How often should I see my doctor or midwife? What happens during prenatal checkups?
If you have no health problems and your pregnancy is progressing normally, you should meet with your health care provider at the following intervals:
A first appointment before 12 weeks of pregnancy
One appointment every 4 to 6 weeks from weeks 12 to 30 of pregnancy
One appointment every 2 to 3 weeks from weeks 31 to 36 of pregnancy
One appointment per week from week 37 of pregnancy until delivery
Who will provide my prenatal care?
Depending on the services available in your region, you may be followed by a family physician, an obstetrician, a midwife, or a specialized nurse practitioner (SNP).
Midwives can only follow women who have a normal pregnancy and no medical history requiring special monitoring. An SNP can follow women with high-risk pregnancies, but follow-ups are done in conjunction with a physician.
Whatever your choice, prenatal follow-ups are fully covered if you have a valid RAMQ health insurance card.
For various reasons, some women experience complications during pregnancy and require special prenatal checkups.
This may mean blood pressure and blood sugar monitoring, depending on the diagnosis. The baby’s growth will also be more frequently monitored, especially in the case of a multiple pregnancy.
The frequency of checkups during a high-risk pregnancy will depend on the nature and severity of the complication. These types of follow-ups often involve a number of specialists, such as obstetricians, internists, and neonatologists.
At your first appointment, your health care provider will ask you a series of questions about your family and medical history to get an accurate picture of your health and adapt your prenatal care to your needs. For example, they will ask if certain chronic or genetic diseases, such as high blood pressure, diabetes, or Down syndrome, run in your or your partner’s family.
They will also perform a complete physical examination (blood pressure, weight, height, heart and lungs, pelvic examination, etc.). If you’ve chosen a midwife for your prenatal care, they will use this appointment to determine whether you are eligible to continue your follow-up with them.
During subsequent checkups, your health care provider will ensure that your pregnancy is progressing well by checking the following clinical parameters:
Your vital signs (blood pressure, heart rate, respiratory rate)
Your baby’s heartbeat and movements
The size, shape, and height of your uterus
The growth and position of the baby (later on in pregnancy)
The presence of contractions, fluid loss, or blood
Your health care provider will generally only perform a vaginal exam during checkups that are closer to your scheduled delivery date.
Your health care provider is also there to answer your questions and give you advice. They should discuss important aspects of pregnancy, such as nutrition, common ailments, and available tests (ultrasound, prenatal screening, etc.).
Choosing your birth location
Women who are followed by a midwife can give birth at a birthing centre. It is also possible to give birth at a hospital or in your home. During your prenatal checkups, your midwife will speak with you about birth location options.
Whichever health care professional you choose to be your prenatal caregiver, they will prescribe urine and blood tests during your pregnancy. These tests allow them to, among other things, determine your blood type (type A, B, AB, or O and your Rh factor [see box on Rh incompatibility]), check for anemia, and screen for diabetes and infectious diseases such as syphilis, HIV, and hepatitis B. You will also be offered screening for cervical cancer (Pap test) and other tests for certain sexually transmitted infections.
In addition, the following tests will be recommended to ensure your pregnancy is going normally and that your baby’s development is on track:
A prenatal screening test (for trisomy 21 [Down syndrome], trisomy 13, and trisomy 18): A first blood test between weeks 10 and 13 of pregnancy, and a second between weeks 14 and 16. The decision to screen for trisomy 21 is completely up to you.
An ultrasound sometime between weeks 11 and 14 of pregnancy: The Society of Obstetricians and Gynaecologists of Canada recommends having an ultrasound at this time to determine how far along you are. You may also be offered an ultrasound to measure your baby’s nuchal translucency. This test measures the thickness of the fluid beneath the skin at the back of your baby’s neck. If the fluid buildup is greater than normal, it may be a sign of Down syndrome. However, the tests you are offered can differ depending on whether the screening is done at a private clinic or through the Quebec Prenatal Screening Program. If the results indicate a high risk of Down syndrome, the health care professional monitoring your pregnancy will recommend amniocentesis with chromosome analysis.
An ultrasound sometime between weeks 18 and 20 of pregnancy: Some hospitals also offer an ultrasound at 32 weeks. This test is used to check your baby’s growth, the position of the placenta, the amount of amniotic fluid, your baby’s anatomy, and the fetal presentation.
A pregnancy diabetes test (oral glucose tolerance test) between weeks 24 and 28 of pregnancy.
Group B streptococcus screening around week 36 of pregnancy. Group B streptococcus (GBS) is a bacteria that is sometimes found in a woman’s vagina, rectum, or bladder. It poses no risk to the mother but can sometimes cause serious infections in the baby. Experts estimate that 10 to 30 percent of pregnant women carry the bacteria in their vagina. A certain percentage of these women may pass it on to their babies during childbirth. One to 2 percent of babies will develop a GBS infection. If you test positive for the bacteria, you will be prescribed antibiotics at the end of your pregnancy.
What is Rh incompatibility?
The blood tests you take during your pregnancy are also done to check for Rh incompatibility between you and your baby.
Some people have a protein on the surface of their red blood cells that belongs to what is known as the Rh blood group system. Those who have this protein are said to be Rh-positive, while those who don’t are said to be Rh-negative. A mother-to-be can be Rh-negative and carry an Rh-positive baby. In this case, if the fetus’s blood crosses the placenta, the woman’s immune system may react by producing antibodies that attack her baby’s red blood cells.
To prevent this from happening, pregnant women who are Rh-negative are given an injection of Rh immune globulin (brand name WinRho) at 28 weeks. The injection prevents the mother’s immune system from reacting to the baby’s blood. This treatment is effective in preventing complications and is safe for both mom and baby. In very rare cases, the mother may have an allergic reaction, but the professionals present at the time of the injection will be ready to intervene.
Pregnant women who are Rh-negative and experience vaginal bleeding before 28 weeks of pregnancy should contact their health care provider or hospital to assess whether the first dose of the vaccine should be administered earlier.
Things to keep in mind
Prenatal checkups begin near the end of the first trimester and become more frequent as your due date approaches.
You can choose from several types of health care professionals when deciding on your prenatal caregiver.
Medical appointments, tests, and exams help detect potential complications, allowing for early intervention to ensure a successful pregnancy.
Scientific review: Roxanne Piché, nursing adviser, Maternal Fetal Medicine Clinic, CHU Sainte-Justine
Research and copywriting: The Naître et grandir team
Updated: September 2021
Photo: 123rf/Wavebreak Media Ltd
Note: The links to other websites are not updated regularly, and some URLs may have changed since publication. If a link is no longer valid, please use search engines to find the relevant information.
Brabant, Isabelle. Une naissance heureuse: bien vivre sa grossesse et son accouchement. Montreal, Fides, 2013, 575 pp.
Doré, Nicole, and Danielle Le Hénaff. From Tiny Tot to Toddler: A practical guide for parents from pregnancy to age two. Quebec City, Institut national de santé publique du Québec. www.inspq.qc.ca
Le Ray, Camille, et al. “Routine third trimester ultrasounds: What is the evidence?” JOGC, vol. 30, no. 2, 2008, pp. 118–122.
Ministère de la Santé et des Services sociaux. “Trisomie 21.” msss.gouv.qc.ca
Qureshi, H., et al. “BCSH guideline for the use of anti-D immunoglobulin for the prevention of haemolytic disease of the fetus and newborn.” Transfusion Medicine, vol. 24, no. 1, 2014, pp. 8–20.
The Society of Obstetricians and Gynaecologists of Canada. Healthy Beginnings. Mississauga, Wiley, 2017, 288 pp.
Fung Kee Fung, Karen, and Erica Eason. “Prevention of Rh alloimmunization.” JOGC. SOGC Clinical Practice Guideline no. 133, reaffirmed in 2018.
Money, Deborah, and Victoria M. Allen. “The prevention of early-onset neonatal group B streptococcal disease.” JOGC. SOGC Clinical Practice Guideline no. 298, 2018.
AboutKidsHealth. “Rhesus hemolytic disease.” 2009. aboutkidshealth.ca