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Pregnancy

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Pregnancy is an exciting and stressful time in a woman's life. Below is our clinic's pregnancy handout with some information about what to expect and evidence based resources to help ease some stress. Contact your healthcare provider if you would like to discuss any of these topics and resources further.

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Our doctors looking forward to providing your perinatal care until you transition to the care of a midwife or obstetrician.  Delivery options in our area include:

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  • Smiths Falls Hospital

  • Almonte General Hospital

  • Brockville General Hospital

  • Queensway Carleton Hospital

  • The Ottawa Hospital (Civic or General Campus)

  • Kingston Health Sciences Centre

  • Midwifery (several locations)

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Here’s what you can expect in terms of appointment and recommended investigations/interventions (in keeping with current Society of Obstetricians and Gynecologists of Canada Guidelines).

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1. Positive pregnancy test – please call to book an appointment when you have a positive home pregnancy test. Let reception know the first day of your last menstrual period (LMP) as this helps us estimate your dates and arrange timely follow up. If not already doing so, please start taking a prenatal vitamin.

 

2. Initial visit – we will ask you some basic questions about your LMP, feelings about your pregnancy and arrange a first trimester dating ultrasound (done around 7 weeks) to establish your official due date. We will also request routine investigations with blood work and urine studies. These include blood counts and type, public health immunity tests, STI screening, urine culture. Other specific tests may be recommended based on your individual history.

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  • Genetic screening – usually discussed at your initial visit or first prenatal visit depending on your estimated due date. Options in Ontario include:

    • Enhanced first trimester screen (eFTS) – OHIP-funded test that includes nuchal translucency ultrasound and blood work (must be completed on the same day) between 11+2 and 13+3 weeks.

    • NIPT (Harmony or Panorama) – private pay ($200-700, OHIP-funded for women > 40 yo, twin/multiple pregnancies and specific high-risk circumstances).

    • Maternal Serum Screen (MSS) or Second Trimester Screen (STS) – OHIP-funded test which includes blood work done between 14+0 to 20+6 weeks.

    • For more information about testing options, please visit:

https://www.bornontario.ca/en/pso/prenatal-screening-options/prenatal-screening-options.aspx

https://www.bornontario.ca/en/pso/resources/Pamphlet/Prenatal_Genetic_Screening_Pamphlet_ONLINE_EN_20231219.pdf

 

3. First prenatal visit – we will ask more detailed questions about your past medical history, obstetrical history, medications, etc. in order to start your Ontario Perinatal Records forms (standardized forms used by family physicians, midwives, obstetricians to track your health and progress through pregnancy). We will also discuss healthy pregnancy habits and what to expect. A physical exam will also be done (which may include pelvic exam for pap smear if due). We begin listening to fetal heart rate around 12 weeks in our office.

 

4. Follow up prenatal visits (every 4 weeks until 30 weeks or transfer of care to your delivery provider) – blood pressure and fetal heart rate will be checked each visit. After 20 weeks, we will also measure your uterus (symphysis fundal height).

 

Recommended Investigations and Interventions

 

  1. First Trimester:

    • Dating (T1) ultrasound and routine blood work

    • Genetic screening (eFTS or NIPT) and nuchal translucency ultrasound (around 12 weeks)

  2. Second Trimester

    • Anatomy/morphology ultrasound (18-22 weeks)

    • Repeat blood work between 24-28 weeks including gestational diabetes screening and repeat blood counts/antibody testing

  3. Third Trimester

    • If you have a negative blood type (Rh negative) – Rhogam/Winrho injection is recommended at 28 weeks to protect future pregnancies from something called “alloimmunization”.

    • Growth/Biophysical Profile Ultrasound(s) – this may be arranged by your delivery provider depending on your pregnancy journey.

    • Routine vaginal/rectal swab around 35-36 weeks to test for Group B Streptococcus (GBS)

  4. Vaccinations in Pregnancy

    1. Covid-19 and flu vaccination is recommended and safe in pregnancy in any trimester.

    2. Pertussis booster (TdAP) recommended between 27-32 weeks. This protects baby against whooping cough until they can receive their initial vaccination at 2 months. See www.pregnancy.sogc.org for more information.

    3. RSV (Abrysvo for pregnant person or Beyfortus for infant) – both products are safe and effective. Discuss further which is recommended based on your risk factors and due date.

    4. For additional details, please visit: https://www.ontariomidwives.ca/immunization​

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Postpartum care

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We are happy to accept your child into our practice and provide ongoing newborn care.

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  • If you are followed by an obstetrician, we will see your newborn within the first week of life. Please call the office when you are discharged, and we will book an initial appointment.

  • If you are followed by a midwife, they will typically follow you and your newborn until 6 weeks. Please book an initial appointment with us for well baby check and first vaccinations at 2 months. If an appointment if needed or desired earlier, please call our office to book.

  • Your postpartum follow up usually occurs at 6 weeks with your delivery provider (OB or midwife). We are happy to follow up with you if you’d prefer.

 

FAQs

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  1. I have pain, a headache and/or fever. Can I take any medication for this?

    • Yes, generally Tylenol (Acetaminophen) is considered safe in pregnancy. Avoid NSAIDs such as ibuprofen (Advil), naproxen (Aleve), etc.

  2. I have morning sickness (nausea and vomiting of pregnancy). What can I try to help?

    • Nausea and vomiting of pregnancy is common and treatable. It usually peaks in the first trimester and improves thereafter. Some safe, non-prescription strategies include having frequent small meals, avoiding trigger foods/smells, staying hydrated, eating ginger candies/chews or ginger gravol, vitamin B6, acupressure wrist bands. If these strategies are not helping, please discuss further with your doctor for some prescription options.

  3. I have spotting, abdominal pain and/or cramping. What should I do?

    • If you are less than 20 weeks pregnant, you should present to the emergency department for assessment. This will likely include blood work and an ultrasound (bedside and/or formal).

    • If you are over 20 weeks pregnant, you can call the labour & delivery triage number and/or present there for assessment.

 

Additional Resources

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Born Ontario: www.omama.com

Society of Obstetricians and Gynecologists of Canada: www.pregnancy.sogc.org

Prenatal Education: www.ontarioprenataleducation.ca

Ottawa Childbirth Education Association: www.ottawacea.com

Lanark Public Health Pregnancy and Parenting: 

Rourke Baby Record: https://www.rourkebabyrecord.ca/

Naitre et Grandir (Bilingual) : naitreetgrandir.com

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