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The Centreville Clinic

Pregnancy

Visits During Your Pregnancy

Congratulations on your pregnancy!

During the course of your pregnancy you can expect to be seen in the office once every four weeks until 32 weeks gestation, every second week until 36 weeks and once weekly thereafter. We may modify this schedule as needed. You will be sent for blood tests before the twelfth week and again at 24 - 28 weeks. It is routine to do an ultrasound at 20 weeks; more ultrasounds are performed only if medically indicated. We will modify our routine for each patient as needed.

There are some screening tests that can be used to determine the likelihood of your baby having certain genetic problems. These must be done early in your pregnancy. The tests offered vary, depending on a mother's age and past medical history. Most of the testing does not involve any risk to the baby. It is important to note that the tests give a probability only and do not tell us with certainty if your child has one of these problems. We will be discussing this at your first or second visit.

Family, friends and children are always welcome at office visits and we encourage questions. The more you understand about the process, the easier your delivery and early parenthood will be. If we feel we do not have adequate time to discuss your concerns during your visit, we will book an additional appointment.

About one week after the delivery, we will see you and your child in the office for follow-up care. Once your baby is gaining weight well and there are no health concerns related to labour, delivery and adaptation to newborn life, your newborn will be discharged to the care of your regular family physician. We will see you approximately six weeks after delivery to discuss birth control and to do a Pap test. At that time we send a copy of all relevant prenatal and birth information to your family doctor.

Helpful Resources

The following are some resources that you may find helpful at some point during your pregnancy.

BC Prenatal Screening Information

bcprenatalscreening.ca

Prenatal Classes (Okanagan College)

250-545-7291 ext.2850

Nausea and Vomitting

www.sogc.org
www.motherisk.org

BC Nurse Line (For questions outside office hours)

1-866-215-4700

Vernon Jubilee Hospital Maternity Ward

250-558-1213

Friendship Center (Prenatal Programs / Care Nutrition, Breastfeeding, Support)

250-542-5448

Friendship Center (Other programs)

250-542-1247

School of Massage Therapy

250-558-3718

Health Web Sites

BabyCenter BabyCenter.com
Health Canada www.hc-sc.gc.ca
The Mayo Clinic www.mayoclinic.org
WebMD (US) www.webmd.com

Healthy From the Start

We encourage all of our patients to visit the Healthy From the Start web site or call 1-855-868-7710.
Speak to a public health nurse, ask questions, and get connected to services and programs in your area!

Weight Gain in Pregnancy

We are often asked how much weight you can expect to gain in pregnancy. As a guideline, you can use this calculator from Health Canada. These are guidelines only, so please discuss this with us if you have any concerns. In general, the higher your BMI at the beginning of pregnancy, the less total weight you would be expected to gain.

Pregnancy Calendar

If you know your due date, you can use this form to make a customized Pregnancy Calendar. It will display the date on the left side and your current number of weeks of gestation on the left. It was created by Dr. Poulin, so please let him know if you have any problems with it.

Working in Pregnancy

Please refer to the following information from the Society of Obstetricians and Gynaecologists of Canada. Working During Pregnancy

There is also a helpful (but much more detailed) document that is primarily for health care providers (but may be helpful for some patients) at this site.

Iron Supplements in Pregnancy

If you just want to know what to take, here are your two main choices:
ferrous sulfate - 65 mg elemental iron per tablet, one tablet three times per day
ferrous gluconate - 28 to 36 mg elemental iron per tablet, one to three tables two to three times per day
For better absorption, take with vit C or orange juice. Avoid antacids.
If you would like to know more, read below about anemia in pregnancy.

Medications in Pregnancy

We will discuss any medications that we prescribe in pregnancy.

The following is a list of over-the-counter medications that are considered low risk in pregnancy. If you have any questions, please discuss them with us or your pharmacist before taking any medication that you are unsure of.

Many herbals or supplements do not have sufficient safety information for us to be able to recommend them in pregnancy. Please be aware of this when taking any supplement. If you believe that a supplement has potential to change your health, then you should consider it a medication. All medications have risks.

Anemia in Pregnancy

Anemia (low hemoglobin levels) is quite common in pregnancy. It is usually caused by low iron stores. Your body requires more iron than usual in pregnancy, and it's easy to fall behind.

Anemia may cause you to feel weak or fatigued, especially with exercise or exertion. You may also experience headaches or "restless legs". Low hemoglobin levels have been associated with low amniotic fluid levels and concerning fetal heart rate patterns in pregnancy. Having a low hemoglobin level just before delivery can also make your recovery more difficult. We encourage iron supplementation if you are anemic in pregnancy.

The main limiting factor in getting iron in pregnancy is how often you take it. Gastro-intestinal side effects are common, and many women stop taking their iron for this reason. We encourage you to try to take some iron, even if it is a small amount. The amount of side effects is usually related to the amount of iron.

There are a few preparations of iron available. Whatever the preparation, the recommended total daily iron intake in patients with iron deficiency anemia is 150 to 200mg/day of elemental iron.

There are usually three kinds of tablets available:

ferrous sulfate - 65 mg elemental iron per tablet, one tablet three times per day
ferrous gluconate - 28 to 36 mg elemental iron per tablet, one to three tables two to three times per day
ferrous fumarate - 106 mg elemental iron per tablet, one tablet twice per day

These are all equally effective at the same amount of total iron, but the lower amounts of iron (ie. ferrous gluconate) tend to be less bothersome.

The least expensive is preparation of iron is usually ferrous sulphate 325 mg tabs (65 mg of elemental iron). One tablet taken three times daily would suffice for the recommended daily intake.

A newer preparation of iron called FeraMax contains 150mg of elemental iron. It is a polysacharride-iron complex and is designed to have fewer side effects than other iron supplements. It is more expensive, but may be an option for those who can't tolerate other preparations of iron.

It is also possible to use iron elixir (10 mL of iron sulfate contains 88 mg of elemental iron) mixed in with a glass of orange juice and taken 30 minutes before breakfast. The amount of elixir can be reduced if the full dose causes stomach upset. This preparation can be expensive.

If you have any further specific questions when you are purchasing iron supplements, you may wish to ask the pharmacist.

Iron salts should not be given with food because it will bind to the food and lower absorption. It is also best absorbed in a slightly acidic environment. This can be enhanced with a tablet of Vitamin C (ascorbic acid) or a half-glass of orange juice. Avoid antacids at the same time as your iron.

Dr. Poulin

FAQ

Will I see the same doctor for my entire pregnancy?

You will usually be followed by one physician through your pregnancy and that physician will be responsible for most of your visits. Occasionally, however, if your primary physician is not available you may be seen by one of the other doctors in the clinic.

Will you be at my delivery?

Due to the shortage of doctors providing obstetrical care and the professional and personal pressures that we are subject to, we cannot be present at all of the deliveries that originate from our own private practices. All of the doctors in our office share a similar philosophy. Where there are choices, we do our best to listen to an individual's needs and adapt our care to them. All of the doctors have up to date obstetrical and neonatal resuscitation skills and we feel confident that you will receive excellent care from any of us as we attend your delivery. You have the option of meeting each of us in the office during your prenatal visits should you wish to do so.
We also share call with other family physicians who have dedicated themselves to providing maternity care. You may also meet one of these physicians at the time of your delivery.

Maintained by Dr. Poulin