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9 Questions You Must Ask At Your First Prenatal Visit

 

First Prenatal visit questions

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The following questions are among the most important to ask at your first prenatal visit based on the experience of expectant couples who have gone through the childbirth process (from prenatal care to postpartum recovery).

9 Must Ask Questions at Your First Prenatal Visit

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It is important to note that these questions are only intended to initiate conversation with your prenatal care provider and are not all-inclusive. There are many other very important questions based on an individual’s desires or expectations.

It is best to ask these questions at your first prenatal visit to address any differences in opinion or management.

It is also important to remember that your unique medical history and physical exam may impact management decisions as your pregnancy advances.

It is important to be proactive at your first prenatal visit.

     9 Questions You Must Ask At Your First Prenatal Visit

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

Every medical practice has a labor and delivery schedule to cover the management of laboring patients 24 hours a day.

The schedule is often made 3 to 6 months in advance and includes the doctors in the medical practice who work in labor and delivery. Many Women’s Health practices also have doctors who manage only women’s health problems not involving pregnancy (gynecologists).

There are also medical practices that use physicians called laborists. These doctors only manage patients in labor and delivery. This role was created to improve continuity of care and ultimately the patient care experience during childbirth.

So who will deliver your baby?

It is not possible to be sure your doctor will be working in labor and delivery when you go into labor. Labor can occur at any time and your doctor cannot cover labor and delivery 24 hours a day, every day.

There are a few situations where there is a higher likelihood your doctor will manage your delivery:

  • Inductions that are not emergent can be scheduled with your personal physician.
  • If you are having a scheduled repeat cesarean section, this will be scheduled with the doctor providing your prenatal care.

2. If I require urgent care during my pregnancy, at what facility will I be evaluated and who will manage my care if my provider is not available?

The answer to this question will differ a great deal from one medical practice to another. Before you choose a doctor, you will want to find out certain information about how the medical practice functions during off hours 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.

    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 appoints 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 its due date. This topic is discussed very often and renders two approaches to management (assuming management is within the standards of medical care).

  1. Intervention by induction of labor.
  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?

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.

 

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

Many women choose a doctor for their pregnancy based on a mutual perspective toward pain management during labor.  Either strongly in favor or natural childbirth without medication or getting an epidural as soon as it is an option during labor.

The reason this question is important is that the doctor you see for your care works with a group of physicians. All the physicians in the medical group share hospital coverage to manage patients in labor. Unlike many many years ago, the option of seeing a solo practitioner who will manage everything in a medical practice is (with rare exception) is no longer available.

 

9. What childbirth preparation class do you recommend for your parents?

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 provider 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 childbirth classes post.  The childbirth class you take will depend on your desires, expectations, and philosophy about labor and delivery.

There is a tremendous amount of information available for expectant moms who are still undecided about what childbirth class to take.

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, at a time when there may be little or no opportunity to discuss options due to urgent management decisions.

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.

9 questions first prenatal visit

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