This guide is given out at the first pre-natal visit

Appointments in my office are by referral only

A Guide to Maternity Care  

DR. S. Kalaichandran, MBBS, MD, FRCSC,FSOGC (Canada), FRCOG

Lecturer University of Ottawa
Obstetrics and Gynaecology

Congratulations on your pregnancy and welcome to my office for your maternity care. 

    A visit to the doctor's office is usually a stressful event, particularly if it is your first visit to that doctor. The main reason for the stress/anxiety is not knowing what to expect at these visits. This leaflet addresses this issue, and gives a brief guide to maternity care, tests and procedures in my office and at the hospital. 

    Ideally I would like to see potential mothers several months before they attempt a pregnancy, for pre-pregnancy counseling. This is particularly important for women with medical conditions, previous unsuccessful or complicated pregnancies, smokers, drug or alcohol abuses and those with a family history of inheritable conditions-biochemical or structural defects. All women running the risk of pregnancy should take folic acid supplement for three months before conception and during the first twelve weeks of pregnancy. Folic acid prophylaxis reduces the risk of neural tube defects (spina bifida and anencephaly) in the foetus by up to seventy percent. Chronic medical conditions like diabetes, epilepsy and hypertension and the medications used to treat these and other conditions may adversely affect the outcome of the pregnancy. These patients should have pre- pregnancy counseling to optimise their condition and change the medication if necessary.    

The first Pre-Natal Visit

    The first pre-natal visit is the most important visit of all. This is the time for risk assessment, counseling and planning for the rest of the pregnancy. The first visit, in an otherwise uncomplicated pregnancy, should be in the first trimester. At the first visit, the pre-natal forms are completed and this requires considerable amount of time. The family history, social history, past medical, surgical and obstetric history, prescription and other drug history are all entered on the pre-natal sheets 1 & 2. Expected date of confinement (EDC) is calculated if the last menstrual period (LMP) is known with certainty. A full general physical examination is carried out. (No footwear please on the examination table and winter boots should be left outside the office). The foetal heart sounds will be detected at 11-12 weeks pregnancy by the Doppler ultrasound. 

The routine blood tests include hemoglobin level, screen for abnormal haemoglobulins like Sickle and Thalassaemia, blood group and antibody screen, blood glucose, thyroid tests and screening for Rubella, syphilis, hepatitis and HIV.

A pap test, if not done recently, and cervical swabs for Chlamidial and Gonoccal infections will also be done at this visit.

Subsequent Pre-Natal Visits

In an uncomplicated pregnancy, subsequent visits will be every 4 weeks until 28 weeks of pregnancy and then every 2 weeks until 36 weeks pregnancy and weekly thereafter until delivery. 

Between 11 and 14 weeks of pregnancy, you will be offered an Integrated Pregnancy Screening (IPS) to screen for Downs Syndrome in the baby. This consisting of an Ultra Sound Scan (USS) and a blood test. A further USS will be booked at 18-19 weeks pregnancy to check for the fetal parts. Mothers who were late for the IPS will be offered Maternal Serum Screening (MSS).This is a blood test to be done between16 and 19 weeks of pregnancy.

At these visits, you will check your urine with the uristix provided and report. Your weight and blood pressure will be checked. You will be asked for any complaints or concerns_ in particular the all-important question “ Is the baby moving well”.
Once the results of the booking blood work are received, these are entered on the prenatal record and the yellow and white copies of the prenatal record 1 and 2 are given to the mother. The mother keeps these records with her at all times and these are updated at every visit. These records become part of the hospital record of the mother and baby when the mother comes in labour. These may be required if the patient has to be seen earlier by a doctor. 
The height of the uterus is measured and the foetal heart sounds are listened to with the Doppler at every visit. The presentation and engagement is checked by abdominal palpation in late pregnancy. 

A screening blood test for diabetes is performed at about 25 weeks pregnancy. If the mother's blood group is Rhesus negative, she will receive WinRho injection at the hospital at 28 weeks. Vaginal and rectal swabs to screen for Group B Strep (GBS) colonization is performed between 35 and 37 weeks of pregnancy. Those who are positive for GBS will be treated with IV antibiotics in active labour. This reduses the risk of invasive GBS, a potentially lethal condition for the new born.
 
I offer induction of labour at 41 weeks gestation. If this is not accepted, close foetal monitoring is mandatory. 

Labour and Delivery

 

When you have regular painful contractions, rupture of membranes, abdominal pain or vaginal bleeding, you should contact my office and/or the labour ward at the Hospital and you will be asked to go in for assessment. YOU MUST TAKE YOUR PRE-NATAL RECORDS WITH YOU. 

In order to provide 24 hour coverage to all of our patients, the ob/gyns have formed a call group where the “on call” ob/gyn covers for the whole group.

Epidural service is available at the hospital. I would recommend a timely request as there may be a waiting period for it.

I believe in active management of labour. When you are in active labour, and labour does not progress in the first stage, it is augmented with artificial rupture of membranes and intravenous oxytocin infusion. In the second stage, an instrumental delivery may be carried out if oxytocin does not achieve delivery. 

Postpartum Care

The usual postpartum stay for normal delivery is 2 days. You will be discharged when the baby is discharged and you are happy with breast- feeding. You will receive MMR injection and/or WinRho injection if indicated before discharge. You should continue to use prenatal vitamins while breast-feeding. I would encourage you to do pelvic floor exercises (kegal). This will reduce the risk of urinary incontinence and utero vaginal prolapse in later years. You will be seen for follow up in my office 4 weeks after delivery. 

 

Post-Natal Office Visit
 

You'll be seen in my office 4 weeks after delivery. Examination of breast, abdomen and pelvis will be carried out and contraception will be discussed.