Your Pregnancy: A Guide to Getting Started

Congratulations on your pregnancy! This guide provides important information to help you have a healthy pregnancy and prepare for your baby's arrival.

What to Expect at Your Prenatal Visits

You will have regular appointments throughout your pregnancy to monitor your health and your baby's development. At your first visit, we performed a complete health assessment, including blood tests, urine tests, and screening for infections. These tests help us identify any conditions that need special attention during your pregnancy.

Typical visit schedule

• Every 4 weeks until 28 weeks of pregnancy
• Every 2 weeks from 28 to 36 weeks
• Every week from 36 weeks until delivery

At each visit, we will check your blood pressure, weight, urine, and your baby's heartbeat. We will also measure your belly to track your baby's growth.

Choosing Your Delivery Hospital and Provider

Early in your pregnancy, we recommend thinking about where you would like to deliver and which obstetric (OB) or midwife provider or practice you prefer for your pregnancy and delivery care.

Most OB and midwife practices limit the number of patients they accept for each delivery month—often around 25 patients per due-date month. Because of this, availability is never guaranteed, even when referrals are placed early. Sharing your preferences as soon as possible allows us to submit referrals promptly and may improve the chance of securing care with your preferred provider.

What to Expect with Referrals

• Referrals are typically placed after your initial prenatal visit once an ultrasound confirms pregnancy.
• Acceptance is determined by the OB or midwife practice and hospital, not our clinic.
• A referral does not guarantee acceptance, as practices may already be full.
• Many patients do not have their first visit with the OB or midwife practice until around 20 weeks of pregnancy, even after a referral is accepted.
• Many patients expect the OB or midwife they see during pregnancy to deliver their baby, but this is not always the case.
• Delivery is usually handled by the provider who is on call at the hospital when you go into labor, regardless of which provider you see for prenatal visits.
• If your first choice is unavailable, we can help discuss alternative options. Sharing a list of acceptable providers or hospitals gives us more flexibility to reroute any declined referral.
• If you do not have a preference, we are happy to send the referral to a provider based on location, gender, and hospital affiliation.

If You’re Not Sure Yet

If you come to your appointment without a delivery hospital or provider preference, we can still place a referral, but options may be more limited.

Waiting to decide or delaying a referral may further reduce availability, and changing providers later in pregnancy may not always be possible. In some cases, referrals may need to be based on either hospital preference or provider characteristics, but not both. For the best chance of delivering where and with whom you prefer, we strongly encourage you to come to your first prenatal visit prepared with your preferences. If you have questions about hospitals, OB or midwife practices, or the referral process, please let us know—we’re here to help guide you.

Taking Care of Yourself During Pregnancy

Prenatal Vitamins

Take a daily prenatal vitamin that contains at least 400 micrograms (mcg) of folic acid, 30 mg of iron, 200-300 mg of calcium, and 400 IU of vitamin D. Folic acid is especially important during the first 12 weeks of pregnancy to prevent birth defects of the brain and spine. Start taking prenatal vitamins now and continue throughout your pregnancy and while breastfeeding.

Nutrition and Diet

Eat a well-balanced diet rich in fruits, vegetables, whole grains, lean proteins, and dairy products. Important nutrients during pregnancy include:

• Calcium: 1,000 mg daily (1,300 mg if you are under 19 years old) from milk, yogurt, cheese, and dark green leafy vegetables
• Iron: Found in lean meats, beans, fortified cereals, and dark green vegetables
• Vitamin D: From fortified milk, cereals, salmon, and eggs
• Omega-3 fatty acids: Eat 2-3 servings per week of low-mercury fish such as salmon, sardines, or tilapia

Weight Gain

Healthy weight gain during pregnancy depends on your weight before pregnancy:

• Underweight (BMI less than 18.5): Gain 28-40 pounds
• Normal weight (BMI 18.5-24.9): Gain 25-35 pounds
• Overweight (BMI 25-29.9): Gain 15-25 pounds
• Obese (BMI 30 or higher): Gain 11-20 pounds

Exercise

Regular physical activity is safe and beneficial during pregnancy. Aim for at least 30 minutes of moderate exercise (such as brisk walking, swimming, or prenatal yoga) on most days of the week. Exercise can help reduce back pain, improve your mood, and prepare your body for labor. Avoid contact sports, activities with a high risk of falling, and exercises that require lying flat on your back after the first trimester.

What to Avoid During Pregnancy

Substances

• Alcohol: No amount of alcohol is safe during pregnancy. Alcohol can cause serious birth defects and developmental problems.
• Tobacco and smoking: Smoking increases the risk of miscarriage, premature birth, low birth weight, and other complications. If you smoke, ask us about programs to help you quit.
• Marijuana: Marijuana use during pregnancy can lead to low birth weight and other problems. Avoid all marijuana products, even if prescribed for medical reasons.
• Caffeine: Limit caffeine to less than 200 mg per day (about 2 small cups of coffee). High caffeine intake is associated with miscarriage and low birth weight.

Foods to Avoid

To prevent foodborne illness, avoid:

• Unpasteurized (raw) milk, juice, or soft cheeses
• Raw or undercooked meat, fish, eggs, and shellfish
• Raw sprouts
• Deli meats and hot dogs (unless heated until steaming hot)
• High-mercury fish such as shark, swordfish, king mackerel, and tilefish
• Refrigerated smoked seafood

Medications and Supplements

Many medications are not safe during pregnancy. Before taking any prescription medication, over-the-counter drug, herbal supplement, or vitamin (other than your prenatal vitamin), check with your healthcare provider.

Generally safe medications include:

• Acetaminophen (Tylenol) for pain and fever (use the lowest dose for the shortest time needed)
• First- and second-generation antihistamines for allergies
• Antacids and certain heartburn medications

Avoid ibuprofen (Advil, Motrin) and other nonsteroidal anti-inflammatory drugs (NSAIDs), especially in the third trimester.

Environmental Exposures

Avoid or limit exposure to:

• Cat litter boxes (risk of toxoplasmosis infection)
• Hot tubs and saunas, especially in the first trimester
• Cleaning products with strong fumes
• Paint fumes and chemical solvents
• X-rays and radiation (tell all healthcare providers that you are pregnant)

Common Pregnancy Symptoms

Many women experience the following symptoms during pregnancy:

• Nausea and vomiting (especially in the first trimester)
• Fatigue and tiredness
• Frequent urination
• Heartburn and indigestion
• Constipation
• Back pain
• Mood changes

Most of these symptoms are normal. We can discuss ways to manage them at your prenatal visits. Ginger (1,000-1,500 mg daily) is safe and effective for treating mild to moderate nausea.

When to Call Your Healthcare Provider

Contact us right away if you experience:

• Vaginal bleeding or fluid leaking from your vagina
• Severe abdominal pain or cramping
• Severe headache that doesn't go away
• Vision changes (blurred vision, seeing spots)
• Fever over 100.4°F (38°C)
• Painful or burning urination
• Severe vomiting (unable to keep food or liquids down)
• Sudden swelling of your face, hands, or feet
• Decreased fetal movement after you have started feeling the baby move regularly

Additional Testing and Screening

During your pregnancy, you will be offered several screening tests:

• Genetic screening: Tests to check for chromosomal abnormalities such as Down syndrome. These can be done through blood tests and ultrasound or through cell-free DNA testing.
• Ultrasounds: Usually performed around 11-14 weeks and 18-22 weeks to check your baby's development and anatomy.
• Glucose screening: Around 24-28 weeks to check for gestational diabetes.

We will discuss all testing options with you and help you make informed decisions about which tests are right for you.

Preparing for Your Baby

As your pregnancy progresses, we will discuss:

• Childbirth education and what to expect during labor and delivery
• Pain management options during labor
• Breastfeeding benefits and techniques
• Newborn care basics
• Postpartum recovery and mental health

References

1. Prenatal Care: An Evidence-Based Approach. Ramírez SI. American Family Physician. 2023;108(2):139-150.
2. Beyond Too Little, Too Late and Too Much, Too Soon: A Pathway Towards Evidence-Based, Respectful Maternity Care Worldwide. Miller S, Abalos E, Chamillard M, et al. Lancet. 2016;388(10056):2176-2192. doi:10.1016/S0140-6736(16)31472-6.
3. Pregnancy Myths and Practical Tips. Caro R, Fast J. American Family Physician. 2020;102(7):420-426.
4. Management of Pregnancy (2023). Colleen C. Blosser MSN RN, Michael Bybel DO FAAFP, Alicia Christy MD MHSCR, et al. Department of Veterans Affairs.
5. Prepregnancy Counseling. Daniel M. Breitkopf, Micah Hill. American College of Obstetricians and Gynecologists (2019).
6. Dietary Guidelines for Americans 2020-2025: Recommendations From the U.S. Departments of Agriculture and Health and Human Services. Arnold MJ, Harding MC, Conley AT. American Family Physician. 2021;104(5):533-536.
7. Over-the-Counter Medications in Pregnancy. Powers EA, Tewell R, Bayard M. American Family Physician. 2023;108(4):360-369.
8. Screening for Fetal Chromosomal Abnormalities: ACOG Practice Bulletin, Number 226. Obstetrics & Gynecology. 2020;136(4):e48-e69. doi:10.1097/AOG.0000000000004084.