Some questions about the medical process of pregnancy

November 20, 2013 12:01 PM

What happens, from a medical process standpoint, when you first tell a doctor you may be pregnant? Where do midwives and other professionals fit in?

Actively trying for a first (and probably only) wanted baby, and I have a few questions about how the medical process works. Do I call my regular doctor as soon as I get a positive pregnancy test, for a referral to an OB doctor? Or do they not want to see you that soon? What happens at that first appointment or two, from a medical standpoint?

I also was wondering about a midwife. I am not sure if it is a midwife I would need or something else (a doula? Some other professional I don't know about?) and when/how to bring them into the process. My significant other has a disability (and is immune compromised) so I want to make sure that if he is not at 100% or if we are there for awhile and he has to go home to sleep, I have someone who can be there with me, keep me company, do whatever taking care of etc. Who would I need for this, and at what point in the pregnancy would I hire them?

I am in Ontario (Canada) if that matters...

posted by anonymous to Health & Fitness (14 answers total)

Preemptive congrats on your future-baby!

- The timing of the first appointment varies depending on your age, risk status, and your individual OB/GYN. If you are relatively young and low-risk and have a typical doc, they may not even want to SEE you until you're between 8 - 12 weeks along.

- The first apt. will be a LOT like a general physical (weight, blood pressure, urine sample, health history, etc.), with an added pelvic and abdominal exam.

- All subsequent appointments until much later in the pregnancy are pretty brief, IIRC - just a check-in to make sure everything's progressing as it should. Once you get closer to your due date, they'll be more involved.

- What you want is a doula (who's basically a birth-support-friend). I wouldn't retain their services prior to the point of viability (~24 weeks), but nor would I wait until 9 months (because you want to KNOW the person who'll be helping you through labor).
posted by julthumbscrew at 12:14 PM on November 20, 2013 [1 favorite]

I gave birth with a midwife in Ontario. I had to call around to midwife practices myself after getting pregnant, not through a doctor referral, although it wasn't until about 8 or 9 weeks that I had my first appointment. Midwives in Ontario are regulated and totally covered under OHIP.

My only piece of advice regarding midwives is to call immediately after getting a positive pregnancy test. I was lucky to get in with the 4th place I called.... all the others were already booked up, just a few days after getting a positive test. There is such a shortage of midwives relative to the number of women who want them here. (Although I am speaking about Toronto - I'm not sure what it's like elsewhere in the province.)

(I had a great experience with my midwife as well - please feel free to memail me if you have any questions.)
posted by barnoley at 12:15 PM on November 20, 2013

I'm not sure how the Canadian health care system is, but you may want to get established with an Ob-Gyn BEFORE you get pregnant, if you're not already seeing one for annual checkups. Some of the good practices can be hard to get appointments with, at least here in the US.
posted by pantarei70 at 12:18 PM on November 20, 2013 [1 favorite]

Oh sorry... I didn't realize at first from your question that you already decided on an OB. In Ontario you have the choice of a doctor OR a midwife, but not both. If you want to go with a doctor, then you would be looking for a doula (not midwife) if you want extra help at the birth.

Midwives are fully covered in Ontario for both hospital and home births. I also had a complication during my pregnancy that required the care of a high-risk OB, but I was able to see him as well as my midwife because it was just for periodic check-ups. However, since there was no concern about the birth itself, I was able to deliver in the hospital with only my midwives there in the delivery room.
posted by barnoley at 12:19 PM on November 20, 2013

Right - a midwife would take the place of your OB and is there for your appts and the delivery. What you're describing is a Doula who will be very familiar with the process and be able to advocate for you and just help out with what you need during the delivery. Beyond meeting them once or twice beforehand, you won't see them until the delivery.

Midwives totally rock, imho. The atmosphere of the office is so different and they are more approachable so if you have a ton of questions, they don't mind (of course, I only know about 6 and some, I'm sure, can be jerks, as in every profession).
posted by dawkins_7 at 12:23 PM on November 20, 2013

It sounds like what you want for childbirth is a doula, who will be there with you throughout the birthing process.

Whether you want an OB or a midwife is a personal choice. We've been receiving midwifery care throughout my pregnancy in the US, in part because I'm hoping for a home birth but also in part because, in my experience, they give more personalized care (spend more time with you per visit, that sort of thing). I actually didn't see any health care provider until I was 6 weeks along, unless you count a visit at 2 weeks for a UTI caused by trying (whoops!). We went in for our first appointment with our midwives intending to interview them as well as other practitioners but hit it off so well, we stopped there. Our midwives didn't do anything but a pee test until our 11 week appointment, precisely because it was "too early." Everything is pretty uncertain at that stage! In fact, I haven't had a pelvic exam once throughout my pregnancy (and a friend of mine who also received midwifery care reported a similar experience), though this seems to be the norm with OB care. However, each appointment is still about an hour long. I've gotten my BP tested, done a pee test, had other standard testing (GD test, etc) and talked about any and all concerns at each one.
posted by PhoBWanKenobi at 12:24 PM on November 20, 2013

In Ontario, you would have either a midwife or an obstetrician. If you want a midwife, you probably need to call midwifery practices as soon as you find out you are pregnant, as midwives are in high demand in many parts of Canada, and you might need to be on a waiting list. This is a link to some information from the Ontario Midwives association, including a directory of midwives.

A doula is a person who accompanies you during labour to provide support, suggest comfort measures, fetch and carry for you and your partner, and just generally be there for you. It sounds like a doula could be very helpful to you considering your significant other's needs. You should be aware that there's no standardised training for doulas, and exactly what they do really varies! Around 20 weeks or so could be a good time to start looking for a doula, but some women look later. Many doulas will meet you for a first interview without any fee or commitment--take that time to see if their birth philosophy is a good fit for you, and if you feel you'd be comfortable with them. Most have some kind of package that includes some prenatal appointments (so you can get to know each other) as well as the doula's presence at your birth. This seems like it could be a good place to start looking for Ontario doulas. (I am a doula, but not in Ontario, so I don't know the local groups.)
posted by snorkmaiden at 12:28 PM on November 20, 2013

You should get an OB referral now. First, it's probably a good idea to have a preconception checkup for health reasons (e.g., in case you have some health issue that might affect a pregnancy). Second, establishing a relationship with an OB before pregnancy will ensure that you'll have someone to call with questions if you have any urgent issues and because you want to find someone who's a good match while you still have some time to look around.

And if you're not already taking folic acid supplements, start today: "...women who take the recommended daily dose of folic acid starting at least one month before conception and during the first trimester of pregnancy reduce their baby's risk of neural tube defects by 50 to 70 percent."

And here's some more information on preconception health in Ontario.
posted by Mr.Know-it-some at 12:36 PM on November 20, 2013

A doula is good, if you have the dough for it, but you can also include a friend or family member. Preferably someone who will accompany you and your partner to childbirth preparation classes.

My friend's daughter gave birth in February here in Atlanta. I was her only 'family' in the state, so I helped out during her pregnancy. When she went into the hospital, her mom (my friend) came up from Miami. Her uncle flew in from a business trip in Washington, D.C. In addition to her husband, who was there with her the whole time. The whole family camped out in her room, and the staff even gave them little mattresses and blankets to sleep on the floor. Michi was in labor for 3 days (long story, not very interesting.) So I ferried back and forth with noms, and sundries (and sleep aids). Once the baby arrived, all but the husband headed to hotels for the next few days. I still stopped by with different noms, as the hospital fed the mother, but not the rest of the folks and there was an on-site McDonalds, but...yuucchh.

You want a person who will step in for your husband as well as advocate for you. So a Doula or a trusted member of the family.

Typically your GYN is also an OB, so you may want to go directly to your GYN, even before you become pregnant, for advice and some pre-conception discussions.
posted by Ruthless Bunny at 12:41 PM on November 20, 2013

Meet different obstetricians. Recognize that they get to go on vacations, and you might have another person in their practice. Research the OB and the hospital by infection rate and c-section rate. It's nice to have an OB you feel good about, in a hospital you like, but having an infection = not fun. Read a lot, go to birthing classes, and have your partner do the same. You need an informed advocate and partner.

A good doc will talk to you about their process, who would be on call for them, costs, and more. You'll usually see the doc once a month, then once a week near your due date.

At the 1st appt., you'll get to hear the baby's heart, which is thrilling, and maybe have an ultrasound and see the wiggly little thing. Good luck!
posted by theora55 at 2:54 PM on November 20, 2013

Just in case you don't know (as I didn't): choosing a midwife rather than an OBGYN does not mean that you can't get all the tests you want (ultrasounds, genetic testing, etc.). I wanted a midwife because I didn't really want a hospital/epidural/c-section medicalized birth, but I went with an OBGYN because I thought that I needed to, since I was over age 35 when I conceived and I knew I wanted scientific verification that my baby was healthy. Turns out I could have gone with a midwife from the start and still had all the science I wanted. (I did end up switching to a midwife late in my pregnancy and really wish I had known I could have seen a midwife for the whole pregnancy.)
posted by rabbitrabbit at 4:05 PM on November 20, 2013 [1 favorite]

I've had a pregnancy and birth in Ontario not long ago. In general the process is call your regular doctor once you Get a positive pregnancy test. They will first want to see you around the 8 week mark. Then monthly until about the 5 month when you will likely be transferred to an OB. It's a good idea to choose your OB early, before the 8 week mark as their practices fill up quickly based on due dates. You can call around to the OB offices to find out what info they need from you. Choose an OB who practices out of the hospital you want to deliver at. Generally your regular Doctor will fax them the referral. You will see the OB monthly until you get closer to your due date, then biweekly, and finally weekly at the end. The first screening, ultrasound and blood test (approx weeks 11 & 16) will be arranged by your regular doc.

To have someone with you to help with the birth will be a doula. I suggest that you pay the "upgrade" fee to get a private room in the hospital. Much better for Doula and partner support.

Hope that helps! Best of luck!

If you happen to be in the KW area I have an amazing OB to recommend.
posted by saradarlin at 11:50 PM on November 20, 2013

I know I've already posted a couple times in this thread, but I just wanted to give you a little more information about midwives in Ontario. At my birth, there were two midwives in the delivery room with me at all times, and then a third came towards the end to help out as well. The general idea is that there is one midwife to look after the mother, and one to look after the baby; I also had a third because one was a student at the time. So if you did choose a midwife over an OB, you would not feel left alone if your partner was not able to be with you the entire time. They never made me feel rushed or uncomfortable. They were just there with helpful suggestions to move the labour along.

Before going to the hospital, I was on the phone with one midwife every 30 minutes or so from about 5pm when my contractions started... and they were there waiting for me in the delivery room when I arrived at the hospital around midnight. (No need to check in or anything at the hospital - the midwives took care of all the paperwork before I arrived.) They stayed with me until my baby was born near 11 am, and stayed for about an hour afterwards to help with breastfeeding and other questions. I had the option of being discharged right away, or staying the night - and because I had a difficult birth, I decided to stay for one night. When I was discharged, a midwife came to my home within an hour of us arriving home to help out more with breastfeeding and to see how we were settling. When I had some trouble with breastfeeding later that night, a midwife came to our home after 9 pm for more help. They also visited our home on the 3rd and 5th day after birth, and again at 1 and 2 weeks. After that I visited the midwife practice for two checkups before being transferred back to my family doctor for care.

ALL of this care was 100% covered by OHIP, with no out of pocket costs for me. I was blown away at the level of care and personal attention. The midwives were always available by phone if I had any questions (I would page them and someone would call back within 15 minutes, any time of day or night).

Since I gave birth in a hospital, there was still an OB on call at any time if their services were required. This seemed like the best of both worlds since I could have the care of a midwife, but the availability of an OB if anything unexpected happened.

I just wanted to give you something to think about, since you do have a choice in Ontario. There are some women who still choose to hire a doula in addition to the midwife, but in my case I did not find it necessary. If you chose a midwife, then the practice would likely have a list of doulas to recommend to you if you chose that route. Additionally, as mentioned above you still get the usual ultrasounds and blood work that would occur with an OB - there is just a bit more choice in what you want to do. I still did ultrasounds and even had an amnio due to an elevated risk for chromosomal abnormalities.
posted by barnoley at 7:52 AM on November 21, 2013 [1 favorite]

I hesitate to post this, having not been in the Canadian medical system, which could well be different. In the US, my experience has been, as noted (and with an OB), they want to see you at about 8-9 weeks. That is 8-9 weeks after your last period started, NOT the day that you think you may have conceived or the date of your missed period.

At that first appt, it is generally too early to reliably hear the heartbeat through the doppler thingy, so they will often (depending on the practice, and what you want to do) do a transvaginal ultrasound to check things out and make sure that the pregnancy looks viable. To be clear, the "doppler thingy" is like a little wand that they press against your belly. The transvaginal ultrasound requires a different little wand that is inserted into the vagina, and then they can look at the baby onscreen, and so can you. They will also have you pee in a cup to test levels of stuff (I'm no doctor) that is important. They will check your blood pressure, weight, and heart rate. They will likely give you some sort of "congratulations, you're pregnant, here is a huge amount of information to take in!" package, which may include some books, pamphlets, etc. It will often include information about prenatal testing that you may have done during the pregnancy. They will likely ask you about prenatal vitamins and give you a recommendation about that if you aren't already on one.

Like others have mentioned, the next appt will likely be about a month later. At that appt, they may or may not check for the heartbeat, because again, it's apparently a little early for hearing it with the doppler and it can kind of stress people out if they can't hear it with the doppler. They won't really do a whole lot else other than blood pressure, heart rate, weight, and peeing in a cup again. They will probably measure your stomach (from below your breasts down to the pubic bone area). They may recommend some blood tests and other tests to start scheduling. Generally speaking, you have a choice about what tests you want to do.

Here in the US, it seems pretty typical to stay on once a month until the third trimester, when you would be switched to every 2 weeks, and then every week in the last month or so. Of course, if other things come up along the way, you may be in more frequently.

Here, amniocentesis is NOT done as a matter of course, only if indicated, and there is usually a "big" ultrasound at about 20 weeks, which is when you most likely find out the sex of your baby (if you want to know).

I hope that someone who has had a baby in Canada can confirm or deny that it's pretty much like this.

p.s. Doulas are awesome.
posted by freezer cake at 2:30 PM on November 21, 2013