Since I’ve officially made it through the first trimester of pregnancy (this is my second child), I thought it would be a good time to talk about why there is no good reason that the typical healthy woman who is having no unusual symptoms must go to a doctor or midwife in the first trimester (unless she wants to).
I’m not a medical professional. Please do your own research and consult your practitioner on what is best for you. To be clear, I’m not telling you what to do, just giving another perspective. Please only do what you feel comfortable with. I’m not going to judge you either way. Please read the full post before commenting.
Why You Don’t Have to Have a First-Trimester Prenatal Appointment
Just like a lot of women, I was surprised that my midwives didn’t want to see me before 12 weeks. I thought that you basically rushed off to the doctors the minute you found out you were pregnant.
I think this view has become common because of the medicalization of pregnancy in the US. We treat pregnancy like an illness that needs to be managed instead of a natural biological process that our bodies usually know how to do on their own. Yes, there are times when women (including myself) need some medical help in pregnancy and thank goodness for its availability, but typically birth happens without all of that.
Not only that, but many interventions are potentially harmful to you or baby and should only be used when necessary and not routinely. Of course, if you are having unusual symptoms or not sure if your symptoms are unusual, (or if you just want to!) give your practitioner a call!
Bottom line: A woman who has no underlying health issues and is otherwise healthy (especially if she has had a previous pregnancy that was normal and healthy) may not need to go to a first-trimester prenatal appointment.
Should you call your doctor or midwife? Sure! Starting a connection with a midwife or doctor is a good idea so you can have someone to call for any reason or so you can have a phone consult if needed. I’m specifically talking about the standard first-trimester prenatal in-person appointment. I am NOT advising anyone not to call their doctor or midwife.
Why I WOULD Go to a First Trimester Appointment
There are a few reasons that I would go to an early first-trimester appointment.
If I could refuse any intervention I didn’t want (I can, legally), and my doctor or midwife would offer a thyroid test and a blood sugar test, I would consider having this appointment.
There is currently a debate among experts as to whether thyroid testing should be standard in early pregnancy Because of how a thyroid problem in pregnancy impacts the child later in life. From my research and my experience (having a diagnosis midway through my second pregnancy), I would ask for this test early in my first pregnancy.
Also, because I have a known thyroid condition I would need to see my PCP for an adjustment of my med in early pregnancy. This is not a penatal appointment!
Blood Sugar Test
New research suggests that an early first-trimester blood sugar test can catch gestational diabetes (GD) early which allows for more time to adjust diet for a healthier pregnancy.
At the time of this writing, these tests are not part of a standard first-trimester prenatal appointment. So while I would have a first-trimester appoint for these tests, many doctors won’t offer them, and may not even do them if you ask.
With this being said, the following is why a first-trimester prenatal appointment is not as important as you may think.
1. Home Pregnancy Tests are Just as Good as Doctors’ Urine Tests
There is no need to go to a doctor or midwife to confirm a pregnancy. Unless you are near menopause (which increases HCG levels and can cause a false positive) a positive test means you are pregnant.
A negative test means you are either not pregnant or have tested too early. Yes, you could go to the doctor and have a blood test, which is more sensitive and might provide a positive result, but I don’t recommend it.
The reason is that yes, a positive result means you’re pregnant BUT it doesn’t mean you will stay that way.
Early miscarriage is common and we have no way of knowing how common it is to miscarry before getting a positive HPT or missing a period. Many women would probably just think they didn’t conceive.
It’s enough of a loss to get your period when you are trying to conceive that I don’t see any benefit to knowing about a pregnancy before a urine test can confirm it and then face the huge chance of losing it.
Therefore, it makes sense to wait and test at home.
2. There’s Not Much to See or Hear
You typically can’t hear a heartbeat with a doppler until 12 weeks. In fact, you can barely feel the uterus at 12 weeks because it’s still way down in the pelvis. That means your doctor or midwife may not even bother measuring you at your 12-week appointment.
There will definitely not be anything to measure before that. Any appointment before 12 weeks will likely just be chatting and getting to know your practitioner which can be great but isn’t medically necessary (and can be done over the phone if needed).
3. Routine Ultrasounds are Unnecessary (and Potentially Harmful)
It is increasingly common for women to get routine ultrasounds in the first trimester, starting as early as 6 weeks. For a normal healthy woman (and I would argue for many others as well) there is no benefit to routine ultrasounds.
The American College of Obstetricians and Gynecologists discourage the use of ultrasound diagnostic without cause, arguing that, though there isn’t a proven connection between ultrasound use and ill effects on the mother or fetus at this time, there is a real possibility that it could be discovered in the future.
One study published in the New England Journal of Medicine concluded that the use of ultrasound scans did not improve fetal outcome. Even when the ultrasound discovered abnormalities the fetal survival rate was the same for the group who was given ultrasound scans and the group who was not.
Some doctors might argue that an ultrasound can accurately predict an estimated due date (EDD). Still, judging by last menstrual period is just as accurate (I like this online due date calculator for the most accurate dating).
Many readers have mentioned ectopic pregnancy and missed miscarriage. These are valid concerns as an ectopic pregnancy, though rare, can be very dangerous and a missed miscarriage carries the potential for infection (not to mention the emotional turmoil).
If I were someone with a history of ectopic pregnancies or was high risk for them (being a smoker or having pelvic inflammatory disease or endometriosis) I may want to have an early ultrasound to rule out ectopic pregnancy. I can also understand someone with this history wanting one to ease their mind after a previous ectopic pregnancy. Stress is terrible for a healthy pregnancy.
We all have to weigh the benefits and risks of our choices. I personally believe that for me the risks of early ultrasounds etc. are greater than the risk of a symptom-less ectopic pregnancy or missed miscarriage.
4. Routine Pelvic Exams are Unnecessary (and Potentially Harmful)
Unless there is a reason, symptoms of an infection, for example, pelvic exams are unnecessary and potentially harmful.
While researching for this post I had a really hard time finding what exactly these first trimester pelvic exams were looking for. To me, that seems like a red flag in and of itself.
Here is what I found the first-trimester exam is supposed to do:
Confirmation of pregnancy – I really don’t understand this one. How is a urine test not enough confirmation? Not to mention the lack of menstruation, constant peeing, sore breasts, etc. I’d really love to hear from some medical professionals on this one.
STD screening – If you’re in an exclusive relationship and have been tested in the past then you really don’t need to be tested again. Even if you are concerned about STDs, Chlamydia and Gonorrhea can now be tested for with urine. The point is: This shouldn’t be a routine procedure but should be utilized on a case by case basis.
Pap smear – If you’ve had a pap smear recently then you don’t need one in pregnancy. In fact, many practitioners won’t do one until after the birth. This is partly because any abnormalities wouldn’t be addressed until after the birth anyway.
Furthermore, though the doctor’s instruments are sterile, the vagina is not. An exam could push bacteria from the opening of the vagina back to the cervix, which then could cause infection. An Exam can also cause pain and bleeding. It’s one thing to agree to a procedure that is harmless just in case. A pelvic exam, though, is potentially harmful so shouldn’t be routine.
If the practitioner can’t gather any useful information why do some still bother seeing women in the first trimester?
We have to remember that the standard of care is put in place for the general public. That includes people who are uneducated/uninformed, addicted to drugs, don’t get healthcare regularly, and have unprotected sex with multiple partners. That doesn’t mean if you had this appointment you are any of these things! It simply means that the standards are set to address the needs of these people. Those standards happen to be unnecessary at best and harmful at worst for women who don’t fall into these categories.
Taking this into account it makes sense that an OB would want to see a pregnant woman in the first trimester to talk about nutrition and other health concerns such as drug use.
It also makes sense that they would want to check for STDs. Many STDs have no symptoms but can be very serious for your baby.
We also need to remember that a hospital is a business. I’m not saying that they are just out to get your insurance payments. I believe that most doctors and nurses truly care about giving the best medical attention they can.
I’m just saying that hospitals aren’t going to question whether those extra appointments are necessary. They’re getting paid for them and you are consenting to them and no harm is being done (depending on who you ask). So, they have no reason to question whether early appointments are necessary or not.
Many of the routine tests and procedures in obstetrics are not relevant to every woman or every pregnancy.
Becoming Informed and Confident
I have considered adding one more reason that you don’t have to go to the doctor in your first trimester. That would be – #5. Because you are in control of your body, life, and child! I think we sometimes forget this with doctors guilting, shaming, and otherwise emotionally manipulating us into doing what they want us to do. No, not every doctor! I believe many are great. But this has happened to me and has happened to many other women.
Does that mean I think women should put themselves or their babies in danger to assert their autonomy? No, of course not!
I’m not actually advising you not to have a prenatal appointment in the first trimester. Please read this sentence again before commenting please: I’m not advising you to skip a prenatal appointment in the first trimester.
If it makes you feel better to go and you can decline any procedure that is not harmless, then great. If you think the above interventions are good and necessary, do as you want.
Definitely make any necessary appointment if you have a thyroid issue or other underlying health problems. Call your midwife or doctor when you find out you are pregnant so they can get records transferred if necessary and know who you are in case you need an appointment for whatever reason.
I am simply offering information so that you don’t have to feel powerless in your pregnancy. If you have some information when you call to interview your doctor or midwife you are in a better position to choose someone who respects you and your wishes.
Ultimately we need to be our own advocates, do our own research, and choose a provider we trust. That way we can make informed decisions for ourselves and our families, right?
If you’re hoping to have a healthy pregnancy and birth based on evidence-based maternity care then I recommend a few resources:
Ina May Gaskin is amazing. I wanted to have a natural birth but was scared but reading Ina May’s Guide to Childbirth was a turning point for me. She gave me the confidence to attempt a natural birth. She also gave me the knowledge to explain to friends and family why I believed it was best for me. Other excellent natural birth books are Hypnobirthing, Birthing From Within, and The Birth Partner which is great for getting spouses on board with a natural birth.
A Natural Birth Class
Check out this natural birth class online. You’ll learn how to achieve the natural birth experience you desire. This class is run by my good friends and is an amazing resource for new moms, seasoned moms, VBAC moms, and anyone else hoping to achieve a natural childbirth.
A Midwife and/or Doula
Midwives follow an evidence-based model of care and are your best chance at a natural birth if you want one. If a midwife isn’t an option for you, a Doula is the next best thing. A Doula will stay by your side through your labor and delivery and can be your voice in a hospital birth setting.
What Do You Think?
Did you have a first-trimester prenatal appointment? Do you think they are important or not?