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Prenatal care: 1st trimester visits

Pregnancy and prenatal care go hand in hand. During the first trimester, prenatal care includes blood tests, a physical exam, conversations about lifestyle and more.

Prenatal care is an important part of a healthy pregnancy. Whether you choose a family physician, obstetrician, midwife or group prenatal care, here's what to expect during the first few prenatal appointments.

The 1st visit

When you find out you're pregnant, make your first prenatal appointment. Set aside time for the first visit to go over your medical history and talk about any risk factors for pregnancy problems that you may have.

Medical history

Your health care provider might ask about:

• Your menstrual cycle, gynecological history and any past pregnancies
• Your personal and family medical history
• Exposure to anything that could be toxic
• Medications you take, including prescription and over-the-counter medications, vitamins or supplements
• Your lifestyle, including your use of tobacco, alcohol, caffeine and recreational drugs
• Travel to areas where malaria, tuberculosis, Zika virus, mpox — also called monkeypox — or other infectious diseases are common

Share information about sensitive issues, such as domestic abuse or past drug use, too. This will help your health care provider take the best care of you — and your baby.

Your due date is not a prediction of when you will have your baby. It's simply the date that you will be 40 weeks pregnant. Few people give birth on their due dates. Still, establishing your due date — or estimated date of delivery — is important. It allows your health care provider to monitor your baby's growth and the progress of your pregnancy. Your due date also helps with scheduling tests and procedures, so they are done at the right time.

To estimate your due date, your health care provider will use the date your last period started, add seven days and count back three months. The due date will be about 40 weeks from the first day of your last period. Your health care provider can use a fetal ultrasound to help confirm the date. Typically, if the due date calculated with your last period and the due date calculated with an early ultrasound differ by more than seven days, the ultrasound is used to set the due date.

Physical exam

To find out how much weight you need to gain for a healthy pregnancy, your health care provider will measure your weight and height and calculate your body mass index.

Your health care provider might do a physical exam, including a breast exam and a pelvic exam. You might need a Pap test, depending on how long it's been since your last Pap test. Depending on your situation, you may need exams of your heart, lungs and thyroid.

At your first prenatal visit, blood tests might be done to:

• Check your blood type. This includes your Rh status. Rh factor is an inherited trait that refers to a protein found on the surface of red blood cells. Your pregnancy might need special care if you're Rh negative and your baby's father is Rh positive.
• Measure your hemoglobin. Hemoglobin is an iron-rich protein found in red blood cells that allows the cells to carry oxygen from your lungs to other parts of your body. Hemoglobin also carries carbon dioxide from other parts of your body to your lungs so that it can be exhaled. Low hemoglobin or a low level of red blood cells is a sign of anemia. Anemia can make you feel very tired, and it may affect your pregnancy.
• Check immunity to certain infections. This typically includes rubella and chickenpox (varicella) — unless proof of vaccination or natural immunity is documented in your medical history.
• Detect exposure to other infections. Your health care provider will suggest blood tests to detect infections such as hepatitis B, syphilis, gonorrhea, chlamydia and HIV , the virus that causes AIDS . A urine sample might also be tested for signs of a bladder or urinary tract infection.

Tests for fetal concerns

Prenatal tests can provide valuable information about your baby's health. Your health care provider will typically offer a variety of prenatal genetic screening tests. They may include ultrasound or blood tests to check for certain fetal genetic problems, such as Down syndrome.

Lifestyle issues

Your health care provider might discuss the importance of nutrition and prenatal vitamins. Ask about exercise, sex, dental care, vaccinations and travel during pregnancy, as well as other lifestyle issues. You might also talk about your work environment and the use of medications during pregnancy. If you smoke, ask your health care provider for suggestions to help you quit.

Discomforts of pregnancy

You might notice changes in your body early in your pregnancy. Your breasts might be tender and swollen. Nausea with or without vomiting (morning sickness) is also common. Talk to your health care provider if your morning sickness is severe.

Other 1st trimester visits

Your next prenatal visits — often scheduled about every four weeks during the first trimester — might be shorter than the first. Near the end of the first trimester — by about 12 to 14 weeks of pregnancy — you might be able to hear your baby's heartbeat with a small device, called a Doppler, that bounces sound waves off your baby's heart. Your health care provider may offer a first trimester ultrasound, too.

Your prenatal appointments are an ideal time to discuss questions you have. During your first visit, find out how to reach your health care team between appointments in case concerns come up. Knowing help is available can offer peace of mind.

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• Lockwood CJ, et al. Prenatal care: Initial assessment. https://www.uptodate.com/contents/search. Accessed July 9, 2018.
• Prenatal care and tests. Office on Women's Health. https://www.womenshealth.gov/pregnancy/youre-pregnant-now-what/prenatal-care-and-tests. Accessed July 9, 2018.
• Cunningham FG, et al., eds. Prenatal care. In: Williams Obstetrics. 25th ed. New York, N.Y.: McGraw-Hill Education; 2018. https://www.accessmedicine.mhmedical.com. Accessed July 9, 2018.
• Lockwood CJ, et al. Prenatal care: Second and third trimesters. https://www.uptodate.com/contents/search. Accessed July 9, 2018.
• WHO recommendations on antenatal care for a positive pregnancy experience. World Health Organization. http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/anc-positive-pregnancy-experience/en/. Accessed July 9, 2018.
• Bastian LA, et al. Clinical manifestations and early diagnosis of pregnancy. https://www.uptodate.com/contents/search. Accessed July 9, 2018.

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Your First Prenatal Visit

If you did not meet with your health care provider before you were pregnant, your first prenatal visit will generally be around 8 weeks after your LMP (last menstrual period ). If this applies to you, you should schedule a prenatal visit as soon as you know you are pregnant!

Even if you are not a first-time mother, prenatal visits are still important since every pregnancy is different. This initial visit will probably be one of the longest. It will be helpful if you arrive prepared with vital dates and information. This is also a good opportunity to bring a list of questions that you and your partner have about your pregnancy, prenatal care, and birth options.

What to Expect at Your First Pregnancy Appointment

Your doctor will ask for your medical history, including:.

• Medical and/or psychosocial problems
• Blood pressure, height, and weight
• Breast and cervical exam
• Date of your last menstrual period (an accurate LMP is helpful when determining gestational age and due date)
• Birth control methods
• History of abortions and/or miscarriages
• Hospitalizations
• Medications you are taking
• Medication allergies
• Your family’s medical history

Your healthcare provider will also perform a physical exam which will include a pap smear , cervical cultures, and possibly an ultrasound if there is a question about how far along you are or if you are experiencing any bleeding or cramping .

Blood will be drawn and several laboratory tests will also be done, including:

• Hemoglobin/ hematocrit
• Rh Factor and blood type (if Rh negative, rescreen at 26-28 weeks)
• Rubella screen
• Varicella or history of chickenpox, rubella, and hepatitis vaccine
• Cystic Fibrosis screen
• Hepatitis B surface antigen
• Tay Sach’s screen
• Sickle Cell prep screen
• Hemoglobin levels
• Hematocrit levels
• Specific tests depending on the patient, such as testing for tuberculosis and Hepatitis C

Your healthcare provider will probably want to discuss:

• Recommendations concerning dental care , cats, raw meat, fish, and gardening
• Fevers and medications
• Environmental hazards
• Travel limitations
• Miscarriage precautions
• Prenatal vitamins , supplements, herbs
• Diet , exercise , nutrition , weight gain
• Physician/ midwife rotation in the office

Possible questions to ask your provider during your prenatal appointment:

• Is there a nurse line that I can call if I have questions?
• If I experience bleeding or cramping, do I call you or your nurse?
• What do you consider an emergency?
• Will I need to change my habits regarding sex, exercise, nutrition?
• When will my next prenatal visit be scheduled?
• What type of testing do you recommend and when are they to be done? (In case you want to do research the tests to decide if you want them or not.)

If you have not yet discussed labor and delivery issues with your doctor, this is a good time. This helps reduce the chance of surprises when labor arrives. Some questions to ask include:

• What are your thoughts about natural childbirth ?
• What situations would warrant a Cesarean ?
• What situations would warrant an episiotomy ?
• How long past my expected due date will I be allowed to go before intervening?
• What is your policy on labor induction?

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When to schedule a prenatal visit

Prenatal visitation schedule, how should i prepare for a prenatal visit, what happens during prenatal visits, how can i make the most of my pregnancy appointments.

Make an appointment for your first prenatal visit once you're aware you are pregnant – when you receive a positive home pregnancy test, for example. Booking it around week 8 of pregnancy is typical.

You'll come back regularly in the weeks and months following that initial appointment. Most people have between 8 and 14 prenatal visits throughout the course of their pregnancy.

During this time, you'll see a lot of your healthcare practitioner. That's why it's so important to choose someone you like and trust. If you're not comfortable or satisfied with your provider after your first visit or visits, don't be afraid to find someone with whom you have a better connection.

Typically, a pregnant woman will visit their doctor, midwife , or nurse practitioner every four weeks during the first and second trimesters. In the third trimester, you'll be seen more often – usually every other week until 36 weeks, and then every week until the baby is born.

For more information on what happens at these visits, see:

Your first prenatal visit

Second trimester prenatal visits (14 weeks to 27 weeks)

Third trimester prenatal visits (28 weeks through the end of pregnancy)

The specific number of scheduled appointments you'll have depends on if your pregnancy is considered to be high-risk. This is determined by your medical history and whether you have any complications or conditions that warrant more frequent checkups, such as gestational diabetes , high blood pressure , or a history of preterm labor . If you've had any medical problems in the past or develop any new problems during this pregnancy, you may need more prenatal visits than the average pregnant woman.

In the weeks before each visit, jot down any questions or concerns in a notebook or a notes app on your smartphone. This way, you'll remember to ask your practitioner about them at your next appointment. You may be surprised by how many questions you have, so don't miss the opportunity to get some answers in person.

For example, before you drink an herbal tea or take a supplement or an over-the-counter medication , ask your provider about it. You can even bring the item itself – or a picture of the label – with you to your next appointment. Then, your doctor, midwife, or nurse practitioner can read the label and let you know whether it's okay to ingest.

Of course, if you have any pressing questions or worries, or develop any new, unusual, or severe symptoms , don't wait for your appointment – call your practitioner right away.

In addition to your list, you may want to bring a partner, friend, family member, or labor coach with you to some or all of your prenatal visits. They can comfort you, take notes, ask questions, and help you remember important information.

The goal of prenatal visits is to see how your pregnancy is proceeding and to provide you with information to help keep you and your baby healthy. It's important that you go to all of your prenatal appointments, even if you're feeling just fine and believe that everything is progressing perfectly.

Your practitioner will start by asking how you're feeling physically and emotionally, whether you have any complaints or worries, and what questions you may have. They'll also ask you about your baby's movements once you begin to feel them, typically during the second trimester. Your practitioner will have other questions as well, which will vary depending on how far along you are and whether there are specific concerns.

Your midwife, doctor, or nurse practitioner will also:

• Check your weight , blood pressure , and urine
• Check for swelling
• Measure your abdomen
• Check the position of your baby
• Listen to your baby's heartbeat
• Perform other exams and order tests, as appropriate
• Give you the appropriate vaccinations
• Closely monitor any complications you have or that you develop, and intervene if necessary

Near the end of your pregnancy, your provider may also do a pelvic exam to check for cervical changes. You will also discuss your delivery plan in more depth.

At the end of each visit, your practitioner will review their findings with you. They'll also explain the normal changes to expect before your next visit, warning signs to watch for, and the pros and cons of optional tests you may want to consider. Lifestyle issues will likely be a topic of discussion, as well. Expect to talk about the importance of good nutrition , sleep, oral health, stress management, wearing seatbelts, and avoiding tobacco , alcohol , and illicit drugs.

Many people look forward to their prenatal appointments but are disappointed to find that, with the exception of the first visit, they're in and out of the office in 10 minutes. A quick visit is typical and is usually a sign that everything is progressing normally. Still, you want to make sure your concerns are addressed – and that you and your baby are being well cared for.

Here are some things you can do to ensure that your prenatal visits are satisfying:

• Speak up. Your practitioner isn't a mind reader and won't be able to tell what you're thinking just by performing a physical exam. So, if anything is bothering you, say your piece. Are you having trouble controlling your heartburn ? Managing your constipation ? Suffering from headaches ? This is the time to ask for advice. Consult the notebook of questions you've been compiling. In addition to physical complaints, let your practitioner know if you have emotional concerns or fitness or nutrition questions.
• Ask the staff about the administrative stuff. Save your questions about things like insurance and directions to the hospital for the office staff so your practitioner has more time to answer your health-related questions. Go to the admin staff with any inquiries about payments, scheduling, office policies, and your contact information.
• Be open-minded. When talking with your doctor, midwife, or nurse practitioner, you should feel comfortable speaking freely. But remember to listen, too. Take notes if you find it helpful.

Keep in mind, too, that some days are busier than others. This is especially true during the COVID-19 pandemic. That doesn't mean your practitioner doesn't have to answer your questions, but sometimes a discussion can be continued at the next visit if it's a really busy day or if your practitioner needs to head to the hospital to deliver a baby.

At the same time, don't tolerate a healthcare practitioner who won't give you thorough answers, doesn't show reasonable compassion, or barely looks up from your chart. You and your baby deserve more than that.

Now that you know what to expect during all those prenatal visits, you might like a sneak peek at what else is in store. Here's an overview of the next nine months .

Learn more:

• The ultimate pregnancy to-do list: First trimester
• 12 steps to a healthy pregnancy
• When will my pregnancy start to show?
• Fetal development timeline

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What happens at second trimester prenatal appointments

What to expect at your first prenatal appointment

What to expect from third trimester prenatal appointments

Prenatal testing

BabyCenter's editorial team is committed to providing the most helpful and trustworthy pregnancy and parenting information in the world. When creating and updating content, we rely on credible sources: respected health organizations, professional groups of doctors and other experts, and published studies in peer-reviewed journals. We believe you should always know the source of the information you're seeing. Learn more about our editorial and medical review policies .

MedlinePlus. (2021). Prenatal care in your first trimester. https://medlineplus.gov/ency/patientinstructions/000544.htm Opens a new window [Accessed September 21, 2021.]

March of Dimes. (2017). Prenatal Care Checkups. https://www.marchofdimes.org/pregnancy/prenatal-care-checkups.aspx Opens a new window [Accessed September 21, 2021.]

Office on Women’s Health. (2019). Prenatal Care and Tests. https://www.womenshealth.gov/pregnancy/youre-pregnant-now-what/prenatal-care-and-tests Opens a new window [Accessed September 21, 2021.]

NIH: Eunice Kennedy Shriver National Institute of Child Health and Human Development. (2017). What happens during prenatal visits? https://www.nichd.nih.gov/health/topics/preconceptioncare/conditioninfo/prenatal-visits Opens a new window [Accessed September 21, 2021.]

NIH: Eunice Kennedy Shriver National Institute of Child Health and Human Development. (2017). What is a high-risk pregnancy? https://www.nichd.nih.gov/health/topics/pregnancy/conditioninfo/high-risk Opens a new window [Accessed September 21, 2021.]

NIH: Eunice Kennedy Shriver National Institute of Child Health and Human Development. (2018). What are some factors that make a pregnancy high-risk? https://www.nichd.nih.gov/health/topics/high-risk/conditioninfo/factors Opens a new window [Accessed September 21, 2021.]

March of Dimes. (2020). Over-the-Counter Medicine, Supplements, and Herbal Products During Pregnancy. https://www.marchofdimes.org/pregnancy/over-the-counter-medicine-supplements-and-herbal-products.aspx Opens a new window [Accessed September 21, 2021.]

Associates in Women’s Healthcare (2021). Preparing for Your First Prenatal Visit. https://www.associatesinwomenshealthcare.net/blog/preparing-for-your-first-prenatal-visit/ Opens a new window [Accessed September 21, 2021.]

National Health Service (UK). (2018). Your baby’s movements. https://www.nhs.uk/pregnancy/keeping-well/your-babys-movements/ Opens a new window [Accessed September 21, 2021.]

MedlinePlus. (2021). Prenatal care in your third trimester. https://medlineplus.gov/ency/patientinstructions/000558.htm Opens a new window [Accessed September 21, 2021.]

UCLA Health. (2021). Schedule of prenatal care. https://www.uclahealth.org/obgyn/workfiles/Pregnancy/Schedule_of_Prenatal_Care.pdf Opens a new window [Accessed September 21, 2021.]

UCR Health. (2021). Healthy Pregnancy: The Importance of Prenatal Care.   https://www.ucrhealth.org/2018/07/healthy-pregnancy-the-importance-of-prenatal-care/ Opens a new window [Accessed September 21, 2021.]

Mayo Clinic. (2020). Prenatal care: 1 st trimesters visits. https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/prenatal-care/art-20044882 Opens a new window [Accessed September 21, 2021.]

Where to go next

Your Guide to Prenatal Appointments

Medical review policy, latest update:.

Minor copy changes.

Typical prenatal appointment schedule

Read this next, what happens during a prenatal care appointment, what tests will i receive at my prenatal appointments, what will i talk about with my practitioner at prenatal care appointments , first trimester prenatal appointments: what to expect, second trimester prenatal appointments: what to expect, third trimester prenatal appointments: what to expect, questions to ask during prenatal appointments  .

Prenatal care visits are chock-full of tests, measurements, questions and concerns, but know that throughout the process your and your baby’s wellbeing are the main focus. Keep your schedule organized so you don’t miss any appointments and jot down anything you want to discuss with your doctor and your prenatal experience should end up being both positive and rewarding.

What to Expect When You’re Expecting , 5th edition, Heidi Murkoff. American College of Obstetricians and Gynecologists,  Having a Baby After Age 35: How Aging Affects Fertility and Pregnancy , 2020. American College of Obstetricians and Gynecologists,  Routine Tests During Pregnancy , 2020. US Department of Health & Human Services, Office on Women’s Health,  Prenatal Care and Tests , January 2019. Journal of Perinatology ,  Number of Prenatal Visits and Pregnancy Outcomes in Low-risk wWomen , June 2016. Mayo Clinic,  Edema , October 2017. Mayo Clinic,  Prenatal Care: 2nd Trimester Visits , August 2020. Mayo Clinic,  Prenatal Care: 3rd Trimester Visits , August 2020. Jennifer Leighdon Wu, M.D., Women’s Health of Manhattan, New York, NY. WhatToExpect.com, Preeclampsia: Symptoms, Risk Factors and Treatment , April 2019. WhatToExpect.com, Prenatal Testing During Pregnancy , March 2019. WhatToExpect.com,  Urine Tests During Pregnancy , May 2019. WhatToExpect.com,  Fetal Heartbeat: The Development of Baby’s Circulatory System , April 2019. WhatToExpect.com,  Amniocentesis , Mary 2019. WhatToExpect.com,  Ultrasound During Pregnancy , April 2019. WhatToExpect.com,  Rh Factor Testing , June 2019. WhatToExpect.com,  Glucose Screening and Glucose Tolerance Test , April 2019. WhatToExpect.com, Nuchal Translucency Screening , April 2019. WhatToExpect.com, Group B Strep Testing During Pregnancy , August 2019. WhatToExpect.com,  The Nonstress Test During Pregnancy , April 2019. WhatToExpect.com,  Biophysical Profile (BPP) , May 2019. WhatToExpect.com,  Noninvasive Prenatal Testing , (NIPT), April 2019. WhatToExpect.com,  The Quad Screen , February 2019. WhatToExpect.com,  Chorionic Villus Sampling (CVS) , February 2019. WhatToExpect.com,  The First Prenatal Appointment , June 2019. WhatToExpect.com,  Breech Birth: What it Means for You , September 2018.

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Prenatal care in your first trimester

Trimester means "3 months." A normal pregnancy lasts around 10 months and has 3 trimesters.

The word prenatal means before birth. The first trimester starts when your baby is conceived. It continues through week 14 of your pregnancy. Your health care provider may talk about your pregnancy in weeks, rather than in months or trimesters.

Your First Prenatal Visit

You should schedule your first prenatal visit soon after you learn that you are pregnant. Your doctor or midwife will:

• Draw your blood
• Perform a full pelvic exam
• Do a Pap smear and cultures to look for infections or problems

Your doctor or midwife will listen for your baby's heartbeat, but may not be able to hear it. Most often, the heartbeat cannot be heard or seen on ultrasound until at least 6 to 7 weeks.

During this first visit, your doctor or midwife will ask you questions about:

• Your overall health
• Any health problems you have
• Past pregnancies
• Medicines, herbs, or vitamins you take
• Whether or not you exercise
• Whether you smoke, use tobacco, drink alcohol or take drugs
• Whether you or your partner have genetic disorders or health problems that run in your family

You will have many visits to talk about a birthing plan. You can also discuss it with your doctor or midwife at your first visit.

The first visit will also be a good time to talk about:

• Eating healthy , exercising, getting adequate sleep, and making lifestyle changes while you are pregnant
• Common symptoms during pregnancy such as fatigue, heartburn, and varicose veins
• How to manage morning sickness
• What to do about vaginal bleeding during early pregnancy
• What to expect at each visit

You will also be given prenatal vitamins with iron if you are not already taking them.

Follow-up Prenatal Visits

In your first trimester, you will have a prenatal visit every month. The visits may be quick, but they are still important. It is OK to bring your partner or labor coach with you.

During your visits, your doctor or midwife will:

• Check your blood pressure.
• Check for fetal heart sounds.
• Take a urine sample to test for sugar or protein in your urine. If either of these is found, it could mean that you have gestational diabetes or high blood pressure caused by pregnancy.

At the end of each visit, your doctor or midwife will tell you what changes to expect before your next visit. Tell your doctor if you have any problems or concerns. It is OK to talk about them even if you do not feel that they are important or related to your pregnancy.

At your first visit, your doctor or midwife will draw blood for a group of tests known as the prenatal panel. These tests are done to find problems or infections early in the pregnancy.

This panel of tests includes, but is not limited to:

• A complete blood count (CBC)
• Blood typing (including Rh screen)
• Rubella viral antigen screen (this shows how immune you are to the disease Rubella)
• Hepatitis panel (this shows if you are positive for hepatitis A, B, or C)
• Syphilis test
• HIV test (this test shows if you are positive for the virus that causes AIDS)
• Cystic fibrosis screen (this test shows if you are a carrier for cystic fibrosis)
• A urine analysis and culture

Ultrasounds

An ultrasound is a simple, painless procedure. A wand that uses sound waves will be placed on your belly. The sound waves will let your doctor or midwife see the baby.

You should have an ultrasound done in the first trimester to get an idea of your due date. The first trimester ultrasound will usually be a vaginal ultrasound.

Genetic Testing

All women are offered genetic testing to screen for birth defects and genetic problems, such as Down syndrome or brain and spinal column defects.

• If your doctor thinks that you need any of these tests, talk about which ones will be best for you.
• Be sure to ask what the results could mean for you and your baby.
• A genetic counselor can help you understand your risks and test results.
• There are many options now for genetic testing. Some of these tests carry some risks to your baby, while others do not.

Women who may be at higher risk for these genetic problems include:

• Women who have had a fetus with genetic problems in earlier pregnancies
• Women, age 35 years or older
• Women with a strong family history of inherited birth defects

In one test, your provider can use an ultrasound to measure the back of the baby's neck. This is called nuchal translucency .

• A blood test is also done.
• Together, these 2 measures will tell if the baby is at risk for having Down syndrome.
• If a test called a quadruple screen is done in the second trimester, the results of both tests are more accurate than doing either test alone. This is called integrated screening. If the test is positive, an amniocentesis or cell-free DNA test may be recommended.

Another test, called chorionic villus sampling (CVS) , can detect Down syndrome and other genetic disorders as early as 10 weeks into a pregnancy.

A newer test, called cell free DNA testing, looks for small pieces of your baby's genes in a sample of blood from the mother. This test is newer, but offers a lot of promise for accuracy without risks of miscarriage. It may reduce the need for an amniocentesis, and so is safer for the baby.

There are other tests that may be done in the second trimester .

When to Call the Doctor

Contact your provider if:

• You have a significant amount of nausea and vomiting.
• You have bleeding or cramping.
• You have increased discharge or a discharge with odor.
• You have a fever, chills, or pain when passing urine.
• You have any questions or concerns about your health or your pregnancy.

Alternative Names

Pregnancy care - first trimester

Gregory KD, Ramos DE, Jauniaux ERM. Preconception and prenatal care. In:.Landon MB, Galan HL, Jauniaux ERM, et al, eds. Gabbe's Obstetrics: Normal and Problem Pregnancies . 7th ed. Philadelphia, PA: Elsevier; 2021:chap 5.

Hobel CJ, Williams J. Antepartum care. In: Hacker N, Gambone JC, Hobel CJ, eds. Hacker & Moore's Essentials of Obstetrics and Gynecology . 6th ed. Philadelphia, PA: Elsevier; 2016:chap 7.

Magowan BA, Owen P, Thomson A. Antenatal and postnatal care. In: Magowan BA, Owen P, Thomson A, eds. Clinical Obstetrics and Gynaecology . 4th ed. Philadelphia, PA: Elsevier; 2019:chap 22.

Symonds I. Early pregnancy care. In: Symonds I, Arulkumaran S, eds. Essential Obstetrics and Gynaecology . 6th ed. Philadelphia, PA: Elsevier; 2020:chap 18.

Williams DE, Pridjian G. Obstetrics. In: Rakel RE, Rakel DP, eds. Textbook of Family Medicine . 9th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 20.

Review Date 4/19/2022

Updated by: John D. Jacobson, MD, Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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Pregnancy: Your First Visit

Congratulations! You’re expecting for the first time. Now, what’s the next step? Once you get a positive pregnancy test, one of your first steps should be to call your board-certified OB GYN’s office. That’s because early prenatal care helps you get a healthy start for you and your baby.

Here’s what you can expect at your first prenatal visit.  

Prenatal visit timing

You’ll typically visit your OB GYN for the first time during or after your eighth week of pregnancy. If you have certain medical conditions, your OB GYN may want to see you sooner. Or, if you have symptoms like bleeding or severe abdominal pain, you may need to see a doctor right away.

When you call to make an appointment, be sure you know the first date of your last period. Your OB GYN will use that as the starting point to calculate how many weeks along you are.   

Check your health

Expect your first prenatal visit to take a bit longer than your yearly well-woman check. At your visit, your OB GYN will perform a routine exam and run several tests.

According to the National Institute of Child Health and Human Development, these may include:

• Blood pressure and weight
• A pelvic exam, including a Pap test and cultures for sexually transmitted diseases
• Blood tests to check your blood type, hormone levels, infections, or red blood cell counts
• A urine sample to check for infections and HCG (pregnancy hormone)

Check your baby’s health

Typically, you’ll have an ultrasound to check on your baby. During the first trimester, your OB GYN may use a wand inserted into the vagina to get better images. Not only does this give you a first look at your little one, but the images also help confirm your baby’s gestational age. By eight weeks, you should be able to see and hear your baby’s heartbeat.   

Your OB GYN will also talk with you about genetic screening tests. These can help you understand your baby’s risk for conditions like cystic fibrosis or Down syndrome.

Guidelines for a healthy pregnancy

If this is your first pregnancy, you may have a lot of questions about what you should or shouldn’t do. And that’s completely normal.

You may want to talk with your OB GYN about:

• Nutrition and foods to avoid
• Prenatal vitamins
• Medications or other substances to avoid
• Morning sickness and normal pregnancy symptoms
• Managing stress
• Safe exercise
• Healthy weight gain
• Warning signs
• Your health history
• Any other questions you may have

Feel free to bring a list of questions to your visit. Your board-certified OB-GYN is there to help guide you through any concerns. With your first prenatal visit complete, you’ll be better prepared to keep yourself and your baby healthy for the months to come.  

National Institutes of Health

Published on July 7, 2020

Read More Articles About Pregnancy

• First Trimester
• OB-GYN & Prenatal Care

What to Expect at the First Prenatal Visit

You got a positive pregnancy test —congratulations are in order! Now it’s time to plan your first prenatal visit. You might be feeling nervous (or is that morning sickness already?!), and you probably have lots of questions, but not to worry—your provider will be there every step of the way. In the meantime, you might want to brush up on what to expect at your first pregnancy appointment. Ready for answers? We’ve consulted with ob-gyns on all the important info.

When Should You Schedule Your First Prenatal Visit?

After you get that positive test, you can take a day or two to soak in the news and celebrate, but it’s a good idea to book that first prenatal visit with your chosen ob-gyn or midwife pretty soon after. (If you haven’t picked a provider yet , you’ll want to get on that ASAP!)

Andrea Braden , MD, IBCLC, an ob-gyn and founder of the lactation company Lybbie , advises to “be on the safe side and give the office a call as soon as you find out you’re pregnant.”

When Will Your First Prenatal Visit Happen?

It’s ideal to schedule your first prenatal visit for when you’re around 7 to 8 weeks pregnant, says Braden. Doctors recommend this timing because that’s when an ultrasound can likely detect baby’s heartbeat . (The earliest a fetal heartbeat can be detected is around week 6, according to Cleveland Clinic .)

If you’ve had complications in an earlier pregnancy, you may want to go in earlier than 7 to 8 weeks. “Sometimes we want to watch these early pregnancies closer because with a history of complications, you have an increased risk of having complications in a subsequent pregnancy,” notes Braden.

On the other hand, if you miss the 7-to-8-week mark, Braden says the goal would be to get you in before 12 weeks, when the first trimester ends. “After that point, just get in as soon as you can because there will be some catching up to do!” she adds.

How Can You Prepare for Your First Pregnancy Appointment?

Want a handy checklist for your first prenatal appointment? Here’s what you need to prepare, according to the experts.

• The date of your last menstrual period (LMP). During your first pregnancy appointment, your ob-gyn will compare the LMP to an ultrasound to determine your due date , says Braden. “If the last period was irregular or unpredictable, sometimes you need to know the first day of the period before that one,” she adds.
• Your medications and medical history. Gather a list of medications and dosages to bring to your provider to discuss their safety during pregnancy, advises Michael Platt-Faulkner , DO, an ob-gyn at St. Elizabeth Physicians in Northern Kentucky. “Writing down any significant personal medical or surgical history and family history of genetic diseases is also helpful information for your visit,” he adds.
• Your pharmacy information. Your doc might prescribe prenatal vitamins or other medications, depending on your medical history, so make sure you have a convenient pharmacy in mind.
• Any questions about symptoms or other concerns. Those first-trimester symptoms—nausea, fatigue, peeing all the time—can cause anxiety. Plus, figuring out what to eat (and not to eat) and questions like “ Can I have coffee while pregnant? ” can be confusing. Platt-Faulker suggests writing all your questions and concerns down for your provider, so you don’t forget them in the heat of the moment.
• Somewhere to track the rest of your pregnancy appointments. “There will be a lot of information coming at you,” says Braden. “You want to have a place to write down future appointments and take any notes.”

What Happens at Your First Prenatal Visit?

What happens at your first prenatal visit can vary widely depending on your state and the type of practice you’re visiting, says Braden. In some practices, you get both an ultrasound and a consultation during your first pregnancy appointment, while other providers’ offices split up these to-dos.

Here’s generally what to expect at your first prenatal appointment.

Your provider may perform an ultrasound to confirm the pregnancy, help determine your due date, check baby’s heart rate and check for any complications, according to Cleveland Clinic . “Oftentimes, an early-pregnancy ultrasound may use a vaginal probe and can be mildly uncomfortable—which can be helpful to know in order to be best prepared for your visit,” says Platt-Faulkner. By about 12 to 14 weeks of pregnancy, your provider will be able to hear baby’s heartbeat with a small device called a Doppler ultrasound, according to Mayo Clinic .

Medical history

“Your provider will review your pregnancy, medical and surgical histories in detail,” says Platt-Faulkner. “Your ob-gyn will [also] review how any medical diagnoses, pregnancy complications or surgical history may affect your pregnancy.” Your provider will also take a look at your medication list and discuss any pregnancy-related safety concerns with the medications you’re taking. Omoikhefe Akhigbe , MD, an ob-gyn at Pediatrix Medical Group in Maryland, adds that your provider may also discuss whether there are any specialty doctors you should start seeing or continue to see.

Lifestyle discussion

Your provider will discuss the lifestyle choices you plan to make during pregnancy. (Remember that, for starters, that means no smoking or alcohol .) “You’ll learn about foods that are safe to eat in pregnancy and the way to keep yourself healthy,” says Braden. “They will answer questions about exercise, diet, nutrition, rest, common symptoms and how to treat them and what to do if you do have discomfort in pregnancy.”

Genetic testing

At your first pregnancy appointment, your provider might perform or discuss future genetic testing. “There are genetic tests that are time-sensitive and can be done as early as 10 weeks,” says Braden. “There are some that are done with an ultrasound around 12 or 13 weeks pregnant, and some that are done in the second trimester. Depending on your history and what you desire, that’ll likely be brought up.” There are some specific tests your provider may offer based on your age or family history too, she adds.

Blood testing

You’ll likely get blood drawn during your first prenatal visit. You’ll be tested for a variety of conditions, including anemia, hepatitis B, syphilis and HIV, as well as for your blood type and Rh factor .

Urine testing

For starters, your provider might test a urine sample to confirm your pregnancy, as well as to test kidney function and screen for the presence of protein, as noted by the Cleveland Clinic .

Physical exam

You can expect a full physical exam at your first prenatal visit, which may include a pelvic examination and a breast exam. “If you’re due for a pap smear and you’re over 21 years of age, then you can expect that you’ll have a pap smear screening test done for cervical cancer along with an HPV test if indicated,” says Braden. “Typically, we also test for sexually transmitted infections at the time of the first prenatal visit.”

Questions to Ask at Your First Prenatal Visit

You’re likely full of questions—and that’s completely normal! Make sure to write them down—and bring this list to your first prenatal appointment in case you feel like you’re forgetting something.

• Questions about symptoms. Of course, you should bring any questions about symptoms to your appointment. Akhigbe says it’s also important to ask “when and where to call for an urgent question, what constitutes an emergency, what is an urgent question and what is a routine question that could probably wait for normal business hours.”
• Questions about testing. Which tests will you need during pregnancy? What will your insurance pay for? “Ask about common resources to use and where you can find the evidence-based information about your pregnancy and guidelines and information about tests,” advises Braden. A lot of people also want to know when they’ll find out baby’s sex , she adds. (Spoiler alert: With non-invasive prenatal testing (NIPT) , you can find out as early as 10 weeks.)
• Questions about your ultrasound plan. How many ultrasounds will you get? “Sometimes it depends on insurance, sometimes it depends on your medical history and sometimes it depends on your provider. Do they do them in-house or at a different center?” says Braden.
• Questions about lifestyle choices. Your doctor will review information about how to eat a healthy pregnancy diet with you, but if you have any specific concerns—such as about drinking alcohol or eating sushi—be sure to let them know.
• Questions about logistics. You’ve got a long journey ahead of you! Your provider will likely “review their practice structure, visit schedule and confirm the hospital where you’ll deliver,” says Platt-Faulkner. But if they’ve missed anything, Akhigbe recommends asking follow-up logistical questions, like how many providers you’ll see and which doctor is most likely to deliver baby. (Remember, there are no guarantees!)

There’s a lot of information to take in at your first prenatal visit. It might seem overwhelming, so make sure to bring questions, take notes and do whatever else you need to feel comfortable. Bringing your partner or a good friend along for the ride can help ease some nerves too. “If you have a support person that will be going along this journey with you, it’s always great to bring them to this visit if that’s allowed,” says Braden.

While it might feel like a lot to take in, know that your provider is there to make sure you and baby are healthy during your first prenatal visit and throughout your whole pregnancy—and that you’re making a wonderful first step in your pregnancy journey.

Please note: The Bump and the materials and information it contains are not intended to, and do not constitute, medical or other health advice or diagnosis and should not be used as such. You should always consult with a qualified physician or health professional about your specific circumstances.

Plus, more from The Bump:

15 Early Signs of Pregnancy

Pregnancy Checklist: Your First Trimester To-Dos

When Do You Start Showing in Pregnancy?

Omoikhefe Akhigbe , MD, is an ob-gyn and medical director at Pediatrix Medical Group in Maryland. She earned her medical degree from Meharry Medical College School of Medicine in Nashville, Tennessee.

Andrea Braden , MD, IBCLC, is an ob-gyn, board-certified lactation consultant and founder of the lactation company Lybbie . She earned her medical degree from the University of South Alabama School of Medicine.

Michael Platt-Faulkner , DO, is an ob-gyn at St. Elizabeth Physicians in Northern Kentucky. He earned his medical degree from the Heritage College of Osteopathic Medicine at Ohio University.

Cleveland Clinic, Fetal Development , March 2023

Cleveland Clinic, Ultrasound in Pregnancy , September 2022

Mayo Clinic, Prenatal Care: 1st Trimester Visits , August 2022

Nemours KidsHealth, Prenatal Tests: First Trimester , July 2022

Cleveland Clinic, NIPT Test , October 2022

Cleveland Clinic, Your First Prenatal Appointment: What to Expect , December 2022

Learn how we ensure the accuracy of our content through our editorial and medical review process .

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SARAH INÉS RAMÍREZ, MD, FAAFP

Am Fam Physician. 2023;108(2):139-150

Related AFP Community Blog:   Practice Ancestry-Based Medicine, not Racial Essentialism

Related editorial:   Perinatal Care of Transgender Patients, Adolescent Patients, and Patients With Opioid Use Disorder

Author disclosure: No relevant financial relationships.

Well-coordinated prenatal care that follows an evidence-based, informed process results in fewer hospital admissions, improved education, greater satisfaction, and lower pregnancy-associated morbidity and mortality. Care initiated at 10 weeks or earlier improves outcomes. Identification and treatment of periodontal disease decreases preterm delivery risk. A prepregnancy body mass index greater than 25 kg per m 2 is associated with gestational diabetes mellitus, hypertension, miscarriage, and stillbirth. Advanced maternal and paternal age (35 years or older) is associated with gestational diabetes, hypertension, miscarriage, intrauterine growth restriction, aneuploidy, birth defects, and stillbirth. Rh o (D) immune globulin decreases alloimmunization risk in a patient who is RhD-negative carrying a fetus who is RhD-positive. Treatment of iron deficiency anemia decreases the risk of preterm delivery, intrauterine growth restriction, and perinatal depression. Ancestry-based genetic risk stratification using family history can inform genetic screening. Folic acid supplementation (400 to 800 mcg daily) decreases the risk of neural tube defects. All pregnant patients should be screened for asymptomatic bacteriuria, sexually transmitted infections, and immunity against rubella and varicella and should receive tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap), influenza, and COVID-19 vaccines. Testing for group B Streptococcus should be performed between 36 and 37 weeks, and intrapartum antibiotic prophylaxis should be initiated to decrease the risk of neonatal infection. Because of the impact of social determinants of health on outcomes, universal screening for depression, anxiety, intimate partner violence, substance use, and food insecurity is recommended early in pregnancy. Screening for gestational diabetes between 24 and 28 weeks is recommended for all patients. People at risk of preeclampsia, including those diagnosed with COVID-19 in pregnancy, should be offered 81 mg of aspirin daily starting at 12 weeks. Chronic hypertension should be treated to a blood pressure of less than 140/90 mm Hg.

Family physicians provide family-centered care for individuals and families before, during, and after the birth of a child. Well-coordinated prenatal care that follows an evidence-based, informed process results in fewer hospital admissions, improved education, greater care satisfaction, improved perinatal outcomes, and mitigates pregnancy-associated morbidity and mortality. 1 Family physicians are uniquely positioned to address social determinants of health while ensuring quality of care.

Prenatal Care Visits

Initiation of care between six and 10 weeks allows for identification of preexisting conditions that negatively affect maternal-fetal outcomes (e.g., diabetes mellitus, hypertension, obesity) 2 ; however, 22% of pregnant patients do not receive care during this time. 2 The COVID-19 pandemic resulted in a reevaluation of the number of physician visits needed, with an emphasis on increased flexibility, allowing for a combination of virtual and in-person visits depending on risk. 3 Table 1 outlines the components of prenatal care. 1 , 4 – 22 Table 2 provides opportunities for educating pregnant patients during prenatal care visits. 6 , 8 , 14 – 19 , 23 – 29

PHYSICAL EXAMINATION

Weight, height, and blood pressure should be measured at the first prenatal visit. Early identification of periodontal disease and treatment decreases adverse pregnancy outcomes. 7 Treatment may be performed in the second trimester, and emergent treatment may be completed at any time during pregnancy. 7 A bimanual pelvic examination has poor predictive value for clinical pelvimetry and screening for disease (i.e., sexually transmitted infections and cancer) but may be used as a diagnostic aid in patients with a discrepancy between uterine size and gestational age, which warrants ultrasonography assessment. 30 A pelvic examination is also useful in a symptomatic patient for evaluating spontaneous labor (e.g., cervical dilation, rupture of amniotic membranes). The clinical breast examination is a diagnostic aid in the symptomatic patient and addresses breastfeeding concerns or barriers but does not demonstrate benefit in patients already receiving screening mammograms and does not decrease mortality. 31 – 33

MATERNAL WEIGHT GAIN AND NUTRITION

A prepregnancy body mass index (BMI) greater than 25 kg per m 2 is associated with preterm delivery, gestational diabetes, gestational hypertension, and preeclampsia. A BMI greater than 30 kg per m 2 is also associated with an increased risk of miscarriage, stillbirth, and obstructive sleep apnea. 6 Prepregnancy BMI informs the timing of fetal surveillance, nutritional counseling, and goals for gestational weight gain. Table 3 lists general dietary guidelines for pregnant people. 8 , 17 , 34 , 35 For Black and Hispanic people, a prepregnancy BMI greater than 25 kg per m 2 and the associated poor outcomes are worse compared with non-Hispanic White people. 36

PARENTAL AGE AT CONCEPTION

Advanced maternal and paternal age (35 years and older) is associated with poor outcomes (i.e., aneuploidy, birth defects, gestational diabetes, hypertension, intrauterine growth restriction [IUGR], miscarriage, and stillbirth). Activities focused on improving perinatal outcomes for this group, such as a detailed fetal anatomic screening on ultrasonography, may decrease morbidity and mortality. 37

PREGNANCY DATING AND ULTRASONOGRAPHY

Accurate gestational age estimation is critical to quality care because it enables more precise timing of interventions (e.g., aspirin for preeclampsia prevention, steroids for fetal lung maturity), screening tests, and delivery. Up to 40% of people estimate their last menstrual period incorrectly; therefore, ultrasonography is recommended if uncertainty exists and for patients with irregular menstrual cycles, irregular bleeding, and discrepancy between uterine size and gestational age. 1 , 38 Ultrasonography before 24 weeks decreases missed multiple gestations and post-term inductions. 39 Although routine third-trimester ultrasonography may increase detection of IUGR, it does not improve outcomes. 40 If malpresentation is suspected on physical examination, confirmation with ultrasonography is recommended. 4

ALLOIMMUNIZATION

For patients who are RhD-negative and carrying a fetus who is RhD-positive, the alloimmunization risk is 1.5% to 2% in the setting of spontaneous abortion and 4% to 5% with dilation and curettage. The risk is decreased by 80% to 90% with anti-D immune globulin. 41 Testing for the ABO blood group and RhD antibodies should be performed early in pregnancy. A 300-mcg dose of anti-D immune globulin is recommended for RhD-negative pregnant patients at 28 weeks and again within 72 hours of delivery if the infant is RhD-positive. 41

Iron deficiency anemia increases the risk of preterm delivery, IUGR, and perinatal depression. The U.S. Preventive Services Task Force found insufficient evidence to assess the benefits and harms of screening for anemia in pregnancy. 42 Screening is recommended by the American College of Obstetricians and Gynecologists early in pregnancy, with iron treatment if deficient. 43 Intravenous iron should be considered for patients who cannot tolerate oral iron or in whom oral iron has been ineffective at correcting the deficiency. 43 Patients with non–iron deficiency anemia, or if iron repletion is ineffective within six weeks, should be referred to a hematologist for further evaluation. Iron supplementation in the first trimester decreases the prevalence of iron deficiency. 43

INHERITED CONDITIONS

Pregnant patients should be counseled and offered aneuploidy (extra or missing chromosomes) screening in early pregnancy, regardless of age. 44 In the United States, 1 in 150 infants has a chromosomal condition, the most common being trisomy 21 (Down syndrome). 44 Table 4 compares screening tests for Down syndrome. 1 , 45 , 46 If a screening test is positive, amniocentesis at 15 weeks or more or chorionic villous sampling between 11 and 13 weeks is recommended. Both procedures have similar rates of fetal loss. 47 At 35 years of age, the risk of Down syndrome (1 in 294 births) is similar to that of fetal loss from amniocentesis. 47 Serum and nuchal translucency testing can screen for other trisomies, including 13 and 18, the protocols for which have lower sensitivities and higher specificities compared with screening protocols for trisomy 21 because they are rarer. 47

Additional genetic screening should be based on maternal and paternal personal and family histories. Race is a social construct, necessitating a shift in genetic risk stratification from race-based to ancestry-based. Sickle cell disease affects up to 100,000 people in the United States, but its inheritance pattern (1:10) is based on people with African ancestry, which includes much of the world. 48 Cystic fibrosis is inherited mainly by people of European ancestry (1:25), but ignoring the possibility of European ancestry in certain racial and ethnic groups results in an underestimation of its prevalence: African (1:61), Hispanic (1:40), and Mediterranean (1:29). 49

NEURAL TUBE DEFECTS

In the United States, neural tube defects affect approximately 2,600 infants per year, with the highest prevalence in Hispanic populations. 35 , 50 All pregnant patients should be counseled and offered screening with maternal serum alpha fetoprotein. 35 Folic acid, 400 to 800 mcg daily, started at least one month before conception and continued until the end of the first trimester, decreases the incidence of neural tube defects by nearly 78%. 35 Patients taking folic acid antagonists (e.g., carbamazepine, methotrexate, trimethoprim) or who have a history of carrying a fetus with a neural tube defect should take 4 mg of folic acid daily, starting at least three months before conception. 35

THYROID DISORDERS

There is no evidence that screening for thyroid disorders improves pregnancy outcomes. Thyroid-stimulating hormone levels should be measured if there is a history of thyroid disease or symptoms of disease. If the level is abnormal, a free thyroxine test helps determine the etiology. 51 Hypothyroidism complicates 1 to 3 per 1,000 pregnancies and increases the risk of fetal loss, preeclampsia, IUGR, and stillbirth. Hyperthyroidism occurs in 2 per 1,000 pregnancies and is associated with miscarriage, preeclampsia, IUGR, preterm delivery, thyroid storm, and congestive heart failure. 51 The effect of subclinical hypothyroidism on a child's neurocognitive development is not well understood, and the effectiveness of treatment with levothyroxine is unproven. 51

CERVICAL CANCER

Intervals for cervical cancer screening are based on patient age, cytology history, and history of the presence of high-risk human papillomavirus (HPV). Routine screening for people at average risk of cervical cancer should begin at 21 years of age. Screening can be performed with either cytology alone every three years, HPV screening alone every five years, or cytology plus HPV screening every five years starting at 25 years of age. Screening is not indicated for people 65 years and older with negative screening in the previous 10 years, and no history of cervical intraepithelial neoplasia grade 2 or higher in the past 25 years. 52 Colposcopy is indicated when the risk of cervical intraepithelial neoplasia grade 3 is greater than 4%. Surveillance of high-grade lesions should be performed every 12 to 24 weeks. 52 , 53 Although colposcopy and cervical biopsy can be safely performed during pregnancy, endocervical sampling should be deferred until postpartum. 53

Infectious Disease

Bacteriuria.

Asymptomatic bacteriuria complicates up to 15% of pregnancies in the United States, 30% of which progress to pyelonephritis if untreated. 54 All pregnant patients should be screened for bacteriuria at the first prenatal visit. 54 A culture from a midstream or clean-catch sample with greater than 100,000 colony-forming units per mL of a single pathogen is considered positive and treated to decrease the risk of pyelonephritis and subsequent preterm delivery. 54

SEXUALLY TRANSMITTED INFECTIONS

Sexually transmitted infections can affect prenatal outcomes. 55 – 57 Table 5 lists routine screening and treatment for sexually transmitted infections in pregnancy. 55 , 56

Rubella immunity screening during the first prenatal visit is recommended. Postpartum vaccination should also be offered if the patient is not immune to prevent congenital rubella syndrome in subsequent pregnancies. 1 , 58 The presence of rubella immunoglobulin G should be interpreted with caution in patients recently migrating from areas where rubella is endemic because this may indicate a recent infection. 58 Rubella is a live vaccine and should not be administered during pregnancy but is safe during lactation after delivery. 59 , 60

Maternal varicella can result in congenital varicella syndrome (i.e., IUGR and limb, ophthalmologic, and neurologic abnormalities) and neonatal varicella; infection can occur from approximately five days before to two days after birth. A negative history of varicella infection or vaccination warrants serologic testing, and if immunoglobulin G is negative, varicella exposure should be avoided. Postpartum vaccination should be offered. 61

Although tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccination is recommended for anyone in close contact with the infant, only antenatal maternal vaccination ensures increased protection against neonatal pertussis. 62 Pregnant patients should receive a Tdap vaccine beginning at 27 weeks to maximize time for passive immunity to the fetus through the placental transfer of maternal antibodies; vaccination is recommended in each subsequent pregnancy. 62

INFLUENZA AND COVID-19

Influenza and COVID-19 infection in pregnancy increase the risk of intensive care unit admission, preterm delivery, stillbirth, and maternal death. 63 , 64 COVID-19 infection almost doubles the risk of developing preeclampsia 64 ; therefore, initiating low-dose aspirin (81 mg daily) starting at 12 weeks should be considered. 5 Pregnant patients and their household contacts should be vaccinated for influenza and COVID-19. 63 , 64

GROUP B STREPTOCOCCUS

In the United States, group B Streptococcus (GBS) is the leading cause of infection in the first three months of life; 25% of all pregnant patients are GBS carriers. 65 , 66 Screening with a vaginal-rectal swab for culture between 36 and 37 weeks is recommended. 67 Intrapartum antibiotic prophylaxis decreases neonatal mortality. Antibiotics are recommended when there is GBS bacteriuria with the current pregnancy, a history of a previous infant affected by GBS (e.g., septicemia, meningitis, pneumonia, death), or unknown GBS status and risk factors (e.g., preterm labor, rupture of membranes more than 18 hours before delivery, GBS in previous pregnancy). 67 Patients with GBS bacteriuria in the current pregnancy are assumed to be colonized and do not need subsequent screening. 67

Social Determinants of Health

Social determinants of health represent up to 80% of the factors that directly affect a person's health. 68 Physicians who provide prenatal care play a critical role in mitigating the burden that social determinants of health play on maternal-child health without compromising the quality of care delivered. 69 An increased burden from social determinants of health increases the risk of depression, anxiety, intimate partner violence, substance use, and food insecurity 70 , 71 ; therefore, universal screening is recommended early in pregnancy.

DEPRESSION AND ANXIETY-RELATED DISORDERS

After the COVID-19 pandemic, rates of perinatal depression and anxiety have increased. People who are non-White, 24 years or younger, or who have 12 years or less of education, lower socioeconomic status, or a history of intimate partner violence or sexual trauma are at higher risk. 11 , 72 , 73 If untreated, depression and anxiety-related disorders increase the risk of preeclampsia, preterm delivery, IUGR, substance use, maternal suicide, infanticide, psychosis, and homicide. 11

INTIMATE PARTNER VIOLENCE

Intimate partner–related homicide is the leading cause of death in the United States in pregnancy. Screening is recommended at the first prenatal visit and once per trimester. 13 Intimate partner violence increases the risk of miscarriage, placental abruption, premature rupture of membranes, IUGR, and preterm delivery. 13 Family physicians should be aware of the signs of intimate partner violence (e.g., frequent sexually transmitted infections, repeated requests for pregnancy tests when pregnancy is not desired, fear of asking a partner to use a condom), the effect of violence on health, and the increased risk of child abuse after delivery. 13

SUBSTANCE USE

Substance use during pregnancy increases the risk of IUGR, preterm delivery, stillbirth, fetal malformations, and maternal death. 74 The use of prescription opioids complicates 7% of pregnancies in the United States; of these, 20% of patients report misuse. 75 Opioid use in pregnancy increased by 131% from 2010 to 2017 in the United States, and the incidence of babies born with withdrawal symptoms in that time increased by 82%. 76 Fetal alcohol exposure is the leading cause of preventable neurodevelopmental disorders in the United States. 14 However, 14% of pregnant patients report current drinking, and 5% report binge drinking in the past 30 days. 77 Exposure to cigarette smoking in utero increases the risk of sudden intrauterine and infant death. 15

FOOD INSECURITY

Maternal food insecurity increases the risk of poor outcomes (e.g., IUGR, preterm delivery, gestational diabetes, hypertension, depression, anxiety). However, few patients disclose this due to concerns about social stigma; therefore, a universal approach to screening is encouraged. The Hunger Vital Sign tool may be used. 12

Complications of Pregnancy

Gestational diabetes.

Gestational diabetes complicates up to 14% of U.S. pregnancies, with up to 67% of patients developing type 2 diabetes later in life. 78 Racial and ethnic minorities are at the highest risk. 79 Gestational diabetes is associated with hypertension, macrosomia, shoulder dystocia, and cesarean deliveries. 80 Screening for undiagnosed type 2 diabetes at the initial prenatal visit is recommended for people at increased risk 80 ( Table 6 5 , 80 ) . Universal screening for gestational diabetes should occur between 24 and 28 weeks with a one-hour (50-g) glucose tolerance test and, if results are abnormal, should be followed by a confirmatory, fasting, three-hour (100-g) test. 80

HYPERTENSION

Blood pressure should be monitored at each prenatal visit, and education should be provided on preeclampsia warning signs. 5 Patients at increased risk of preeclampsia should be screened for thrombocytopenia, transaminitis, and renal insufficiency, including proteinuria, during the first or second trimester and started on prophylactic daily low-dose aspirin (81 mg) between 12 and 16 weeks 5 , 85 ( Table 6 5 , 80 ) . [Updated] Screening for proteinuria in isolation has little predictive value for detecting preeclampsia. 5 Chronic hypertension (hypertension before 20 weeks) is treated to less than 140/90 mm Hg. 81

PRETERM DELIVERY

Preterm delivery (between 20 and 37 weeks) is a significant cause of neonatal morbidity and mortality, complicating 10.5% of U.S. pregnancies. 2 Modifiable risk factors include prepregnancy BMI (less than 18.5 kg per m 2 and greater than 25 kg per m 2 ), substance use, and short interval between pregnancies (i.e., less than 18 months). 82 Several options are available for the prevention of preterm labor in a singleton pregnancy. 82 Patients with a previous preterm delivery before 34 weeks should have a cervical length assessment starting at 16 weeks through 24 weeks. 82 These patients should be treated with progesterone supplementation (vaginal or intramuscular). In the asymptomatic patient with a short cervix and without a history of spontaneous birth before 34 weeks, vaginal progesterone (200 mg) started between 16 and 20 weeks and continued through 36 weeks is recommended. 82

POST-TERM DELIVERY

Stillbirth complicates 3 per 1,000 post-term (42 weeks or greater) pregnancies. 20 Antenatal testing should be initiated at 41 weeks; if the results are not reassuring, induction of labor is recommended. 20 , 21

Cultural Considerations

Maternity care improves outcomes; however, vulnerable populations (i.e., racial, ethnic, and religious minorities) are less likely to engage in care if it is not culturally centered, which acknowledges the effect of culture on health conditions (e.g., depression) and enhances patient-physician trust. 83 Addressing cultural needs (e.g., doula, community health workers, interpreters) throughout pregnancy helps mitigate barriers and improves outcomes.

This article updates previous articles on this topic by Zolotor and Carlough 1 ; Kirkham, et al. 17 ; and Kirkham, et al. 84

Data Sources: A search was completed using the key terms prenatal care, COVID-19, oral health, pelvic examination, prepregnancy body mass index, pregnancy dating and ultrasound, maternal and paternal age and impact on pregnancy outcomes, aneuploidy screening, inheritance patterns of sickle cell disease and cystic fibrosis, anemia, cell-free DNA analysis, thyroid disease, cervical cancer screening, management of abnormal cervical cytology, screening guidelines for sexually transmitted infections in pregnancy, group B Streptococcus screening, social determinants of health and prenatal outcomes, intimate partner violence, polysubstance abuse, food insecurity, maternity care deserts, hypertension in pregnancy, progesterone for preterm birth prevention, post-term delivery, and preconception care. Also searched were PubMed, Essential Evidence Plus, the Cochrane database, U.S. Preventive Services Task Force, American College of Obstetricians and Gynecologists, American Cancer Society, American Family Physician , and reference lists of retrieved articles. Search dates: July 1, 2022; February 19, 2023; and June 16, 2023.

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What Happens at the First Prenatal Visit

Once you get a positive home pregnancy test, you should set up your first prenatal visit with a doctor or midwife .

Establishing care early on and attending regular prenatal visits helps keep you and your baby healthy.

Here’s what to plan for and what to expect at your first prenatal visit.

When to Schedule Your First Prenatal Visit

The first prenatal visit is typically scheduled for when you’re 7–10 weeks pregnant. This is counted from the first day of your last period.

This timing is important, as “it confirms a viable pregnancy and ideally gives the most accurate due date,” says Katy Orr , a certified registered nurse practitioner at the University of Alabama at Birmingham’s Department of Obstetrics and Gynecology.

If you’re further along in your pregnancy by the time you make that first appointment, don’t worry. Your doctor or midwife will get you in for a visit as soon as possible, says Jessica Salak, M.D. , board-certified ob-gyn at Tufts Medical Center in Boston.

It’s best to call as soon as you know you’re pregnant, since appointments can book up quickly. At your visit, the provider will check to make sure you’re healthy and your baby is developing as expected.

What Will Happen at Your First Prenatal Appointment

“The first visit is the longest visit of the entire pregnancy,” says Salak.

That’s because your doctor or midwife will complete the following assessments and tests:

• Measure your vital signs (height, weight, body temperature, and blood pressure)
• Collect a urine sample (the urine will be tested for kidney function/protein and look for any signs of infection)
• Do an ultrasound to confirm the pregnancy and provide an accurate due date
• Do a pap smear and breast exam (if you’re due for them)
• Draw blood to check your blood type and screen for potential concerns
• Offer genetic screening tests to screen for conditions such as Down syndrome

They’ll gather a lot of information from you too, says Salak. They will:

• Review your medical history, including any medications you take
• Discuss family health history (for both you and the baby’s other parent)
• Ask about tobacco, alcohol, and drug use , and recommend resources for quitting (if needed)
• Talk about your job to see if there are work-related risks to the pregnancy
• Ask about your relationships to be sure they’re healthy and safe

They may also offer some education around what to expect at each prenatal visit and throughout the pregnancy, says Salak. To do this, they will likely:

• Review healthy habits to follow during pregnancy
• Offer strategies to help pregnancy symptoms such as morning sickness
• Go over the schedule of prenatal visits
• Give you an opportunity to ask questions

What to Bring to Your First Prenatal Doctor’s Visit

Gather the right information and details before your first prenatal visit. Having these items can help make it go as smoothly as possible:

• Important health documents. Bring a valid ID and your health insurance card to your appointment. “And be prepared to discuss billing options,” says Orr.
• Date your last period began. This helps your provider assess how far along your pregnancy is, says Orr.
• Previous pregnancy history. Bring along any records you may have from past pregnancies, including delivery information. Also be sure to discuss any history of abortion, miscarriage, or fertility problems, says Orr.
• Personal medical history. Be sure to discuss any health conditions or issues you’re managing, such as high blood pressure. Tell the provider about any medications you’re currently taking and their exact dosages, Orr says. This is also a good time to mention any allergies you may have, adds Salak.
• Extended family medical history. “Talk to your family about any genetic disorders that may run in the family,” adds Salak. “Be prepared with your partner’s [or other parent’s] family history as well, because not everyone knows the details of that side’s family history.”
• Overall honesty. It's important to be honest when your provider asks you questions about habits like smoking, alcohol, or drug use, or if you’ve experienced any domestic violence, notes Salak. They can help you get the support you need to keep you and your growing baby safe.

Questions to Ask at Your First Prenatal Appointment

Take time before the appointment to gather your thoughts and concerns.

“Be ready with a list of questions written or typed in your phone so you don’t forget what you want to ask during the visit,” advises Orr.

Common questions to ask at the first prenatal visit include:

• How often do I need to come in for pregnancy-related visits?
• How many ultrasounds will I get during pregnancy?
• What types of prenatal screenings or tests do I need?
• Should I be making any changes to my diet?
• What prenatal vitamin do you recommend?
• Which exercises are safe for me during pregnancy?
• How much weight should I gain throughout the pregnancy?
• Where will I deliver the baby?
• What’s the best way to reach you with any questions or concerns?

And remember: No question you have is too silly, simple, or off the table. “We get all types of questions,” says Orr.

FAQ: If You Have a Partner, Should They Come to the First Prenatal Visit?

If you have a partner, they should be as involved in your prenatal care as possible. Attending the first prenatal visit is an important place to start. Consider involving the other parent even if you aren’t in a relationship.

“The first visit is usually more complex than most, with discussion about details of the pregnancy, the hospital or healthcare team, scheduling, billing, and expectations. This is also when the first ultrasound is usually done,” says Orr. “It helps to have both parents here for this, not just for support but also to help remember details, ask questions, take notes, and bring up concerns.”

You May Also Like:

• 6 Tips for Easier Prenatal Visits
• Your Guide to First-Trimester Tests and Screenings
• 8 Things to Consider When Choosing a Doctor for Your Pregnancy

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• Timing of first antenatal appointment

Evidence review H

NICE Guideline, No. 201

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Review question

When should the first antenatal booking appointment occur?

Introduction

The literature shows that outcomes for pregnant women and their babies are improved through effective antenatal care. The first antenatal care appointment involves an important assessment of needs and risks to determine whether a woman needs additional care and support during the pregnancy. However, the timing of when this appointment should occur has not yet been established. Therefore, this review aims to determine when the first antenatal booking appointment should occur.

Summary of the protocol

Please see Table 1 for a summary of the Population, Intervention, Comparison and Outcome (PICO) characteristics of this review.

Summary of the protocol (PICO table).

For further details see the review protocol in appendix A .

Methods and process

This evidence review was developed using the methods and process described in Developing NICE guidelines: the manual 2014 . Methods specific to this review question are described in the review protocol in appendix A .

Declarations of interest were recorded according to NICE’s conflicts of interest policy .

Clinical evidence

Included studies.

A systematic review of the clinical literature was conducted but no studies were identified which were applicable to this review question.

See the literature search strategy in appendix B and study selection flow chart in appendix C .

Excluded studies

Studies not included in this review with reasons for their exclusions are provided in appendix K .

Summary of clinical studies included in the evidence review

No studies were identified which were applicable to this review question (and so there are no evidence tables in Appendix D ). There were no studies identified therefore no meta-analysis was undertaken for this review (and so there are no forest plots in Appendix E ).

Quality assessment of clinical outcomes included in the evidence review

No studies were identified which were applicable to this review question.

Economic evidence

A systematic review of the economic literature was conducted but no economic studies were identified which were applicable to this review question.

Economic model

No economic modelling was undertaken for this review because the committee agreed that other topics were higher priorities for economic evaluation.

Evidence statements

Clinical evidence statements.

No evidence was identified which was applicable to this review question.

The committee’s discussion of the evidence

Interpreting the evidence, the outcomes that matter most.

The committee agreed that severe maternal morbidity, and any fetal death and fetal abnormalities were critical outcomes. Admission to hospital, uptake of antenatal services, women’s experience and satisfaction of care, and low birth weight were important outcomes.

The quality of the evidence

No evidence was identified for this review question.

Benefits and harms

Since there was no evidence identified for when the first antenatal booking appointment should occur, the committee did not change the recommendation from the 2008 NICE guideline on antenatal care for uncomplicated pregnancies (CG62) stating the booking appointment should occur by 10 weeks’ gestational age. The committee acknowledged that this also aligns with the early pregnancy screening programmes recommended by the UK National Screening Committee (NSC). The committee discussed that it is important to have appointments early enough that information about lifestyle factors such as smoking cessation can be shared early on in the pregnancy. Supporting women to stop smoking early in pregnancy can have significant benefits. The booking appointment is an opportunity to assess medical, obstetric and social risk factors which then enables early management and care planning according to the woman’s individual situation. Furthermore, the committee were aware of qualitative evidence (not included in this review) that suggests women desire more information earlier on in their pregnancy. Therefore, balancing the need for early contact with healthcare professionals against possible harms in terms of excess appointment and treatment burden for women the committee recommended offering a booking appointment by 10+0 weeks.

Based on their experience, the committee discussed that some women have their booking appointment much later, for example at 14 gestational weeks. The committee were aware of literature suggesting that women from ethnic minorities, or women from socially deprived areas were more likely to start their antenatal care later. This could be due to difficulty accessing antenatal care or limited knowledge of the antenatal care services. Based on the committee’s knowledge and experience starting antenatal care later may lead to worse outcomes because the early pregnancy screenings, risk assessments and information sharing has not been done. Therefore, the committee made a consensus recommendation that women who have been referred to or contact antenatal care later than 9+0 weeks should be offered a booking appointment within two weeks of first contact, if possible, so that their antenatal care can be started swiftly. The committee agreed that this may be difficult for services to organise but the recommendation gives a clear steer to what the aim should be.

The committee agreed that women who book late should be asked about the reasons for this so that potential underlying social, emotional, medical issues or vulnerabilities could be identified and addresses, as needed. This could also help the service providers in planning services to be accessible in a timely manner to all pregnant women.

The committee discussed that there was no new evidence to change from the existing recommended practice, so the committee made a research recommendation about the effectiveness of different models of antenatal care, including the ideal timing of the booking appointment. The details of the research recommendation can be found in appendix L in evidence review F Accessing antenatal care.

Cost effectiveness and resource use

A systematic review of the economic literature was conducted but no relevant studies were identified which were applicable to this review question.

There was no evidence to inform the timing of the booking appointment, therefore, the committee had no reason to change current practice. Whilst the vast majority of women present at or before 9 gestational weeks it was noted that a sizeable proportion of women present later. It would require some flexibility from clinics to schedule these groups an appointment within two weeks. However, as no additional appointments are required there should be no additional resource use.

Appendix A. Review protocols

Review protocol for review question: When should the first antenatal booking appointment occur? (PDF, 261K)

Appendix B. Literature search strategies

Literature search strategies for review question: When should the first antenatal booking appointment occur? (PDF, 247K)

Appendix C. Clinical evidence study selection

Clinical study selection for: When should the first antenatal booking appointment occur? (PDF, 110K)

Appendix D. Clinical evidence tables

Clinical evidence tables for review question: when should the first antenatal booking appointment occur, appendix e. forest plots, forest plots for review question: when should the first antenatal booking appointment occur, appendix f. grade tables, grade tables for review question: when should the first antenatal booking appointment occur, appendix g. economic evidence study selection, economic evidence study selection for review question: when should the first antenatal booking appointment occur.

A single economic search was undertaken for all topics included in the scope of this guideline. No economic studies were identified which were applicable to this review question. See supplementary material 2 for details.

Appendix H. Economic evidence tables

Economic evidence tables for review question: when should the first antenatal booking appointment occur.

No economic evidence was identified which was applicable to this review question.

Appendix I. Economic evidence profiles

Economic evidence profiles for review question: when should the first antenatal booking appointment occur, appendix j. economic analysis, economic evidence analysis for review question: when should the first antenatal booking appointment occur.

No economic analysis was conducted for this review question.

Appendix K. Excluded studies

Excluded clinical and economic studies for review question: when should the first antenatal booking appointment occur, clinical studies, table 3 excluded studies and reasons for their exclusion.

View in own window

Economic studies

Appendix l. research recommendations, research recommendations for review question: when should the first antenatal care appointment occur.

The committee made a research recommendation about the relating to this review question, about the effectiveness of different models of antenatal care. The details of the research recommendation can be found in appendix L in evidence review F Accessing antenatal care.

Evidence reviews underpinning recommendations 1.1.4 to 1.1.6

These evidence reviews were developed by the National Guideline Alliance, which is a part of the Royal College of Obstetricians and Gynaecologists

Disclaimer : The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.

Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.

NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the Welsh Government , Scottish Government , and Northern Ireland Executive . All NICE guidance is subject to regular review and may be updated or withdrawn.

• Cite this Page National Guideline Alliance (UK). Timing of first antenatal appointment: Antenatal care: Evidence review H. London: National Institute for Health and Care Excellence (NICE); 2021 Aug. (NICE Guideline, No. 201.)
• PDF version of this title (417K)

In this Page

Other titles in this collection.

• NICE Evidence Reviews Collection

Related NICE guidance and evidence

• NICE Guideline 201: Antenatal care

Supplemental NICE documents

• Supplement 1: Methods (PDF)
• Supplement 2: Health economics (PDF)

Similar articles in PubMed

• The first antenatal appointment: An exploratory study of the experiences of women with a diagnosis of mental illness. [Midwifery. 2015] The first antenatal appointment: An exploratory study of the experiences of women with a diagnosis of mental illness. Phillips L, Thomas D. Midwifery. 2015 Aug; 31(8):756-64. Epub 2015 Apr 16.
• Timing of first antenatal care attendance and associated factors among pregnant women in public health institutions of Axum town, Tigray, Ethiopia, 2017: a mixed design study. [BMC Pregnancy Childbirth. 2019] Timing of first antenatal care attendance and associated factors among pregnant women in public health institutions of Axum town, Tigray, Ethiopia, 2017: a mixed design study. Gebresilassie B, Belete T, Tilahun W, Berhane B, Gebresilassie S. BMC Pregnancy Childbirth. 2019 Sep 18; 19(1):340. Epub 2019 Sep 18.
• Late booking amongst African women in a London borough, England: implications for health promotion. [Health Promot Int. 2019] Late booking amongst African women in a London borough, England: implications for health promotion. Chinouya MJ, Madziva C. Health Promot Int. 2019 Feb 1; 34(1):123-132.
• Review Scientific basis for the content of routine antenatal care. I. Philosophy, recent studies, and power to eliminate or alleviate adverse maternal outcomes. [Acta Obstet Gynecol Scand. 1997] Review Scientific basis for the content of routine antenatal care. I. Philosophy, recent studies, and power to eliminate or alleviate adverse maternal outcomes. Villar J, Bergsjø P. Acta Obstet Gynecol Scand. 1997 Jan; 76(1):1-14.
• Review Improving antenatal engagement for Aboriginal women in Australia: A scoping review. [Midwifery. 2020] Review Improving antenatal engagement for Aboriginal women in Australia: A scoping review. Simpson N, Wepa D, Bria K. Midwifery. 2020 Dec; 91:102825. Epub 2020 Aug 31.

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Prenatal Visit Guidelines

Clinic A/P, adults , OB/GYN

The USPSTF strongly recommends screening for hepatitis B virus infection in pregnant women at their first prenatal visit.

Sources: – NIH.Gov, What tests might I need during pregnancy? – NIH.Gov, What happens during prenatal visits?

First and Second Trimester Screening

Prenatal Visit Schedule

Healthy pregnancies will go by the following schedule.

What will happen at each visit? At every visit, we will:

• Check weight and assess weight gain.
• Urinalysis (UA) – urine culture is done at the first visit, after that, a UA is done at every subsequent visit.
• Fundal Height
• FHT (Fetal heart tones) – Starting at 11-12 weeks.
• Edema – Check hands and feet for swelling.
• Education – Answer questions or address concerns. Have patients write questions down and bring.
• Pelvic/cervix exam: 1st visit and any other visits if the patient is having contractions, bleeding, discharge, leaking, or at term.

Palpate to determine the fetal position after 36 weeks but not before due to inaccuracies and discomfort. Follow the above table to do tests, such as blood tests or an ultrasound exam.

*Antenatal testing (NST / AFI) – Bi-weekly -Start at 36 weeks if:

• Advanced Maternal Age
• HTN / Pre-Eclampsia

Naegele’s rule Used to calculate EDD (Estimated Date of Delivery) or EDC (Estimated Date of Confinement) from the 1st day of the LMP. EDD = Add 7 to the date of the 1st day of LMP and  count back 3 months. I.e. EDD =( 7 + 1st day of LMP) – 3 months. Of course, when you get your answer, the due date will be in the next calendar year. I.e. add 1 year to the answer above.

Pregnancy wheels may have a five-day error. A lot of docs now use electronic devices to calculate EDC Use U/S dating if LMP unsure, unreliable, or abnormal. Some studies have suggested exclusive use of U/S date if it was done before 22 weeks gestation.

Fetal Development Fetal heart sound is first heard at 11-12 weeks by pocket Doppler and 16-19 weeks by Delee fetal stethoscope. Fundal height: Palpable at the pubic symphysis at 12 weeks, midway between symphysis and umbilicus at 16 weeks, umbilicus at 20 weeks.

Image from rphcm.allette.com.au

GnP(TPAL) e.g.  G6P3124. Gn: Total number of pregnancies T: Total number of term deliveries (≥37 weeks) P: Total number of preterm deliveries (20-37 weeks) A: Total number of abortions or miscarriages (<20 weeks) L: Total number of living children.

Resources: Thomas Zeng, MD, Obstetrics & Gynecology, Comprehensive Handbook, 2nd Edition. Pages First-Trimester or Second-Trimester Screening, or Both, for Down’s Syndrome print

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Under new budget, ny is the first state to mandate paid prenatal leave.

Apr 24, 2024 —

The new state budget includes the first-ever paid prenatal leave mandate in the country. Now, New Yorkers will get 20 hours of paid time off from work for healthcare appointments during pregnancy. SUNY Potsdam sociology professor Lauren Diamond-Brown, who studies reproduction, says the 20 hours of leave will help people access prenatal healthcare but won't be enough for those in rural places who have to travel long distances to their appointments. She spoke with Lucy Grindon. Their conversation has been lightly edited for clarity.

LAUREN DIAMOND-BROWN: To start off with, many pregnant people work. So even if we look at married couples — and there's plenty of people who are having children that are single — but if we just look at, say, married couples, [in] 65% of families, both parents are employed today. They also need to see their maternity care provider a lot. So when you look at a standard schedule of maternity care, you're looking at, I'd say, 10 to 15 visits throughout the course of the pregnancy, and that's if you're low risk. And most jobs don't have that many days of sick leave.

LUCY GRINDON: So, Governor Hochul initially proposed 40 hours of paid prenatal leave, but the new budget only has 20 hours, which is still more than any other state, but is that enough to cover just the basic prenatal doctors' appointments?

DIAMOND-BROWN: It depends on lots of factors, right? If you're low risk or high risk, how far you have to travel for those appointments, how long your appointments last... You know, if it took you an hour round-trip for travel, and you were spending an hour or an hour and a half in that visit, combining wait time with the office visit, and you're doing that [for] 10 to 15 visits, [that's] adding up to [around] 45 hours. So the 20 hours of paid sick leave isn't quite there. Now, maybe people have sick days from their job that they can combine with that. But again, they might have to use that for other reasons.

GRINDON: What you said about travel time brings me to my other question, which is: what are some of the biggest barriers to accessing prenatal care for people in the North Country?

DIAMOND-BROWN: Travel is a huge barrier. And that's gotten worse as we've seen a decline, you know, and hospitals that are no longer doing obstetrics care.

GRINDON: This is a sort of broad, general question, but who's not getting enough prenatal care in the North Country? And how does that affect them?

DIAMOND-BROWN: People who don't receive prenatal care are three to four times more likely to die from pregnancy-related complications... Who in the North Country? I don't have data off the top of my head to report that, but broadly speaking, it's probably people who are low-income, who don't have transportation. You know, I'm just beginning to recruit participants for a study on perinatal care in the North Country. I'm just starting to put out flyers around the community and advertise. I'm asking in this survey if people had prenatal care, and when they started it, and a lot of questions about the quality of that care, as well as questions around other unmet social needs, and if they're maternity care was asking them about things like food insecurity, intimate partner violence, childhood trauma, and then [whether] they were given resources. And then, hopefully, I'll have data to really directly answer that last question.

GRINDON: How can people participate in this?

DIAMOND-BROWN: It's at tiny url.com/NorthCountryBirth .

GRINDON: And what do you hope will be the use of that research? What do you hope will come from it?

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DIAMOND-BROWN: I'm hoping to use it for advocacy. You know, for instance, one of the few hospitals remaining up here, Canton-Potsdam Hospital, doesn't do VBACs — does not offer vaginal birth after cesarean, and that makes our C-section rate in the county really high. And we have other kinds of opportunities, I think, to improve our perinatal healthcare up here, as well as information on if people are connecting to the resources that exist or not. And [if not] where are those gaps? I want to use this data to directly improve our perinatal healthcare and support systems in the county. A few concerned citizens is not always persuasive to people in power, but I know that data speaks.

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Senate Passes 2024-25 Budget Addressing Critical Priorities for New Yorkers & Enacting Key Majority Proposals

April 20, 2024

• 2024-2025 Budget

File New York State Senate Majority Passes SFY 2024-25 Budget Addressing Critical Priorities for New Yorkers & Enacting Key Senate Ma

(Albany, NY) — The New York State Senate is proud to announce the successful passage and enactment of the New York State budget, a testament to the dedication and tireless efforts of the Senate Majority in delivering meaningful relief and progress for the people of New York. This comprehensive budget reflects the Senate Majority’s commitment to addressing the pressing needs of working individuals and families, safeguarding public education, and implementing a holistic approach to housing reform and affordability.

Senate Majority Leader Andrea Stewart-Cousins said, “The enactment of this budget represents a significant step forward in advancing the Senate Majority’s vision for a fairer and more prosperous New York. By prioritizing the needs of working families and investing in critical areas such as affordability, education, housing, environment and healthcare, the Senate Majority remains steadfast in its commitment to delivering tangible results and building a brighter future for all New Yorkers. I thank Governor Hochul, Speaker Heastie and all of my colleagues for their dedication and collaboration in delivering this vital budget. I am confident that this budget will make a meaningful difference in the lives of New Yorkers across the state.”

Senate Majority Deputy Leader Mike Gianaris said, “The State Senate worked hard to build a budget that serves our communities and delivers tangible benefits for New Yorkers. I am proud we achieved important policy priorities, including my proposals to provide additional funding for school security to combat increasing hate crimes, and improved reliability on public transit and express bus routes. The restoration of education aid was also a victory for students throughout the state. Though this budget reflects progress in tackling the decades-long housing crisis, that work remains unfinished and more remains to be done to further protect tenants and find comprehensive solutions to our affordability crisis.”

Finance Committee Chair Senator Liz Krueger said, “As is always the case, we did not get everything we wanted in this final budget, but it represents progress for the people of New York across many important areas. We have defended schools across the state against drastic cuts while laying the groundwork for long-term solutions on school funding and mayoral control; we have taken steps toward protecting all tenants in the state and supporting new affordable housing development; we have eased the tax burden and the child care burden for working families; we have given localities new tools to stop illegal cannabis shops; and we have successfully restored clean water and environmental funding. I thank Leader Stewart-Cousins and my colleagues for their dedication and collaboration, and I particularly thank all our staff for their tireless work throughout this extended budget process.”

Carrying on the proud legacy of being the “education conference,” the Senate Democratic Majority ensured that no cuts would be made to school funding, and that kids across the state would still receive the investments that they both need and deserve. Thanks to the Democratic Conference’s advocacy, this year’s budget will also include transformative investments in higher education to make continued learning more accessible These wins include: 

School Funding

• Rejecting the Executive’s proposal to eliminate Hold Harmless and also increasing Foundation Aid for the poorest 63 districts in the State. This is a Foundation Aid increase of $934 million, or 3.9 percent, over the current school year, which is an increase of $430 million, or 1.8 percent, over the Executive’s Foundation Aid proposal.
• A Comprehensive Study by The Rockefeller Institute and NYS Department of Education to develop a modernized school funding formula.
• $180 million to continue our historic commitment to providing universal school meals for thousands of New York children.
• Extending Mayoral Control for two years. 
• An additional $100 million for Universal Pre-K to allow school districts throughout the state to serve at least 90% of eligible four year olds.
• A study to work towards a pathway for expanded afterschool across New York State.

Higher Education

• The Enacted Budget increases SUNY Operating Aid by $60 million, Capital by $60 million and Community College Support by $6 million over the Executive’s proposal. 
• Increases CUNY Operating Aid by $40 million, Capital by $40 million and Community College Support by $4 million over the Executive’s proposal.
• The Senate also provided significant support for the SUNY Hospitals, providing operating assistance to cover their debt service and $150 million in capital. 
• Increasing the household income limit for dependent students from $80,000 to $125,000
• Increase the married, no children income ceiling from $40,000 to $60,000 (Net Taxable Income) 
• Increasing the max income limit from $10,000 to $30,000

Amidst the ongoing housing crisis in New York, the Senate Democratic Conference put forward and secured a transformative housing deal that targets both the affordability and supply of the current market through meaningful tenant and homeowner protections, along with real incentives to replenish the stock. This historic deal includes: 

Hard fought Senate Majority proposals in final package:

• Housing Opportunities for the Future - a new $150 million program to build affordable homes and rentals across New York State. 
• A new opt-in construction or commercial conversion tax exemption for affordable housing outside the City of New York.
• Authorization for municipalities to adopt a local tax exemption to make it easier for individuals to build accessory dwelling units.

Historic Tenant and Homeowner Protections: 

• A rent increase is presumptively unreasonable if it is greater than the annual change in CPI plus 5%, or 10%, whichever is lower. 
• A lease can only be terminated for one of the good causes lined out within the bill. 
• Takes effect immediately in New York City, while localities in the rest of the state may opt in and provides for flexibility in defining the small landlord and high-rent exemptions. 
• Sunsets in ten years. 
• The SFY 2024-25 Enacted Budget also establishes the crime of Deed Theft, to protect homeowners from having someone steal the title to their home through fraudulent or deceptive practices, often which are targeted towards elderly homeowners. This provision would allow for the prosecution of individuals who intentionally alter, falsify, forge, or misrepresent property documents unlawfully transfer ownership rights of real property.
• $140 million in capital funding for NYCHA, 
• $80 million to support Mitchell-Lamas and $75 million to support public housing authorities outside of New York City.
• $40 million in the Homeowner Protection Program (HOPP)
• A total of $10 million in Eviction Protection Funding in New York City and $40 million for outside New York City 

Needed New York City Specific Housing Advances:

• The Enacted Budget includes an extension of the 421a construction completion deadline until 2031 to ensure that vested projects that had started construction prior to the expiration of 421a are able to continue. 
• It also implements 485x, a new version of 421a, to build new multifamily buildings across New York City with stronger labor and wage standards and requires levels of affordability.  It also lifts the Floor Area Ratio (FAR) cap to allow for higher density buildings.
• This budget includes a pilot program to legalize basement and cellar apartments within identified geographic locations in the City of New York and to ensure those apartments are brought up to code to allow individuals to live in them safely. 
• And, it builds on previous conference wins to include a tax incentive program for Commercial Conversions with higher affordability requirements. 

In this year’s state budget, the Senate Democratic Conference continued its efforts to ensure New York remains affordable and opportunity-filled for working and middle class families to put down roots. This year, those measures included:

• A historic $350 million for a new supplemental tax credit for families eligible for the Empire State Child Tax Credit to provide direct support to working families, and continues to implement the lowest Middle-Class Tax rate in over 70 years, saving average New Yorkers millions of dollars. 
• Allowing children ages 0-6 to remain continuously enrolled in Medicaid or Child Health Plus without having to redetermine eligibility, to ensure children have stable and affordable health insurance for their first years. 
• Advances $50 million for customers enrolled in the NYSERDA EmPower+ Program to electrify their homes, providing subsidies to guarantee customers don’t spend more than 6% of their income on an electric bill.   
• Thanks to the Senate’s efforts, this budget will also include long overdue and critical Tier 6 reform by changing the final average salary calculation window for Tier 6 members from five to three years to help incentivize workforce retention. 
• The successful Senate inclusion of a 2.84% COLA for Human Services includes a 1.7% target salary increase for specific support, direct care, clinical, and non-executive administrative staff. This represents a notable increase over the Executive’s 1.5% COLA proposal.
• $50 million in transformative new funding for Anti-Poverty Efforts in Rochester, Syracuse and Buffalo. 

Access to Affordable Child Care: 

• The Enacted Budget includes $1.78 billion for the New York State Child Care Block Grant, an increase of $754.4 million, which will provide subsidies for 119,000 eligible children. 
• It further includes $280 million in underutilized federal pandemic funds to continue the Workforce Retention Grant program and provide another round of bonus payments to employees at 14,000 programs statewide. 
• The Enacted Budget will also continue $6.25 million for the Child Care Facilitated Enrollment program in New York City and $5.6 million to the rest of the state. This program is designed to help qualifying working parents get access to child care in New York City.  

In ongoing efforts to bolster New York’s economy from the ground up, New York State Democrats are continuing to invest in small businesses and development at all levels of the economy. This year’s state budget includes:

• Empire AI, a pioneering consortium to develop and inaugurate a cutting-edge artificial intelligence computing center in Buffalo, with statewide partners to ensure New York’s leadership in the burgeoning AI space. 
• It will create a personal income and corporate franchise tax credit for certain qualifying, independently owned print media or broadcasting entities, including those that have experienced workforce or circulation decline in the last five years.  
• It places a total cap on the credit per entity of $300,000, and an annual cap of $30 million. It sets aside $4 million to provide a $5,000 credit for the hiring of new employees, and $26 million set aside for the retention of current staff. Half of the funds will be set aside specifically for those with 100 or fewer employees.
• This budget adds $365,000 over the Executive proposal in additional funding for the Minority and Women-Owned Business Development lending program, for a total of $1 million.
• It also increases the grant amounts for Entrepreneurial Assistance Centers from $175,000 to $250,000 to support small businesses and MWBEs across the state and help establish EACs in unserved areas. 
• This budget successfully enacts the Retail Security Tax Credit, which helps small businesses make the investments needed to keep employees safe.
• The Senate Majority successfully added its investment of $1 million for beginning farmers, along with $1 million for socially and economically disadvantaged farmers.
• Language to lower the medical cannabis tax rate from 7% to 3.15%  and direct revenue to counties in order to keep them whole. 
• $100,000 for the Cannabis Farmers Alliance, and $50,000 for the Cannabis Association of New York.
• Increased enforcement powers for the Office of Cannabis Management (OCM) to enable cities and counties to crack down on illegal cannabis shops.

In a continued effort to support the wellbeing of all New Yorker’s at every stage of life, the Senate Majority fought to bolster health care resources and continue investing in mental health services for everyone throughout the state. The SFY 2024-25 budget includes:

• $7.5 billion invested in New York’s health care system through modifications to the state's 1115 Medicaid Waiver to be used for promoting health equity, diminishing health disparities, and enhancing access to primary and behavioral health care.
• $800 million in support for distressed and safety-net hospitals.
• Continuing to increase the minimum wage for home care workers.
• Establishing minimum collection policies for medical debt, increasing eligibility for hospital financial assistance, a uniform financial assistance application for all hospitals, prohibiting hospitals from using immigration status as a criterion for financial assistance eligibility, requiring reporting on users of financial assistance, and clarifying that the notice requirements on medical credit cards apply to hospitals as well as other health care providers. 
• Eliminating cost-sharing for insulin in commercial insurance for thousands of New Yorkers.
• Requiring commercial insurance to reimburse outpatient behavioral and substance use disorder treatment services at no less than the Medicaid rate.  

Mental Health  

• Providing $55 million to establish 200 new inpatient psychiatric beds at State-run facilities.
• Investing $33 million to enhance mental health services targeting first responders and aiding individuals with mental illnesses involved in the criminal justice system.
• Allocating $19 million for mental health services for school-aged children.
• $75.8 million increase for Crisis Services, which includes improving public safety by addressing serious mental illness, and providing critical care to young people.
• $8 million increase to the Judiciary to support Mental Health Court operations. 
• Extending the Mental Health Support and Workforce Reinvestment Program for an additional three years, allowing Office of Mental Health to reinvest savings from the closure of State-operated inpatient facilities for workforce development activities and community mental health services

As New York continues to be a beacon for the nation amidst ongoing attacks on reproductive rights, the Senate Democrats used this year’s State Budget to advance greater protections and resources for those who utilize these services, ensuring that they remain available to all who need them. This includes:

• Passing First in the Nation Paid Prenatal Leave, providing 20 hours of paid sick time for pregnant employees to use for their prenatal care visits.
• Codifying the Reproductive Freedom and Equity Grant Program to provide funding for abortion providers and non-profit entities to support increased access to abortion.
• Enacting the Community Doula Expansion Grant Program to provide funding to community-based organizations for recruitment and retention and startup and administrative costs to increase the number of community doulas.
• Allowing the Health Commissioner to issue a statewide, non-patient specific order to provide doula services for any pregnant, birthing, or postpartum individual.
• Requiring Paid Breaks for Breast Milk Expression in the Workplace for 30 minutes.

The New York Senate Democrats have always understood that a brighter future starts with investments into our youth. Through this advocacy, the SFY 2024-25 Budget includes vital funding for youth programming and intervention services, with:

• $103.2 million for After School Programs, an increase of over $20 million from last year’s budget 
• $10 million for the Youth Sports Initiative. 
• $1.5 million in additional funding for the Youth Development Program, for a total of $15.6 million.
• $1 million in additional funding for the Runaway and Homeless Youth Act program, for a total of $8.1 million.
• $2 million in additional funding for Child Advocacy Centers, for a total of $7.2 million.

The SFY 2024-25 Enacted Budget continues the Senate Democratic Majority’s commitment to meeting New York’s climate goals by forging ahead on key investments and advancing modern policy to address the needs of the moment so we can not only stop, but also reverse the effects of climate change. This includes:

• Adding $250 million over the Executive proposal for the Clean Water Infrastructure Act for a total of  $500 million.
• Successfully reversing cuts to the Environmental Protection Fund for an investment of  $400 million to support climate priorities across New York State.
• Expediting the siting and construction of electrical transmission and commercial energy storage through the RAPID Act, with the addition of Senate Majority proposals to preserve prime agricultural land, incorporate greater community input in the siting process, and improve labor standards. 
• $300 million in Capital for enhancing and improving parks statewide and $150 million for the New York Statewide Investment in More Swimming (NYSWIMS) program to improve pools and build new ones in communities across the State. 

The New York State Senate Majority is building on record investments to infrastructure and local municipalities by restoring roads funding and putting more money into local government. This includes: 

• $50 million increase in AIM funding for local governments, the first increase in AIM in over a decade for a total of $765.2 million.
• The Senate’s successful inclusion of Sammy’s Law, which will authorize citywide speed limits to be reduced at DOT’s discretion, upon authorization from the New York City Council, allowing for the speed limits to be changed from 25 mph to 20 mph, and to lower special traffic-calming zones from 15 mph to 10 mph. 
• $2.5 million added by the Senate Democrats to establish and support the Dr. John L. Flateau Voting Rights and Elections Database of New York to assist in efforts to enforce the John R. Lewis Voting Rights Act of New York, increasing both accountability and transparency in New York’s elections system, and $5 million in assistance for Local Boards of Elections.
• $10 million in additional funds for Upstate STOA funding, for a total of $333.2 million.
• $4.2 billion for the MTA, an increase of $140 million or 3.4 percent from SFY 2023-24. 
• $551 million for non-MTA downstate systems, a 5.4 percent increase in funding. 
• $60 million in additional funding for CHIPS, for a total of $598 million.
• $40 million in additional funding for State Touring Routes, for a total of $140 million.
• $200 million per year for BRIDGE NY
• $150 million per year for PAVE NY
• $200 million for Pave our Potholes
• $100 million for Extreme Winter Recovery

The SFY 2024-25 Enacted Budget puts meaningful resources into public safety and the protection of all New Yorkers, of all backgrounds. This year’s funding builds on previous Senate Majority efforts by: 

• Expanding the range of offenses that can be prosecuted as hate crimes.
• Investing an additional $35 million in the Securing Communities Against Hate Grant to safeguard houses of worship, religious schools, and other vulnerable locations.
• Allocating $347 million to continue efforts to reduce and prevent gun violence in New York.
• Providing $35.7 million to combat and prosecute domestic violence crimes.
• Investing $7.1 million to provide more intensive supervision for individuals on parole through the Supervision Against Violent Engagement (SAVE) program
• Expanding transitional housing and college programming across all state prisons.
• $1 million for transportation for visitors to and from State Correctional Facilities.
• Implementing measures to combat toll evasion on roads and fare evasion on subways, commuter rails, and buses, including cracking down on vanish plates and fraudulent paper plates. 
• Creates a Class E felony for assaulting a retail worker. 
• Allowing for aggregation of retail theft crimes to make it easier to prosecute repeat offenders. 
• This budget creates a new Class A misdemeanor, Aggravated Harassment in the Second Degree, which would make it a crime for an individual to intentionally subject a transit worker to unlawful physical contact.
• Protecting against Sexually explicit Artificial Intelligence- expands the existing statutory right to privacy, which says that it is unlawful to use a person’s name, portrait, or picture for commercial advertising without consent, by adding “likeness and voice” to the list of protected characteristics. 
• Combatting the use of Deep fakes in Elections- the legislation requires distributors or publishers of “materially deceptive” political communications to disclose the use of digitization. It also gives candidates a private right of action to seek injunctive relief and court and attorneys’ fees.
• The Senate fought to include $30 million for AAPI Equity Coalition priorities for crisis intervention initiatives and community-based programs to combat bias crimes.
• The Senate fought to enact the Limousine Passenger Safety Task Force’s recommendations, including increasing the minimum fine for operating a stretch limousine that has been suspended with an out-of-service defect, requiring stretch limos to be equipped with a window break tool as well as a fire extinguisher, equipping stretch limos with anti-intrusion and roll-over protections, improving safety data reporting and requiring a pre-trip safety briefing for limo passengers.

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Ukraine uses long-range ATACMS against Russia for the first time

The U.S. provided Ukraine with powerful long-range ballistic missiles for the first time earlier this month, and its military has already used them twice in the last week against Russian forces, according to three U.S. officials. 

The first strike was about 100 miles inside Crimea’s border on the morning of April 17, targeting a Russian military airfield, according to the officials. The Ukrainian military used the U.S.-provided Army Tactical Missile System, known as ATACMS, for the second time Tuesday night, targeting Russian forces east of the southeastern Ukrainian town of Berdyansk in Zaporizhzhia Oblast, officials said.

The Biden administration has not previously acknowledged sending ATACMS to Ukraine, but a National Security Council spokesperson confirmed that the U.S. has provided them. They were part of the $300 million military aid package unveiled March 12.

The NSC spokesperson said the administration did not reveal at the time that it was sending Ukraine the long-range missiles for operational security reasons. President Joe Biden directed his national security team to send the ATACMS to Ukraine secretly, the spokesperson said. 

The powerful missiles have a range up to 300 kilometers (about 187 miles) and allow Ukraine to strike the Russian military throughout Crimea and in occupied parts of eastern Ukraine that had been difficult to reach. The U.S.-provided ATACMS included both warheads with cluster munitions and with unitary blast fragmentation. 

The revelation that Ukraine has used the long-range ATACMS came as Biden signed into law a foreign aid package providing billions of dollars in weapons and support to Ukraine, Israel and Taiwan. The measure, which will provide about $61 billion for Ukraine, was hung up for months due to opposition in the Republican-led House.

The Biden administration was already preparing a military aid package for Ukraine worth more than $1 billion, according to two U.S. officials familiar with the planning. It will include a range of equipment that the U.S. has already provided Ukraine, including ammunition, stinger missiles, artillery rounds, infantry fighting vehicles and other military equipment, the officials said.

NBC News was first to report in February that the Biden administration was planning to provide ATACMS to Ukraine. 

Late last year, the U.S. began to supply Ukraine with the missiles, but until now they had limited the shipments to older medium-range models amid concerns that taking the longer-range ones from U.S. stockpiles could endanger military readiness. In early February, the U.S. Army presented a plan to buy new ATACMS directly from industry and send ones in storage to Ukraine, and the Biden administration approved. 

The White House also concealed the decision to send the medium-range ATACMS in 2023, acknowledging it only after Ukraine used them in combat. Administration officials also cited operational security as the reason for its secrecy.

The Biden administration had resisted sending the long-range missiles over the past two years because officials worried Ukraine would use them to strike inside Crimea or Russia and prompt Russian President Vladimir Putin to escalate the conflict. White House and Pentagon officials have expressed similar concerns about other sophisticated weapons systems but have repeatedly decided to provide them to Ukraine.

But after multiple warnings to Russia not to use long-range weapons inside Ukraine and to stop attacking Ukrainian energy grids went unheeded, the White House decided to give Ukraine the same capabilities.

An NSC spokesperson said Biden directed his team to send the ATACMS after North Korea provided Russia with ballistic missiles that have now been used in Ukraine and after Russia has repeatedly attacked civilian infrastructure inside Ukraine.

The U.S. imposed limitations on the use of the long-range systems, including that they cannot be used to strike inside Russia and must be used within sovereign Ukrainian territory, which, according to the U.S. government, includes Crimea. 

Testifying before the House Appropriations Subcommittee on Defense last week, Defense Secretary Lloyd Austin warned that without funding for more weapons to Ukraine, Russia is gaining the upper hand. 

"We’re seeing the Ukrainians be challenged in terms of holding the line — they’re doing a very good job, a credible job — but in order to continue to do that, they’re going to need the right materials, the right munitions, the weapons to be able to do that," Austin said.

An NSC spokesperson said more military aid will provide a boost to Ukraine on the battlefield, but it cannot turn the tide of the war alone. Ukraine is running low on munitions and equipment, while Russia continues to launch waves of drones and missiles, the spokesperson said.

Speaking on NBC News’ “Meet the Press” on Sunday , Ukrainian President Volodymyr Zelenskyy said the new aid will give the country a chance at “victory” as it  defends itself  from Russia.

“I think this support will really strengthen the armed forces, I pray, and we will have a chance at victory if Ukraine really gets the weapons system, which we need so much, which thousands of soldiers need so much,” he said.

Courtney Kube is a correspondent covering national security and the military for the NBC News Investigative Unit.

Cubs visit Fenway Park for the first time since 2017: 'Awesome, historic'

Notes: lefty justin steele threw in an extended spring training game friday..

BOSTON, MASSACHUSETTS - APRIL 26: Dansby Swanson #7 of the Chicago Cubs celebrates with manager Craig Counsell after scoring a run against the Boston Red Sox during the second inning at Fenway Park on April 26, 2024 in Boston, Massachusetts.

Maddie Meyer/Getty

BOSTON – Cubs president of baseball operations Jed Hoyer pointed out to center field, where the Fenway Park wall comes to a point, and Pete Crow-Armstrong’ s gaze followed the gesture.

“That triangle is so unbelievably deep,” Hoyer explained later.

The decal on the wall indicates that it’s 420 feet. Wrigley Field, by comparison, is 400 feet to center field.

Crow-Armstrong was roaming Fenway’s unique center field for the first time in his major-league career Friday. Hoyer, a former longtime Red Sox executive, had watched more than enough games at the ballpark to pass on exactly how it plays.

The Cubs returned to Fenway on Friday for the first time since 2017. It wasn’t only rookies who were playing in the storied building for the first time.

“I’m excited to go on the field there,” second baseman Nico Hoerner said. “Obviously, you get there a little early, walk around, go out to the [Green] Monster. Still a fan of the game, obviously, so it’ll be really exciting.”

Hoerner was supposed to play in the Cape Cod League’s annual showcase at Fenway Park – where players from the college summer ball league take batting practice and go through a workout on the field – in 2017. But it was rained out, he said.

Left fielder Ian Happ had better luck with the weather when he was in the Cape Cod League. But Friday marked the first time he’d played a competitive game at the Red Sox’ park.

“I think it’s awesome, historic,” Happ said. “It just feels a lot like Wrigley when you walk through the concourse, and everything’s green. It’s cool.”

Fenway Park, which opened in 1912, is the oldest ballpark in MLB. Wrigley Field, which opened two years later, ranks No. 2. Both rise out of dense sections of their respective cities. And the city streets give them their unique dimensions.

The Cubs play a three-game set against the Red Sox this weekend. The Cubs entered the series with a 5-4 record at Fenway.

Offense filling in

Hoyer addressed reporters Friday for the first time since center fielder Cody Bellinger landed on the 10-day injured list with fractured ribs.

His injury, in the Cubs’ series opener against the Astros Monday, was a blow to an offense that was already without Seiya Suzuki , their hottest hitter to start the year. But the Cubs swept the three-game series against the Astros.

“What I really liked about our offense at the beginning of the season was it felt like the lineup was really long and we had some depth,” Hoyer said. “And so now we’re sort of pushing that depth.

“And having some of the young players come up and contribute is really valuable. And if they can have some success, I think that’ll carry us a long way throughout the season because we’re going to need their contributions throughout. I mean, Seiya and Cody’s injuries are not going to be the last injuries we’re going to face.”

Steele’s extended spring start

Left-hander Justin Steele (strained left hamstring) threw 47 pitches in 2 ⅓ innings Friday in extended spring training. He will remain in Arizona to continue his rehab, according to the team.

Rare visit by House speaker to campus escalates tension at Columbia

“Get off our campus!” one student yelled. “Go back to Louisiana, Mike!” someone shouted.

NEW YORK — House Speaker Mike Johnson and his Republican colleagues were met with boos, laughs and pro-Palestinian chants after parachuting into one center of the roiling protest movement against Israel’s war against Hamas: Columbia University in New York City.

Johnson and a group of GOP lawmakers landed on campus — where tensions are high between the university administration and students who have erected pro-Palestinian encampments — and demanded that Columbia’s president, Nemat “Minouche” Shafik, resign for failing to quickly dismantle the encampments and, in their view, for not doing enough to ensure that Jewish people on campus feel safe.

Around 4 p.m. Wednesday, the Louisiana Republican — who just shepherded through Congress a $26 billion aid package for Israel, including $9 billion in humanitarian help to Gaza and elsewhere — appeared on the steps of Columbia’s stately library, which looks out over the student encampments. Signs of a campus on edge were all over: A dozen New York police officers stood guard outside the school’s big black gates on Broadway. Bike racks strung with yellow police tape cordoned off some of the sidewalk.

“I am here today joining my colleagues and calling on President Shafik to resign if she could not immediately bring order to this chaos,” Johnson said. “As speaker of the House, I’m committed today that the Congress will not be silent as Jewish students are expected to run for their lives and stay home from their classes hiding in fear.”

A crowd of students, swelling as Johnson and his colleagues began speaking, intermittently laughed and yelled that they couldn’t hear the congressman or his colleagues. The students booed the speaker, chanted in support of Palestine, including “Free Palestine,” “Stop the genocide” and “ From the river to the sea ,” a phrase that some say constitutes antisemitic speech.

“Enjoy your free speech,” Johnson rejoined, sounding uncharacteristically irritated.

As Johnson wrapped up, the students renewed their boos and began to chant, “Mike, you suck!”

House Republicans have long accused elite colleges and universities of skewing left and pursuing a “woke” agenda that tramples on parental rights. But the antiwar outbursts on campuses across the country that began shortly after Hamas’s Oct. 7 attack on Israel — and the rise of antisemitism on college campuses, according to the Anti-Defamation League — are now oft-repeated targets of Republican criticism. GOP lawmakers are seeking to slash federal funding for universities and have hauled university officials to Capitol Hill to answer questions such as whether “calling for the genocide of Jews” would violate their schools’ code of conduct.

“If these campuses cannot get control of this problem, they do not deserve taxpayer dollars,” Johnson said. “We’ll continue to work on legislation to adjust this at the federal level. This Congress — and I genuinely believe there’s bipartisan agreement on this — will stand for what is good and what is right.”

House Democrats descended Monday onto Columbia’s campus to express outrage over antisemitic harassment of Jewish students on and around campus. They included Jewish Reps. Josh Gottheimer (N.J.), Dan Goldman (N.Y.), Jared Moskowitz (Fla.) and Kathy Manning (N.C.).

The lawmakers’ pleas were not as forceful as Republicans’, who left no room for distinction between those targeting Jewish students and those peacefully protesting the Israel-Gaza war . But the Democrats were adamant about the need to protect students with backgrounds like theirs.

“Imagine trying to study for finals at Columbia, while people outside the library are calling for your death,” Gottheimer said at a news conference following their walk through campus. “To the administrators at Columbia and beyond, here are our demands: Stop the double talk and start acting. Discipline harassers. Restore civility on this campus. Encourage peaceful, constructive, civil dialogue. Every student has a right to be safe on campus.”

Johnson’s remarks came after he met with Jewish students at Columbia University, shared a meal with the university’s Rabbi Yuda Drizin and briefly met with Shafik before the news conference with three New York House Republicans and House Education and the Workforce Chair Virginia Foxx (R-N.C.). Johnson said Republicans met with Shafik and other top officials and left the meeting believing that they had “not acted to restore order on the campus.”

Asked whether he believes the National Guard should be sent in to restore order on college campuses across the country, Johnson said, “If this is not contained quickly, and if these threats and intimidation are not stopped, there is an appropriate time for the National Guard.”

Johnson also said he would call President Biden to inform him about what he saw on campus and “demand that he take action. There is executive authority that would be appropriate.”

The speaker’s visit marks the first time the top representative in the U.S. House has visited a college campus amid ongoing protests that have led to tense exchanges between pro-Palestinian and Jewish students. More than 100 people on Columbia’s campus were recently arrested and charged with trespassing, with several students who took part in the protest facing suspension just weeks before year’s end. Shafik called on the New York Police Department, whose officers arrived in riot gear, to arrest protesters just one day after she and other Columbia leaders told Congress she would make changes aimed at ending the harassment of Jewish students. The school also announced it would start a hybrid learning model for the rest of the year.

Neither Johnson nor Congress has any power to force a university president’s resignation. White House press secretary Karine Jean Pierre on Wednesday declined to weigh in on whether Shafik should resign, telling reporters, “Columbia’s a private institution. We’ve been very consistent here about not commenting on personnel matters.”

House Republicans who visited Columbia with the speaker made clear they would follow through with punishing colleges and universities if the protests are not controlled.

“The inmates are running the asylum,” Foxx said. “The [Education and Workforce] committee will pursue every possible avenue to create a safe learning environment for Jewish students.”

Rep. Michael Lawler (R-N.Y.) was much more forceful in his rebuke of students, acknowledging that he too wants Palestinians to be free “from their oppressor, Hamas,” and characterized any students who support the terrorist organization as “an absolute abomination.”

“If you are a protester on this campus, and you are proud that you’ve been endorsed by Hamas, you are part of the problem,” fellow N.Y. Rep. Anthony D’Esposito (R) said.

House Republicans have been pummeling the heads of elite university institutions for months, using them as a punching bag to make a broader point about how out-of-touch elite institutions are with normal Americans. Johnson has previously invited Jewish students to meet with him in the Capitol, and he has often allowed them to tell their stories of being under attack at school during news conferences.

At a December hearing, the interrogation by House GOP Conference Chair Elise Stefanik (R-N.Y.) of Harvard President Claudine Gay over whether antisemitic remarks should be protected under free speech went viral.

The hearing led to a bipartisan call on Capitol Hill to denounce or demand the resignation of leaders at Harvard, the University of Pennsylvania and the Massachusetts Institute of Technology for their responses, which were deemed out of touch. Penn President Liz Magill and Gay both resigned amid public outcry.

The hearing launched further investigations by the committee and continual hearings to combat antisemitism on college campus, ending in Shafik’s Capitol Hill testimony last Wednesday.

The Israel-Gaza war is also contentious among House Democrats, with liberals clashing with some Jewish colleagues early on in the war. That prompted Democratic leadership to attempt to keep attacks from becoming personal. Over the weekend, 37 liberals voted against sending $14 billion in aid to Israel over concerns that humanitarian aid would not reach Gaza, joining 21 Republicans who did not support the measure over spending concerns.

It’s just as complicated on Columbia’s campus. Basil Rodriguez, 23, argued Wednesday that Johnson and any lawmaker who backed sending aid to Israel is responsible for the deaths of thousands of Palestinians.

“I would urge him to reckon with his own positionality in the United States government and how the U.S. has been sending weapons that are falling in Gaza,” said Rodriguez, who is participating in the student encampment on campus. “He is directly complicit in this genocide unless he is a vocal advocate for it to stop.”

For Jewish student Spencer Davis, 19, the situation at Columbia is more nuanced than many of its critics have portrayed.

A member of a joint program between the Jewish Theological Seminary and Columbia, he was in the crowd watching Johnson speak. He said he feels safe on campus but understands why others do not and that his roommate booked a last-minute flight home over safety concerns. Davis said people have thrown things at members of his Jewish fraternity.

Still, Davis said, he believes the protests have been largely peaceful and questioned the motivations of politicians such as Johnson who have decried the encampment and Columbia’s leadership. “I think that a lot of Republican congresspeople are using this opportunity to further their culture war against liberal institutions like Columbia,” Davis said. “I think it has less to do with protecting Jewish students and more to do with their agenda, and they’re using Jewish students as pawns.”

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2024 NFL Draft rumors: Bills receiving calls at No. 33 overall; five players teams may target in a trade up

Defense could go early when day 2 of the 2024 nfl draft begins.

After trading down from No. 28 overall to No. 32 overall, and then again from No. 32 overall to No. 33 overall, the Buffalo Bills now hold the rights to an important piece of real estate. As teams re-gather themselves following the first round of the 2024 NFL Draft and re-stack their boards, they will set course on plans for Day 2. NFL Media is reporting that the Bills have received calls from teams exploring the idea of moving up. 

Could Buffalo make their first pick of the event or will they trade down for a third time? Here are five players that could be targeted in a potential trade:

CB Cooper DeJean, Iowa

DeJean is still available because there are more questions about his ability to play cornerback than those taken before him at the position. DeJean is going to find a way onto the football field and he is going to fill his role at a high level. There comes a point in every draft when teams have to take good football players and hope that is works out. The point could be nearing with CBSSports.com's No. 25 overall prospect. 

A year ago, Pittsburgh stayed put at No. 33 overall and took a Big Ten cornerback: Penn State's Joey Porter Jr.

CB Kool-Aid McKinstry, Alabama

McKinstry sat and watched as his teammate, cornerback Terrion Arnold, was picked late in the first round, wondering when his time would come. Once viewed as a top-10 overall prospect in this draft class, McKinstry has fallen down the board after a less than stellar closing season. He is a great player and a team getting him at this stage of the draft will get a Day 1 starter at a premium position. He is CBSSports.com's No. 29 overall player .

DT Johnny Newton, Illinois

So you want to apply pressure from the shortest path to the quarterback? Newton is your guy. Texas' Byron Murphy II was the first and only defensive lineman taken in this draft but teams solely looking for pass rush help from that role may find Newton more suitable. No one would have blinked if he had been taken in the first round but now CBSSports.com's No. 26 overall prospect represents great value on Day 2.

WR Adonai Mitchell, Texas

Mitchell is a vision rather than a finished product. There is room for growth as a player, which is simultaneously terrifying and exciting for NFL teams . If he reaches his full potential, Mitchell can be an impactful X-receiver at the next level. At 6-foot-2, 205 pounds with nearly 33-inch arm length, CBSSports.com's No. 27 overall prospect ran the 40-yard dash in 4.34 seconds. It could be argued that is more impressive than what his teammate, the NFL Combine's fastest man Xavier Worthy, was able to accomplish. 

OT Kingsley Suamataia, BYU

As the driver of the Suamataia bandwagon, I had to pull over to type this section. When the dust settled, there were nine offensive linemen taken on the first night of the NFL Draft. Yet teams like the Patriots and Commanders still have a desperate need to find contributors at tackle. Supply may be dwindling, but demand certainly is not. Anyone familiar with the law of economics knows that creates a sellers market and, as noted in the intro, Buffalo is holding a valuable piece of real estate. 

Coverage of Day 2 of the 2024 NFL Draft begins at 7 p.m. ET. Fans can follow along in our liveblog for up the minute news and reaction. 

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2024 NFL second-round mock draft: Bills address the one big need

The Bills are sitting (for real this time) on the 33rd pick, the first of the second round, and FanNation Draft has them grabbing the best player, for them, available.

• Author: Neal Coolong

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The Buffalo Bills actively did everything they could to get out of the first round of the 2024 NFL draft. Trades down with Kansas City and Carolina netted them the 33rd overall pick, the first of the second round and the kickoff pick of day 2. And FanNation Draft's Tyler Forness sees them putting it to good use, selecting Texas wide receiver Adonai Mitchell.

Good size (6-2, 205 pounds), excellent speed (4.33 40), Mitchell fits the bill of exactly what the Bills need, weighing in the decision to part ways with Stefon Diggs in March.

The argument can easily be made Mitchell was worth either of the two first-round picks the Bills had, and traded, Thursday, and both picks landed their respective teams other wide receivers -- Xavier Worthy was taken by the Chiefs at 28 and Xavier Legette was selected by Carolina at 32. The 49ers took Florida's Ricky Pearsall at 31 for good measure.

It seems like Mitchell would be the odds-on favorite for 33, and the Bills can and should feel pretty good about adding more picks along with adding Mitchell.

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