Maternity Care

Congratulations on your pregnancy! We are delighted that you have chosen us to provide your care at this important time. At the Family Medicine Centre we provide health care for patients of all ages and all health conditions in an interprofessional, family-centered way. We have a special interest in maternity care and the care of babies and children.

Our Academic Family Health Team provides care to pregnant women through a team which includes our staff physicians, residents, nurses, dietitians, a pharmacist, a social worker, a prenatal resource nurse and midwives. Physician care is provided in a shared care format, which means care is delivered by both a staff physician and a resident physician. Residents are doctors who are completing their two years of specialized training in family medicine and who are supervised by experienced family physicians. We alternate visits so that you have plenty of opportunity to get to know both of your doctors by the time your baby is due. At the time of the birth, both your resident and staff doctor will attempt to attend the birth. However, in the event that either is not available, they will be replaced by another physician with the same level of expertise and shared philosophy. This means that you will always have two physicians, one staff family physician and one resident, at your birth. Our prenatal resource nurse and other team members are also available to you throughout your pregnancy. We also welcome the opportunity to provide newborn and well baby care.

You can book an appointment by calling 416-586-5158. Your staff physician and resident physician will be discussed in conversation. Your prenatal resource nurse is Alison Meikle (ext. 6326). Our team nurses are Jackie (ext. 6044) and Ronit (ext. 2806). 

The after hours walk in clinic is available for urgent concerns on Monday and Thursday between 5-6 pm. 

If you have urgent problems at any time, call your physician’s phone number and follow the instructions. If you are more than 20 weeks (5 months) pregnant and you are experiencing an emergency related to your pregnancy, or if you are in labour, please call the hospital switchboard at 416-596-4200 and ask for the Family Medicine Resident on-call for obstetrics to be paged. You may also call Mount Sinai Hospital Labour Triage (15^th floor) for advice at 416-586-4800 ext. 3210. We look forward to supporting you throughout your pregnancy and birthing experience. If you have any questions, please do not hesitate to ask one of our team members.

Pre-Pregnancy Resources: 

• Growing Your Family with a Family Physician

First Trimester Resources: 

• COVID-19 and Pregnancy
• Best Use of Medicines in Pregnancy
• Mother to Baby
• Prenatal Genetic Screening Leaflet by Prenatal Screening Ontario
• Prenatal Classes
• Exercise in Pregnancy Infographic by University of Alberta's Program for Pregnancy and Postpartum Health
• Canadian Society for Exercise Physiology's Pregnancy Guidelines

Third Trimester Resources: 

• Having a Baby at Mount Sinai Hospital
• Support for Visitors during COVID-19
• Pregnancy, Birth, and Early Parenting Information
• Choosing a child car seat
• Cord Blood Banking
• Labour Decision Tree
• Infant Feeding
• Skin to Skin
• Group B Streptococcus

Postpartum Resources: 

• LactMed
• Depression and Anxiety after the Birth of your Baby
• Children and Pets

The Maternity Care Team is happy to take referrals of low risk women for prenatal, intrapartum and postpartum care. We will send mother and baby back to you after they have completed their course of care. Please note maternity care here will not affect FHO services at your location. Please download the new patient form that is found on this page to refer patients.

We are unable to provide routine maternity care to non-residents of Canada. Non-residents are advised to defer their visits to Canada until after their pregnancy is concluded.

Prenatal classes offer a lot of helpful information to prepare a woman and her partner for birth and beyond. Classes are offered through a variety of programs in the community and at Mount Sinai Hospital. On this page, you will find a list of programs for your consideration. Enrollment should be done early on in your pregnancy, as some programs tend to fill quickly.

The ultrasound department is located at 700 University Ave. 3rd Floor (OPG building). The phone number is 416-586-8556.

What to bring

• Health card
• Hospital card
• Prenatal testing requisition for 12 week ultrasound and blood test

Images of your ultrasound are available at each appointment for $30 per CD (compatible with PCs). Please inform your sonographer prior to the scan if you wish to purchase.

Appointments

Prenatal testing at ~12 weeks (Allow ~2 hours): Bring requisition for Nuchal Translucency Ultrasound & Blood Test (for Down syndrome)

Anatomy ultrasound at ~19 weeks (Allow ~2 hours): 

No requisition is required. If you wish to find out the sex of the baby, please inform the sonographer prior to the scan. Often a repeat scan will be advised.

3rd trimester ultrasound (will be booked): ‘POST DUE’ date ultrasound will be arranged for you closer to due date if required. Appointment will be auto-cancelled if you deliver. Please return to Family Health team clinic after this ultrasound.

Vaginal bleeding or spotting can occur in 20-30% of all pregnancies. Bleeding can happen for a variety of reasons. If you are bleeding, you will need to be evaluated by your health care provider. Not all bleeding in the first trimester requires an immediate evaluation- and the information below will help you navigate appropriate steps to your care.

You will need to go to the emergency room:

• If you are having severe vaginal bleeding or pelvic pain
• If you faint or feel very dizzy
• If you are bleeding and develop a fever over 38 degrees Celsius

If you are not experiencing the above symptoms, you should call the family medicine centre when the office is open and ask to speak to a nurse. The nurse will ask you some questions, and then book you in for an appointment with a member of our team. If the office is closed and you would like to speak to a health care provider, please call the telehealth nurse at 1-866-797-0000.

Common reasons to bleed include:

Implantation bleeding - small amount of bleeding usually at the time you would expect your period.

Postcoital bleeding - bleeding after sexual intercourse.

Miscarriage - About half of women who have bleeding in the first trimester will have a healthy pregnancy, and half will miscarry. An ultrasound, physical examination of your cervix and blood test will help determine the status of your pregnancy. In the first trimester, nature will take its course and there are no medical interventions available to save a threatened pregnancy.

Ectopic pregnancy - A fertilized egg implants outside the uterus. As the egg grows, it can rupture the fallopian tube and cause serious bleeding, light headedness and pain. Most ectopic pregnancies will cause pain before the 10^th week of pregnancy. If you have symptoms of an ectopic pregnancy, you must seek immediate medical attention.

More than half of all pregnant women suffer from nausea and vomiting during their pregnancy. Although common in the morning, "morning sickness" can happen at any time of the day. It is believed to be caused by changes in hormone levels and for many women it will improve after the first trimester. The following are some dietary suggestions for relief.

• Eat small meals every 2 or 3 hours rather than 2 or 3 large meals
• Avoid having an empty stomach; feeling hungry may make your nausea worse.
• Eat whatever food appeals to you in frequent small amounts until you are feeling better
• Plain, bland foods might help ease symptoms. Try: crackers, pretzels, mashed potatoes, rice, dry cereal or plain noodles. Other times fruity or tart foods help. Try fruit popsicles, lemonade, pickles, and watermelon.
• Drink fluids between meals rather than with meals to avoid feeling too full. Broth, ginger ale, or jello may seem more appealing
• Limit your intake of high fat and fried foods, garlic, caffeine and spicy foods
• Eat a few crackers before getting out of bed in the morning. You can keep them in an airtight container at your bedside.
• Avoid strong food and cooking smells by eating cold foods, opening windows to freshen the air or having others cook for you.
• Wait a while after eating before brushing your teeth. Be careful brushing your tongue.

Sometimes, nausea and vomiting in pregnancy can be excessive and can not be managed by diet alone. Lack of food, fluids and nutrients can lead to dehydration, which may be harmful to the well-being of both mother and baby. Signs of dehydration may include infrequent urination or dark yellow urine, dry mouth, fatigue or light headedness. You must seek medical attention if you suffer from dehydration.

If nausea and vomiting is affecting your well-being and your daily activities, there is an effective prescription medication available to treat nausea and vomiting in pregnancy called doxylamine succinate/pyridoxine HCL (Diclectin). This medication is a combination of vitamin B6 and an antihistamine called doxylamine. It is the only medication approved in Canada for the treatment of nausea and vomiting in pregnancy. Its safety and effectiveness throughout pregnancy has been long established and studies have shown no evidence that harmful effects are experienced by babies.

Constipation is a common complaint during pregnancy, affecting about one in three women. During pregnancy, constipation may be caused by hormonal changes that relax the digestive tract and slow the movement of wastes through the colon. The longer that the wastes stay in the colon, the more water is absorbed from it (going back into the body). This results in harder, dry stools that are difficult to pass. The growing uterus also puts more pressure on the colon making bowel movements more difficult. Less physical activity, bed rest and iron supplements may also lead to constipation.

To help reduce constipation:

• Increase fibre intake. Fibre helps to increase stool bulk and keeps food moving through the digestive tract. Aim for 28 grams of fibre per day. If you are not currently eating a lot of fibre, you will want to increase your intake slowly to minimize any cramping or excessive gas. Good sources of fibre include: whole grain breads and cereals, vegetables and fruit, and legumes (e.g. beans, lentils)
  • Eat at least 5 servings of whole grain products every day (whole wheat bread instead of white, choose higher fibre cereals)
  • Eat at least seven servings of fruit and vegetables every day choose whole fruits, including the peel, instead of drinking juices o Try including some beans, lentils or chickpeas in your meals
• Drink between 8 and 12 cups of fluids every day, in the form of water, milk, broth or juice. This helps to keep the stools soft and easier to pass. Some women find that drinking warm or hot liquids stimulate the bowels.
• Maintain an active lifestyle. Even moderate amounts of exercise, such as walking may help.
• Do not take over-the-counter medications or laxatives without speaking with your doctor.

Heartburn is a burning sensation in the lower part of the esophagus. It is caused by gastric reflux, or acid coming up from the stomach into your lower esophagus. It is caused by hormonal changes in pregnancy that relaxes the valve between the stomach and the esophagus. As the fetus grows, the expanding uterus also presses down on the stomach, forcing stomach contents up into the esophagus.

To help reduce heartburn:

• Eat smaller, more frequent meals
• Eat slowly and chew your food well
• Drink fluids between meals when possible to limit how full you become at mealtimes
• Avoid spicy and high fat foods (fried or greasy foods)
• Limit coffee, chocolate, and mint
• Limit acidic foods like oranges, lemons, tomatoes and their juices
• Do not lie down for at least 1-2 hours after eating
• It may be helpful to raise the head of your bed with extra pillows
• Wear loose-fitting clothing that does not add additional pressure on your stomach
• Talk to your doctor in heartburn becomes problematic or begins to interfere with your dietary intake

Your health care provider will check your blood type early in your pregnancy. If your blood type has the word 'negative' associated with it, you will be scheduled to have an injection called RHOGAM when you are 28 weeks pregnant. You will also need a Rhogam injection if you have any bleeding in your pregnancy. Rhogam is given in the Maternal Infant Program in the Ontario Power Generation Building. You will be required to do a blood test prior to administration of the injection, so expect to be available for about 3 hours. Your nurse will book your appointment.

The injection protects an Rh negative woman from developing antibodies in her blood that could react against a baby who may have an Rh positive blood type. Rhogam is a preventive drug and offers important protection with very minor side effects.

Preeclampsia is a pregnancy-specific syndrome characterized by new-onset high blood pressure (over 140/90 mmHg) and protein excretion from the urine. It usually occurs after 20 weeks' gestation. Preeclampsia is classified into mild and severe types and, in its extreme, may lead to liver and kidney failure and seizures. The only cure is delivery of the baby. If preeclampsia develops before the baby is ready to be born, rest and close monitoring of the pregnancy are needed and medication may be prescribed.

If you experience headache, abdominal pain, especially in your right upper quadrant of your abdomen, visual changes or sudden swelling of your face and hands, you must seek immediate health care attention. If you are beyond 20 weeks in your pregnancy, go to the labour and delivery unit at Mount Sinai Hospital. If you are under 20 weeks, go to the Emergency Department.

Group B Streptococcus (GBS) are common bacteria that can be found in the vagina, rectum or bladder of 15-40 percent of women. Women usually do not have any symptoms associated with the bacteria. Sometimes, a woman can develop pain and inflammation in their bladder, kidneys or uterus. In pregnancy, a mother can pass on the bacteria to their baby during the birthing process. A baby who is infected with GBS bacteria may become seriously ill. Taking antibiotics before the baby is born will prevent many babies from contracting the GBS infection.

At the family medicine centre, we screen all women for GBS bacteria sometime between 35 and 38 weeks gestation. You may collect the sample on your own. You will be given a black tube with cotton swab for collection. To collect your sample, remove the top of the black tube and throw it out. Take the cotton swab and insert the cotton tip about 1 cm into the vagina and then take the same swab and insert it 1 cm into the rectum. Place the swab into the black tube and give it to one of our clinic assistants.

More information on GBS infection in pregnancy can be found here.

You will be in active labour if you are contracting regularly and your cervix is dilating. Sometimes it can be difficult to decide when to go to the hospital. If you have found to be GBS positive, you will be asked to go to the hospital at the earlier stages of your labour or when your water breaks to start antibiotics. If you are having any bright red bleeding that is more than pink mucous, you will need to go to the hospital.

This labour decision tree can help guide you when to come to the labour unit. If at any time you are unsure of what to do, you should call your doctor or the labour assessment unit at 416-586-4800 ext. 3210.

Some labours can be very long, and women may be assessed and sent home if not in active labour. This is quite common, especially during first pregnancies -so don't be discouraged!

Backache: Maintain good posture. Avoid sitting or standing for long periods. Use a footstool when sitting. Use good body mechanics-no heavy lifting. Wear low heeled shoes. Consider massage, chiropractic or osteopathy, pelvic tilt exercises, and yoga.

Broad and Round Ligament Pain: Feels like sharp twinges/muscle pull usually on the lower left or right side of abdomen. Move slowly, especially when getting up or turning in bed. Use pillows to support abdomen. May treat with warm compresses/heating pad and Tylenol if necessary.

Bleeding Gums: Due to increased blood flow. Get regular dental check-ups. Floss regularly and gently. Use a soft bristled tooth brush. Eat food high in Vitamin C.

Constipation: Drink 2-3L of water a day. Increase fibre in your diet (whole grains, fruits and vegetables). Moderate exercise 3-4 times/week for 30 mins. May take psyllium husk (Metamucil) as directed if needed. Consult doctor if unable to manage with the above.

Dizziness/Lightheadedness: Often due to low blood pressure or low blood sugar. Often with getting up too quickly. Rise slowly, avoid standing for long periods. Stay well hydrated and well nourished, especially in hot weather

Fatigue: Rest and take naps when possible. Eat a healthy diet. Limit sugar and processed foods. Remember to take your prenatal vitamin.

Frequent Urination: Limit fluid intake prior to bedtime. Avoid caffeinated beverages. Practice pelvic floor exercises (Kegels). If accompanied by any discomfort or pain with urination, please notify your doctor.

Hemorrhoids: Avoid constipation. Try to avoid straining during bowel movements. Pelvic floor exercises. May consider Witch Hazel wipes, Tucks, warm soaks, Preparation H.

Headache (mild): Stay hydrated and rested. Massage. If severe, consult your physician. If headache is accompanied by visual changes, swelling in hands or face or pain in upper right side of abdomen, please proceed to the Labour Triage for assessment as this can be a sign of preeclampsia.

Heartburn: Eat smaller, lighter meals. Avoid spicy, fatty foods and drinks with caffeine. Consider not eating and drinking at the same time. Drink fluids >30 mins after a meal. Do not lay flat after eating. Consider sleeping slightly upright with a wedge or extra pillow. May take TUMS as directed. If no relief from above, may discuss options with your doctor.

Leg Cramps: Stay hydrated and active. Eat a diet high in calcium and magnesium or consider a supplement. Stretch often, especially before bed. Avoid standing for long periods.

Nausea: Eat small frequent meals. Plain bland foods may help. Limit intake of high fat or spicy foods and caffeine. Consider ginger tea. If unable to remain nourished and hydrated or if your nausea and/or vomiting is affecting your well-being or daily activities, please discuss with your doctor. There is a prescription medication (Diclectin) that may help. Usually resolves by the second trimester.

Swelling of Ankles and Feet: Exercise (walking). Increase water intake. Keep legs raised when sitting and above level of heart when possible.

Sleeplessness: Take a warm bath before bed. Avoid eating right before bedtime. Use extra pillows as necessary. Avoid mental stimulation before bed and in the middle of the night (e.g. screen use). Consider relaxation techniques.

Sinus Congestion: Saline drops and Neti Pot. Stay hydrated. Sleep with head slightly elevated. Consider Breath-right strips.

Varicose Veins: Avoid sitting for long periods and crossing legs. Put feet up when possible. Discuss support stockings with your doctor.

Vaginal Discharge: Wear cotton underwear. Change as needed. Omit underwear at night. Avoid panty liners. Do not douche or use perfumed soaps/body washes. If there is a foul odour or irritation, discuss with your doctor.