At Briar Hill Midwives, we have a number of midwives that work in teams or as independent practitioners. Depending on which midwife or team you are in the care of, your initial appointment will vary. Some of our teams will call early in pregnancy and may complete some of your prenatal history with you over the phone. Some testing options are required within a certain timeframe and many of our midwives will call and discuss them with you. If you were not contacted by phone, please do not worry, our midwives will have plenty of time with you during your first appointment. In general, either in conjunction with an early pregnancy telephone call or all at once and in person, your initial appointment will include:
Please note, it is not always possible to hear your baby’s heart at this early visit.
What is Midwifery Care?
Midwives are specialists in normal childbirth. Midwifery is based on the principles of health and well-being, recognizing that conception, pregnancy, birth and breastfeeding are natural life processes. The midwife gives holistic care, advice and supervision to birthing families during pregnancy, labour, birth and the postpartum period and conducts normal births. This care includes promotion of normal birth and breastfeeding, preventive measures, detecting abnormal conditions in mother and child, accessing medical assistance when necessary and taking emergency measures in the absence of medical help. Midwives can and do access other health care professions where it is deemed appropriate for consultation or ongoing care. Midwives provide continuity of care throughout the childbearing cycle.
Midwifery is a partnership between a midwife and a pregnant person, which is based on mutual respect. Midwifery actively encourages informed choice throughout the childbearing cycle by providing relevant, objective information about care alternatives, including risks and benefits, to facilitate informed decision making. Midwives assist the pregnant person to develop understanding, skills, and motivation necessary to take responsibility for and control of their own health and that of their family.
We offer personalized, professional care for the birthing family. Our services include preconception counseling, prenatal care, labour and birth care in the home, birth center or hospital; postpartum care, breastfeeding support, parenting information, as well as contraceptive and family planning counseling.
Adequate prenatal care is necessary to safeguard the health of the mother and baby. Physical well-being of mother and baby are monitored at each visit. Time is also spent in counseling and teaching.
Labour and Birth
During labour, the midwife monitors the well-being of the birthing person and baby, assesses the progress of labour, supports the birth of the baby and placenta, repairs the perineum (if necessary), examines the baby, and monitors the condition of the two after the birth. The midwife will provide all medical supplies for out of hospital births. Parents are expected to provide non-medical supplies.
Should abnormal conditions be detected, the midwife will accompany the birthing person and/or baby to the hospital.
The midwife ensures that everyone is stable before they return home, or in the event of a homebirth, before the midwives depart. Three to five visits are made to the home in the week after the birth. The schedule for home visits is arranged according to individual needs. Physical well-being of the birthing person/baby is assessed, breastfeeding initiated and any other teaching or support is provided. The Newborn Metabolic Screening blood test is collected from the baby. A two week and six week postpartum assessment is done including well woman care and family planning counseling.
In order to minimize risk, it is necessary for each member of the birthing family unit to be responsible for their own health and that of their baby. This includes maintaining a balanced diet and a healthy lifestyle, receiving adequate prenatal care and acquiring knowledge and skills necessary for labor, birth and the early postpartum period.
There are some distinct benefits and risks to any place of birth. It is the parents’ responsibility to become as informed as possible, to weigh the benefits and risks to make decisions appropriate for themselves.
As part of ongoing research to support the numerous benefits that midwifery has to offer not only birthing families but our health care system in general, we are required to record personal information regarding our clients and their outcomes in our care. This process is completely confidential and the information is stored in a secure and protected database. If you have questions about this process or are concerned about your privacy, please feel free to discuss this matter with your midwives.
People (families) face many choices in their pregnancy and want to make decisions that are best for themselves, their baby and their family. The decision to proceed with any prenatal testing is a personal one. At your first midwifery appointment a family history is taken and a discussion will take place regarding prenatal testing options available to you.
Due to the many and varied prenatal testing options and the time sensitive nature of some of the tests, we have provided you a link below to discover which, if any, options are right for you.
Option 1: No testing. This may or may not include an 18 week anatomical ultrasound even, this is your choice. While an ultrasound can provide us (and you) with some valuable information, it is still a form of testing that we do not require unless we have concerns about pregnancy dating, placenta location, multiple pregnancy or another concern which may require ultrasound follow up. A routine ultrasound is offered to every woman in Alberta.
Option 2: Dating Ultrasound: This ultrasound is frequently completed around 7.5-10 weeks of pregnancy to determine/confirm how many weeks pregnant you are. This ultrasound may be required prior to having First Trimester Screening.
Option 3: First Trimester Screening.
Option 4: Non-Invasive Prenatal Testing. This is a paid for option. Your midwives often have the kits available to give you. You may pick up a kit at no cost and book an appointment at Calgary Lab Services.
Invitae Non-Invasive Prenatal Screening
Harmony Non-Invasive Prenatal Testing
SHOULD A BIRTH DEFECT OR CHROMOSOMAL CONDITION BE DETECTED IN PREGNANCY:
Genetic counselling is available to review the results, answer your questions and ensure you have sufficient information to help you make decisions about whether to continue your pregnancy. As well, it may help you feel better prepared to parent a child with special needs.
TAKE HOME MESSAGES:
Nausea and vomiting is often one of the most challenging aspects of early pregnancy for many women. Mild nausea and occasional vomiting is a normal part of pregnancy and among the most common symptoms between 6 – 12 weeks. Although challenging, especially when sometimes family, friends and coworkers are not yet aware of your pregnancy, it is not harmful to your baby or yourself. However persistent and severe nausea and vomiting in pregnancy is not normal if you are losing weight or unable to function with daily activities. Please talk to your health care provider to find out what options for treatment are. You will also find a list of helpful resources here.
Managing Morning Sickness: Care Instructions
Healthy eating in pregnancy:
Foods to avoid:
Exercise in Pregnancy:
Depending on your midwifery team, follow up visits are generally 20 to 30 minutes in length. During each visit, the health of you and your baby will be carefully assessed by evaluating physical changes which may include:
Laboratory and diagnostic tests (such as ultrasounds), or referrals to other Healthcare Providers are booked as needed.
Time is spent discussing important issues to the mother and her family; preparation for labour and birth, emotional and mental health, coping strategies, relationship concerns, sibling and parenting matters, balancing work and family.
Every visit is an opportunity to get to know your care providers and for us to get to know you! We welcome all questions and concerns.
If you’ve experienced a previous cesarean section, you may be wondering what options are available to you in future pregnancies. Your midwives will carefully review your history and offer you a consultation with an Obstetrician to see if you are a candidate for a vaginal birth. The majority of women will meet the criteria for a VBAC.
Association of Ontario Midwives:
DECIDING HOW TO GIVE BIRTH AFTER A CAESAREAN SECTION
Alberta Health Services:
In the beginning of your pregnancy, in your routine blood work, we tested your blood type.
Along with the letters A,B,AB or O, is a trait called Rh factor and is expressed using a + or -.
85% of the world population is Rh factor +, leaving only 15% to carry the – trait. So what does that mean in pregnancy?
If you have a negative blood type, you may need to have a blood product called WinRho to help prevent the formation of antibodies that can affect future pregnancies. If the baby you are carrying has a positive blood type and there is mixing of their blood with yours at any time in pregnancy, your immune system may form antibodies to the positive blood. Bleeding in pregnancy, including miscarriage, or during the birth is when this is most likely to happen.
If your blood type is negative and you have bleeding in pregnancy or have a miscarriage, it is recommended that you have WinRho. This will help to prevent the formation of antibodies that can affect future pregnancies.
Pregnant women typically receive RhoGAM twice during their pregnancy: once at approximately 28 weeks and once within 72 hours of delivery, if in fact, the newborn baby is Rh positive. Your midwife will be able to give these to you without an extra trip to the lab.
When your baby is born your midwife will take some blood from the cord after it has been cut. You will also have some blood taken before your midwife leaves. Both blood samples will be taken to the lab for testing. If the baby is positive, your midwife will bring another dose of WinRho to your home visit to help prevent antibody formation.
Your pregnancy Routine tests – Rh blood groups – Society of Obstetricians and Gynaecologists of Canada (SOGC)
When You Need Rh Immune Globulin – Alberta Health Services
The Society of Obstetricians and gynaecologists of Canada recommend that all pregnant people are offered screening for gestational diabetes in pregnancy. Screening will be offered to you between 24 and 28 weeks of pregnancy and depending on your risk factors may involve a smaller amount (50g) or a larger amount (75g) of glucose drink and require up to 2 hours at a lab.
Risk factors for developing Diabetes in Pregnancy include:
It should be noted that risk factor based screening may miss cases where risk factors are not present.
The earlier we can diagnose diabetes in pregnancy, the more likely we can suggest diet and lifestyle changes which can help. We will also refer you to a special Diabetes in Pregnancy clinic for extra support.
Screening for Gestational Diabetes – AHS
Preparation for a Glucose or Lactose Tolerance Test
Gestational Diabetes – What NOT To Do! – Lily Nichols RDN (a copy of this book is available in our lending library)
You are getting close now. Nerves and excitement abound. Around your 36th week of pregnancy and depending on your care team, your midwives may plan a longer visit to help you prepare for your upcoming labour and birth. You will be asked what choices you would like in reference to the following information:
Group B Strep screening (GBS)
GBS in Pregnancy 2022 – Association of Ontario Midwives
Group B Streptococcal Infections in Newborns – Alberta Health Services
Your pregnancy Routine tests – Group B Streptococcus screening – Society of Obstetricians and Gynaecologists of Canada (SOGC)
Group B Strep – Evidence Based Birth
Vitamin K for newborns | Caring for kids – Canadian Paediatric Society (CPS)
Evidence on: The Vitamin K Shot in Newborns – Evidence Based Birth
Management of the third stage of labour:
The third stage of labour is the time period from the birth of the baby to the expulsion of the placenta and membranes.
Management of the third stage of labour – Evidence based birth
For some people the decision on where to give birth is an easy one. Perhaps you’ve always imagined being at home surrounded by family and friends, or this is something that you are newly considering.
Below you will find links to some studies about home birth.
If a home birth is something you are considering, please discuss with your midwife so we can ensure you are a good candidate.
Outcomes of planned home births with certified professional midwives: large prospective study in North America | The BMJ
Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician | CMAJ
Perinatal mortality and morbidity in a nationwide cohort of 529 688 low‐risk planned home and hospital births – de Jonge – 2009 – BJOG: An International Journal of Obstetrics & Gynaecology – Wiley Online Library
Planned home birth presents little risk where midwifery is well-integrated
The following items should be ready by your 36 weeks home visit.
Please use a spare Laundry basket or box for the following items:
Keep the following items together : we will ask they go in the dryer prior to babys birth:
Suggested but not mandatory:
*** We sell the above items on their own or a birth bag for $45 which includes the above as well as pregnancy tea & homeopathic easy birth (used for labour preparation), 2 pairs of disposable underwear, a package of 10 absorbent incontinent pads and some flexible straws.
Always have a hospital bag packed: with clothes/toiletries for yourself and the baby in case you need to go to the hospital.
Ensure that the car seat is installed in your car and that you know how to use it properly. This should be done by 37 weeks.
A hard surface is needed like the top of a dresser/change table that is cleared off with close access to an electrical outlet. We use this for our set-up. Please also have a cookie sheet available.
Birth Bed Preparation
Make up your bed as usual, then on top of this place the plastic sheet or shower curtain and an older fitted sheet on top of the plastic. Do not do this until early labour as the plastic will make you hot and sticky!
A regular sized bathtub may work well for water births, it will depend how deep you can get the water. The benefits are:
However, if your tub is small or you’d rather, birth pools can be rented or bought for a reasonable price.
Our friends can help you out:
Birth Supplies Canada – www.midwiferysupplies.ca or 1-888-802-0474
You’ll need a small fishnet or kitchen sieve, with handle for removing debris from the pool.
If you are not using your own bathtub, you’ll also need an adaptor for the faucet and clean/rinse hose for filling the pool. It is best to put a plastic barrier between your floor and the tub – just in case!
In labour – Turn up your hot water tank as high as it will go
The following items should be packed and ready by your 36th week. Even if you are planning to birth your baby at home, we ask that a small bag is packed and ready to go in the event we need to transfer in.
The birth centre has a fridge you can store your snacks in.
Suggested but not mandatory:
*** We sell the above items on their own or as part of a birth kit.
Please see this document for information on Iron Deficiency
Optimal Fetal Positioning:
It’s incredible the first time you feel your baby move inside your body. The first movement may feel like a light flutter and is common between 16 and 22 weeks of pregnancy. As the pregnancy progresses, the movements become more distinct as your baby becomes bigger and stronger.
In the final trimester of your pregnancy, after 28 weeks, your midwife will discuss Fetal Movement Counting (FMC).
Please see the links below for some information about fetal movement counting. You can download and print this handy chart to track your baby’s movements or ask your midwife for a copy at your next visit. At any time, if you are worried that your baby has not been moving within the 2 hour timeframe, please reach out to your midwife.
Please note that it is not necessary for you to count movements in every two hour time frame. A handy tip is for you to use your baby’s most active time of day, have something to eat or drink and then put your feet up and pay attention to the movements.
Counting Your Baby’s Movements: Care Instructions – Alberta Health Services
Fetal Movement Count Chart – Alberta Health Services
It is normal to wonder what Vaccines can be taken during pregnancy. The Society of Obstetricians and Gynaecologists of Canada (SOGC) recommend the following vaccines in pregnancy:
We recognize not every pregnant person will feel comfortable with vaccines in pregnancy and your choices will be respected.
Please see the following helpful links to help inform yourself and feel free to discuss further with your care team.
Diphtheria, Tetanus, Acellular Pertussis Vaccine Information Sheet – Alberta Health Services
Q & A on Tdap Vaccination Against Pertussis (Whooping Cough) During Pregnancy in Canada – SOGC
Influenza Immunization Information if You are Pregnant, Breastfeeding, or have a Newborn.
Immunization in Pregnancy – SOGC
Flow and Uterus
Perineum and Pain
Day 1 – 1 pee and 1 poop
Day 2 – 2 pees and 2 poops
Day 3 – 3 pees and 3 poops
Page your midwives if ANY questions or concerns arise with baby or birthing parent. If the problem cannot be resolved over the phone, your midwife will visit.
Taking care of your incision:
Managing your pain:
You did it! Your baby is here! Now what?
Your midwives will be visiting you in hospital or at home over the first week and you will come to clinic again at 2 weeks and 6 weeks postpartum for a check on you and baby.
It is common to have many questions but your midwives will help you every step of the way to navigate your new normal.
Newborn blood spot screening – this is completed most often by your midwives but sometimes by hospital staff if you remain in hospital care for a time. This test is done between 24-72 hours of age. The blood spot collection is completed on a special paper that is dried and sent to Edmonton for testing. Results are usually within the week.
Early Hearing Detection – Screening in Infants – This screening tool is available in our region for all newborns. If your baby was born in the hospital and remains there after 15 hours of age, this test is most likely going to be completed by specially trained hospital staff. If however you gave birth at home or are discharged before the test, we simply refer you to community testing within a couple weeks. You are not required to participate in the screening program.
A video of the screening test can be found here:
Alberta’s Early Hearing Detection & Intervention (EHDI) Program – Newborn Hearing Screening Overview
How to Register your babys birth?
Your midwives will have completed all of the necessary paperwork from the birth. You will be responsible to register your babys birth and name with Alberta Health Services. This is now done online using the link below. 10-14 days after you have submitted this, you can go to a local registry office to pick up your babys birth certificate. There is a cost to this which varies from location to location. If you are having problems with accessing this form online, we have paper forms available at the clinic.
Register a birth | Alberta.ca – Information
Alberta government – Online form
In the early days of parenthood, it can be difficult to remember when your baby has breastfed, fed, pooped or pee’d. While you are still having your home visits by your midwifery care team, we use this important information to determine your babys ability to effectively transfer milk and thrive. There are many apps and charts available online but some find it easier to write it down. If you have a hard time remembering (like at 3am)!, please use the chart below and feel free to write down your questions.
Breastfeeding (and common problems):
The first thing to note is your only job for the first several days should be to eat, sleep and feed your baby.
It is common to have questions and concerns about how much your baby is drinking and your midwives will be with you to answer any questions and offer support and encouragement.
Below you will find some helpful links to some common concerns that can happen with breastfeeding. Problems arise for different reasons but many can be overcome with some extra support.
Proper Latch Techniques
Breastfeeding, starting out right
Sore Nipples / Blocked Ducts / Engorged Breasts / Mastitis
International BreastFeeding Centre | Blocked duct and mastitis – Dr Jack Newman
NATURAL REMEDIES FOR PROBLEMS IN BREASTFEEDING – Susun Weed Herbal Medicines
International BreastFeeding Centre | Blocked duct and mastitis
International BreastFeeding Centre | Candida Protocol
Candida or thrush of the nipple and breast . Issues and Concerns – Mothers . Canadian Breastfeeding Foundation . Fondation canadienne de l’allaitement
Dr Jack Newman is cited in many of the above handouts and has been a champion for breastfeeding in Canada and around the world. His website has lots of resources and links to excellent videos which you may find helpful
For information on cloth diapering, please click the link below: