Obstetrics

Please note: every pregnancy is unique and therefore may require a variety of visits as well as different tests. This prenatal calendar is meant to give parents an idea about some of the common things that will happen throughout the pregnancy. Additional information will be given at each prenatal visit specific for each mom and baby. If you have any questions, please do not hesitate to ask our health care team.

First prenatal appointment

– At your first visit, we will do a complete history and physical including height, weight and blood pressure. If you have not had a recent pap smear, this may be done at the first visit. We will arrange for any tests that you may need done in the first trimester including a dating ultrasound and blood work.

Weeks 9-14: First trimester screen

– The first trimester screen (FTS) is an option genetic screening test that involves both blood work and ultrasound to screen your pregnancy for three common genetic chromosomal conditions and early identifiable birth defects including Down syndrome (Trisomy 21), Trisomy 13 and Trisomy 18.

– Maternal blood testing should be performed between 9 -13+6 weeks and ultrasound performed between 11 – 13+6 weeks to measure the fetal nuchal translucency (NT).

– These tests are arranged through EFW in Calgary and your physician will provide you with the requisitions required to complete the testing.

– If the screening test is positive then additional testing can be offered in the form of a diagnostic amniocentesis which is no cost to the patient or non-invasive prenatal testing (NIPT) which is a blood test that requires patients to pay an out of pocket fee.

Week 9-14: Office visit

– After all your initial investigations are complete, we will see you in the clinic to listen to your baby’s heart rate for the first time and review your test results.

– An ultrasound to assess your baby’s complete anatomy will be booked for sometime between 18 and 20 weeks. This can be done in Canmore, but should you want to know the gender of your baby, the ultrasound needs to be booked in Calgary.

– You will have follow up appointments every four weeks. At each appointment we will do routine checks of your weight and blood pressure, as well as listen to your baby’s heart rate. These appointments are your opportunity to bring up any concerns you may have and ask any pertinent questions to the health of your pregnancy.

Week 20

– Your 18-20 week ultrasound will tell us the location of the placenta and check the overall health of your growing baby.

– We will now start measuring the height of your growing uterus (symphysis fundal height).

– Now is a good time to start thinking about prenatal classes (between weeks 24-36) with a partner or labour support person.

Week 24-28

– At this point your baby weighs about 1 pound and most moms are feeling fetal movements on most days.

– You will be tested for diabetes in pregnancy and have your blood work rechecked at this time. A Rhogam (WinRho) injection will be given to any mothers with Rh negative blood types.

Week 30

– Clinic appointments will now increase in frequency to every 2 weeks.

– You will receive a 30 week handout which will answer some common questions as you enter the 3rd trimester.

– There are a number of instances that may warrant the need for a repeat ultrasound in the 3rd trimester, which will be discussed with each woman individually. In the case of a normal and healthy pregnancy, no 3rd trimester ultrasound is required.

Week 32

– We will start to check the position of your baby and assure the baby is head down and discuss daily fetal movement counts.

– Some women start to experience Braxton Hicks contractions, which are benign tightenings of the uterus.

Week 36

– We will collect a vaginal swab to test for group B streptococcus (GBS), which is a common bacteria found in the vagina of 30% of women. It is not dangerous to women but can be harmful to the newborn baby should it become infected with this bacteria during delivery. If your GBS swab is positive, this means you will require antibiotics once your water breaks and/or when you start labouring. Remember to let your physician know if you are penicillin allergic.

– We will also perform a vaginal exam or ultrasound to assure your baby is head down in the pelvis.

– Once the results of your GBS swab has returned we will send a copy of your prenatal record to the hospital.

– You will now have appointments every 1 week until delivery.

Week 38-40

– We will offer membrane sweeping to help prepare the cervix for delivery and optimize the chance of spontaneous labour. Membrane sweeping may help reduce your likelihood of going over-due.

Week 41

– If you reach this point then you are officially over-due. We will start to discuss induction of labour in order to achieve delivery of your baby prior to 42 weeks gestation.

After Baby is Born

– We will see you and your baby within the first week of life to help support you with breastfeeding and/or bottle feeding. We will be monitoring your baby’s intake, output and jaundice.

– Most babies lose weight in the first week of life and should be back to birth weight by 14 days of age.

– Depending how feeding is going and well your baby is growing, we may decide to see you in weekly or bi-weekly follow up appointments.

– Both mom & baby will be seen for a 6 week check-up, where we will review appropriate milestones that baby should be achieving and complete a full exam for mom.

Position of the fetus

All babies need to be head down to deliver vaginally in Canmore.

If found to be in the wrong position an onsite ultrasound will confirm.

If a breech position is confirmed at 36 weeks then a version will be booked at the Foothills Hospital. Please read the link of interests, breech delivery in the pregnancy section. If this fails then a breech vaginal delivery is still possible in Calgary. An option is always an elective caesarian section performed by Dr Ian Macdonald.

State of the cervix

Your cervix is the neck of your womb. This is what is usually tight during your pregnancy and only starts to soften in the last month. Mothers who have delivered babies vaginally will have a slightly softer and slightly open cervix but with first-time mothers the cervix usually remains closed until near labour. You will be informed as to the state of your cervix giving you some indication about the timing  of delivery.

When your cervix is examined; 4 things are found.

1.  The station of the head i.e. how far down the head has come into the pelvis.
2. The length of the cervix.
3. How open is the cervix. This is called dilatation.
4. How soft and stretchy the cervix feels. The stretchier it is the easier it will open once effective contractions start.

At home in Labour

You will have direct contact with the doctors as soon as your labour begins so that we have a plan as your labour progresses. You will either be examined in the clinic or at the Canmore Hospital  and informed once active labour has begun. If you live in Banff or west of Banff then Dr Jane Fowke will personally see you either at home or in the Alpine Medical Clinic untill your labour is active and has to be followed further at the Canmore hospital.

At home stay relaxed, eat and drink. Listen to your body and be aware as things progress. If contractions feel more intense try either a  shower or bath if membranes have not broken. If your contractions settle down then you know that active labour has not yet begun.

Active Labour

Active labour is when your cervix has been stretched to 4-5 cms and there is no more length. Your contractions are now occurring every 2-3 minutes and lasting 60 seconds.  This is when your labour speeds up and labour is more imminent. Labour is a process that can only be successful if you are completely at peace with your body and feel totally relaxed in your surroundings.

What needs to happen to have a successful vaginal delivery?

1. Complete relaxation.
   Stay relaxed, go inside yourself and feel the power of the contractions. Pain is only felt if you have not fully come to terms with your labour and feel fear and try to control the process. A lot if women can go into an hypnotic state by being completly relaxed.
2. Contractions need to be strong, frequent and last about 60 seconds.
3. Perfect position of the babies head.
   If the babies head is trying to come out face up then it will be turned with you placed on all fours. This speeds up labour and improves your chance of a vaginal delivery. Many  caesarian sections are done for persistent face up deliveries because the diameter of the head is much larger

If progress in Labour is slow then we look at things that we can improve:

1. Unable to relax.
   An epidural may be needed to achieve this state.
2. Poor contractions can be determined by slow progress and minimal descent of the head felt on vaginal examination.
   An intravenous of syntocinin infusion.
3. Incorrect position.
   The baby is turned internally while you are on all 4’s. this is not painful and usually is an easy procedure. This unfortunately is not done by all  doctors thus increasing the chance of a Caesarian section.

A Caesarian section is a necessity if the baby is showing signs of getting into trouble or if progress stops despite the above corrections.

A vacuum delivery may be necessary if the baby needs help in coming through the vaginal canal. Vaginal tears can be minimized by slowly guiding your baby out of your vagina. 3rd/4th degree tears are very rare.

Warm cloths, oil to your liking and staying off your back are recommended.

Fetal Kick Chart
Anxiety BC for Mothers

HealthLink for Pregnancy
Health Canada Pregnancy
Mother Risk: Resources and Information on Depression and Pregnancy
Birth and Babies
Pelvic Floor Exercises
Health Parents Healthy Children
Hormonal Physiology of Childbearing
Healthy Eating Exercises and Weight Gain
Prenatal testing
Panorama Prenatal Screening
Umbilical cord blood collection.
The Cord Blood Centre- Cord Blood Banking
Collection & Storage of Breastmilk
Nausea and vomiting in pregnancy
Group B strep infection in pregnancy
Normal childbirth.
Vaginal birth after caesarian section
Working during pregnancy
Breech childbirth