congratulations on your pregnancy!
Cornerstone Maternity provides low risk maternity care and newborn care to women in Saskatoon and surrounding communities. We accept both self-referrals and referrals from physicians for patients who are not CMC family practice patients. Cornerstone Maternity was previously known as Lifebridge Maternity.
Our Cornerstone Maternity moms-to-be have an entire team of doctors to help! During your pregnancy you will have one primary care provider but you are welcome to book visits with any member of our team during your pregnancy so you can feel comfortable with all of your providers.
cornerstone maternity team
why should you choose a family physician as your pregnancy and birth caregiver?
We are here to support you from preconception to birth and beyond. Our senior members have been in practice delivering babies since 2003. All of our team members are committed to providing excellent maternity care. We have participated in ongoing educational events, teaching of students and residents, interprofessional development with obstetrical colleagues and participation in the ‘in-house’ family medicine program which provides 24 hour in-hospital back up to all family physicians providing obstetrical care in Saskatoon. All of our physicians have up to date certification in ALARM (Advances in Labor and Risk Management), NRP (Neonatal Resuscitation) and participate in department-led continuing education.
Here are some guidelines on how to get your pregnancy off to a healthy start. If you have any questions please ask your doctor.
- Start taking a prenatal vitamin with folic acid right away. Folic acid helps prevent spine defects in developing babies. This should ideally be started before pregnancy (when possible), and is most important in the first 3 months of pregnancy. Look for a vitamin with 0.4 – 1 mg of folic acid per day (some women may need more – ask your doctor). Vitamin D at a dose of 600-2000 IU per day is also recommended for most women. You might consider taking DHA 200 mg per day (omega 3) if you eat fish or seafood less than twice a week. Ask your doctor if you need any other supplements in pregnancy.
- Don’t drink alcohol. This can cause fetal alcohol spectrum disorder (FASD), which can lead to serious problems for babies. These babies may be smaller than normal, have growth concerns and learning and behavioural problems which can last a lifetime. There is no known safe amount of alcohol in pregnancy.
- Stop smoking. Smoking can cause significant growth problems for your baby, as well as many health problems for moms. See www.smokershelpline.ca
or call 1-877-513-5333 for advice.
- Say no to recreational drugs. Remember- anything you use, your baby is using too. If you need help quitting smoking, drugs or alcohol – contact Mental Health and Addictions Services at (306) 655-7777. They are located at Suite 156 Sturdy Stone Building, 122-3rd Ave North, Saskatoon or see www.saskatoonhealthregionca/locations_services/Services/mhas
- Eat healthy. Aim for a balanced diet with lots of vegetables, fruits, whole grains, protein and dairy or alternatives. Aim for a calcium intake of 1000 mg per day (ideally from food/beverages – ie 3-4 servings of dairy/day). Your recommended weight gain will depend on your pre-pregnancy weight –discuss this with your doctor.
- Nausea and vomiting are common pregnancy symptoms, especially in the first trimester. Try to keep up with drinking small sips of fluids often. Small, frequent snacks/meals may help. If you have trouble coping – ask your doctor, who may prescribe medication. If you are worried you are getting dehydrated – see a doctor or go to the hospital right away.
- Small amounts of vaginal bleeding or spotting can be normal in pregnancy (especially in the first trimester), but should always be reported promptly to your doctor. If you have any heavy bleeding (ie soaking a pad an hour), continuous fluid leaking or intense cramping, go to the hospital right away. If you are unsure, contact your doctor, the Healthline at 811 or the Labour and Delivery Assessment nurse at RUH at 306-655-1995.
- Your immune system is less strong during pregnancy. Wash your hands often or use hand sanitizer. If you have the option- avoid close contact with sick people. Take extra care to make sure your food is safe to avoid food poisoning – meat, fish and eggs should be well cooked. Avoid sushi, raw sprouts, non-dried deli meat and unpasteurized cheese.
- Let someone else change the cat litter box. Cat feces (poop) can have a parasite called toxoplasmosis that can be harmful to unborn babies. If you must scoop the litter yourself – wear disposable gloves and wash your hands well afterward.
- Exercise in moderation may help reduce aches and pains in pregnancy and prepare you for the challenges of labour. It also helps prevent complications related to high blood pressure in pregnancy. Often women can continue exercise that they were doing before they got pregnant. You should still be able to talk in a full sentence while you exercise. If you have not been doing regular exercise, start slowly and gradually. Discuss what is safe with your doctor. Avoid contact sports or activities with a risk of falling – such as horseback riding. No scuba diving. Drink plenty of water.
- Avoid excess heat – ie hot tubs and saunas, or exercising in hot weather.
- Go to your prenatal appointments. Usually we recommend once a month until 28 weeks, then every 2 weeks until 36 weeks, then weekly visits after that. This schedule may be changed if there are any concerns in the pregnancy. These appointments are important for monitoring baby’s growth and signs of any complications, like high blood pressure or diabetes.
- Allow more time to rest. You may feel more tired in pregnancy, especially in the first trimester.
- Limit caffeine to no more than 300 mg/day (about 1-2 cups of coffee).
- Plan to breastfeed your baby. Babies who are breastfed don’t get sick as often, and are less likely to have diabetes and obesity later in life. Breastfeeding is highly recommended for babies and has lots of benefits for moms too! It lowers your risk of breast cancer, and saves a lot of money. If you have challenges with feeding, make sure to ask for help from your nurse, doctor, or lactation consultant. At CMC, we can arrange a consultation for you with Dr. Sullivan, a physician with a special interest in breastfeeding medicine. Learn more at: Saskatoon Breastfeeding Centre (306) 655-4806, (www.saskatoonhealthregion.ca/breastfeeding) or: La Leche League www.lllc.ca. If you choose to formula feed your baby, rest assured that we will support this decision too.
- Be careful with any prescription or over the counter medications. It’s best to have your pharmacist or doctor check if they are safe in pregnancy before taking anything. Many medications have not been thoroughly studied in pregnant women.
a) For pain and fever in a healthy pregnant woman: Acetaminophen (Tylenol) is generally considered low risk at the following doses – up to 4000 mg per day if using occasionally, and up to 3000 mg per day if using frequently.
b) Anti-inflammatories, including ibuprofen (Advil or Motrin), aspirin and naproxen (Aleve), are NOT recommended in the first trimester, or after 32 weeks of pregnancy. Ask your doctor before taking them at any time during pregnancy.
- Take good care of your teeth – brush, floss and visit your dentist. You want to prevent bad gum disease, which is a risk factor for high blood pressure and pre-term delivery.
- Avoid travel to areas with the Zika virus while you are pregnant. This virus can cause serious birth defects in babies. If you are travelling out of the country during pregnancy or with an infant, it is recommended to go to a travel health clinic for advice and any needed vaccines. Book this appointment as far in advance as possible. See www.cdc.gov/zika.
- Learn more about pregnancy, giving birth and caring for your newborn at prenatal classes, which are a great source of info. In Saskatoon call (306)655-4820 or check out www.saskatoonhealthregion.ca (search: prenatal education). We absolutely love Yliza Benjamin’s prenatal classes. She is a dedicated labour and delivery nurse who offers prenatal education in Saskatoon. See her website at www.regardingbirth.ca
- Ask your friends and family for support. If you need extra help contact Healthy Mother Healthy Baby at 306-655-4810, or www.saskatoonhealthregion.ca
(search healthy mother healthy baby).
- Get vaccinated. Pregnant women are considered at high risk of complications related to influenza infection. A flu shot is safe anytime during pregnancy. We also recommend vaccination with the pertussis (whooping cough) vaccine in your third trimester of pregnancy. If you receive these immunizations in your pregnancy, your antibodies will also cross the placenta which will help to protect your newborn.
- Be aware of your mental health, and talk to your doctor if you are struggling with depression, anxiety, or other concerns. Adult mental health and addiction services is a great resource as well.
First trimester bloodwork/urine testing: tests for complete blood count, blood type, iron level, thyroid function, immunity to: varicella (chickenpox), rubella and parvovirus, immunity to/infection with Hepatitis B and C, HIV, syphilis, chlamydia and gonorrhea and bladder infections.
Prenatal genetic screening:
Maternal serum screening – 2 sets of blood tests done between 11-13 weeks and then 15-20 weeks of pregnancy. This is a screening test to see if your baby is at high or low risk of Down Syndrome, Trisomy 18 and spinal cord defects. The result comes back after the second test, as long as the first one was low risk. Most of the time the result is “low risk”. If your result is high risk, you may have the option to do further testing such as an amniocentesis.
Non-Invasive Prenatal Testing (NIPT) – Panorama (LifeLabs) – a relatively new test that screens for Down’s syndrome (trisomy 21) and other genetic syndromes. You can also test for baby’s sex. It is a single blood test done anytime after 10 weeks of pregnancy, and results take about 2 weeks to come back. NIPT measures cell-free fetal DNA present in the mother’s blood. The cost of NIPT is not covered by Saskatchewan Health.
Nuchal Translucency – A specialized ultrasound can be performed by qualified obstetricians that measures nuchal translucency, which is the thickness of a fold at the back of the baby’s neck. Elevated measurements can be found more often in babies with certain genetic syndromes. Nuchal translucency measurements are particularly helpful in stratifying risk for genetic syndromes in certain populations such as advanced maternal age (age greater than or equal to 35 years), moms with bleeding in pregnancy and for twin pregnancies.
Ultrasounds: in your first trimester, your doctor will order a dating ultrasound at 7-12 weeks if possible – this determines your due date and whether you are having 1 or more babies. Looking ahead, you will have another ultrasound for the baby’s anatomy – done around 20 weeks – to check the baby’s structures such as the heart, brain, spine and kidneys. This also gives an idea of how the baby is growing. Sometimes your doctor may ask for an extra ultrasound(s) to check on the baby’s growth or position later in the pregnancy.
You should be confident that you know your due date by 20 weeks. Please discuss this directly with your physician. In the event of a preterm delivery, knowing an accurate due date is very important in the care of your preterm infant.
Your baby is now growing faster. You can support your baby’s growth by eating a well balanced diet and staying active. This is a good time to look into prenatal classes and start preparing your home for the arrival of your new baby.
During the second trimester we would like to continue seeing you every 4 weeks.
Important tests to complete this trimester include:
- anatomical ultrasound between 20-22 weeks
- repeat complete blood count and iron levels
- gestational glucose tolerance test to screen for diabetes between 24-28 weeks; a non-fasting test; blood will be collected one hour after drinking a sweet drink
- if you are blood type negative or if this is your first pregnancy, you will require a repeat test of your blood type and antibody screen. Most mother’s with negative blood type should receive WinRho at 28 weeks, after birth and in the event of any bleeding episodes or trauma. https://www.pregnancyinfo.ca/your-pregnancy/routine-tests/rh-blood-groups/
The third trimester is a time of intense anticipation, excitement and often anxiety. It is normal to have mixed feelings throughout your pregnancy. During the third trimester, most women start becoming quite uncomfortable – low back pain, hip pain and pelvic pressure are just a few common symptoms. Many women struggle with sleep. You may need additional help around your home or caring for young children.
Medical leave during pregnancy requires a medical diagnosis. Pregnancy is not considered an illness. A normal pregnancy does not make one eligible for sick leave. Under employment law, a women may start her maternity leave 8 weeks prior to her due date without any medical documentation. Should there be complications that arise during the pregnancy, then appropriate leave or work modifications will be discussed/advised.
Office visits are now every 2 weeks from 30 to 36 weeks and weekly from 36 weeks until 1 week after your due date.
Important tests and preparations:
- Ensure your diabetes screen is completed by 28 weeks.
- If your blood type is negative, ensure you have received WinRho between 28-30 weeks.
- All pregnant mothers in their 3rd trimester should receive a booster vaccination for whooping cough (pertussis). Immediate care givers for your baby should also ensure they are up to date with one adult booster.
- Aim to complete prenatal classes by 34 weeks.
- Obtain a copy of your prenatal record at 28 weeks and an updated copy weekly starting at 36 weeks to birth. Keep it with you and take it to the hospital.
- Additional ultrasounds may be required in the third trimester. Discuss this with your physician.
- Pelvic floor physiotherapy can be helpful in preparation for birth and postpartum.
- Group B Streptococcal vaginal and rectal swab at 36 to 37 weeks. This is a bacteria that some women have in their vagina or lower rectum. It doesn’t usually cause women symptoms, but can make the baby sick if the bacteria travels up into the uterus during labor/delivery. If you have the bacteria, antibiotics are recommended during labour.
- Decide whether you would like to bank your baby’s cord blood. There are currently no options for cord blood donation in Saskatchewan, but you can opt to privately store cord blood for personal/family use. http://pregnancy.sogc.org/wp-content/uploads/2014/05/PDF_umbilicalcordblood_ENG.pdf
- Prepare your hospital bag.
- Discuss your birth preferences with your labor supports and with your physician.
Labour and Delivery Page
The day you have been waiting for is finally here! It’s almost time to meet your baby!
Here is some important information about what to expect during your labour and the delivery of your baby.
As already discussed in the 3rd Trimester tab, we encourage you to have your hospital bag packed and ready, and your birth plan discussed with your physician in advance of the big day.
IS LABOUR IMMINENT?
For a few weeks leading up to the birth of your baby, your body may show signs that it is getting ready. Unfortunately, the timing for these “warning signs” are different for everyone, so it is not possible to predict with certainty when labour will begin for you.
- Your baby may “drop” into your pelvis (your belly may look lower, and you might have more bladder pressure).
- You might lose your mucous plug from the cervix (this might have some bloody discharge associated with it).
- You might have irregular contractions here and there, with no discernible pattern. The latent or early labour phase typically starts with contractions that are irregular with progression to more regular contractions over a number of hours or even up to 24 hours. When you are in active labour, we suggest you go to the hospital (see below).
THERE ARE FOUR MAJOR REASONS TO HEAD TO JIM PATTISON CHILDREN’S HOSPITAL:
- You are bleeding like a period: light spotting or a bit of bleeding can be normal when contractions start and your cervix is dilating. But if you are having a moderate amount of bleeding or bleeding that is worsening, you should present to hospital to be assessed.
- Your baby is not moving or you are perceiving decreased fetal movement and you are worried about your baby. Your physician will talk to you about kick counts. Generally, if you do not feel your baby kick/flutter/roll at least 6 times in a 2 hour period, you should present to hospital for assessment.
- Your water breaks. For most women, this will happen during labour. When your water breaks, or you think it is broken, even if you are not in labour, you are to go to hospital.
- You are having strong, regular contractions in a regular pattern around every 3 to 5 minutes. Your contractions are strong enough that you are having to breathe through them. They are typically lasting 1 minute in length (approximately), and this has been going on for about an hour. We call this the 4-1-1 rule (contractions every 4 minutes, lasting 1 minute, for 1 hour). If you think you might be in active labour but aren’t sure, go to the hospital for assessment.
JIM PATTISON CHILDREN’S HOSPITAL IS LOCATED AT 103 HOSPITAL DRIVE IN SASKATOON.
PAIN CONTROL OPTIONS:
Labour and delivery is a painful process for women as the uterine contractions occur and the baby’s head is putting pressure on the cervix and pelvis. There are several options for pain management:
- There are several drug-free options that you may find useful. These include altering your breathing (slow or rapid, panting/blowing), changing positions, vocalizing, having a partner or support person provide massage, and altering your surroundings with music or pillows etc. Some women find labouring in the tub or on a birthing ball is helpful. You are welcome to bring/use a TENS (transcutaneous electric nerve stimulation) machine, which is another drug-free pain control option that sends small impulses to your nerves to block pain signals.
- Medication options for pain control are also available. These include nitrous oxide (“laughing gas”), opioids such as Morphine or Fentanyl, or epidural anaesthetic. Your physician will talk to you about what your wishes are for pain control and what the best option is for you.
INTRAPARTUM FETAL SURVEILLANCE
Most of the time, if you are healthy and having an uncomplicated pregnancy, and baby is doing well, we will listen to the baby’s heart beat periodically throughout your labour with an external doppler. This is called intermittent auscultation.
If you have certain risk factors or complications, we will recommend continuous monitoring with this external doppler. This is called continuous External Fetal Monitoring (EFM). You would wear the doppler on your belly which is held there by an elastic band that wraps around you. EFM allows us to see the baby’s heart rate pattern to help us make decisions about how well your baby is tolerating the labour. Certain patterns can be a warning that your baby is not tolerating labour and may need to be delivered quickly (for example by caesarean section or operative vaginal delivery).
Sometimes it becomes necessary for us to attach an electrode directly to the baby’s scalp to aid in monitoring of the baby’s heartbeat more precisely.
THE PUSHING AND BIRTHING PART
Once your cervix is fully dilated and the baby’s head has descended far enough in the pelvis you will start to feel a significant urge to push. The pushing phase of labour can last for an hour or more, especially for first time moms. Unless there are specific complications you will be allowed to push in whatever position you feel most comfortable. Your physician and nurse will coach you in “how” to push. Typically, once you feel a contraction starting, we ask you to take a cleansing deep breath and let it out. This helps oxygenate your blood for your baby. Then we ask that you fill your lungs again but this time hold your breath and push down hard like you are having a bowel movement. It helps to curl your body so your pelvis is tilted up and to draw your legs upwards and outwards. When baby’s head starts to fully exit your body we will ask you to stop pushing hard and to instead push more lightly. Your physician will ask you to stop pushing completely while they are checking for an umbilical cord around your baby’s neck and then will help you deliver your baby’s shoulders and the rest of the body. Your baby is born!!!
Once baby is delivered we typically place the baby right up on your chest. If time allows and baby is doing well, we will offer for your partner or support person to cut the umbilical cord. We usually delay cord clamping for 30-60 seconds after the baby is born to allow more blood to go to your baby. This is sometimes not possible if it is evident that baby needs immediate medical attention.
After your baby is born your physician will manage the delivery of your placenta and repair of your perineum if necessary as you hold and cuddle your new baby.
ASSISTED VAGINAL DELIVERY
There are certain instances where a vaginal operative delivery may be considered to assist the safe arrival of your baby. Vacuum assisted delivery and forcep assisted delivery are both options that may be considered. Family physicians are well trained in vacuum assisted deliveries. A vacuum is a small plastic device that has a soft cup on the end. The cup is placed on the crown of the baby’s head and gentle suction is applied.
If it is determined that a vaginal delivery is possible but that a vacuum is not the way to go, sometimes forceps are needed to assist with delivery. If this is the case, an obstetrician will need to be consulted.
There are several reasons why it may be determined that a C-Section is the right choice for you. Some of these reasons are evident prior to labour (breech position, multiple previous C-Sections, placenta previa) and some do not become evident until labour has begun (abnormal heart rate of the baby, cervix not dilating.)
A C-Section is a safe surgical procedure, but like all surgical procedures it carries risks. Your physician will have a detailed discussion with you about the risks and benefits of C-Section if it becomes evident that this is what should happen.
For more information on labour and birth please visit:
https://www.saskatoonhealthregion.ca/locations_services/Services/Maternal-Services/Pages/Before-coming-to-hospital.aspx Saskatoon Health Region Maternal services website. Includes links to prenatal education, orientation nights, forms and more
www.regardingbirth.ca We love Yliza Benjamin’s prenatal classes. She is a dedicated labor and delivery nurse offering prenatal education in Saskatoon.
Risks and benefits (Canadian Pediatric Society) – circumcision