Section 5 - Pregnancy

This section is dedicated to topics pertaining to pregnancy.  Below is an overview of the topics we will discuss at various stages of your pregnancy. 

Early pregnancy (20 weeks):  You will have attended an information session if you are new to midwifery care.  At your first two visits with us, we will perform a health history where we learn more detailed information about you.   Common tests performed at that time are:

  • Blood work: Routine blood work is a CBC (complete blood count), Group and Screen to determine your blood type, random glucose, and various Public Health Tests.  Public Health tests routinely performed are to rule out presence of syphilis and Hepatitis B.  You will be offered HIV testing as well, as there is a risk of transmission to the baby through the birth process.  We also test to see if you are immune to Rubella (often gained through vaccination) and offer you immunity testing for Parovirus (Fifth’s disease) if you are unsure of your immunity.
  • Urinalysis: At the history visit we obtain a mid stream urine sample to test for bacteria which could then develop into a urinary tract infection (UTI).  Pregnant women are prone to UTI’s and the symptoms can mimic pregnancy, particularly in the early stages.  Left untreated it can lead to complications.  There is more information on UTI’s in the section titled  “Common Complications of Pregnancy”.   
  • Pap Smear: Pap smears are done every 3 years . If you are due for a Pap smear, we can perform this in early pregnancy or after the baby is born.
  • Sexually Transmitted Infection (STI) screening: We offer all women screening for STI’s in pregnancy, specifically Gonorrhea and Chlamydia, which can be done either by swabs (pelvic exam) or by testing your urine.  Untreated STI can lead to complications for the baby which is why screening is offered.
  • Dating ultrasound: Prior to coming to your first visit, you may have been offered a dating ultrasound by our clinic or your family physician.  This ultrasound is recommended if you are unsure of your last menstrual period or have irregular cycles.
  • Anatomy scan (18-20 weeks): This ultrasound is offered to perform an anatomy scan of your baby. For more information read the section on ultrasounds in pregnancy.
  • We will also start performing the following screening tests at each visit: Blood pressure monitoring, checking the growth of your uterus by palpating your abdomen and listening to the baby’s heart rate (after 12 weeks of pregnancy). 

 

Second Trimester (20-30 weeks):  You will continue to see us every 4-5 weeks.   We will start to use a tape measure to monitor the baby’s growth.  Other topics we will cover at these visits will include:

  • Glucose testing
  • Pain relief in labour
  • If your blood group is Rh Negative, you will be offered Rhogam in pregnancy
  • Place of birth: We will discuss in more detail choice of birthplace and your preferences. We ask that regardless of your place of birth, you register with our local hospital and/or the hospital closest to your house. These forms can be obtained from your midwives or our administrator.
  • Vaccination: New guidelines recommend all pregnant women have a Tdap booster.  This is recommended so the baby will be given passive immunity from the mother for the first two months of life to protect against pertussis (whooping cough).  Vaccination is arranged through your family doctor.   The flu vaccine is also safe for pregnant women to receive.

Third Trimester (30-36 weeks):  Your frequency of visits increases to every two weeks.  We will focus more of our visits on discussing plans for your birth and post partum period.  We also discuss topics that focus on your baby, like infant feeding and tests/treatments.  Other topics we will cover will be:

  • Group B Strep testing @ 35-37 weeks
  • Weight check at 36 weeks to have a baseline should you need an aesthetic in labour
  • For people planning home births, we book a home visit at 36 weeks. You will also obtain a birth kit from our office (free of charge) for the birth.

 

Third Trimester (37 weeks – birth):  You will come to our clinic weekly.  At this stage we enter the waiting game as we wait for your baby 

 

Some of the tests highlighted above are covered in more depth in this section or in other areas of this guide. Our association also posts resources for clients; visit aom.on.ca – click on Midwifery CareClient Clinical Resources.   Also feel free to borrow books from our lending library.  Happy reading!

Section 6 - Complications

GBS is a topic your midwife will discuss with you in the 3rd trimester.

 What is Group B Streptococcus (GBS)

 How to test for GBS

 Factors that increase the risk your baby will have a GBS infection and options that aim to reduce the chance of your baby becoming sick due to GBS in the first seven days of their life (early-onset GBS)

 What choices you have to make around the management of your pregnancy and labour in relation to your GBS results (if you test).

        AOM Clinical Practice Guidelines on GBS  

Midwives regularly measure the blood pressure of women who are pregnant or have recently given birth. Most women will have normal blood pressure during pregnancy.

About 10% of pregnant women will develop high blood pressure. Most women who have high blood pressure while pregnant or after giving birth will not experience any major problems, nor will their babies.

Hypertensive disorders of pregnancy

AOM Clinical Practice Guideline – Hypertensive Disorders

Low Dose ASA 

A vaginal birth after cesarean (also called VBAC) is a safe choice for the majority of women who have had a caesarean section (c-section) before. Midwives are experienced in caring for women who choose VBAC. If you have had a c-section before, your midwife will talk to you about your options for this pregnancy.

Deciding How To Give Birth After Caesarean Section

AOM Clinical Practice Guideline – VBAC  

SOGC Clinical Practice Guideline – VBAC    

Best Birth Clinic VBAC Information Booklet

 It is not unusual for pregnancies to last longer than 40 weeks. Anywhere between 37 and 42 weeks is considered a normal term pregnancy. It’s important to keep in mind that estimated due dates are just that – they’re best guesses based on the information available (such as the date of your last menstrual period or the results of an ultrasound). Only about 5 in 100 women give birth on their due date. 

Postdates pregnancy handout 

AOM Clinical Practice Guideline – Pregnancy beyond 41 weeks

Most women who are expecting a baby at age 40 or older are healthy, and have normal pregnancies and births. Your midwife will review with you the research on risks associated with maternal age, and discuss the option of extra monitoring of your pregnancy towards your due date and an earlier induction of labour. 

Pregnancy beyond 40 handout

Many mothers struggle with emotional changes during pregnancy and the transition to motherhood. Here are a few helpful resources. Please speak to your midwife if you are having new feelings of anxiety or depression, having negative thoughts, or feeling just unlike your self — we are here to listen and help. 

Here To Help 

Depression During Pregnancy Fact Sheet 

Depression During Pregnancy (Perinatal Depression) Fact Sheet about Treatment 

Mother Matters Online Support Group 

Blues and PPD Fact Sheet  

Canadian Mental Health Association

The ultrasound said my baby has CHOROID PLEXUS CYSTS

The presence of isolated choroid plexus cysts (CPCs) on a second trimester ultrasound is a common cause of anxiety, although it is almost always an innocent finding. Here are the answers to some commonly asked questions about CPCs.

What are choroid plexus cysts? The choroid plexus is the part of the brain that makes cerebrospinal fluid, the fluid that normally bathes and protects the brain and spinal column. In about 1 to 2 percent of normal babies — 1 out of 50 to 100 — a tiny bubble of fluid is pinched off as the choroid plexus forms. This appears as a cyst inside the choroid plexus at the time of ultrasound. A choroid plexus cyst can be likened to a blister and is not considered a brain abnormality.

What is going to happen to the cyst? In the vast majority of cases, the cyst resolves or disappears and has no consequences.

What is the concern? As mentioned, choroid plexus cysts are present in 1 to 2 percent of normal fetuses. However, in a very small percentage of fetuses with choroid plexus cysts, there is an associated chromosome disorder called trisomy 18. Trisomy 18 is rare. It is present in less than 1 in 3,000 newborns. Choroid plexus cysts are relatively common in normal fetuses. Most fetuses with a choroid plexus cyst are normal. Furthermore, many of the abnormalities associated with trisomy 18 can be detected by a careful ultrasound. In fact, fetuses with trisomy 18 almost always demonstrate abnormalities on ultrasound in addition to choroid plexus cysts, although some of these abnormalities can be quite subtle. If no additional abnormalities are detected by the ultrasound, the likelihood the fetus has trisomy 18 is very low. Only 10% of babies born with Trimsomy 18 had chroid plexus cysts as an isolated finding.

What are the odds that it is a sign of trisomy 18? The precise rate of risk is difficult to estimate and is somewhat controversial, but most doctors believe it is well under 1 percent. In other words, a fetus with choroid plexus cysts but an otherwise normal ultrasound has a better than 99 percent chance of not having trisomy 18.

Does the size of the cyst matter? Ordinarily, the size does not matter, although multiple, large cysts are slightly more worrisome.

BUT I’M REALLY SCARED. A small study performed in 2006 (2) showed that the majority of women who had an ultrasound report showing CPCs had a negative response to the news. In addition, many women had a difficult time believing that their baby was ‘OK’. “Weeks after (learning their baby had CPCs), 62% continued to believe that the CPC presented some danger to their baby”. If you are one of the 62%, you do have the option of another ultrasound later in the pregnancy to see if the CPCs have either dissolved/disappeared or have shrunk in size. When making this decision, keep in mind 2 things: 1) what will you do with the information? 2) what if the CPCs are still present and/or the same size as the first ultrasound? Will this increase or decrease your anxiety? In terms of ‘where to go from here’, it may be a difficult decision for you to make. Sometimes looking at the whole picture is helpful. For instance, was the baby otherwise ‘normal’; what is the overall suspected risk of the baby having a chromosomal abnormality (e.g. less than 1%); how will you feel after having another ultrasound etc.? Speak with your midwives further about the topic of choroid plexus cysts as needed to help you make an informed decision.

This information is copied from a website called UCFC Medical centre (link: http://www.ucsfhealth.org/education/choroid_plexus_cysts/) References: 1. Fetal Soft Marker CPG, SOGC , No 162, June 2005 2. E A Cristofalo, J A DiPietro, K A Costigan, P Nelson and J Crino. Women’s response to fetal choroid plexus cysts detected by prenatal ultrasound. Journal of Perinatology (2006) 26, 215–223. doi:10.1038/sj.jp.7211489; published online 23 March 2006

Section 7 - Labour and Birth

Section 8 - Postpartum

Section 9 - Newborn