Week 6: First Prenatal Appointment

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This is your Pea in the Podcast for week six of your pregnancy. I'm Bonnie Petrie, joined by Dr. Laurie Swaim, an obstetrician with Houston Women's Care Associates, in Houston, Texas.

Well now that your baby's heart is beating, it's time to see a doctor. "A lot of my patients come in at week six, they're all excited and maybe we can show them something on the ultrasound and answer questions. We have sort of a long visit, actually in my office my nurse practitioner usually sees the patients at their first visit unless they have any real big medical issues. She talks to them about things you can eat, things you can't eat, exercise, sometimes we talk a little bit about weight gain although that's sort of an on-going discussion, so the pregnancy earlier on we talk about their vitamins, we talk about changes in their body, we talk about common questions that they have. It's funny because some women come in and they're like 'I want to talk about delivery' and I'm like 'let's talk about that a little later on'."

So at this appointment you'll be answering a lot of questions but Dr. Swaim says a lot of you will be asking one too. "'When should I tell my family' is a very common one question and my answer to them is if you have a fetus with a heartbeat then the risk of a miscarriage is less than 10%. I think what people are asking me is 'Can you promise I'm not going to miscarry?' Now of course we can't do that but the risk is much lower when we see a heart beat."

Now of course there are some advantages to sharing the news early on, first of all, well, it's fun to share your excitement and some people find they just can't wait and it's great to have people to talk to about all of the decisions ahead. You can also get recommendations about those who will participate in your prenatal care. For example, if you're going to use a doula you can ask your friends if they used a doula and if so if they liked them and then get their number. Also if something does go wrong with your pregnancy you have a lot of loving support available. The disadvantages of telling, really, well you start getting that advice and unsolicited input right away and it doesn't stop until your kid's in college, even then it probably doesn't stop, it can get overwhelming. Also if you tell early and you miscarry of course you have to face having to tell everyone that unhappy news. If you wait to tell you have time for it to be something special, just between you and your partner, a really special moment. You get time to digest the news as well and make decisions about your baby without everyone else in the world's advice and if you miscarry you won't have to face telling people who celebrated your joy about your heartbreaking loss. Now this can also be a disadvantage because if no one knows you're pregnant, you'll have no one to support you through your loss. Some people tell their loved ones immediately and then wait to tell their larger circle of friends and colleagues. That's what we did; we told our immediate families right away and waited several weeks to tell friends and colleagues that a baby was coming.

Now the period right around this week is a critical time in the development of your now peppercorn sized progeny. Now believe it or not, this is when exposure to drugs, chemicals, alcohol and infections are the most dangerous for your developing baby because the building blocks of its being are falling into place right now. "Obviously the heart is already starting to be formed so that's important. And neural development is exceedingly important and it's important early enough where you have to take foliate for six weeks prior to getting pregnant and the first six weeks of pregnancy because brain development and spinal development and what have you. All these little organs are just starting to be formed. And I think the fetus produces thyroid hormones at a very early age, not this early, but the point is that things are really starting to gear up."

Now the head and the tail become easily recognizable and the baby folds into that telltale 'C'. Important portions of the eyes form and basic facial features are starting to appear. The earliest forms of the liver, pancreas and lungs appear this week, the cerebral brain hemispheres are growing, the primary intestinal loop is there along with the digestive and respiratory system. Dr. Swaim says your body is doing a lot to compensate for its quickly developing passenger, "There are a lot of systemic changes that occur in the first trimester that will begin to occur early. For example, there's a marked increase in blood volume in a woman, it's eventually 40% more than what she started with. There are changes in the pulmonary mechanics, the way women breathe, basically the amount of volume in the lungs sort of changes because now you're essentially breathing for two. The cardiac output, the amount of work the heart does every minute, starts to increase. You can imagine everything has to be what we call 'hyperdynamic' and it's going to be on its toes, basically, to supply nutrients and what have you for the developing baby."

Now if you didn't feel pregnant last week, this week you may be saying to yourself, "Hmmmm I feel a little different than I usually do. A little less peppy, breast tenderness is fairly common, maybe a little breast enlargement, urinary frequency, maybe constipation." So you're peeing a lot and you're constipated, great. Some moms-to-be also get terrible heartburn. Dr. Swain says if you do get a bad case of reflux early it could be a sign that you have reflux when you're not pregnant. Now she says if your doc prescribes a reflux med, don't stress out, it's safe. "Sometimes we will suggest medicines for women and they'll say 'well it's not that bad, I'll live with it'. There's really no point to living with it, most of the medications used to treat reflux are perfectly safe in pregnancy and reflux can be dangerous after a time. If acid keeps going up into the esophagus over and over and over it kind of erodes the esophagus, and so I think that if it's recommended to you it's not just recommended so you feel better, martyrdom is not necessarily a good idea in pregnancy either."

Now you may just be starting to feel queasy or you may be one of the lucky ones who avoids morning sickness, or all day sickness, altogether but if you're feeling a little off, just remember stress can make morning sickness worse. So be kind to yourself, get enough sleep, your body is demanding it anyways, isn't it? You probably haven't seen Letterman in a week or more, so give in and rest. Also, it wouldn't hurt to look around for a prenatal yoga class, make sure it's okay with your doctor but most docs agree the best thing you can do for your developing baby is have an active pregnancy. Why not start now when Junior isn't taking up too much space yet. You are six weeks pregnant; there are only 34 weeks to go until the big week, week 40.

So that's it, your Pea in the Podcast for week six of your pregnancy. Dr. Swaim and I look forward to talking to you again next week. Enjoy this week and we'll talk to you then. I'm Bonnie Petrie, thanks for listening.