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Red, white and due?
Summer is the most popular time to give birth in the US, with July and August consistently ranking as the busiest delivery months. The summer surge is fueled by higher conception rates in the cooler fall and winter months.
No matter when you become pregnant, preparing for a baby is a major undertaking that can feel overwhelming at times.
Fortunately, most pregnancies — even high-risk ones — follow a predictable path, and understanding pregnancy care can make the journey feel less intimidating.
From appointments to screening tests, here’s a look at your 10-month journey by trimester.
First trimester (weeks 1-13)
The first trimester can be a blur of emotions. The good news is thaty you don’t have to rush to make an appointment with their obstetrician.
In many cases, we prefer patients establish care between weeks 6 and 9. However, those who have previously had an ectopic pregnancy, a potentially life-threatening condition where the fertilized egg implants outside the uterus, should contact their doctor as soon as they learn they’re pregnant.
Pregnancy should inspire nutritional changes that support fetal development and maternal health. We encourage aerobic exercise and other healthy lifestyle activities.
One thing we want to make sure you’re doing is taking prenatal vitamins because they contain folic acid, which prevents serious birth defects. In fact, you should start taking prenatal vitamins, or folic acid by itself, several months before trying to conceive.
Those at risk of preeclampsia, a dangerous blood pressure disorder, should supplement their daily prenatal vitamin with low-dose aspirin, typically started between 12 and 16 weeks.
You should avoid alcohol, tobacco and recreational drugs and focus on staying hydrated. Staying adequately hydrated can be hard for individuals struggling with morning sickness, a common first trimester symptom along with fatigue.
Patients who establish prenatal care in the first trimester are offered a range of genetic testing options. These include screening tests for conditions such as Down syndrome and hundreds of inherited genetic disorders, as well as diagnostic testing.
Some people choose to defer genetic testing, which is a personal decision that should reflect their values and goals.
Non-invasive prenatal testing is a highly accurate blood test offered after week 10 to assess the fetus’ risk for Down syndrome and several other age-related genetic abnormalities and sex chromosome abnormalities.
The first trimester is also the time to start discussing goals for care and delivery. These conversations will continue throughout pregnancy, as patients should plan to see their provider at least once a month.
Second trimester (weeks 14-27)
I like to think of the second trimester as the honeymoon period because those annoying first trimester symptoms ease and third trimester discomfort hasn’t set in.
During this time, we perform ultrasounds to screen for birth defects. Our ultrasound assessments can identify major and minor issues. If new problems are identified, some patients who declined diagnostic testing may choose to revisit that decision and pursue amniocentesis.
A small amount of amniotic fluid is removed to check for chromosomal abnormalities. The test is typically done between weeks 15 and 22 and, while it can identify genetic conditions that may not be apparent on ultrasound, there is a small associated risk of miscarriage.
It’s common in the midtrimester for quickening to occur. When this happens, you’ll feel the baby’s first movements, which resemble fluttering or movement of intestinal gas.
Between weeks 24 and 28, patients get screened for gestational diabetes. This is a fairly common pregnancy complication that is driven by placental hormones. If they test positive, they will need to manage their blood sugar with diet and/or insulin.
Third trimester (weeks 28-42)
Early in the third trimester, we administer the TDaP vaccine to protect against tetanus, diphtheria and pertussis, or whooping cough.
Whooping cough, in particular, can be devastating to unvaccinated babies. Vaccinating patients helps transfer protective antibodies to the baby before birth. Vaccination of partners and close family members can provide additional protection.
Depending on the time of year, RSV vaccination is available between weeks 32 and 36 to prevent severe disease in infants. COVID-19 and flu vaccines can be given any time.
In this trimester, we’re focused on checking blood pressure and watching for signs of preeclampsia, like vision changes that can appear as blue or black dots, nausea, vomiting, headaches and pain in the upper right abdomen.
We also monitor fetal growth closely. During prenatal visits, this is generally done by measuring the height of the uterus using a paper tape measure.
If a fetus is measuring large or small, or if patients have risk factors for fetal growth problems such as high blood pressure or diabetes, we may also perform additional ultrasounds. These scans can evaluate fetal growth and wellbeing.
General signs to monitor include a tightening of the abdomen, leaking of amniotic fluid, bleeding, a sudden increase in vaginal discharge and menstrual-like cramps. If you notice these symptoms or a decrease in the baby’s movements or you have a sense that something just doesn’t feel right, you should immediately call your provider.
As pregnancy advances, the frequency of office visits increases. Appointments occur every two weeks in the third trimester. At week 36, we start seeing patients weekly. Extra surveillance will depend on circumstances like preeclampsia.
In the meantime, patients should solidify their delivery plans while leaving room for flexibility. In my experience, having some flexibility in birth planning is important as fetal tolerance of labor does not always go as expected.
Even when labor does not unfold exactly as planned, our teams work to ensure that patients feel heard and have the birthing experience that they want.
I recommend taking hospital tours and birthing classes and considering your infant feeding goals. The more prepared you are, the less stressful the process.
Although babies born after 37 weeks generally do very well, 39 weeks is often considered the sweet spot for development because most organ systems have reached optimal maturity.
Time in the hospital depends on delivery mode and complications. For vaginal births, patients tend to be in the hospital for two days. For C-sections, it’s three days.
About one third of patients have C-sections, though this risk varies by institution. Patients who experience complications, like preeclampsia, may need additional time in the hospital.
Fourth trimester (weeks 1-12 after delivery)
Your care doesn’t end when you give birth.
At a minimum, we see patients at least twice during the six weeks after delivery, but we’ll see patients more often if they have a high blood pressure complication or struggle with their postpartum mental health.
The weeks after delivery are a time of tremendous physical and emotional adjustment. Sleep deprivation, nursing challenges, recovery from birth and changes in mood are common. Just as prenatal care is important during pregnancy, postpartum care is essential for helping parents recover and thrive.
Pregnancy can feel overwhelming because there is so much information available. My advice is to focus on the basics: establish prenatal care early, take your prenatal vitamin, attend your appointments and don’t hesitate to call if something doesn’t feel right.
Most pregnancies go very well, and we’re here at NYU Langone Health to guide patients every step of the way.
Dr. Justin S. Brandt is director of the Division of Maternal-Fetal Medicine at NYU Langone Health, where he provides inclusive, evidence-based care for high-risk pregnancies and obstetrical complications.
