Your Pregnancy Schedule

Maternity Care Pathway

The TRFO Clinic follows this schedule for our general visits:

  • First prenatal visit - once referred to our clinic and a new patient visit is available

  • Every 4 weeks until 28 weeks

  • Every 2 weeks until 36 weeks

  • Every 1 week until delivery

At each visit, you can expect the following:

  • Weight and blood pressure measurement

  • Listening to the fetal heart beat

  • Measurement of your belly size (starting between 20-24 weeks)

  • Answering your questions

  • Reviewing any lab results and ultrasound reports

  • Discussing next milestones in the pregnancy

Certain visits include additional lab tests or examinations, including:

  • Dating ultrasound (prior to 14 weeks)

  • Genetic screening (10-13 weeks; 15-20 weeks)

  • Nuchal translucency measurement* (11-13 weeks)

  • Detailed anatomy ultrasound (18-22 weeks)

  • Gestational diabetes testing (24-28 weeks)

  • GBS testing (36 weeks)

  • Bedside ultrasound (36 weeks) to confirm fetal positioning

* - not all women require a nuchal translucency measurement

First Prenatal Visit/First Trimester

For many women, this appointment will happen with their family physician or primary care provider. This visit includes:

  • questions about your own health and your family health history

  • a history of any previous pregnancies, including any complications that might have happened

  • a discussion of your current lifestyle (eg eating habits, activity, smoking, work) to identify ways we can support you for a healthy pregnancy

  • a brief physical examination, including the heart, lungs, neck, belly

    • this may include a breast exam depending on your history and any concerns you have

  • a Pap smear if yours is not up to date

    • both the SOGC and BC Cancer agency support the safety of Pap smears in pregnancy

    • in pregnancy, we only take cells from the visible surface of the cervix and not from inside the cervix

    • new HPV self swabs are now available for cervical cancer screening per BC Cancer agency guidelines but can’t be done in pregnancy so will be recommended post partum once no ongoing bleeding

This is also the visit where we discuss the option of genetic screening in pregnancy

  • genetic screening looks specifically at the risk of open neural tube defects (spina bifida and anencephaly) and certain chromosome abnormalities (Trisomy 21 [Down syndrome], Trisomy 18 [Edwards syndrome])

  • please see Genetic Screening for more discussion on genetic screening and more links for information

A note on your due date - last period vs dating ultrasound:

We will use the due date given by your dating ultrasound. This has been proven many times to be the most accurate, even if you are certain of your last period or even the date you ‘conceived’. This is because the sperm and egg may not meet and fertilize at the time of intercourse - this might not happen for up to 5 days after!

These five days can become critical in making decisions about a post-dates pregnancy or for pre-term deliveries.

Second Trimester Visits

13-26 weeks

You will be seen every four weeks during this time. Each visit will include the usual measurements and checks mentioned at the top of the page.

The second trimester also include:

Second part of genetic screening labwork (15-20 weeks)

Detailed anatomy ultrasound (18-22 weeks)

  • Check of baby’s growth

  • Check of placenta growth and placement

  • Check that all parts of baby’s body are growing and developing as expected

  • If you want to know your baby’s sex, this is the ultrasound that can tell you that

Gestational diabetes screen and repeat hemoglobin (24-28 weeks)

  • Pregnant woman can develop problems with their blood sugar, even if they have no other risk factors for diabetes

  • You will drink a very sweet liquid and then have your blood sugar checked 1 hour later

    • If your blood sugar is above a certain level, you will go on to have a second test to confirm gestational diabetes

  • Your hemoglobin (red blood cell count, the part of the blood that carries oxygen) will also be checked at this time

    • Most women’s hemoglobin becomes lower in pregnancy

    • If it is too low, you may need extra iron to help build up your blood levels again

Third Trimester Visits

26-40 weeks

You will be seen more often by your doctor during the third trimester. This is the time you are more likely to have complications, if you are going to have any. Seeing you often during this times means we can screen for complications and treat them early if they occur.

Keep in mind that most women do not have any complications in their pregnancy. Seeing you often during this time also helps us to answer your questions about the upcoming labor and delivery and provide you with teaching about this.

Visits during the third trimester can include:

Repeat ultrasound (if needed) for placenta placement (28 weeks)

  • Sometimes the placenta sits very close to the opening of the cervix (internal os)

  • If this was seen on your detailed anatomy ultrasound, you will have a repeat ultrasound to check that the placenta has moved away from the cervix

    • If the placenta remains too close to the cervix, it may be dangerous for you to have a vaginal delivery, and you may need to meet with an obstetrician to discuss this

Group B Streptococcus (GBS) Screen (36 weeks)

  • Group B Strep (GBS) is a type of bacteria that can live on all of our skin without making us sick

    • It is a weak cousin of the Group A Strep that causes strep throat

  • While it doesn’t make most of us sick, it can make newborn babies incredibly sick - a condition called sepsis

  • We check pregnant women for whether this bacteria lives on or near the vagina

    • This is done with a quick test where a cotton swab is placed gently and shallowly in the vagina then the rectum (bum)

  • If this bacteria is present on or near the vagina, you will receive antibiotics (penicillin unless you are allergic) during your labor or when your water breaks (membranes rupture)

Teaching about signs of labor and preterm labor (most visits)

  • This is the chance for you to ask questions about planning your labor

  • We will talk to you about what signs of labor and membrane rupture (water breaking) looks and feels like

    • This will include talking about signs of preterm labor and what should cause you to come in to be assessed

  • Discussions of options for pain management in labor

Membrane Sweeping (38 weeks and later)

  • A membrane sweep is a method of helping the cervix and the body be ready for labor to start

  • This is an optional procedure that some women want to help reduce their chances of going post-dates (more than 40 weeks pregnant)

  • It is a simple procedure that can be done in the office

    • Your doctor will insert a gloved finger into the vagina to reach the cervix (the connection between the vagina and the uterus that must dilate in labor)

    • Your doctor will then ‘sweep’ their finger between the inner part of the cervix and the membranes of the amniotic sac

    • This helps your body and cervix to release natural hormones and chemicals that soften the cervix and prepare it to dilate and thin out for labor

Discussion of Induction for Post-Dates Pregnancies

  • If you reach 40 weeks and do not have signs of labor starting soon, your doctor will talk with you about inducing labor at 41 weeks

    • We start induction at 41 weeks with the goal of you delivering your baby by 42 weeks, which is when we see a big increase in risks for you and your baby

  • Please see our page on Induction of Labor for more information and discussion

Post-Partum Visits

0-6 weeks after delivery

After you have given birth and gone home from hospital, we will continue to see you and your newborn baby at the TRFO clinic for several visits.

First Post-Partum Visit (7-14 days after delivery)

This visit focuses on growth and feeding, and how you are healing after delivery

  • Your baby will be weighed to check that they are gaining weight well

    • All babies lose some weight after birth - the goal is that they will start gaining weight fast enough to be back to their birth weight by 10 days old

  • Your doctor will talk to you about the feeding habits of your baby and any challenges you have faced with this

    • We encourage breast feeding for all our mothers but we also recognize this can be a very difficult part of the parenting experience

    • Please visit our page on Breastfeeding for more information on ways to make this more successful, as well as more resources

  • You will be asked about your physical health, including pain and bleeding

  • You will be asked about your emotions and mental health

    • Having a newborn baby is an incredibly stressful experience, whether you are a first time parent or have had many children

    • Post-partum depression is a condition that can make this time even more difficult

      • It is also something that can be managed with the right supports for you

      • Please reach out to your doctor, family and friends if you are noticing emotional struggles

      • Please visit our page on Post-Partum Depression for more resources

6 Week Check-Up

  • This will generally be your last visit with the TRFO clinic

  • Your doctor will check your baby’s weight, measurements, and development

  • You will be asked about your physical health, including any pain and bleeding

  • You will be asked about your emotions and mental health

  • If you are due for a pap smear, it will be done at this appointment or information for HPV self swab if appropriate for cervical cancer screening

Additional Post-Partum Visits

  • You may have a few extra appointments during the post-partum period if you or your baby have additional needs

  • Reasons for these visits commonly include:

    • Weight gain or feeding challenges for your baby

    • Excessive or ongoing bleeding for you

    • Concerns for infection, either of the uterus or breasts

    • Monitoring for complications of pregnancy, such as pre-eclampsia

You will now be discharged back to your family physician or primary care provider

We know that not every woman or family has a family physician or primary care provider at this time. Whenever possible, we are referring our patients on to accepting clinics, but this is not always possible. Please ensure that you have called 8-1-1 to place your name on the waitlist for a family physician.