Prenatal Care
Congratulations! You are pregnant. Now comes the big wait for the next life event – the birth of a child. However, before we reach that point, there are quite a few hurdles (both technical and administrative) before we get there.
First off, although the majority of pregnancies proceed without trouble, up to 25% have a risk of miscarriage, most commonly in the first trimester. As such, if you have any signs of bleeding, cramping or discomfort; please do not hesitate to contact the office or proceed to the emergency department if there is significant pain or bleeding. There is nothing that we are aware of that can either SIGNIFICANTLY decrease or increase your miscarriage risk via normal activities. Most miscarriages are the result of a genetic defect in the fetus (75%) and is one way that nature prevents pregnancies that would not result in a healthy child.
Total Gestation time = 40 weeks
First Trimester (up to 12 weeks)
Since we start counting your dates from the first day of your last period; by the time you miss your period (and notice); you are generally counted as being 4-5 weeks pregnant. With the new screening methods available we are under a bit of time pressure to get most of the paperwork ordered in time so it is a bit busy.
Visit Schedule
~ 6 weeks = First diagnosed pregnancy. First visit in clinic to discuss
= optional blood tests / confirmation
= urine tests are accurate IF showing positive (not very useful in negative)
~ 8 weeks = Prenatal visit #1
= Prenatal physical and Antenatal form (paperwork) completion and bloodwork.
~ 12 weeks = Prenatal visit #2
= Screening for genetic / birth defects discussion
= generally the Integrated Prenatal Screen (IPS) is offerred; for certain populations (age, family history) an amniocentesis would be offered
(12-14 weeks) = IPS#1 ultrasound & bloodwork if prenatal testing selected
Second Trimester (14 to 28 weeks)
For most women, this trimester consists of simple visits to the doctor every 4 weeks or so. We should be able to detect a fetal heart rate in office starting approximately 16-18 weeks and we welcome your spouse to attend if they wish to listen. Around 19 weeks is when the “quickening” happens which is when you begin to notice fetal movements on your own.
Visit Schedule
~ 16 weeks = Prenatal visit # 3
= the last time dependent visit, here we order your next stage of IPS#2 which must be done between 15-17.5 weeks
= we also generally order the 2nd trimester ultrasound (not part of IPS)
(15-17.5 weeks) = IPS#2 bloodwork
(18-21 weeks) = 2nd trimester ultrasound
~ every 4 weeks = Prenatal Visits
= (18, 22, 26 weeks approximately)
Also, as soon as possible in the 2nd trimester, we would like to get you set up to see the obstetrician. For routine prenatal care in our region ; they specialists will take over at approximately 24-28 weeks (end of 2nd trimester).
Third Trimester (28+ weeks)
Visits will generally be taken over by the obstetrician. Expect to attend visits every 2 weeks until the last month when visits are on a weekly basis. It gets busy. Even busier when the baby arrives.
Who can deliver a baby?
Midwives = If you are interested in a midwife delivery, you must make the choice very early on and contact the midwife for availability. This is OHIP funded the patient must choose and contact the midwives themselves. All the prenatal care (other than diagnosis) should be done by the midwife. The great thing is that the midwife will probably be the one to deliver you and some even allow a home birth option. As long as you are comfortable with the concept of a non-physician doing the delivery, this is a good option for LOW RISK pregnancies only.
Specialist Obstetricians = In the region, obstetricians participate in a call group doing deliveries at the hospital. For the last part of the pregnancy (approximately 26 weeks and onwards); we will transfer your care to your obstetrician who will supervise your medical care for the third trimester. This is default option for the vast majority of patients and required for all HIGH RISK pregnancies.
You WILL be delivered in the hospital for this option.