Congrats, you’re pregnant! Now what? If you’ve just taken an at-home pregnancy test and it’s positive, you may want to take a moment and process your feelings around it. Everyone has a unique fertility journey, so you may be feeling ecstatic, cautiously optimistic or even downright nervous! Once you’ve had a moment to process, here are some next steps as your pregnancy progresses.
1. Call your doctor and schedule an appointment
Your doctor can order a blood pregnancy test to monitor the levels of human chorionic gonadotropic (hCG) hormone (the pregnancy hormone) in your body. This confirms the pregnancy, but also gives your doctor a baseline for your hCG levels which are about to double every two days. They will also measure your baseline height, weight and blood pressure, and your obstetrician (OB) or midwife will keep track of it throughout your pregnancy.
Your family doctor can refer you to an OB during this first visit. If you want midwifery care instead, contact your preferred midwifery group as soon as possible. Midwives can get booked up very quickly as they are in high demand.
What’s the difference between an OB and a midwife?
Both OBs and midwives are very highly trained. Note that it’s common practice to pick one or the other to oversee your pregnancy care and labour assessment (and often insurance will only cover one or the other). In the event of an emergency, a midwife can work with an OB and their team at a shared hospital location (the hospital where your midwife has privileges).
The main differences between an OB and a midwife:
- Midwives typically work with small teams. You could see one or all the midwives on your team.
- OBs are typically part of a larger medical network—this means that although you might see the same OB for all your prenatal appointments, your labor and delivery will be with the OB on-call at the hospital when you go into labor. (Of course, if you have a scheduled C-section, you’ll likely be scheduled on a day your OB is working.)
- You will typically have longer appointments with a midwife versus an OB, about 30 minutes on average.
- OBs provide labour and delivery care in hospitals only. Midwives can accommodate at-home births, those at birthing centres, or in hospital (provided the hospital accommodates midwives—not all do).
- Midwives are experts in low-risk pregnancies, whereas certain high-risk cases should be managed by an OB. (These could include: if you have insulin-dependent type 1 diabetes, if you’ve recently had an organ transplant or if you’re pregnant with triplets.) If you are carrying twins, have a breech baby, have a low-lying placenta or have a history of pre-eclampsia you can still have your prenatal care managed with a midwife.
- Midwives can be present for surgical procedures (like emergency cesarian sections), but cannot perform the surgery themselves—this needs to be done by an OB.
- A midwife will visit you in your home within days of your birth to check on both you and baby. An OB will often do a checkup at three to six weeks postpartum, though your baby will need to be checked by a medical professional within days of birth—typically this is done with a family doctor or paediatrician at their office.
What if I notice spotting or bleeding?
About one in four women will experience bleeding or spotting during the first trimester of their pregnancy. Any spotting or bleeding should be reported to your doctor, though if you’re noticing heavy bleeding (soaking through more than two pads in an hour for more than two hours) and pain it’s better to go straight to the hospital emergency department since this indicates a higher risk of miscarriage. Your doctor or treating healthcare team will run an hCG blood test and do an ultrasound to try to find the source of the bleeding and check to make sure the pregnancy is viable.
2. Schedule your first ultrasound
During that first visit with your doctor, they will also provide you with an ultrasound requisition. An obstetrical ultrasound will be scheduled around week eight of your pregnancy so that your doctor can make sure the embryo is in fact in your uterus (and not somewhere it shouldn’t be, like a fallopian tube, which would be an ectopic pregnancy). They also check to make sure there are no visible complications with the pregnancy. This is also called a dating ultrasound because a doctor can get a better idea of how far along you are by looking at the size and development of the fetus. Without this, your doctor will use the first day of your last menstrual period to calculate how many weeks pregnant you are. For example, if you typically have a 28-day cycle, ovulate on cycle day 14 and have a positive pregnancy test on day 28 or 29, you are already considered four weeks pregnant.
You want to book the initial check in with your doctor as soon as you find out you’re pregnant so that this can all be arranged. If you have a very busy doctor or ultrasound clinic it may take time before they can schedule you in, so book early.
What if my care is with a fertility clinic?
If you’ve gotten pregnant using advanced reproductive technologies (ART) such as medicated timed intercourse, intrauterine insemination (IUI) or in vitro fertilization (IVF), you will continue to check in with your fertility clinic during these early days. If you’ve done an at-home test, your clinic will have you scheduled for a pregnancy blood test. If positive, they will run a second blood test run two or three days later to check that your hCG levels have at least doubled in those couple days. This confirms that the implanted embryo is growing. Once it’s confirmed that your hormone levels are increasing healthily, you’ll be referred to an OB who will take over your care throughout the rest of your pregnancy. (You can also choose to see a midwife instead if you are considered to have a low-risk pregnancy.)
What if my hCG doesn’t double?
If your hCG levels haven’t doubled in two to three days, or if the levels suddenly drop, it could indicate a chemical or ectopic pregnancy and the pregnancy may not be viable. Your doctor may continue to test your hCG in another two or three days and may include an ultrasound to see what’s happening in your uterus.
3. Continue to take (or start!) your prenatal vitamin
Preconception (three months prior to conception) and the first trimester are the most important times to take Folic Acid since the fetus is depending on this nutrient to ensure the proper formation and closure of the neural tube—your baby’s earliest spinal cord.
Having inadequate Folic Acid can lead to spina bifida and abnormal brain development, so keep up with a daily prenatal vitamin with at least 400 mcg of Folic Acid or 5-Methyltetrahyrofolate (the active form of Folic Acid).
4. Follow up with your other healthcare providers
Some medications and supplements cannot be taken during pregnancy. If you’ve been prescribed medications by a doctor or specialist, or have been taking supplements under the care of a naturopath, now is the time to reach out and update them with your pregnancy so that they can make any necessary changes to your treatment plan.
5. Consider non-invasive prenatal testing (NIPT)
This genetic test can be done in early pregnancy to screen your baby for abnormal chromosomes and genetic conditions. (Being able to accurately test for trisomies like Down’s Syndrome used to be done with amniocentesis—an invasive and high-risk test that is no longer the go-to, especially since modern testing for abnormalities is a simple blood test.) A non-invasive prenatal test (NIPT) can be done around week 10 of your pregnancy and uses fetal cell-free DNA found in the mother’s blood. This test has been used by physicians around the world for the routine diagnosis of chromosomal abnormalities, and it has a lower false positive rate (0.1 percent or lower) when compared to standard first- and second-trimester screening. This test screens for trisomy 13, 18 and 21, as well as sex chromosome trisomies. You can also add on testing for genetic microdeletions and reveal the sex of the fetus with over 99 percent accuracy.
Save and print this handy pregnancy test check-in reminder to keep you on track throughout your pregnancy.
Timeline of first trimester pregnancy check-ins and testing:
First month of pregnancy:
- Embryo implants—positive pregnancy test!
Second month of pregnancy:
- First prenatal appointment with your MD (you’ll get lab requisitions for an ultrasound and bloodwork)
- Decide if you’d like your pregnancy and labour care with an OB or midwife (and get a referral (OB) or contact your preferred team (midwife) asap)
- First dating ultrasound
- Get a requisition for NIPT (if you’re interested in testing)
Third month of pregnancy:
- Have NIPT done (if you want—this can be done as early as nine to 10 weeks)
