Frequently Asked Questions: Pregnancy

Congratulations! Whether you’re a first-time mom or a seasoned parent, learning that you’re pregnant can fill you with many emotions and questions about the year. Natalia S. Richey, CNM, MSN, interim chief of the Obstetrics & Gynecology Midwifery Service at Massachusetts General Hospital answers some of the most frequently asked questions we hear from expectant parents.

Q: What should I consider when selecting a prenatal provider and hospital?

A: There are several important things to consider when selecting a prenatal provider and hospital.

Review your health insurance to see what is and isn’t covered—it’s ideal to find providers/hospitals that are in your network

Consider your personal health history. If you have pre-existing medical issues, you might consider an obstetrician (OB) or a maternal-fetal medicine specialist (MFM) for higher-risk pregnancies. If you are healthy and interested in a lower-intervention approach, you might consider a midwife who can independently conduct all your prenatal visits and attend your labor and delivery. If you’re unsure about your level of risk, you can always consult with a midwife or obstetrician to help guide you

Select a practice where you can conveniently attend your prenatal care appointments, because there are usually between 10-15 for a full-term pregnancy. Many hospitals, including Mass General, have numerous satellite clinics across the region that offer prenatal visits with midwives and obstetricians. These community locations, including Danvers and Waltham, are often less busy, which allows for more time with your provider, and are easy to drive to and park at.

Q: What is a midwife?

A: At Mass General, you have the choice of having either an obstetrician (OB) or nurse-midwife as your pregnancy healthcare provider. All the midwives in our Midwifery Service are certified by the American College of Nurse-Midwives and provide prenatal, labor and delivery, and postpartum care to pregnant patients having an uncomplicated pregnancy and delivery. They are trained to recognize abnormalities at every stage of pregnancy, labor, delivery and postpartum. Midwives write prescriptions for medications and prescribe and administer analgesic medication and local anesthetics. Our midwives practice in collaboration with our obstetricians. In the event of medical or obstetrical complications, the midwives consult, collaborate and refer to the appropriate physician specialists.

Learn more about midwifery care

Q: What if I select a midwife for my prenatal care but then my pregnancy becomes complex or complicated?

A: Most midwives manage low to moderate-risk pregnancies and can also co-manage a pregnancy that has become more complex with the help of an OB or MFM. However, this decision should be made on a case-by-case basis as every pregnancy is unique and therefore the care team that is best fit for each pregnant person should be decided carefully.

Q: When should I see someone if I think I’m pregnant?

A: If you think you’re pregnant, we encourage you to call your selected OB or midwifery practice to establish care. You should make note of the date of your last menstrual period (if you know it) as you will be asked for this information to help date your pregnancy/evaluate if an early ultrasound is needed

Typically, most first prenatal visits occur anywhere between 8-10 weeks of pregnancy, depending on your level of risk, health history, and knowledge of your last period.

Q: What are the milestones appointments I should be aware of during my prenatal care?

A: While every pregnant person and pregnancy is unique, the below list could serve as a guide for milestone appointments for an uncomplicated pregnancy. As always, your care team is your best source for the specifics about your pregnancy care.

8-12 weeks: First prenatal appointment. The fetal heartbeat can often be heard, and lab work is routinely sent to screen for immunities, blood type, and genetic screening if desired

12-14 weeks: Genetic testing with ultrasound is offered

18-20 weeks: Full fetal anatomy scan (ultrasound) is performed

24-28 weeks: Bloodwork is collected to test for gestational diabetes and anemia is checked

35-37 weeks: A swab is collected to check for group beta strep (GBS)

37-40 weeks: Your pregnancy is considered full-term, and your baby can safely be born

41 weeks: The pregnancy is considered post-term. Typically, an induction of labor is recommended but your care team will discuss your options with you

Learn more about other prenatal tests

Q: How frequent are my appointments?

A: The following is a general schedule for an uncomplicated pregnancy:

From the beginning of your pregnancy through 28 weeks you will have a monthly appointment

From 28-36 weeks, you will have an appointment every 2-3 weeks

From 36 weeks until delivery, you will have a weekly appointment

You may schedule more than one appointment at Massachusetts General Hospital at a time. Routine prenatal visits, in which you may ask all your questions and have your blood pressure, weight, urine and status of your baby checked, are usually 15 minutes long. If we anticipate a longer visit for prenatal diagnostic testing, we will let you know in advance so you can plan accordingly. We make every effort to keep appointments running on time. If you are going to be late, please call the office to arrange an alternate time. Unexpected emergencies do arise that we need to address immediately, which may cause delays in the schedule. Please bear with us.

Q: What should I contact my care team about if I’m concerned? What should I watch for throughout my pregnancy?

A: Pregnancy is a normal, physiologic process that comes with many physical and emotional changes over the course of 40 weeks. Some discomforts and pains can be normal, but any time you are experiencing new or concerning symptoms, you should contact your OB or midwife. Throughout your pregnancy, your OB or midwife will review what types of things to look out for during each trimester, but in general:

1^st trimester: vaginal bleeding, painful cramping, fainting, persistent nausea/vomiting

2^nd trimester: vaginal bleeding, painful cramping, loss of fetal movement

3^rd trimester: vaginal bleeding, leaking of fluid, persistent and painful contractions, decreased fetal movement, new headaches, visual changes, itching on hands or palms of feet

Q: Can I exercise?

A: Before beginning any exercise program, talk with your health care provider to make sure you do not have any obstetric or health conditions that would limit your activity. Ask about any specific exercise or sports that interest you. Your OB or midwife can offer advice about what type of exercise routine is best for you.

The extra weight you are carrying will make your body work harder than before you were pregnant. Exercise increases the flow of oxygen and blood to the muscles being worked and away from other parts of your body. Therefore, it is important to not overdo it. Try to exercise moderately so you don’t get tired quickly. If you can talk normally while exercising, your heart rate is at an acceptable level.

Q: Can I garden?

A: Yes, as long as you feel comfortable doing it. You should wear gloves and wash your hands thoroughly after working with the soil.

For more information about preventing infections during pregnancy, visit the Centers for Disease Control and Prevention

Q: Can I paint?

A: Paint fumes are usually non-toxic if the area is well-ventilated. Water-based latex paints are acceptable. If you have a question about the type of paint you are using, ask the manufacturer or call us.

Q: What about my hair care?

A: You may perm and color your hair during pregnancy as there is no danger to your baby.

Q: What if I need dental work?

A: It is not necessary to delay your dental work until after your pregnancy. If your dentist needs to take x-rays, just be sure to properly shield your abdomen. Local anesthetics are permitted. If your dentist has any questions, please ask them to call us.

Q: Am I allowed to travel?

A: Travel poses no specific risks during pregnancy, but you should take some minor precautions. Use your seat belt throughout your pregnancy. During long trips, take time out to stand and move about. Consider access to obstetrical care. Although travel does not cause premature labor, there is the possibility that you may deliver far from home. Most airlines have restrictions in the last month of pregnancy, so check with the carrier. Finally, it is important that you drink lots of fluids.

Q: What is a high-risk pregnancy?

A: Women or pregnant patients who begin their pregnancy with existing medical problems such as diabetes, hypertension, heart problems or known fetal abnormalities require the care of a high-risk obstetrician. Usually, these patients will have their medical information communicated to us by their referring primary care physician or obstetrician prior to their first visit. There are also non-medical situations, such as substance use, spousal abuse or psychosocial problems, which may also make a pregnancy high risk. Having a baby when you are older (35 years+) does not automatically make you a high-risk patient if you are otherwise in good health.

Q: What is a genetic counselor?

A: Genetic counselors are healthcare professionals certified by the American Board of Medical Genetics or the American Board of Genetic Counseling. They work with your obstetrical team to provide in-depth genetic information and counseling to expectant parents who may have questions or concerns based on their individual history, such as: diseases that run in families or specific ethnic groups; couples who have had a child with a birth defect; couples with a history of stillbirth or more than one miscarriage; pregnant patients older than 35. Genetic counselors may also discuss the effects of medications, drugs and alcohol on pregnancy as well as the effects of maternal medical conditions such as diabetes, seizures, high blood pressure and radiation therapy.

Q: Will I need genetic testing?

A: Prenatal diagnostic testing is always your choice. Your obstetrician or nurse-midwife will assist you with deciding which, if any, testing is most appropriate for you. Learn more about the Ultrasound Prenatal Diagnostics Program.

Please note: If you have questions about exposures to medications, drugs, chemicals, x-rays, infections and possible risks during pregnancy, you may call the Genesis Fund Pregnancy Exposure InfoLine at 800-322-5014 or 781-466-8474. Sponsored by the Genesis Fund, the hotline is open Monday through Friday from 9:00 am to 4:30 pm. All calls are confidential and free of charge. You can also visit www.thepeil.org for additional information.

Q: I’ve heard traumatic birth stories and I’m worried about things happening to me vs. with me as a decision-maker during labor and delivery. What advice can you offer?

A: While birth is the incredible culmination of many weeks of pregnancy, it can often come with surprising and sometimes unexpected twists and turns. At the end of the day, it is a process that is often spontaneous and somewhat out of one’s control. Our OB and midwifery service is staffed with providers who collectively have decades of experience and have delivered thousands of babies safely into the world. You can rest assured that during your labor/birth process, we will include you in all our discussions and provide a rationale for our recommendations at every step of the way.

It is important to remember that we are on your side in the sense that what we want is a healthy birthing person and baby and we will do everything we can to help ensure that this happens. Sometimes this means that the anticipated plan (such as a spontaneous vaginal delivery) might require intervention or change.

Q: Should I make a birth plan? What should I include?

A: Birth plans can be tricky—birth is an often spontaneous process that can’t be predicted. I often discourage people from creating super detailed birth plans, because likely something is bound to not follow the pre-determined written plan because of how unpredictable the process of labor and childbirth is. I do think it can be valuable to think about what kinds of things might be important to you in terms of pain management and labor support because some level of pain is a very predictable aspect of labor and birth. It is sometimes common for people to include things like delayed cord clamping, skin-to-skin, etc. though at Mass General we tend to automatically do these things.

Q: I don’t live in Boston, and I’m worried about driving to Mass General when I’m in labor. Will I get there in time?

A: In all likelihood, yes! The most important thing is to communicate with your OB or midwife whenever your labor symptoms start or if you think your water broke. A huge part of our job is helping guide patients in early labor over the phone, so never hesitate to call to discuss what you’re feeling. If this is your fist baby, you can anticipate labor to take anywhere from 6-36 hours, so there is generally plenty of time to get to the hospital. If this is your second baby or if you have a history of fast labors, feel free to discuss this with your care team at the end of your pregnancy to make a plan about when to call and come to the hospital.

Q: When should I come into the hospital if I think I’m in labor?

A: Generally, if this is your first baby, you should wait until contractions are coming regularly every 2-3 minutes and you are having a hard time talking through contractions. If this is your second baby and beyond, you should come in once your contractions are every 5-6 minutes OR whenever you feel that labor is happening/baby is coming (remember you have experience!). The most important thing is to call us when your labor symptoms start or if you think your water broke so that we can discuss what you’re feeling and make a plan for when you should arrive at the hospital.

Q: Will I have my own obstetrician or midwife delivering my baby when the time comes?

A: After spending the vast majority of your pregnancy caring for you, your health care provider would like nothing more than having the privilege of delivering your baby. However, this is not always possible as we do not control the timing of when you go into labor or deliver. Babies are born 24 hours a day, 7 days a week and this means the labor unit never closes, making it necessary for obstetricians and midwives to rotate coverage. As the labor unit is always staffed by both an obstetrician and a midwife, we try to respect your choice of provider type. Although we suggest you remain with your chosen provider for all of your prenatal visits, you may schedule some of your visits with other providers. As Mass General is a teaching hospital, obstetrical residents may possibly be involved with part or your care.