Importance of Prenatal Appointments in the First Trimester
by Nancy Sullivan, CNM, MS, FACNM

Q. My husband and I just moved to a new state for his job, which (being a teacher) doesn't begin until late August. I just found out that I am five weeks pregnant with our first, but the HMO won't allow us to sign on to their health insurance until his job officially begins. They won't even let us make an appointment to see one of their doctors if we pay for it ourselves. How bad of a situation is this? My instinct is to not stress about it and just make an appointment as soon as possible in August or September, and hope in the meantime that everything goes well. Does that sound safe to you?

A. A first-trimester visit is important for the following reasons:

1. to screen for any serious health problems, such as diabetes or hypertension, that could have an adverse effect on the pregnancy

2. to establish baselines for weight and blood pressure

3. to establish gestational age (number of weeks pregnant) since this becomes more difficult later in the pregnancy, and

4. to counsel on pregnancy-related topics such as stopping alcohol, recreational drugs and tobacco as well as any medications that might have an adverse effect on the baby, and to advise the mother to take a prenatal supplement with adequate folic acid and iron, and to eat a healthy diet.

However, you can take care of many of these things on your own - and report to your midwife or doctor when you do see that person that you have already been following a healthy lifestyle. Certainly, if you are a healthy young person with a good diet (lots of fresh fruits and vegetables, protein, and minimum sugar and fat) and no medical problems, knowing when you had your last menstrual period or when you conceived, you will be fine waiting until you can get an appointment. But I agree with you - the system should do everything it can to make sure moms are seen early in pregnancy, rather than putting barriers in your way. Good luck!