From a practical perspective, if you would be willing to terminate a pregnancy for a chromosomal disorder or neural tube defect, and you are quite concerned about that possibility, a prenatal appointment not much later than the end of your first trimester will allow you to arrange with the health care provider the optimum time for doing a quad screen or similar test. If you think you might have an STD, it would help to schedule an appointment as soon as possible. If you are diabetic, or you are taking a medication that you have been told would be dangerous to take while pregnant, your current health care practitioner will want to know as soon as you suspect pregnancy. If you are experiencing scary or weird pains or other symptoms such as unusual bleeding, getting immediate medical help can make a big difference for your health and comfort.
If you aren’t sick, you don’t really need to see a doctor. If you have a family practice physician that you like, or you have someone you see for pelvic exams, Pap smears and so forth, you might want to contact them and arrange an appointment to talk about what’s going on and listen to advice they might have for you. Neither group is guaranteed to be able to or interested in prenatal appointments or attending at your birth, but if they are, and you have a good relationship already established, clearly they are who you would start talking to.
If you don’t have such a person (or they don’t do prenatal, or attend births), at some point you probably will want to find someone. The cold hard truth is that they can’t actually do anything for you, other than give you advice you can equally well get from books, friends, online, etc. (and at your first appointment they may well hand you a book by way of supplying the advice) for the duration of the first trimester. They can take blood or urine to confirm the pregnancy; you probably already did the exact same urine test yourself. They can check your blood pressure (which you can do for yourself, quite easily, with an automatic cuff you can get for about $20 or $30). They could order an ultrasound to try to determine if you have in fact got the right date of conception, which you might want if you think maybe your last period wasn’t really a period. But there’s no rush, and there’s precious little they can do at this point if something does go wrong. Most miscarriages at this point are of babies who have already died of something seriously wrong with them from the start.
If you can find the time, now is a good time to be collecting stories from other mothers and listening carefully to your own reactions to their experiences. This, in combination with reading, will give you a sense of the kind of birth experience you’d like to have. The stories I heard from my mother’s generation made me very fearful of having a large baby, and also caused me to assume I would want access to any pain medication that was available. The stories I heard from mothers in my generation gave me pause. I heard about epidurals that didn’t work, spinal headaches, labors that stopped when effective pain medication was delivered, and infections that resulted from C-sections. As a child, I had heard about birth in more primitive cultures being very different: men weren’t involved, only women, and squatting seemed to be an important part of getting the kid out. As I tried to make all of these things fit together, I understood that some choices preclude other choices. At the same time, I was attempting to make sense of advice about how to eat and what to do to avoid birth defects or other problems and I found a lot of that advice very contradictory. It was at this point that I asked a family practice doctor (my husband’s brother-in-law) for advice about what books would be useful to sort through the evidence for and against the advice I kept hearing. He pointed me at several of the ones I’ve listed above. Your health care practitioner, or a health care practitioner in your extended circle of family and friends, may be able to help you in this way also.
Many people, health care professionals or not, will listen to your questions about how to make sense of all this and assume you want to do something you’ve been told not to, and are looking for permission to do it anyway. They may offer you that permission. They may press you for details about what you want to do. If that is what you are looking for, tell them if you think they might be able to help you work through that issue. But if you are looking for information, find someone who will help you in that process, and who respects that you really want to understand this, not just the rules.
The question of when and who to see for "prenatal care" is a much more dangerous one than it appears to be. It can be difficult to decide to change providers. While it is tempting to just go see someone and rely upon them for information and guidance, few health care providers will give a complete, unbiased summary of your options and no health care provider will support you equally in all of those options. Choosing prenatal care in many ways becomes choosing the kind of birth you will have and the kind of post-birth emotional experience you will have. It is very important to find compatible, sympathetic people for your prenatal care, and finding them will likely take time, because you will need to learn more about yourself to understand who you can be compatible with. There will likely be a great deal of pressure on you to go for prenatal care very early on, despite the lack of medical care they can realistically offer you and the poor quality of the interaction you will have in most prenatal care settings. I urge you to resist this pressure until you have talked to at least a handful of your friends who are mothers, and read at least a little about your options. Prenatal care is, unfortunately, primarily a form of control imposed on pregnant women and thus not subject to rational discourse in most contexts. Further, it's kind of a bum deal in that we've been led to expect that if we are good pregnant women and we assiduously go to our prenatal appointments, we'll have a healthy baby, whereas in fact, there's no correlation between prenatal care and improved outcomes.
Copyright 2005 by Rebecca Allen
Created May 20, 2005 Updated March 8, 2006