1. First Trimester
An initial visit will be booked for around 10 weeks of pregnancy. This visit will be 1 hour long and will include:
- Overview of MIdwifery Care
- Completion of the prenatal record
- Personal medical and surgical history
- Medications and Allergy review
- Family medical history
- Ethnic and Hereditary Risk Factors
- Physical examination
- Blood Pressure
- Weight
- Fetal heart may not be heard during this visit
- Review of nutrition and exercise
- Requisitions for blood work, ultrasounds
- Completion of Midwifery Service Contract
- Booking of next appointment
Nausea and vomiting in pregnancy affects many pregnant women and can occur at any time of day. Nausea typically starts around 7 weeks as a result of the increase of beta-hCG (the pregnancy hormone)and can be worse when B vitamins are low. B vitamins are depleted with use of hormone based birth control. Lack of sleep can also contribute to nausea and vomiting in pregnancy. If you find that you have increasing nausea and vomiting, call your midwives.
Protein, complex carbohydrates and water can help to decrease nausea. Eating simple carbohydrates, including crackers, can actually make your nausea and vomiting worse. Please check out the linked resources for more information, and tips to help decrease nausea and vomiting in pregnancy.
Patient Education: Nausea and Vomiting in Pregnancy
Good Nutrition Book by Lily Nichols Real Food for Pregnancy
Quick Tips to Help
- Have some nuts or protein snack beside your bed and eat as soon as you wake before getting out of bed, then go and make breakfast
- Stay hydrated (if it’s hard to get water down then try infusing it with some fruit, filtered water usually tastes better when pregnant as well)
- Eat every 2-3 hours with a source of protein in each snack/ meal
- Have your spouse cook the meat and then cut it up to dip in a sauce if you get nauseated. Many people can eat meat that has been cooked and cooled because the texture is different and the smell is not as strong.
- Get a good prenatal vitamin (Thorne prenatals)
- If your prenatal vitamins cause nausea, please call your midwives – we can help!
- Platinum prenatal anti nausea supplements help many pregnant people
- Take a Vitamin B Complex in the morning
If your symptoms are preventing you from participating in your daily activities, please call your midwives.
Families face many choices in pregnancy, including options for prenatal ultrasound and genetic screening. The decision to proceed with any prenatal ultrasounds and genetic testing is personal and each family is encouraged to review all options so that they can make an informed choice about the options they wish to pursue.
The standard of care for prenatal ultrasounds and genetic screening options varies across the province depending on services available in the area. Currently, in the Calgary Zone, each client is offered a dating ultrasound, combined first trimester screening or non-invasive prenatal screening and a routine detailed or anatomy ultrasound.
Due to the many and varied prenatal testing options and the time sensitive nature of some of the tests, we have provided links below for you to determine which, if any, options are right for you. These options will be discussed further at your initial visit.
This ultrasound is frequently completed around 7.5-10 weeks of pregnancy to determine/confirm how many weeks pregnant you are. This ultrasound is often required if you would like to have the Combined First Trimester Screen.
During this ultrasound, the crown-rump length (CRL) is measured to determine your expected date of delivery (EDD). This date is accurate to within 3-5 days which is the same as an EDD determined from your last normal menstrual period (LNMP) if you have 28 day menstrual cycles.
First trimester screening is a genetic screening test that must be completed between 11 weeks and 13weeks 6 days of pregnancy. The combined screening involves a blood sample and the ultrasound. Please click on the link below for more information on these tests
Options for non-invasive prenatal screening are currently not covered by Alberta Health.
This testing requires collection of a blood sample. There are currently two options for testing:
Invitae Non-invasive Prenatal Screening This screening is completed in the United States with results available in approximately 14 days. Blood can be collected at or after 10 weeks of pregnancy.
Harmony Non-Invasive Prenatal Screening This screening is completed in Canada with results available in approximately 14 days. Blood can be collected at or after 10 weeks of pregnancy.
Midwives can complete requisitions to have this screening completed and will have a kit available for you to take to the lab with your other blood collection requisitions provided at your initial visit.
If any of the genetic screening tests come back positive, you will be referred to a Maternal Fetal Medicine Doctor who specializes in ultrasound in pregnancy. This specialist will review your screening test and provide your with information for further testing including chorionic villus sampling or amniocentesis. Genetic counseling is available to review the results, answer your questions and ensure you have sufficient information to help you make a decision.
Detailed or Anatomy Ultrasound: This ultrasound is completed between 18-20 weeks and looks at your baby from the top of their head to the tips of their toes and everything in between. Here is a little more information about this ultrasound
- Most babies are born healthy regardless of a woman’s age, obstetric history or family history
- Prenatal testing is an option available to you. Ensure you have sufficient information about your options to make informed choices about testing
- Most women receive reassuring test results that provide peace of mind in their pregnancy. However, some women experience anxiety with testing which you may consider when making a choice about testing
2. Second Trimester
Visits occur monthly for 30 minutes and include:
- Check in with questions answered
- Blood pressure
- Weight
- Fetal heart rate auscultation
- Abdominal palpation for uterus size
- Review of lab results, genetic screening if completed, ultrasound and other results
The Society of Obstetricians and Gynecologists of Canada recommends that all pregnant women are offered gestational diabetes testing in pregnancy. Pregnancy creates a natural state of insulin resistance due to hormonal changes and the need to provide nutrients to the growing fetus.
For many women insulin resistance will not cause any problems however, for some it will lead to gestational diabetes. GDM causes an increase in the amount of glucose in the maternal blood and therefore increased transfer of sugar to the growing fetus.
Risk factors associated with GDM include:
- Maternal age greater than 25,
- certain ethnic groups,
- a previous pregnancy with GDM,
- Family history of diabetes, and
- obesity
Here is the good news! Most often we can help control blood sugars in pregnancy by making small but meaningful changes to nutrition and exercise.
We will review the standard of care and testing options at your prenatal appointment. Testing is offered between 24-28 weeks gestation.
Please see these links for more information!
Websites:
Society of Obstetricians and Gynecologists of Canada: Glucose Testing
My Health Alberta Gestational Diabetes
Gestational Diabetes (diabetes that starts in pregnancy (The Basics)
Gestational Diabetes (Beyond the Basics)
Books:
Lily Nichols Gestational Diabetes: What NOT to do!
⭐Requisition for Gestational Diabetes Screening and other labs will be provided at the 20 week visit to assist in booking a lab appointment for the 26-28 week blood collection period. There is currently a 4-6 week waiting list to book lab appointments
If you have a negative blood type, you may need to have WinRho to help prevent the formation of antibodies that can affect future pregnancies. If your baby has a positive blood type and there is mixing of their blood with yours, your immune system will form antibodies to the positive blood. This is most likely to happen if you have bleeding in pregnancy, including miscarriage, or during the birth. WinRho is a blood product that helps to prevent formation of antibodies to positive blood types that can cause problems in pregnancy.
If your blood type is negative and you have bleeding in pregnancy or have a miscarriage, it is recommended that you have WinRho. This will help to prevent the formation of antibodies that can affect future pregnancies.
WinRho is also recommended around 28 weeks of pregnancy so that you are protected during the birth of your baby. Birth of the baby creates the highest risk of exposure to positive blood.
When your baby is born your midwife will take some blood from the cord after it has been cut. You will also have some blood taken before your midwife leaves. Both blood samples will be taken to the lab for testing. If the baby is positive, your midwife will bring another dose of Winrho to your home visit to help prevent antibody formation.
WinRho is given by injection into the deltoid muscle of your upper arm (intramuscularly). Most common side effects include a sore arm and redness at the site of injection. Rarely there is a risk of more serious adverse effects. Due to this risk, your midwife will give you the injection at the beginning of the visit so that she is with you for 15 minutes after which is the most common time for any reaction.
⭐Blood is tested for type and antibodies in first trimester and at 26-28 weeks with gestational diabetic screening.
More information:
Society of Obstetricians and Gynecologists of Canada Rh Blood Groups
Alberta Health Services When you need Rh Immune Globulin (WinRHo)
Pelvic floor physio can be a helpful resource in pregnancy and postpartum. It can help with painful intercourse, muscle relaxation or strengthening, decreasing risk of prolapse, incontinence, and constipation. Awareness and control of pelvic floor muscles assists with pushing during the second stage of labour.
There are numerous pelvic floor physiotherapists that you can see to help you become more aware of these very important muscles. Please check out our resource tab for their links!
3. Third Trimester
Visits occur every 2-4 weeks to 36 weeks and then weekly until the birth and include:
- Check in and questions answered
- BP
- Weight
- Palpation of abdomento determine fetal position
- Measuring of Symphysis-Fundal Height (size of uterus)
- Fetal Heart Auscultation
The 36 week visit is 1 hour and will include all of the above. During this visit the home birth supply list, Vitamin K for baby, Management of third stage of labour and other wishes for the birth will be reviewed.
It is normal to start feeling the first fetal movements around 15-22 weeks. These early movements may feel like little flutters or gas bubbles. Movements will get stronger as you progress into the third trimester. At 28 weeks we expect you to feel a minimum of 6 movements in 2 hours. As your baby grows, you will become more aware of sleep and awake patterns. Every baby is different and you will get to know what is normal for your baby. If you are concerned about fetal movement at or after 28 weeks gestation, please call the pager to speak with your midwife.
Here is a copy of Alberta Health Services Fetal Movement Count Chart to help you keep track of your little one’s movement if you are concerned.
Here is some information from the Society of Obstetricians and Gynecologists of Canada about Fetal Movement and Kick Counts
Blood volume increases in pregnancy and so your body needs to produce more iron to help increase red blood cells to carry oxygen through the body. It is normal for iron levels to decrease a little in pregnancy. If levels of iron decrease below a certain threshold you may develop symptoms such as fatigue, dizziness/feeling light headed, shortness of breath, weakness, cold hands/feet, irregular heart beats or pale skin. Your midwife will offer testing in pregnancy to help make sure your iron levels are at appropriate levels to help you feel better through pregnancy and postpartum.
Tips for increasing iron absorption:
- Eating iron rich foods with citrus/ Vitamin C
- Avoiding calcium while you eat your iron rich foods (calcium blocks iron absorption)
- Cooking with an iron fish
- Cooking with cast iron pans/ pots
Resources: Iron deficiency anemia and you
Book: Lily Nichols Real Food for Pregnancy
The Society of Obstetricians and Gynecologists of Canada recommend the tetanus, diphtheria and acellular pertussis (TdaP) vaccine in each pregnancy. .This is to help prevent transmission of pertussis or Whooping cough to your baby when they are born. The SOGC also recommends the flu shot in pregnancy.
Currently, Alberta Health Services and the Society of Obstetricians and Gynecologists of Canada, recommend that all pregnant people receive the COVID-19 vaccine.
Please see the information, provided below, for more information. We will provide you with updated information as it becomes available.
We recognize that vaccinations are a personal choice and respect your ability to make an informed choice with information provided here and that you obtain through other sources. If you have any questions, please ask your midwife.
Resources:
Society of Obstetricians and Gynecologists of Canada:
Statement on COVID-19 Vaccine in Pregnancy
Center for Disease Control:
4. 36-Week Resources
Group B Streptococcus (GBS) is a bacteria that can be found in your intestines or genital tract. It doesn’t affect adults, however if a newborn picks it up in the birth canal it can make them sick. Approximately two babies in 1,000 will have symptoms of Group B strep infection. The Society of Obstetricians and Gynecologists of Canada recommend routine vaginal rectal swabs to test for GBS between 35-37 weeks of pregnancy. Standard of Care in Alberta is to treat GBS positive mothers with antibiotics to decrease the number of bacteria in the vagina at time of birth. GBS swabbing will be discussed at your 36 week visit.
Please check out the following links for more information:
Association of Ontario Midwives Group B Strep Guideline
Society of Obstetrician and Gynecologists of Canada Group B Streptococcus Screening
AOM GBS App (it is a great resource for Stats)
Vitamin K is a fat-soluble vitamin that is found in foods we eat and absorbed in the intestines using normal gut flora. Vitamin K is also an important substance that helps with blood clotting. Infants are believed to have low levels of vitamin K due to poor transfer of vitamin K across the placenta, low levels of vitamin K in breastmilk and poor absorption in their gut due to immature gut flora.
Low levels of Vitamin K in the newborn may lead to Vitamin K Deficiency Bleeding (VKDB) in the first 24 hours after birth (early) or between 2 and 6 weeks after birth (late). Risk of bleeding increases with preterm (before 37 weeks) babies and babies born with bruising. The Standard of Care across Canada is to administer Vitamin K to the baby within 1-2 hours after they are born to reduce the risk of VKDB.
Please see the resources below for more information about options for vitamin K. VItamin K for your baby will be discussed at your 36 week visit. Oral vitamin K is prescribed through York Downs Pharmacy in Toronto. It can take 2 weeks for delivery.
Canadian Pediatric Society:
Guidelines for Vitamin K prophylaxis
5. Third Stage Management
The third stage of labour includes the time after the baby is born up to the delivery of the placenta.
There are 2 options for managing the third stage of labour:
Expectant (Physiologic) Management: Your baby will be skin-to-skin with you as soon as they are born with warm blankets placed over you both. This allows transition time for the baby and for release of your own oxytocin to help with birth of the placenta. During this time, your midwives will be monitoring your baby’s transition as well as any signs that your placenta is ready to come. Some people will feel cramping as the uterus contracts as a sign that the placenta is separating. Sometimes we will see what is called a ‘separation gush’ of blood as the placenta releases. You will be encouraged to push when you feel the contractions to help the placenta deliver. Your midwife may assist you to sit up to help the placenta delivery. It is expected that the placenta will deliver within 30 to 45 minutes of your baby’s birth. If there is any concern your midwife will discuss changing to active management.
Active Management: Active management is the standard of care in the hospital and the most common management of the third stage of labour. The Society of Obstetricians and Gynecologists of Canada, World Health Organization, Canadian Association of MIdwives and numerous other worldwide organizations recommend active management of the third stage of labour to help prevent postpartum hemorrhage. Active management involves the injection of oxytocin into a muscle, putting gentle traction on the cord, and massaging the uterus after the delivery of the placenta. Oxytocin is the hormone that causes contraction of the uterus. Following the birth of a baby, contraction of the uterus helps the placenta separate for delivery. Oxytocin can also help decrease the risk of hemorrhage in the first 24 hours following your baby’s birth. Some people will experience nausea, vomiting and cramping following active management.
Management of the third stage of labour will be discussed during your 36 week visit.
Resources:
Third Stage of Labour (USA)
Stages of Labour – Third Stage (Australia)
Third Stage of Labour -delivering cord and placenta (UK)
Ontario Midwives: Post Partum Hemorrhage – An AOM Clinical Practice Guideline Summary (pdf)
If you have a history of HSV2 it is recommended that you take Valcyclovir from 36 weeks until your baby is born. Taking the medication will help to prevent transmission to the baby during the birth. Your midwife can give you a prescription for the medication at your 36 week visit. For more information about HSV2, please see the link below.
Society of Obstetricians and Gynecologists of Canada Herpes
– A shower curtain or plastic paint tarp to cover the delivery area
– 2 Large garbage bags
– Medium sized bowl/ Ice Cream Bucket for the placenta
– 8-10 clean washcloths, used for warm perineal compresses
– 5-6 Older Towels
– Incontinence pads (puppy pads)
– Soaker Pad (great to use in the bed, and is awesome for potty training a toddler later on!)
– 2-3 disposable mesh underwear (are nice to have postpartum)
– 3-5 Receiving blankets
– Hat for newborn
– Small bottle of unopened olive oil/ almond oil/ avocado oil (the oil is used during crowning for delivery)
– Small bottle of hydrogen peroxide (for cleaning if needed)
– 1 package of long overnight pads (Kotex/ Rael), please DO NOT buy Always brand as they are plastic and can cause irritation after delivery.
– Fish Net (If planning water birth)
– Digital thermometer (Vicks or Braun’s are great ones)
Suggested List
– Homeopathic Arnica
– Squeeze bottle for peri-care
– Calendula Tincture
** A great place to purchase birth supplies is Birth Supplies Canada
Preparing your Bed for a Home Birth
Keep your normal fitted sheet on your bed, then place the plastic tarp on the bed. Put some old sheets on the bed that you are ok to give birth on.
Don’t do this until early labour.
– Outfit to wear in labour if you want (there will be hospital gowns at the hospital)
– A comfy outfit to wear home
– Lip balm
– Toiletries
– Slippers or flip flops
– Newborn outfit (undershirt, sleeper, socks, hat)
– Newborn hat
– Music speaker if desired
– Phone Charger
– Have the car seat installed in your car
We often say that the bath is a “midwives epidural” during labour. Many women find that labouring in the tub can help relax your body, reduce pain, provide comfort, help with movement from the buoyancy of the water, reduce risk of severe tearing, and allow a more gentle delivery of the baby.
Waterbirth is safe when the following criteria are met:
-It’s a healthy pregnancy
-A womens pelvis is emerged in the water for the entirety of the delivery
-The water stays at body temperature
-Your pregnancy is term (37 weeks gestation or greater)
-You would be able to get out of the tub if needed
Items needed for a waterbirth:
- A tub or birth pool
- If using a birth pool, a garden hose to fill the tub
- A waterproof tarp (if using a birth pool)
- Sump pump (this will be brought by your midwives)
- A fish net (incase any stool is passed during pushing)
https://www.ontariomidwives.ca/water-birth
Breastfeeding Resources
Although breastfeeding is natural, sometimes it takes time to learn. It is a learned experience between both you and your baby. Give yourself grace as you navigate this journey and know that you are doing a great job! Your midwife is here to support, please call the pager if you are needing support with getting a comfortable latch.
Up to Date Breastfeeding Handout
Jack Newman Videos & Resources
Community Resources
Lactation Consultant
Chiro
Osteo
Acupuncture
- The Wellness Studio, Ciara McNiff
- Airdrie Acupuncture
- Shifra Centre for Wellness, Kerri M
- Moss Postpartum House
Pelvic Floor Physio
Homeopaths
Naturopaths
- Mountain Health Team
- Moss Postpartum House
- Nova Naturopathic Integrative Clinic
- Marda Loop Naturopathic and Wellness Clinic
- Holistic Institute of Health & Fertility
Mental Health
- Calgary Counselling Center
- Caring Beyond
- Distress Centre
- Families Matter
- South Calgary Health Centre
- Pregnancy and Infant Loss Program
- Birth Narratives Counselling
** These resources have come recommended from our clients and other health care providers. If you know of other resources that you love, please let us know so we can add them to the list !**
Miscarriage Information
If you are concerned you are experiencing a miscarriage please call your midwives on the pager.
What is a miscarriage?
A miscarriage is defined as a pregnancy loss before 20 weeks gestation and occurs in 20% of pregnancies. The medical term for a miscarriage is spontaneous abortion.
Why does it happen?
The most common reason why a miscarriage occurs is due to chromosomal abnormalities. Other causes can include: maternal diseases, uterine abnormalities, exposure to teratogens or infection.
Symptoms that May Occur:
- Pelvic pain – this may vary from mild cramping, intense cramps or contractions
- Vaginal bleeding – it may be light or like a heavy period, clots may also be present
- Fever – temperature of 38.5 degrees Celsius or higher
- Passing tissue from vagina
- Asymptomatic – there may not be any symptoms present and the loss will be detected on ultrasound
Reasons to Page your Midwife:
- Heavy bleeding – soaking a maxi pad in less than an hour for two hours
- Passing big clots (the size of an egg or larger)
- Intense abdominal pain
- Fever
- Vaginal discharge with foul (bad) odour
If any of these symptoms are present please call your midwives on the pager.
Most Common Types of Miscarriage:
- Missed Miscarriage – this may happen when the embryo/fetus stops developing and then
weeks later the miscarriage is diagnosed
- Blighted Ovum – this happens when there is a gestational sac but the embryo didn’t start or
didn’t continue to develop.
- Incomplete Miscarriage – this happens when not all of the tissue has been expelled from
the uterus, is may also be referred to as retained products
- Complete Miscarriage – when the embryo/ fetus and all placental tissue has been
expelled from the uterus
Less commonly there can also be a molar pregnancy or ectopic pregnancy. A molar pregnancy
is where the placenta grows into a mass that may or may not contain an embryo. Whereas an
ectopic pregnancy is when the embryo implants into the fallopian tube.
Options After Diagnosis of a Miscarriage:
Your health care provider will go over different options with you and discuss the benefits and
risks of each option once there has been a diagnosis of a miscarriage. Treatment options may
include the following:
Natural or expectant management – letting your body try to pass the pregnancy on its own, or with help from an acupuncturist. This may include severe cramping and heavy bleeding. Advil and tylenol can be taken to help with the pain. The fetus may appear as a white mass or it may look like a small baby with distinguishable features.
Misoprostol – is a medication that is inserted vaginally to help start cramping to expel the
remains of the pregnancy.
Dilation and curettage (D&C) – this is an option before 12 weeks gestation. It is a short
procedure in the OR, where the cervix is dilated and a special instrument is used to scrape
the uterine lining. Usually booked within a week of the diagnosis unless there are
concerns or an opening in the schedule.
Dilation and Evacuation (D&E) – this procedure is done when a pregnancy loss is over 12
weeks gestation.
Caring for the Pregnancy Remains:
Options for the pregnancy remains include taking them to the hospital where they can be
cremated, or there is also the option to bury them in a location of your choosing (backyard,
cemetary etc), please ask your healthcare provider for more information.
If presenting to the Emergency Department the nurses will ask if you brought the pregnancy
remains and if everything has passed. Individuals may refer to the miscarriage with a number of
different terms, please advise healthcare providers on how you would like them to refer to the
loss.
For more information please visit:
https://www.albertahealthservices.ca/services/Page10659.aspx
https://myhealth.alberta.ca/Alberta/Pages/at-the-time-of-your-miscarriage.aspx
https://myhealth.alberta.ca/health/pages/conditions.aspx?hwid=hw44090
Reading list
Real Food for Pregnancy – Lily Nichols
Real Food for Gestational Diabetes – Lily Nichols
Ina May’s Guide To Childbirth – Ina May Gaskin
Spiritual Midwifery – Ina May Gaskin
Childbirth Without Fear – Ina May Gaskin
The Birth Partner – Penny Simkin
Is there a book that you’d like to suggest? Let us know!
