By the end of the first trimester of pregnancy, a unborn fetus is only about 2½ inches long — about the size of passion fruit.

But the baby’s brain, heart, lungs and other organs have formed. Tiny fingernails are created. The fetus can open and close its mouth.

When Nineveh resident Allison Skinner found out she was pregnant, she knew how vital it was to make sure she started her prenatal care as soon as possible.

“It’s all about getting that baseline and finding out if potentially there is something wrong. You want to know about it first and early, so there’s a better chance of fixing it,” she said.

Skinner is one of a growing number of women who have been seeking out medical care early in their first trimester. The push for more prenatal care has become a focus of local health officials, from obstetricians stressing the importance of it to their patients to groups such as Partnership for a Healthier Johnson County making it a priority.

Johnson County ranks as one of the best in the state with women getting care starting in their first trimester. But nearly 30 percent of pregnant women still don’t seek out that vital treatment, meaning the county has ample room to improve.

According to information compiled by the Indiana Youth Institute, 72.5 percent of women pregnant in 2013 received first trimester care in Johnson County.

The rate was the 32nd best in the state, above the average of 67.4 percent. The county has hovered around the 70- percent mark since 2007.

At the same time, the county ranks well in other childhood health indicators, according to the institute. Johnson County had the 18th lowest rate of low birthweight babies in 2013, with 6.1 percent of the babies born.

The infant mortality rate the same year was 2.6 percent, the lowest it had been since 1997.

The first trimester is a vital time for fetuses, said Dr. Heather Andrews of Johnson County Women’s Care Group.

“There are a lot of medical conditions that pre-dispose you or increase your risks for complications later in pregnancy,” she said. “Many of those have interventions that we can get started on in the first trimester. We want to be able to identify those as soon as possible, so we can intervene as soon as possible.”

For example, if a woman’s cervix is shortened, it can put them at greater risk for pre-term delivery. Medications and monitoring can help prevent that.

Thyroid conditions, which can affect how the baby grows and how organs develop, can also be diagnosed early and treated more easily, Andrews said.

Early prenatal care is also important to establish a more exact picture on how far along in pregnancy you are, Andrews said. Ultrasounds are most accurate in that first trimester, when size and development in the fetus are more uniform.

That information is important to know as a woman gets closer to the end of pregnancy.

“If there are complications or a need to deliver early, we know precisely how old that pregnancy is so we can get the additional support for baby when it’s born,” Andrews said. “Babies born at 35 weeks need a whole lot more support when they’re born than even babies born at 37 weeks.”

Skinner discovered she was pregnant during her annual exam at Johnson County Women’s Care Group. Now 30 weeks along in her pregnancy, the 23-year-old has been seeing her doctor for more than six months.

When she had her daughter Jaelynn four years ago, she didn’t start prenatal care until later in the pregnancy. She wanted the peace of mind this time around of seeing her doctor as soon as possible.

“Just to make sure everything was going OK,” she said. “It was at my annual that I found out I was pregnant, so I could get going from the start.”

Skinner had an ultrasound to see the development of the baby, had blood work done to look for any abnormalities in her or the baby, and talked about how the next eight months of care would go.

“It made me feel more comfortable and more at-ease. It’s been great,” she said.

Erin Culbreth, a 37-year-old Franklin resident, felt that it was important to start prenatal care as soon as possible due to her age. Her mother had complications with Culbreth’s brother when he was born, and she wanted to be proactive in addressing any risks that might arise in her own pregnancy.

“I knew that going into it, as soon as I could get in, it would be better for the development of my own child, and my health,” Culbreth said.

She went in for her initial appointment when she was about five weeks pregnant. Now in her 29th week, she has felt the relief of having regular care for almost her entire pregnancy.

Doctors were able to catch a higher-than-normal blood pressure and provide medication to relieve it. High blood pressure during pregnancy can lead to premature birth and kidney conditions such as preeclampsia.

“It’s helped me feel better going through the entire process. Having doctors and nurses who are very knowledgeable right there, that I can contact if I have questions has been great,” Culbreth said.

Andrews recommends women think about early prenatal care even before they are pregnant. In discussions with her patients at their annual check-ups, she talks about the plans to either try to get pregnant in the coming year, or the ways they’re going to prevent that.

If they are trying to have a baby, Andrews puts them on prenatal vitamins just in case.

“Ideally, you’d start taking prenatal vitamins months before conception,” she said. “If you’re even considering getting pregnant, it’s not going to hurt you to be on prenatal vitamins. But there are a lot of benefits to be gained.”

At a glance

Pregnancy 101

What: Pregnancy experts from Franciscan St. Francis Health will answer questions about breastfeeding basics, healthy eating for mom, what to expect in the delivery room and navigating your pregnancy, among other topics.

When: 5:30 to 7 p.m. March 16 and April 20

Where: Sassafras Tea Room, 229 N. Madison Ave., Greenwood

Cost: Free

Registration and information:

Ryan Trares is a reporter for the Daily Journal. He can be reached at or 317-736-2727.