Early to mid-pregnancy (up to 16 weeks)

What You May Be Feeling

Let’s face it, many of the early pregnancy symptoms are not pleasant. You may be feeling constantly tired. You may feel bloated. You may feel breast tenderness. You may have nausea and vomiting. This is a good time to start some self-care. For breast tenderness ensure you have a well-fitting bra that does not have underwire. Ensure you give yourself plenty of time to sleep. Give yourself extra time to get ready before going to work or for outings so you do not feel rushed. Keep hydrated.

For nausea, remember much of this is normal will not harm the developing baby. If you have food aversions, do not be too hard on yourself. Food will in most cases be your friend again. Try eating something bland such as plain toast or crackers before getting out of bed. Eat smaller more frequent meals and snacks. Avoid large meals. Ginger products such as tea, candy, or soda can help. Try taking your prenatal vitamin at night time. If you find your vitamin difficult to digest, switch to a folic acid only vitamin (important for early pregnancy) and a vitamin B6 (helps with nausea). Avoid strong odours, smoking, and second-hand smoking if possible. Acupressure wrist bands (available in pharmacies and health food stores) can help too. Stay hydrated. Discuss this issue with a member of your midwifery team if you are unable to keep fluids or food down despite these measures.

Routine Laboratory Investigations and Ultrasounds

Obstetric Panel and Initial Testing

An obstetric panel is a group of blood tests done to check your health before and during early pregnancy. The results of these tests can help find certain problems during the pregnancy. They can also help guide any treatment you may need during pregnancy or treatment the baby may need right after birth. These tests include: blood type, antibody screening, and a complete blood count (CBC). Other tests in the panel show if an infection such as syphilis or hepatitis B is present. Another test can show if you are immune to rubella. Rubella is also known as German measles. You will also be tested to see if you are infected with human immunodeficiency virus (HIV).

In addition to the tests above, you will be offered testing for common sexually transmitted infections: chlamydia and gonorrhea (these can be done by a simple urine test or vaginal swab). You will also be offered a urine test to rule out bacterial infection which may be masked by your pregnancy symptoms. Untreated bacteria in your bladder can irritate the pregnancy increasing your risk for preterm labour, preterm membrane rupture (water breaking) or low birth weight. You may be offered a PAP test as well if you are due for this. Pap tests can find abnormal cells in the cervix before they become cancer.  It’s free and can be done by a health care provider at their clinic. Anyone sexually active persons with a cervix, including women and transgender people, age 21 to 69 should be screened every 3 years.

Genetic Screening Options

All clients in care in the first trimester are offered optional genetic screening. The screening is an individual risk assessment for a fetus with Downs’ Syndrome or a similar Trisomy (13 or 18). The screen is not a diagnosis. But if your result comes back as high risk, you are offered the diagnostic testing (amniocentesis or Chorionic Villus Sampling). There are three types of genetic screens available:

The most common used is Early First Trimester Screening (eFTS). This screen is covered by OHIP. This screen is done between 11+0 and 13+6 weeks gestation. This screen combines a Nuchal translucency ultrasound (for age of the fetus and soft markers), blood work (to look for specific proteins), and your age to establish a risk score.

Another option is the Non-invasive Prenatal Testing (NIPT). This screen is covered by OHIP only in certain circumstances, but it is also available by private pay. This screen is done any time in pregnancy from 10+0 weeks. This screen is a blood test only and it pieces together fetal DNA circulating your blood stream to give a risk score.

If a client is 14 weeks to 20+6 weeks along, a Second-Trimester Screen (STS) can still offered. This screen is covered by OHIP and uses only the blood work and maternal age to establish a risk score.

Ultrasound Options

Dating Ultrasound

A dating ultrasound can be offered to you either before you are in care with Blue Heron Midwives or at your initial visit with us. Even if menstrual history is correct, the exact time of ovulation, fertilization, and implantation cannot be known. Sperm may survive for 5 to 7 days in the female reproductive tract, a “known” conception date is therefore not completely reliable. Ovulation-to-implantation duration can vary by as much as 11 days, and this may affect fetal size and growth. On the other hand, the embryo or fetus is reliably consistent in size to its age in early pregnancy. Essentially they start out the same size and as the pregnancy continues their growth will vary. A dating ultrasound done sometime between 7 and 14 weeks of pregnancy (where the crown-rump length of the fetus ranges between 10 and 84mm in size) is the most accurate for establishing a final Expected Due Date. To avoid performing extra ultrasounds, it is acceptable to time the dating scan to coincide with nuchal translucency screening.

Nuchal Translucency Ultrasound

If you opt for the Early First Trimester screen (eFTS), this will include a Nuchal translucency ultrasound (done between 11+0 and 13+6 weeks gestation) that will help establish your final due date and/or look for soft markers for Down Syndrome. This ultrasound can also be performed on its own.

Prenatal Classes

We recommend clients (especially if this is their first pregnancy) take quality prenatal classes to help prepare them for labour, delivery, and parenting. One option is to join our free Connecting Pregnancy Program which will combine your prenatal classes and prenatal care together. For other community available quality prenatal classes please visit either Balancing for Birth or Tummies to Toes to find class options that are right for you. The Region of Waterloo has a free on-line prenatal program some good information.