SEEING YOUR DOCTOR
0 NCE YOU are reasonably certain that you have conceived, it is wise to make an appointment to see the doctor. There are several reasons for an examination early in pregnancy. Complications of a serious nature can occur at this time. An example is ectopic pregnancy, or pregnancy in the Fallopian tube. If this condition is discovered and treated early, the consequences are much less serious than if nature is allowed to run its course. Another reason for examination in early pregnancy is that at this time an accurate estimate of the duration of pregnancy can be made. Later on, accuracy is much more difficult. If it becomes necessary to terminate pregnancy, it is obviously of great importance to know how mature the baby is. and if the menstrual history is in doubt, the best criterion is the relative growth of the uterus from early pregnancy.
Further, the prenatal examination is becoming more oriented toward preventive medicine. This is the only time many young women have a physical examination, and numerous abnormalities, from neglected teeth on down, are disclosed. Whether or not they have a direct bearing on the outcome of pregnancy, the sooner neglected disorders are attended to the better. Since the diagnosis of pregnancy is in some doubt until two or three weeks after the missed period, there is no point in seeing your physician earlier. You should all for an appointment with your doctor when your period is a couple of weeks overdue. Our society is continually on the move. have had occasion to consult an internist or a pediatrician, you will almost certainly be able to get the name of an obstetrician from either of them. II you know you will be looking for a doctor as soon as you get settled, it is wise to ask for recommendations ahead of time, from your physician or from other doctors in the city where you have been well acquainted.
Even though your doctor may not know anyone personally in the city you will be moving to. he has access to directories and lists of all types of specialists throughout the country. When you are completely at sea, the local hospital or medical society can furnish you with a list of qualified physicians. If there is a medial school in the area, someone there can supply the names of the members of the obstetrics staff.
While there seems to be no letup in the increasing trend toward specialization, it is not essential to have a specialist in obstetrics. Many general physicians carry heavy obstetric loads and do practically every-thing that the obstetric specialist does. In large cities, hospitals have obstetric clinics where care of a generally high quality is given by the stall of resident physicians. At your first visit, your doctor will take your regular medical history and find out what diseases or operations you have had. In the super-vision of a pregnancy there is increasing emphasis nowadays on obtaining this sort of information. He will want to hear the details of any previous pregnancies.
their duration, the length M labor, the weight of the baby. and any complications you might have had in pregnancy or labor. He will also ask you for details of your family history. Alter taking the history, the doctor probably will do a complete physical examination, including an internal or pelvic examination. He will use an instrument called a speculum to separate the vaginal walls so that he can see the cervix, or neck of the womb. If he is going to do the Pap smear test he will do it at this time. As you may know, this test was designed to detect early cancers of the cervix. These may occur (but very rarely) in the course of pregnancy. When your doctor does the internal examination, he can determine whether the pregnancy is normal and whether the uterus is enlarging as it should at this stage. He will also evaluate the pelvic bones and get a fair idea whether small measurements are going to lead to mechanical difficulties in labor.
Some laboratory tests are also done early in pregnancy. The blood group and Rh type should be obtained, along with a blood count or hemoglobin determination to show whether anemia is present. Urinalysis is also done. Almost all states require a blood test for syphilis, because if an infected mother is not treated in pregnancy. this disease will be transmitted to the unborn child.
Before you are finished with your first appointment, your doctor will have discussed a number of marten with you. He will tell you the estimated due date; that is, the projected date for the birth of your baby. For women with regular monthly menstrual periods this calculation is done by adding a week to the date of the last menstrual period and counting back three months.
The great majority of patients (So to go per-cent) will deliver within ten days, plus or minus, of the estimated due date. There are do’s and don’ts concerning pregnancy that your doctor will want to discuss with you. and he will tell you about such danger signals as pain or bleeding that should alert you to possible complications. You undoubtedly will have questions that he will be glad to answer. Either the doctor or his aide will tell you how he schedules his appointments and will make sure you know when and where you can call him be-tween appointments, if necessary. Before you conclude this first visit. you may even want to make reservations in the hospital. Before the twentieth century the doctor did not see the expectant mother until the onset of labor, unless she developed some sort of complication. Not until it became obvious that many problems could be dealt with properly if they were discovered early did the system of prenatal care as we know it today gradually evolve. In current practice, the pregnant woman usually sees her doctor at monthly intervals until the seventh month.
After that the visits are more frequent. At each visit, the doctor examines the mother to see if the pregnancy is growing properly. By mid-pregnancy she should be able to feel the baby move. Women who have borne children previously and know the signs experience this quickening somewhat earlier than do those pregnant for the first time. This is an important landmark in pregnancy. Since the quickening occurs quite consistently at about four and one-half months. it helps the doctor to decide whether the estimated date of delivery is accurate.
Two or three weeks after the mother has felt the baby kicking, the doctor will be able to hear the fetal heartbeat if conditions for examination are favorable. Toward the end of pregnancy the doctor will be able to tell in what position the baby will be at birth. An internal examination in the last month of pregnancy will disclose the state of the neck of the womb. This information helps in guessing whether labor will be on time or a little early or late.