Who provides my prenatal care?

Depending on what's available in your community and covered by your provincial health system, most women can choose the kind of prenatal care they have - either seeing their family doctor, an obstetrician, or a midwife. In some areas, you can opt to be under the sole care of midwives, who can only handle low-risk pregnancies. If you have an obstetric history that's in any way out of the ordinary, you will likely want to be under the care of an obstetrician.

Where do I go for prenatal check-ups?

Most women have their check-ups at their doctor's office or midwifery clinic. In many areas, you'll only have to visit the hospital for your ultrasound scans and special tests.

Will I see the same caregivers all the way through my pregnancy and birth?
It depends. Some midwifery practices operate a system where you see the same midwife, or her back-up, at each visit. You'll at least get to know the faces of the other midwives. Even though you'll likely see the same doctor throughout your care, she might not be 'on call' when you deliver, so a different doctor could be present at your birth. When you first meet with your doctor or midwife, it's a good idea to ask how their practice works and what happens if they're not 'on call' when you deliver.

What happens at my first prenatal check?

The timing of your first prenatal appointment will vary according to where you live. Most women used to have their first appointment at around 12 weeks of pregnancy. However, most doctors and midwives now like to see you for the initial visit as early as 8 weeks after your last menstrual period. One of the reasons for this is that the dating ultrasound, which is carried out at, or shortly after, the initial visit, is more accurate if you are between 8 and 11 weeks pregnant.

Be prepared for lots of questions (and form filling), as your doctor needs to establish an accurate picture of your health, your partner's health and both of your families' medical history. Here are some of the things she may ask you:

Date of last period -- knowing the date of your last monthly period, or LMP, allows your doctor to calculate your due date. You might also be offered a dating ultrasoundto get a more accurate idea of how pregnant you are and to see if you are expecting more than one baby.

Previous miscarriages, abortions and births -- your 'obstetric history' is important and could have a bearing on how well you cope with pregnancy this time around, plus it can affect how your labour is managed.

Family history of disease/genetic conditions -- screening is now available for known genetic conditions, such as cystic fibrosis (see Blood tests, below), so if you have a family history, your doctor can explain and organize tests. Depending on your ethnic background, your doctor may also offer you a blood test to screen for conditions, such as sickle cell disease, which is more common in women of African and West Indian descent. Also, having a family history of allergies, heart disease or certain other major medical conditions could all have a bearing on your pregnancy, so go prepared with any relevant information about your (and your partner's) medical history.

Your lifestyle -- your doctor or midwife will ask a few questions about how muchalcohol you drink and whether you smoke. As both can affect your baby's health, your doctor will likely offer advice or organizations that can help quit smoking, plus dietary and other advice if needed.

Where to have your baby -- although it's early, your doctor or midwife will explain your birth options so you've got plenty of time to think about it and discuss things with your partner. These will vary depending on your province and community and in some places, you'll even have the option of a home birth.

In addition, at your first visit, your doctor will take your blood pressure and might measure and weigh you so that she can work out your body mass index (BMI). Although it is becoming more common to not be weighed at all during your prenatal care. Your urine will also be checked for protein, which could indicate the pregnancy-related condition pre-eclampsia.

How often will I have prenatal checks?

This will vary slightly from area to area, but the Society of Obstetricians and Gynaecologists of Canada (SOGC) recommends that, after the initial visit, women with a straightforward pregnancy see their caregiver every 4-6 weeks during the beginning of your pregnancy, every 2-3 weeks after 30 weeks, and after 36 weeks, every 1-2 weeks until you go into labour.

What other checks will I be offered prenatally?

Measuring your baby - you won't likely be given internal examinations at your check-ups, but your doctor or midwife may feel, or 'palpate', your abdomen to make sure your uterus and baby are growing properly. Once you are near your due date, she will feel your belly to see what position your baby is in.

Once you get to about 20 weeks, she will also start measuring the size of your belly with a tape measure (from the pubic bone to the top of your abdomen). She will measure in centimetres and the reading should be same as the

number of weeks you are pregnant - give or take 2-3cm. This will give your doctor a rough idea of how the baby's growth is progressing. If she has any concerns about your baby's growth, she may refer you to hospital or diagnostic clinic for an ultrasound.

Blood tests - these involve taking a small sample of your blood, which is then tested for your blood group; whether your blood is rhesus negative or positive; whether you are anemic; whether you are immune to rubella; for syphilis; for hepatitis B; and, if you agree, for HIV. You may also be offered a test for sickle cell disease. Your midwife or doctor can explain to you exactly what is being tested for and why.

Ultrasound scans - many women will be offered a dating ultrasound early on in pregnancy to establish their baby's gestational age and detect multiple pregnancies. You'll also be offered another ultrasound at 18-20 weeks to check that your baby is developing properly, and that your placenta is positioned in a way which won't cause problems with the birth.

Screening tests - If you wish, you can have blood screening tests, in which your blood levels of certain chemicals are checked. Levels which are too high or too low could indicate that your baby has a condition such as spina bifida or Down's syndrome. Some clinics or hospitals also offer a nuchal ultrasound scan at around 11 to 14 weeks, which, along with blood tests, is a screening test for Down's syndrome. These tests can't tell you for certain whether or not your baby is affected - they can only give you an approximate risk.

Diagnostic tests - If screening tests show that your baby has a higher risk of having spina bifida or Down's syndrome, you may choose to have a diagnostic test which can tell you for certain. These include a detailed ultrasound, amniocentesis and chorionic villus sampling, in which a needle is inserted into your uterus to draw off either amniotic fluid or placental cells for examination. These last two procedures carry a small risk of miscarriage.

What if I'm worried about something between prenatal visits?

If you're concerned about something, don't wait until your next prenatal check-up is due: either phone to make an earlier appointment, call or visit your midwife or doctor.

What if I've got special problems?

If you've got special problems such as a pre-existing medical condition, or if you develop a problem during your pregnancy, you'll probably find you're transferred to the care of an obstetrician, if you're not already under an OB's care. You'll then see a doctor at most of your prenatal visits, and may need to go for more regular check-ups than other mothers-to-be. If you have a problem in late pregnancy - particularly a rise in blood pressure, or a concern that your baby isn't moving around a lot - you may find yourself referred to a hospital for tests and closer examination.