Monitoring your bump
Some prenatal appointments are more meaningful, others are more important. We look at what's in store for you.
(Getty Images)

Many of my friends, cousins and colleagues, who range in age from their late twenties to their early forties, are pregnant or have recently given birth.

Most have passed the anxious stage of early pregnancy and many have graduated on to the sleep deprived stage that comes with being a new parent.All are in awe of the baby-making process.

To give you an idea of what lies ahead, we asked them which doctor's visitsor foetal assessments stood out for them.

Ooh-aah ultrasound
Freelance journalist, Lisa Lazarus, has yet to give birth to her baby boy. At 25 weeks she comments: "The scans at the foetal-assessment clinic at 12 and 22 weeks are exciting and nerve wracking.

"They assess your baby incredibly closely. The 12-week scan is the scariest, as they look at your chance of having a baby with Down's syndrome, and if all the fingers, toes and so on are there.

"At this stage it is difficult to believe your baby is real; you don'teven have a visible bump yet."

Marketing manager Adri van der Merwe, who gave birth in April, advises:"It is good to have hubby there for the 'biggies' – the first 12-week scan, the separate nuchal translucency scan (if you decide to go for it) and the heart-abnormalities scan at around 20 weeks."

Loryn Caulfield, a 29-year-old radiotherapist, decided to go for a nuchal scan as her partner's family has a history of Down's syndrome.

She remembers making the decision: "It was a hard call to make, but I felt that I would rather know in advance so we could prepare.

"As it turned out, everything was fine, the baby was perfect and seeing the heart beating for the first time was a feeling that compares to nothing we’ve ever felt before."

Even celebrity moms appear overjoyed by that first encounter. Jools Oliver, mother of Poppy and Daisy with Naked Chef, Jamie Oliver, writes in her book, Minus Nine to One (Penguin):

"There was so much anticipation and excitement that we were going to see our baby properly for the first time. I just can't describe how I was feeling."

This is the general reaction to the amazing ultrasound scan, which shows  your baby and its movements on screen. The first one is usually offered at between 10 and 16 weeks. But why is an ultrasound so important?

Obstetrician/gynaecologist Dr Linda Rogers explains: "The importance of ultrasound is definitely to exclude any foetal abnormalities, rather than simply as a way of telling the baby's gender. Antenatal visits are predominantly there to monitor the health of the mother and the foetus."

Question time
On your first visit, your doctor will ask you a number of questions to compile your medical history. Here's what to expect, and why:

  • What was the date of your last period?
    This is used to estimate the date of delivery.
  • Did you have any difficulty falling pregnant?
    Fertility treatment may mean you are carrying multiples.
  • Have you had any problems up to this point such as bleeding, pain or discharge?
    Do you suffer from a chronic illness? These problems may require special care.
  • Have you had treatment for a psychiatric illness in the past?
    Postnatal depression can then be pre-empted.
  • Have you previously had abdominal or pelvic surgery?
    To help decide whether a Caesarean or vaginal delivery is best for you.

Your honesty in answering these questions will go a long way towards ensuring that you receive the best possible care.

A wee drop
You will be asked to produce a urine sample at your first booking – and most subsequent ones – to monitor for high levels of sugar or protein, the possible result of increased blood flow in pregnancy, which puts pressure on your kidneys.

An excess of sugar in your urine may indicate gestational diabetes, a serious condition that affects between one and three percent of pregnant women. It can often be managed by diet alone, but 10% of patients need additional insulin treatment.

Protein uria, a condition marked by too much protein in the urine, can have several causes. An infection of the urinary tract or kidneys is the most common cause, for which antibiotics will be administered.

Pre-eclampsia may also be indicated, for which the only cure is early delivery of your baby. In most cases, though, a urine test is just a minor inconvenience and should not put you off check-ups.

As Lisa says: "That first scan was the one in which we bonded with our son. We found out we were having a boy, so it all became very real.

"He looked so beautifully formed and like a real little baby that it was extremely exhilarating. It was so exciting that I forgot, at least briefly, about my morning sickness."

What is it?
The test: Chorionic Villus Sampling (CVS) detects chromosomal and genetic disorders such as Down's syndrome and sickle-cell anaemia.

A tube is inserted into the uterus at eight to 12 weeks and cells are taken from the placental tissue.

Pros and cons: Very accurate. There is a miscarriage risk of about two in 100. Results take only two days and will either put your mind at rest or, if an abnormality is found, will help you to make future plans. Some conditions can be treated in the womb.

The test: Nuchal translucency scan
Non-invasive ultrasound carried out at between 11 and 13 weeks to detect chromosomal disorders. "Nuchal" means neck: the scan checks for abnormal thickness in the fold at the back of the baby's neck.

Pros and cons: When combined with a blood test, this is 80 to 90% accurate in predicting Down's syndrome. It is non-invasive and carries no risk of miscarriage. Only consider taking the test if you are going to take action over it.

The test: Amniocentesis
A sample of amniotic fluid is taken, under local anaesthetic, through the abdominal wall at 16 to 18 weeks. Cells are tested for various disorders, including Down's.

Pros and cons: Test is about 90 percent accurate. It reveals baby's gender, which is important for some disorders. There is a risk of miscarriage (about one in 100).

Side effects range from discomfort to bleeding and possible infection afterwards. The results take up to three weeks.

Financial findings
It's a good idea to meet your financial advisor at around the time you tell family and friends you are pregnant to find out exactly what your medical aid and/or hospital plan covers and resolve any other financial queries.

For example, on Discovery Health you will be reimbursed for two ultrasoundscans (2D or 3D) per pregnancy at 100% of their approved rate.

Some retirement-annuity policies, like Liberty Life's Excelsior 1 000, allow you to suspend your premiums for up to six months while on maternity leave. Investigate similar benefits – including discounts on antenatal classes – with your advisor.

12 weeks on
In the second trimester, a special blood test will detect any neurological problems in the foetus, such as spina bifida (for which folic acid is preventative) or hydrocephalus.

Your 20-week ultrasound will then check that your baby is well formed. As this is more detailed than the previous scan, it is usually performed by an experienced sonographer.

The baby's physique, the position of the placenta and blood flow to the womb is all checked.

Infernal internals
After your initial vaginal and pelvic examination at the first antenatal visit, you will probably not have to have another during your pregnancy unless you've complained of discharge or bleeding, or had a previous Caesarean because your pelvic arch was too narrow.

Increased risk?
Women over 35 are generally offered an amniocentesis due to a higher risk of abnormalities in the babies of older moms.

Some women are absolutely determined to have their baby, regardless of problems, and refuse to take the test. Others, however, struggle with the idea of a child with a diminished quality of life and may decide to terminate, says Dr Laura Goetzl in Conception and Pregnancy over 35.

If you're faced with this dilemma, counselling may help you reach adecision.

Third trimester niggles
You can expect to be seen by your caregiver with increasing frequency towards your due date so that he or she can pick up problems that may slow down your baby's growth.

If you are Rhesus negative, for example, you will need an injection of anti-D at both 28 and 34 weeks to prevent you from developing antibodies that might harm your baby. But most women have just minor niggles – indigestion, back pain and itching skin – that need attention.

As many medications are contra indicated in pregnancy, check with your doctor or pharmacist before taking anything.

"As these 'minor niggles' are hugely unpleasant for pregnant women and have a significant impact on their quality of life, sorting them out as effectively as possible is a great relief," adds Dr Rogers.

Lastly, it is important to relax and focus on the positive during this special time. Your emotional and mental state can have a very real effect on your body.

Try and take time out of every day for some meditation, visualisation and positive thinking in case labour starts early and you feel unprepared.

What was your reaction to your first scan? Do you think your gynea made a special effort to make this scan memorable?

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