Diet and Health FAQ

Tagged As: Prenatal Pregnancy

Question:
I'm originally from California, but have been living in Ottawa for the last few years, and am 23 weeks pregnant with my first child. I've had a prenatal visit every month or so, but the examinations have seemed rather cursory: I haven't had any kind of physical exam since becoming pregnant (I had a regular physical about 6 months before conceiving), and my blood pressure was taken for the first time today, which was my third visit. I was weighed for the first time on my last visit. Is this normal? My mother thinks I should be getting better prenatal care and that in the U.S., I would be having a urine test every visit (which I've never had), and more regular blood work, as well as some kind of a physical exam. When I asked my doctor last month whether I should have a physical, he said no, everything looked fine and that the baby seemed to be progressing normally (we had an ultrasound). In all my baby books (which all seem to be written from the American perspective), they talk about the various tests I can expect at each monthly visit, but I haven't gotten most of those. Anyway, just wanted to see what the experience of other women in Canada has been.

Answer:
Well I'm in Calgary and it certainly differs from province to province but I did do urine and weight at each visit, but not much else. Initially there was a physical and towards the end of the pregnancy I was checked once or twice. Generally though it was blood pressure, weight and urine, and the baby's heartbeat once it was detectible. Many things that are done are completely useless; however, I would question a few things. I'm not sure what you mean by physical but if you mean a pelvic exam, that's totally not necessary. In fact, it's often just a good way to introduce foreign bacteria and drive up your risk of infection. You also don't need to be weighed. Blood work really only needs to be done once near the beginning of pregnancy, except maybe for a quick poke to check for anemia later on. Ultrasounds are totally not necessary unless there's some medical indication. Routine screening for gestational diabetes is rather controversial. It's routine for most practitioners in the US, but not routine in many other parts of the world, and you can certianly make an argument that routine screening isn't beneficial, at least for some populations. Screening for group b strep can be done in several ways. Some test for it around 36/37 weeks; others treat based on risk factors during labor. Other screening tests for possible problems are really based on what *you* want, and for the most part don't affect your medical care unless you want to choose to terminate the pregnancy. That said, checking your urine for protein (with just a simple dipstick) and checking your blood pressure probably *should* be routine and happening at each visit. Those are mostly looking for evidence of pre-eclampsia, which usually doesn't show up until a bit later, but it *can* start showing up early (in which case it's usually more serious) and it's good to have a solid baseline measurement anyway. I had very minimalist testing. I think much of it does more harm than good. However, even I had urine and blood pressure checks at each visit. Other than that, I had the basic OB blood panel done early in each pregnancy, some checks for anemia later in pregnancy, and some additional blood work late in my first pregnancy to check for pre-eclampsia. I'm in Ontario as well - not too many hours from Ottawa and every single prenatal since 8 weeks has included a urine test, weight and blood pressure check, fundus height measurement and general discussion about the progress of things. Since I have two doctors (long story - related to no deliveries being done where I live) I get my blood drawn to check for iron every other visit as well.