain medication during labor.

Should you need urgent intervention during your labor, anesthesia will be necessary

Anesthesiologists are employed by the hospital. The schedule for covering anesthesia in labor and delivery will vary depending on the hospital where you plan to deliver.

A level one hospital will have a different coverage arrangement compared to a tertiary care hospital that has 24 in-house coverage at all times.

Tertiary care hospitals are most often teaching hospitals and trauma centers and have a full complement of medical staff in the various subspecialties.

This means from medical students to residents to attending physicians to fellows fulling certified attendings in the subspecialty.  Often these hospitals have an obstetric anesthesia staff as illustrated in our article on 20 hospital questions.

 

5. At my prenatal visit, can I book more than one appointment at a time so I can see my personal prenatal care provider?

Many women want to schedule more than one prenatal visit at a time to get an appointment time that fits into their work schedule and is with their personal provider.

Though many offices will book appointments far out, some will not. Take the time to ask this question if you feel this will impact your daily routine. Especially since there are many routine prenatal visits during your pregnancy.

 

6. How do you manage patients who go past their due date?

Doctors and patients often have a difference in opinion about how to manage a pregnancy that goes past the due date. There are basically two approaches to management (assuming the management you choose is within the standards of medical care).

  1. Intervention by induction of labor: Induction of labor is 
  2. Expectant management: Observation for the onset of labor while doing antenatal testing to monitor fetal well-being. (The problem with this approach is that antenatal testing is not 100% reliable when it comes to assessing fetal well-being.) 

 

Assuming a pregnancy is uncomplicated there is no disagreement about allowing a pregnancy to go one week past its due date or to 41 weeks gestation.

In fact, the majority of pregnancies will deliver within one week before or after the scheduled due date.

It is at 41 weeks where the question comes up. Balancing the risk of induction versus the risk of fetal compromise or death due to uteroplacental insufficiency.

It has been well established that the function of the placenta starts to deteriorate during the weeks following delivery. A term used to describe this process is uteroplacental insufficiency.

When this happens there can be decreased blood flow and oxygen delivery to the fetus.

The evaluation of fetal well-being includes many diagnostic tests to help determine if the fetus is being compromised (fetal-monitoring, ultrasound).

 

7. What is the level nursery at the hospital affiliated with your practice?

Newborn nursery

Knowing the level of nursery at the hospital where you plan to deliver is extremely important. The care can range from a Level I (Well Baby Nursery) to a Level II (Special Care Nursery) to a Level III or Neonatal intensive care unit (NICU).

The NICU was first established in the 1960s by the American Academy of Pediatrics to manage babies with critical medical problems requiring prolonged life support.

The level of nursery essentially correlates with the level of the hospital. Hospitals range from primary to secondary to tertiary care facilities.

Typically, tertiary care hospitals are teaching hospitals and are equipped to handle trauma and advanced medical care.

If you have a medical illness or a pregnancy-related complication that could affect the health of your baby, it is important to know what level of neonatal care is available at the hospital where you deliver.

 

Nicu information

 

8. How do the providers in your practice feel about pain control during labor and delivery?

management of labor pain

Many women choose a doctor for their pregnancy based on a mutual understanding and agreement on pain management during labor. The choices for pain control cover a broad spectrum from:

  1. Strongly desiring to go through natural childbirth without the use of medication during labor.
  2. Wanting an epidural for pain management as soon as it can be administered. When an epidural can be administered is based on criteria that have been defined and comply with the standards of medical care. ***
  3. For women who are not sure if they will want IV pain medication or an epidural, the decision can be managed during labor. There is not a problem with changing your mind about pain management, as long as there is adequate time to administer alternative therapies. The best example of want you don’t want to do is delay your decision.  Epidurals are not easy to place when a laboring patient is fully dilated and imminently going to deliver.

When deciding on pain control during labor. It is very important to plan ahead and be ready for labor and delivery scenarios that might deviate from your birth plan. The two most common are, a personal desire for pain control to treat labor pain and the need for regional anesthesia (spinal or epidural) if a cesarean section is necessary.

*** Some of the clinical criteria that have to be met for epidural placement include:

  1. Confirmation that the patient is in labor, best defined as contractions with cervical change.
  2. Cervical dilatation, a factor that should be discussed with your provider. Some medical practitioners and medical facilities are fine with giving an epidural as long as a patient is in labor, even if in early latent labor. Other doctors prefer to wait until cervical dilatation has reached 3cm. Prior to this, they will administer IV medication for pain relief.
  3. A negative medical history of underlying medical conditions that do not allow for the placement of an epidural. Two such conditions include bleeding disorders or severe back injuries.

The reason this question is important is that the doctor you see for your prenatal care in the office works with a group of physicians. All the physicians in the medical group share hospital coverage to manage patients in labor. Meet the other doctors during your prenatal visits so you can ask questions and know that they are in agreement with your labor plan.

Unlike many many years ago, the option of seeing a solo practitioner who managed everything during your prenatal care(with rare exceptions) no longer exists. This is a result of the advances that have been made in the management of pregnancy, the costly overhead to run a practice, and the number of patients that have been determined to be safe for one practitioner to care for. This is why it is crucial to know the questions you must ask at the first prenatal visit.

So you will want to discuss your philosophy and wishes about pain control. Be sure to ask questions. There is a lot of misinformation that circulates online.

woman with epidural pushing button to give herself a dose

(Woman with an epidural self-administering a dose of pain medication.)

While you certainly don’t need to have any type of birth plan thought out at your first prenatal visit, it isn’t a bad idea to at least consider how you see your future labor and delivery experience unfolding. You can check out our post on developing a stress-free birth plan for some questions you might want to consider about the birth process.

 

9. What childbirth preparation classes do you recommend to your patients?

*Due to COVID-19, childbirth classes are mostly on-line. You will definitely want to ask about childbirth education options at your first prenatal visit.

childbirth classes

 

Many couples have specific requests when it comes to their pregnancy and birth plan. It is not unusual for expectant parents and their prenatal care providers to differ on accepted management options or they may simply have different philosophies or expectations about the childbirth experience.

This question is addressed in detail in our post Are Childbirth Classes Necessary?  The childbirth class you take will depend on your desires, expectations, and philosophy about labor and delivery.

If you are undecided about what childbirth class to take, ask about classes at your prenatal visit. Your provider will have information about classes located near you.  Finding a class that is in alignment with your beliefs about pregnancy will give you the opportunity to address the questions you must ask at your first prenatal visit.

 

Other pregnancy-related articles you may find helpful:

Knowledge is Power, and knowing the answers to the questions above will help you feel more in control and less anxious about situations you may encounter during your pregnancy.

Being well-informed and knowing what to expect (which is a large part of what labor preparation classes are about) can make a huge difference. It is for this reason that it is very important to know what questions you must ask at your first prenatal visit.

9 questions first prenatal visit

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