Pregnancy brings an exciting and busy nine months of preparation before baby’s arrival. It also includes an assortment of medical tests that help ensure mother and baby stay as healthy as possible before and after the birth.

“We want healthy babies and healthy mothers,” said Miranda Salky, a certified nurse midwife with UCHealth Women’s Care Clinic in Steamboat Springs. “Our nurses, doctors and midwives develop an important relationship with patients and together, we work as a team.”

There are a number of medical tests to anticipate.

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“These are just the basics,” she said. “Other tests may be needed, either during a pregnancy or because people have pre-existing conditions. In all cases, we respond on an individual basis to give our patients the best care for both mother and baby.”

Your first appointment: 6-10 weeks

If you’ve taken a home pregnancy test and got a positive reading, make an appointment for an ultrasound/viability scan, typically done six weeks into the pregnancy as this is when a heartbeat can most likely be detected.

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That first appointment is an important one, Salky said. The ultrasound helps determines the age of the fetus and its placement in the uterus.

Other tests include:

· Pre-natal blood work to test the mother for blood type, anemia and any infectious diseases such as HIV, syphilis, Hepatitis B and C, and rubella. Genetic testing is also offered to screen for fetal chromosome abnormalities, such as Down syndrome and cystic fibrosis.

• Urine sample for infection/Group B strep detection
• During flu season, a flu vaccine is recommended

In addition, a nurse will spend about an hour during this visit providing education on:

• Any activity restrictions
• Importance of nutrition and vitamins
• Safe medications in pregnancy
• Exercise and fitness

“It’s a big visit,” Salky said. “A lot of information is covered, as we want to lay the groundwork for the next several months. If there are any abnormal results from the tests, we review all the options, have resources for genetic counseling and will help parents obtain more extensive diagnostic testing if warranted.”

An amniocentesis is no longer routinely done for mothers older than age 35; rather, it’s only done when further testing is necessary if genetic testing indicates fetal abnormalities.

“When it comes to genetic testing, if you don’t want to do it, that’s fine,” said Salky. “Some parents find it helpful to know of any health concerns for baby ahead of time in case additional planning, preparations or joining support groups might be helpful.”

At subsequent visits, patients can expect to be asked how they are doing overall and if they have any needs or are experiencing common discomforts; have their belly measured to assess fundal height and their blood pressure checked; listen to the baby’s heartbeat; and receive an overview of what to expect at the next visit.

14 weeks

Blood work will be drawn to screen for neural tube defects such as spina bifida.

18 weeks

“This is a good time for us to check in to see how the parents are feeling now that they’re in the second trimester,” said Salky.

20-22 weeks

An anatomical ultrasound will be done that includes numerous measurements of the placenta, baby and baby’s organs, including heart, lungs, kidneys and brain. Patients age 35 and older will have another ultrasound at 32 weeks.

24 -28 weeks

A glucose tolerance test, which involves fasting and then drinking a sugary solution, will be completed to check for gestational diabetes, and blood work will be done to check for anemia and syphilis.

27 – 28 weeks

A Tdap vaccine is recommended to protect mother and baby from tetanus, diphtheria and pertussis, or whooping cough. Also, if the mother is Rh-negative, she would receive an injection of anti-D immunoglobulin at certain points in the pregnancy to help to protect the baby.

After this stage in the pregnancy, patients are seen every two weeks through week 36 of pregnancy.

“During this time, and up through week 36 of a pregnancy, it’s good for parents to begin planning before life gets hectic,” said Salky. “We discuss a lot of different things with them –looking into birthing classes, finding a pediatrician, obtaining a breast pump, thinking about what type of pain management they want during labor, deciding about contraception options for after the baby is born and more.”

From 36 weeks until birth

Another screening for group B strep bacteria will occur. If positive, mom will be given antibiotics during labor).

At 39 weeks, parents are offered the choice of having their labor induced. Anyone not having delivered by 41 weeks will come in twice weekly for evaluation of the fetal heart rate with a modality called non-stress testing, and they will have an ultrasound to check amniotic fluid levels.

“We would recommend induction of labor by 42 weeks to decrease risk of stillbirth,” she said. Following delivery, two post-partum visits are done at two weeks and six weeks after the baby is born.

Salky emphasized that these are the recommended tests, but she hopes parents are empowered to ask questions and make sure they have the answers they need.

“Don’t be afraid to truly understand what we’re doing and why,” she said. “We want the best for you and your family. We are so excited and honored to be part of your journey and love partnering with you to ensure you feel heard and are well taken care of.”

Mary Gay Broderick writes for UCHealth. She can be reached at marygaybroderick@comcast.net.