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Obstetrics

Questions you may have about your pregnancy


What to bring to the hospital

For parents to be

  • Health card (OHIP) and any extended hospital insurance information you may have
  • Pillows (breastfeeding pillows are great)
  • Slippers, socks
  • Nursing bras (cotton sports-bra style is best)
  • Your stay is generally 24-48 hours. Hospital gowns will be provided during your labour. For your own comfort you may wish to bring your own clothing and toiletries for the time in hospital after your delivery.

For baby

  • Diapers (10-20)
  • Sleeper or outfit to wear home
  • Blanket, booties, bonnet
  • Infant car seat (on day of discharge if going home by car)
  • All babies will need to see a care provider shortly after discharge from hospital
  • It may be helpful to contact a family doctor (who looks after babies) or pediatrician during your pregnancy so that you have someone to call when you go home

What to expect at your visits

Pregnancy is measured in weeks. A normal pregnancy is about 40 weeks. Generally, the first visit takes place 12 weeks from your last period. You can come sooner if you have concerns.

  • From 12-28 weeks, your visits are generally every 4 weeks.
  • From 28-36 weeks, your visits are generally every 2 weeks.
  • From 36 weeks until you deliver, your visits are weekly.

At 12 weeks, in addition to your regular visit, any ‘routine’ prenatal tests not yet done are completed.  This visit also includes a discussion of available genetic testing.  An ultrasound is usually done.

At 20 weeks, in addition to your regular visit, an ultrasound is usually done. This is the ‘anatomy’ scan, which looks at all the organs in the baby.

Between 24 and 28 weeks a test is done looking for pregnancy related diabetes (GDM). Additionally, your hemoglobin and iron levels are checked, as is your urine for infection.

If your blood is RH negative, you will get an injection to avoid any substances forming in your blood that may harm your baby or future babies.

Between 30 and 34 weeks an ultrasound is usually done to help assess the growth of the baby.

At 36 weeks we do a swab for Group B Strep (GBS).

Please note, there can be many more visits and tests depending on whether there are special problems.

Coping with early pregnancy symptoms

Screening options

Prenatal screening tests

There are tests that can be done which find the chances of some conditions in pregnancy. These are blood tests. They have no effect on your baby. The tests include:

  • EFTS (OHIP funded)
  • MSS (OHIP funded)
  • NIPT (depending on circumstances, may or may not be funded)

These tests are time sensitive. Please call the clinic for further information

Sometimes these tests suggest other investigations that would be helpful. Your doctor will discuss what your options are.

What is a subchorionic hemorrhage (SCH)?

A SCH occurs when there is bleeding between the membranes around the baby (the chorion) and the uterus. They are found with ultrasound. If there is a SCH, the mother often experiences vaginal bleeding. Nothing a mother does causes a SCH. Most SCH’s go away by 20 weeks. Generally SCH are not associated with any abnormalities developing in the baby but for more information ask your doctor.

Health information

Healthy eating in pregnancy resources

Exercise in pregnancy

Vaccinations

It is recommended that all pregnant women receive these vaccines:

  • Flu shot in the winter season
    • Can be obtained at a pharmacy, public health facility, family doctor’s office, etc.
  • TDAP vaccine (whooping cough) within 27-36 weeks
    • Can be obtained in the family doctor’s office or in a walk-in clinic.

Cord blood programs/Victoria Angel of Hope

It is possible to save blood from your placenta at the delivery and store it in a blood bank. This blood may be useful in a number of situations for your baby as he/she grows up.

There are two options:

  • You may choose to store the blood with a private company. This blood would be available for your child only. There are fees. Ask your doctor for further information.
  • You may choose to donate the blood to a common bank. St. Michael's is very proud to be part of the Victoria Angel of Hope. With this program, there are no fees. Your sample becomes part of a donation bank, available to anyone who needs it. This blood may also be used for research. The blood you have donated is not available for your child – it will be drawn from the general blood bank.

Iron deficiency in pregnancy

Many women have been shown to have low iron levels. St. Michael’s Hospital encourages the use of iron supplements. For women who need more, help from the hematologists (blood doctors) is easily available.

Foods that are good sources of iron include: meat, chicken, fish, eggs, tofu, beans and lentils, cream of wheat, enriched grains and cereals, nuts, seeds, dried fruit, potatoes with skin.

Folic acid

If you are considering getting pregnancy, or trying, you should be taking a folic acid supplement. It is best if you take it for three months prior to conceiving. Some women need higher doses than the average recommended dose.

Contact the clinic at 416-867-7421 or your doctor to be sure you are taking the right amount.

Is my baby moving enough?

One of the best ways to keep track of healthy babies is to learn about how much they move. Healthy babies are active, especially in the morning or evening.

  • Begin counting your baby’s movements when you are 28-30 weeks (seven months) pregnant.
  • Do this at the same time every day when your baby is usually active.
  • For a few days, write down the number of times you feel the baby kick or move in one hour. Your baby will probably move about the same number of times per hour during this active time.
  • This will help you to know what is normal for your baby.

Ask at your next prenatal visit if you have any questions about your baby’s normal movement pattern.

Remember that every baby’s activity level is a bit different. Only you can know your baby’s normal movement patent. Only you can notice if it changes. Stay aware of this pattern until your baby is born. It will probably stay the same. This is a sign of health for your baby.

Babies who may be having problems move less than usual. If you notice that your baby:

  • is not moving as much as usual
  • takes longer to move in the usual length of time
  • has stopped moving

Please call your doctor or midwife, or the Labour and Delivery Floor at 416-864-5252. Your doctor may want to check your baby to see how your baby is doing.

Group B Streptococcus (GBS)

The GBS bacteria is a normal bacteria that is sometimes found in the vagina. It is not a sign of infection. If this bacteria is present at the time of birth, it may cause an infection in the baby. To avoid this, we check for this bacteria in the last month of pregnancy and, if present, you will receive antibiotics while you're in labor to clear the bacteria from the vagina and prevent the baby from developing an infection.

Signs of Labour

Am I really in labour? Information for patients and families

Come to the hospital

  • If it is your first pregnancy and your contractions are three minutes apart for 30 minutes
  • If you have previously delivered, you will be advised by your doctor when to come to the hospital
  • If you are having difficulty relaxing between contractions
  • If your discharge is like a period flow or you pass blood clots
  • If the amniotic fluid changes to a green colour or a bright red flow

As your due date approaches, you will probably have mixed feelings of excitement and anxiety. Excitement, since you will finally see your baby. Anxiety, regarding the many unknowns:

  • How will I know I am in labour?
  • How will I cope once I am in labour?
  • Will I be a capable parent?

For some women, the signs of labour are very distinct, for others they are not. We will help you identify the signs of labour. Our further support while you are in the hospital will help you cope, making your birthing experience a memorable one.

Show

Show is a pink bloody stained mucous that has filled the cervix during pregnancy. It may loosen and be expelled vaginally hours to days before you go into labour. Show is normal and does not need to be reported as long as the discharge is pink or bloody and sticky.

When you reach your due date and are undelivered, you may be examined to find out if your cervix is getting ready for labour. Spotting can be common, after an internal exam, as the cervix has been stimulated.

Ruptured membranes

Your baby is enclosed in a bag of waters. This bag of waters may break, before or during labour. It may come as a gush or as a small continuous trickle of fluid, which you cannot control. The colour of the fluid may range from clear to pink.

Many women leak a small amount of urine when they cough or sneeze. It is sometimes difficult to tell whether this is urine or amniotic fluid that is leaking. Remember, amniotic fluid is usually clear or pink and does not smell like urine.

After your membranes have ruptured, do not put anything into your vagina, because it may increase the chance of infection. You are advised to take showers instead of tub baths and to frequently change your sanitary pads.

You should note the time your waters break, how much fluid, the colour of the fluid, movement of the baby and call the Labour and Birth Unit with this information for further advice. Phone 416-864-5252.

Contractions

Initially, contractions may feel similar to menstrual cramps. Aching may begin in your back, lower abdomen and thighs. This cramping will eventually become stronger, lasting for periods and coming at closer regular intervals. The frequency of contractions is timed from the beginning of one contraction to the beginning of the next contraction.

You may have contractions for several hours at a time, and then the contractions may stop. This is called false labour.

If you are not sure, call and ask for advice. It is better to feel confident and sure. Phone 416-864-5252.

These three signs of labour - show, contractions, ruptured membranes - may occur in any order. It is important to relax during the early stages of labour. Taking walks and showers with intermittent rest periods will help. Remember to drink plenty of fluids with light meals and snacks.

It is important that your baby continues to move as he or she did before you went into labour. If this changes, please call the unit for further advice.

If you have any further questions, doubts or fears call our Labour and Birth Unit. Call 416-864-5252. We will be happy to help you feel more confident.

Looking forward to seeing you!

Breastfeeding resources

Best Start
This website can help you when you are pregnant and breastfeeding. It has lots of information about pregnancy and caring for your baby.

Breastfeeding Services 
Use this website to find breastfeeding clinics and other supports in your community.

Rogers Hixon Ontario Human Milk Bank 
Visit this website to learn more about how to donate your breastmilk.

Breastfeeding – Toronto Public Health
This website has lots of information for women who are breastfeeding.

Ten great reasons to breastfeed (460 kb pdf file)
Ten tips for successful breastfeeding (641 kb pdf file)