Chapter 5 - The First Month Approximately 1 to 4 Weeks Congratulations-and welcome to your pregnancy! Though you almost certainly don''t look pregnant yet, chances are you''re already starting to feel it. Whether it''s just tender breasts and a little fatigue you''re experiencing, or every early pregnancy symptom in the book (and then some), your body is gearing up for the months of baby-making to come. As the weeks pass, you''ll notice changes in parts of your body you''d expect (like your belly), as well as places you wouldn''t expect (your feet and your eyes). You''ll also notice changes in the way you live-and look at-life. But try not to think (or read) too far ahead. For now, just sit back, relax, and enjoy the beginning of one of the most exciting and rewarding adventures of your life. What You Can Expect at Your First Prenatal Visit Your first prenatal visit will probably be the longest you''ll have during your pregnancy, and definitely will be the most comprehensive one. Not only will there be more tests, procedures (including several that will be performed only at this visit), and data gathering (in the form of a complete medical history), but there will be more time spent on questions (questions you have for the practitioner, questions he or she will have for you) and answers.

There will also be plenty of advice to take in-on everything from what you should be eating (and not eating) to what supplements you should be taking to whether (and how) you should be exercising. So be sure to come equipped with a list of the questions and concerns that have already come up, as well as with a pen and notebook (or What to Expect When You''re Expecting Pregnancy Organizer) to take notes with. One practitioner''s routine may vary slightly from another''s. In general, the examination will include: Confirmation of your pregnancy. Your practitioner will want to check the following: the pregnancy symptoms you are experiencing; the date of your last normal menstrual period to determine your estimated date of delivery (EDD) or due date (see page 8); your cervix and uterus for signs and approximate age of the pregnancy. A pregnancy test (urine and blood) will most likely be ordered. A complete history. To give you the best care possible, your practitioner will want to know a great deal about you.

Come prepared by checking records at home or calling your primary care doctor to refresh your memory on the following: your personal medical history (chronic illness, previous major illness or surgery, known allergies, including drug allergies); nutritional supplements (vitamins, minerals, herbal, and so on) or medications (over-the-counter, prescription) you are presently taking or have taken since conception; your family medical history (genetic disorders, chronic diseases, unusual pregnancy outcomes); your personal gynecological history (age at first menstrual period, usual length of menstrual cycle, duration and regularity of menstrual periods); your personal obstetrical history (past live births, miscarriages, abortions2), as well as the course of past pregnancies, labors, and deliveries. Your practitioner will also ask questions about your social history (such as your age and occupation) and about your lifestyle habits (how you eat, whether or not you exercise, drink, smoke, or take recreational drugs) and other factors in your personal life that might affect your pregnancy (information about the baby''s father, information on your ethnicity). A complete physical examination. This may include assessment of your general health through examination of heart, lungs, breasts, abdomen; measurement of your blood pressure to serve as a baseline reading for comparison at subsequent visits; notation of your height and your weight (prepregnancy and present); inspection of arms and legs for varicose veins and edema (swelling from excess fluid in tissues) to serve as a baseline for comparison at subsequent visits; examination of external genitalia and of your vagina and cervix (with a speculum in place, as when you get a Pap smear); examination of your pelvic organs bimanually (with one hand in the vagina and one on the abdomen) and also possibly through the rectum and vagina; assessment of the size and shape of the bony pelvis (through which your baby will eventually try to exit). A battery of tests. Some tests are routine for every pregnant woman; some are routine in some areas of the country or with some practitioners, and not others; some are performed only when circumstances warrant. The most common prenatal tests include: A blood test to determine blood type and Rh status (see page 29), hCG levels, and to check for anemia (see page 187) Urinalysis to screen for glucose (sugar), protein, white blood cells, blood, and bacteria Blood screens to determine antibody titer (levels) and immunity to such diseases as rubella Tests to disclose the presence of infections such as syphilis, gonorrhea, hepatitis B, chlamydia, and, very often, HIV Genetic tests for cystic fibrosis, sickle-cell anemia, Tay-Sachs, or other genetic disease, if appropriate (see page 45) A Pap smear for the detection of cervical cancer A blood sugar level test to check for any tendency toward diabetes in women with a family history of diabetes and those who have high blood pressure, have previously had an excessively large baby or one with birth defects, or who had gained excessive weight with an earlier pregnancy. (All women receive a glucose screening test for gestational diabetes at around 28 weeks; see page 266.

) An opportunity for discussion. Here''s the time to bring out that list of questions and concerns. What You May Be Feeling You may experience all of these symptoms at one time or another, or only one or two. What''s important to keep in mind from now on is that every woman and every pregnancy is different; few pregnancy symptoms are universal. Physically Absence of menstruation (though you may stain slightly when your period would have been expected or when the fertilized egg implants in the uterus, around seven to ten days after conception) Fatigue and sleepiness Frequent urination Nausea, with or without vomiting, and/or excessive salivation Heartburn, indigestion, flatulence, bloating Food aversions and cravings Breast changes (most pronounced in women who have breast changes prior to menstruation, and possibly somewhat less pronounced if you''ve had babies before): fullness, heaviness, tenderness, tingling; darkening of the areola (the pigmented area surrounding the nipple). Sweat glands in the areola become prominent, looking like large goose bumps; a network of bluish lines appears under the skin as blood supply to the breasts increases (though, in some women, these lines may not appear until later). Emotionally Instability comparable to premenstrual syndrome, which may include irritability, mood swings, irrationality, weepiness Misgivings, fear, joy, elation-any or all of these What You May Be Concerned About Breaking the News "When should we tell friends and family that we are expecting?" This is one question only you can answer. Some expectant parents can''t wait to tell everyone they know the good news (not to mention a fair number of strangers who happen to pass them in the street or sit next to them on the bus).

Others tell only selectively at first, starting with those nearest and dearest (close relatives and friends, perhaps), and waiting until the condition is obvious before making the pregnancy common knowledge. Still others decide they''d rather put off issuing announcements until the third month has passed, just in case of miscarriage (especially if there''s been a previous pregnancy loss). So talk it over, and do what feels most comfortable. Just remember: in spreading the good news, don''t forget to take the time to savor it as a twosome. Telling the Boss "No one at work knows I''m pregnant yet-and I''m not sure when and how I should tell them, especially my boss. I''m not sure how they''ll react." Since most expectant mothers are also members of the workforce, pregnancy protocol on the job has become an important issue for employees and employers alike. Official leave policies and benefits vary widely from company to company, as do unofficial policies of family-friendliness.

In deciding when and how to broach the subject of your pregnancy with the powers that be at your company, you''ll need to consider the following: How you''re feeling and whether you''re showing. If morning sickness has you spending more time hovering over the toilet than sitting at your desk; if first trimester fatigue has you barely able to lift your head off your pillow in the morning; or if you''re already packing a paunch that''s too big to blame on your breakfast, you probably won''t be able to keep your secret long. In that case, telling sooner makes more sense than waiting until your boss (and everyone else in the office) has come to his or her own conclusions. If, on the other hand, you''re feeling fine and still buttoning your waistband with ease, you may be able to hold off on the announcement until later. What kind of work you do. If you work under conditions or with substances that could be harmful to your pregnancy or your baby (see page 76), you''ll need to make your announcement-and ask for a transfer or change of duties-as soon as you find out you''re pregnant. How work is going. A woman announcing her pregnancy at work may unfortunately-and unfairly-raise many red flags, including "Will she still have th.