Chapter 1
It’s Positive . . . Now What Do I Do?
“It sometimes happens, even in the best of families, that a baby is born. This is not necessarily cause for alarm. The important thing is to keep your wits about you and borrow some money.” —Elinor Goulding Smith
What’s in This Chapter
Are you really pregnant?
Calculating your due date
The birds and the bees
There’s probably one big question running through your mind right now: “I think I’m pregnant. Now what?”
For many of you (and trust us, we felt this way, too) seeing those two lines on the pregnancy test is quite a shock. So let’s take a deep breath and then read on.
Some pregnancies are strategically planned, others just . . . happen.
In an ideal world, you and your partner have a pre-conception visit (a visit that occurs prior to pregnancy) with your OB provider. The OB provider reviews your medical conditions, information about any previous pregnancy or gynecological issues, immunization history, list of medications you are taking, lifestyle issues that may be risky for an unborn baby and mom-to-be (such as drug use, alcohol use, smoking, environmental/work exposures), nutrition, exercise habits, and both partners’ family medical histories to assess for potential genetic disease risks.
Then the OB provider recommends that you start taking prenatal vitamins and change any poor lifestyle habits.
Wouldn’t it be nice if we all did this? Let’s get real. For many of us, pregnancy is a pleasant surprise, which happens without starting those prenatal vitamins or changing bad habits. Don’t panic. That’s why we are here—we will bring you up to speed.
This introductory chapter is a crash course in pregnancy before we discuss your life for the next forty weeks. Yes, some of this is pretty boring stuff (especially if you never liked science or health class). But it is helpful for you to understand what is going on with your body and your baby right from the start. Let’s get rolling.
Am I Really Pregnant?
This question will hit you when you either: a) miss your period; b) feel like you ate some bad takeout; or c) yell at your loved ones for no apparent reason. Then, like all of us, you will run out and buy one (or three) home pregnancy tests to confirm your suspicions.
If your test is clearly positive, congratulations! You can pass go and skip to the next section. But sometimes it’s not that clear-cut. Let’s talk about how those home pregnancy tests work.
Q. What does the pregnancy test actually test for?
The test looks for human chorionic gonadotropin (beta-hCG) in the urine. Beta-hCG is a hormone the body makes during pregnancy. It circulates through the body and then gets eliminated in the urine. In most normal pregnancies, the levels of beta-hCG increase by at least 50 percent every forty-eight hours until about ten weeks of pregnancy. So, by the time a woman misses her period, there is plenty of beta-hCG in her urine to make a test turn positive.
Your OB provider can also order a blood test that measures beta-hCG (obviously not something one does in your own bathroom).
Q. When is the most accurate time to do a home pregnancy test?
Anytime after a missed period. We know it’s hard to wait, especially if you have been trying and are eager to see if those two lines are there. Truthfully, many home pregnancy tests can detect beta-hCG a few days before a missed period, but doing the test too early could give you inaccurate results. In English: You’re pregnant, but the test doesn’t detect it yet. Besides being unnecessarily disappointed and wasting a few bucks, testing too early may lead you to resume habits that could be dangerous for a new pregnancy (like drinking alcohol).
Bottom Line: Be patient. Wait until you miss your period to do the test.
Q. What if the first home pregnancy test is negative but I really feel pregnant?
Early in pregnancy, some women feel the way they do just before they get their period. You may have tender breasts, cramps, moodiness, and cravings.
If you have these symptoms, miss your period, and your first pregnancy test is negative, you’ve got two options.
• Option 1: Wait a few days and take another urine pregnancy test at home.
• Option 2: See your OB provider and get a blood pregnancy test. Because the blood test looks at actual blood levels of beta-hCG, it detects this pregnancy hormone a few days sooner and confirms pregnancy earlier than a urine pregnancy test.
Q. What if there is only a faint line?
A faint line means that there is some beta-hCG in your urine.
You may get one of those “faintly positive” tests (where you have to squint your eyes and put the stick up to the sunlight to see the line) if you do a home pregnancy test a few days before a missed period or very close to the date of the missed period. Or you could have ovulated later than you thought, so you are not as far along as you anticipated. This is common in women who have menstrual cycles that are longer than twenty-eight days.
It’s common for the first few home pregnancy tests to be light (where the test result line is lighter than the control line) because the hormone levels are lower in the early stages of pregnancy. I say the “first few tests” because if you are like most women (and Dr. M includes herself here, as she took eight with her first pregnancy!), you will not take just one test. You will take ten before you even get to your first doctor’s visit! Some women test multiple brands to make sure that they all are positive. I’ve even had a patient make her husband pee on one to act as the control!
Regardless of which test kit(s) you use, it is important to follow the instructions correctly.
Reality Check
Read the test results within five to ten minutes. If you let the pregnancy test sit for an hour and then go back to read it (or pull it out of the trash can to check just one more time—it’s okay, I [Dr. M] did that, too), you may see a faint line that is actually a false positive. The faint line does not mean anything if the test has been sitting for an hour.
Q. What if the first one is faintly positive and the next one is negative?
The most likely reason is that you were pregnant, but you had an abnormal pregnancy. Many women have what doctors informally call a chemical pregnancy. A chemical pregnancy means your body made enough beta-hCG to produce a positive test but not a viable baby. You actually were pregnant, but there was a very early miscarriage that occurred before anything could even be detected by ultrasound. This is common. The good news: It doesn’t usually happen repeatedly. You don’t have to see your OB provider if this happens, but you should call the office and let them know.
What’s My Due Date?
Q. How do I figure out my due date?
A full-term pregnancy is about forty weeks or 280 days long. Docs start counting from the first day of your last menstrual period. Back in the good old days before ultrasounds and pregnancy tests, a birth date or due date was calculated by this equation:
1. Take the first day of your last menstrual period (LMP).
2. Subtract three months.
3. Add seven days.
That date is your estimated due date or estimated date of delivery (EDD). This is also sometimes referred to as the estimated date of confinement (EDC), which is an old Victorian term used when women really were confined for birth.
While this is an easy way to do it, it’s not perfect. It assumes that a woman has a twenty-eight-day menstrual cycle (which many of us don’t) and doesn’t consider leap years or months with fewer than thirty-one days.
If you and math haven’t gotten along since eighth grade algebra, you can use a due date calculator such as one found at uptodate.com/contents/calculator-estimated-date-of-delivery-edd-patient-education.
Your OB provider has something called a “pregnancy wheel” that is kind of a cheat sheet for us. We routinely whip one of these plastic wheels out of our white coats many times during the course of your pregnancy and intensely spin it around to calculate how far along you are. In fact, we are pretty incapacitated without one!
Nowadays, we calculate a patient’s due date using a combination of the first day of the last known menstrual period (LMP) and an ultrasound.
Don’t be alarmed if you can’t remember when your last period was or if you have irregular periods. Your OB provider can make a pretty good approximation after doing an exam and ultrasound. It may sound odd, but your OB provider will have a better idea about dates the earlier an ultrasound is performed.
Women who have conceived with assisted reproductive technology (like in vitro fertilization) have their due date calculated by their fertility specialist. That date is based on the date of the procedure, the stage of the embryo being implanted (for IVF), and early ultrasounds.
Bottom Line: It’s crucial to have accurate dates for a pregnancy because most tests must be done during a specified window of time during pregnancy.
Helpful Hint
To figure out when you need to make your first prenatal appointment, call your OB provider’s office and give them your LMP (the first day of your last menstrual period) and the date of your first positive pregnancy test. They will then know when to schedule the appointment.
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