Prenatal care includes
- Regular appointments with your health professional (see below Regular appointments)
- Blood tests, urine analyses, and vaginal swabs (see below Blood tests and urine analyses and Vaginal swabs)
- Ultrasounds (see below Ultrasound)
- Genetic screening tests, in some cases (see below Screening tests)
Regular appointments allow you to check that your pregnancy is going well and to get screened for potential problems. These appointments also give you the opportunity to get answers to your questions and help you prepare for delivery and the arrival of your newborn.
Pregnancy checkups are a good opportunity to ask any questions you might have.
The frequency of prenatal appointments may vary. If you have a specific health problem, more frequent appointments may be necessary, but generally appointments will be scheduled as follows:
- During the first 11 weeks of pregnancy: first appointment
- Between 12 and 30 weeks: one appointment every 4 to 6 weeks
- Between 31 and 36 weeks: one appointment every 2 to 3 weeks
- From 37 weeks until the baby is born: one appointment per week.
To prepare for your next appointment, you can write down questions you want to ask your health professional as you think of them so you don’t forget.
If you have questions at any time, you can call Info-Santé by dialing 8-1-1.
Starting at 20 weeks of pregnancy, it is often possible to contact your hospital or birthing centre if you have questions about your pregnancy.
Good to know...
At prenatal appointments, you can at any time
- Ask for an explanation of any tests or examinations your health professional wants to perform
- Seek a second opinion from another health professional if you have any concerns
- View your file
Usually the first prenatal appointment will take place between 8 and 11 weeks of pregnancy.
This first appointment is generally longer than subsequent appointments. Your health professional will take the time to ask questions about your health history and will also offer to perform a physical exam.
Type of questions to expect
At your first prenatal appointment, your health professional will probably ask about the following:
- The date of your last menstrual period and the length of your cycle in order to determine how many weeks pregnant you are and estimate your due date
- Your health before and since the start of your pregnancy. For example, you may be asked about health problems, medication, allergies, operations, problems related to anaesthesia, and depression
- If you have ever been pregnant before, including any miscarriages or abortions you may have had
- Your family history and the family history of the baby’s father, i.e., any diseases that run in your family and the father’s family
- If you have ever had gynecological problems, such as cervical surgery, or if you or your partner have herpes
- Your living conditions (sources of income, family situation, support network)
- Your lifestyle (diet, physical activity, tobacco, alcohol, drugs)
- Your religious beliefs and practices
- If there are any sources of stress in your life, and if so, what kind
- What type of work you do in order to determine if it poses any risks during pregnancy
Do you have questions? Are you hesitant to have some tests done? Do you think other tests might be helpful? Now is the time to talk these things over with your health professional so you can make informed decisions.
Some exams, such as genetic screening, for example, should ideally be performed between 11 and 13 weeks of pregnancy (see below Screening tests). If you want to have these exams, your first prenatal appointment is a good time to talk about it.
Your health professional will offer to perform a full physical exam, which may include a gynecological exam.
He or she will check your weight and blood pressure and may listen to your baby’s heartbeat.
A PAP test to screen for cervical cancer will be suggested. This exam can also be performed later during the pregnancy, or after the birth.
You may notice light bleeding within 24 hours of the gynecological examination. Don’t worry, the bleeding is from the cervix, which is more sensitive during pregnancy.
Your baby’s heart starts to beat five weeks after the start of your last menstrual period. Usually, it cannot be heard until 10 to 12 weeks into the pregnancy.
Subsequent appointments are usually shorter.
During the appointments, your health professional will ask how your pregnancy is going and check:
- Your weight
- Your blood pressure
- The height of your uterus (starting around 20 weeks)
- The baby’s heartbeat
Blood tests and urine analyses
During your appointments, your health professional may prescribe blood tests and urine analyses to determine
- If you are anaemic
- If your blood sugar level (blood glucose) is normal
- Between 24 and 28 weeks of pregnancy, your health professional will suggest a screening test for gestational diabetes (see Gestational diabetes). This test measures your blood sugar after you drink a sugary liquid.
- If you have a disease that you could transmit to your baby (such as syphilis, HIV/AIDS, or hepatitis B)
- Your blood type and rhesus factor (Rh factor):
- If you have anti-rubella antibodies
- If you have bacteria in your urine, even if you don’t have any symptoms
- If you have protein in your urine
It is also recommended that pregnant women be tested for certain sexually transmitted infections (STIs) like chlamydia and gonorrhoea. Many of these diseases can go undetected and affect your health and that of your baby. STI screening is completely confidential.
If you think you may have had contact putting you at risk for an STI after your initial screening, don’t hesitate to talk to your health professional about repeating the tests.
Your health professional will suggest a vaginal and anal swab to check for Group B Streptococcus at around 36 weeks. This type of bacteria poses no problems for the mother, but can in rare cases harm the baby if it is not treated. If it is present, you will be treated with antibiotics during labour.
Ultrasound is a type of exam that will be offered by your health professional. Ultrasound enables your health professional to:
- Determine how far along you are and when your due date is
- Check that your baby is the right size for his/her age
- See most of your baby’s organs (heart, liver, kidneys, stomach, bladder, brain, etc.) and limbs
- Confirm how many babies there are
- Determine the location of the placenta
At the time of the ultrasound, it is often (but not always) possible to determine your baby's sex, although there is a slight risk of error. If you want to keep the baby’s sex a surprise, tell the technician and your doctor to avoid any misunderstanding.
Screening tests for chromosomal anomalies may be offered to you as part of your prenatal care.
Trisomy 21 Prenatal Screening Program of Québec
Before you have these tests, think about the decision you will have to make if you find out the baby has a trisomy.
At your first prenatal appointment, your health professional will ask if you want to take part in the Trisomy 21 Prenatal Screening Program of Québec.
Prenatal screening is not mandatory. It is up to you to choose whether or not to do the screening tests and whether or not to use their results. The decision is yours at each of the steps described in the next pages.
In Québec, most of the tests under the screening program are free for women who choose to participate.
These are the steps involved in the Trisomy 21 Prenatal Screening Program:
- Biochemical test, with or without ultrasound
- A genomic test or amniocentesis if the biochemical test shows a high probability. The genomic test may also be offered right away if you meet one of the following criteria:
- You will be over 40 years old at the time of the birth
- You have already had a pregnancy with trisomy 21, 18, or 13
- You have just had a prenatal genetics consultation.
These tests are described below.
The biochemical test consists of two blood test performed during pregnancy:
- One between weeks 10 and 13
- A second between weeks 14 and 16
The test takes into account your age and the blood test results to determine whether your probability of having a baby with trisomy 21 is low or high. Depending on the results, the test may also indicate a high probability of your baby having trisomy 18.
Good to know...
If the results of the biochemical test, with or without ultrasound, show a high probability, this does not necessarily meant that your baby will have trisomy 21 or trisomy 18.
Along with the biochemical test, you may be offered an ultrasound between weeks 11 and 13 of your pregnancy. There may be a fee charged for this test.
This ultrasound is used to measure nuchal translucency, i.e. the space between the skin of the neck and the spine of the fetus. A higher than normal measure of nuchal translucency may indicate a high risk of trisomy 21, other chromosomal abnormalities, or fetal malformations.
If there is a high probability that the baby has trisomy 21 or 18, you will be offered the genomic test. In certain specific situations, you may be offered an amniocentesis right away.
The genomic test is designed to detect trisomies 18 and 13 and make screening for trisomy 21 more certain. It more accurately identifies pregnancies where the risk remains high after the results of the biochemical test.
This test is offered because it is reliable and safe. It is done by a blood test on the pregnant woman.
If the genomic test shows that the risk is high, a diagnostic test called amniocentesis will be proposed to you.
It is normal for you and your partner to feel anxious if you choose to have these tests done. Be sure to ask for all the information you need and take your time to decide.
This test involves inserting a thin needle into the abdomen to take a sample of amniotic fluid from the uterus. This method is a reliable way to determine whether the baby has a chromosomal anomaly, but it does carry some risk of complication, including miscarriage.
If you are faced with the difficult choice of continuing or terminating your pregnancy after completing these tests, you may need help. Don’t hesitate to discuss this choice with your family or a health professional.
You may also want to contact trisomy 21 parent groups. They can help you better understand their reality and make the decision that is best for you. To find groups in your area, contact your CLSC.
For information about the program, visit www.quebec.ca/ en/health/advice-and-prevention/screening-and- carrier-testing-offer and click on Québec Prenatal Screening Program.
Other screening tests
After the birth, you will be given the option of testing your baby’s blood and urine for diseases that are rare, but require early monitoring or treatment (see Neonatal screening).
Amniocentesis: Procedure that involves taking a sample of amniotic fluid for analysis.
Anemia: Condition that can lead to severe fatigue, often caused by a lack of iron in the blood.
Antibodies: Substances made by the body to fight off disease. Also called immunoglobulins.
Chromosomal abnormalities: Errors in the number or structure of one or more chromosomes. Chromosomes are found in all cells of the body and contain the genes transmitted by parents to their children.
Fetus: Developmental stage of a human being in its mother’s womb, from 10 weeks of pregnancy until birth.
Infectious diseases: Diseases caused by a virus, bacteria, fungus, or parasite in the body.
Labour: Process by which the baby passes from the uterus to the outside world, primarily through contractions of the uterus.
Miscarriage: A spontaneous abortion, which can have a variety of causes (e.g., a deformity or disease).
Rhesus factor (Rh factor): One of the characteristics of blood. You are either Rh positive or Rh negative.
Sexually transmitted infection (STI): Infection caused by a bacteria or virus transmitted through sexual contact.
Trisomy: Chromosomal abnormality that occurs when a chromosome pair has an extra chromosome. In the case of trisomy 21, there are three chromosomes on the 21st pair instead of two.
Ultrasound: An examination using an ultrasound device that can see the embryo or fetus in the mother’s womb.