Prenatal Care in Canada

Hi everyone!

We’ve been in Canada for almost three years now, and if they won’t give us citizenship (or even PR), at least a new family member will get a Canadian passport — he arrived on November 9th 🙂

In this post I’ll talk about how prenatal care works in Canada, specifically in British Columbia (though on average it should be pretty similar in other provinces). I won’t be sharing my personal experience, since everyone’s pregnancy is different — I just want to explain the actual process. I wrote this post throughout my entire pregnancy so I wouldn’t forget anything, and now, before publishing, I’ve added literally a couple of sentences with half-closed eyes. I’ll write a separate post about the birth at some point in the future — if I survive!

Before Pregnancy

When we decided that despite our uncertain immigration status, the years were passing and we were ready to grow our family, the first thing you can do is tell your family doctor — if you have one. If not, as usual, you can go to a walk-in clinic, or possibly a telehealth service. If there are no serious chronic conditions, the doctor will order general bloodwork for both partners and advise the woman to start taking prenatal vitamins. All women are also tested for rubella antibodies, and if they’re not present, vaccination before pregnancy is recommended. After that, you can start trying.

In Canada there are standard timeframes considered acceptable for trying to conceive before investigating why it’s not happening: under 35 — one year; 35–40 — six months; over 40 — three months. These aren’t arbitrary — they’re based on global statistics. Only after these timeframes can you see your family doctor and ask for a referral to a reproductive endocrinologist (fertility specialist). They won’t refer you before then, even if you really want to get checked out.

Of course, wait times for fertility specialists range from several months to several years depending on the province. So you can put in a referral a little early by saying the timeframe has already passed (your family doctor wasn’t there with a stopwatch!), and in the worst case you can always cancel the appointment (let’s not forget we’re in Canada, where the main principle is: get in line first, figure it out later, haha).

Insurance coverage for fertility procedures varies significantly by province. Most diagnostics are covered by provincial insurance, but procedure coverage depends on where you live. For example, in BC even initial rounds of procedures (IUI, IVF) are paid out of pocket, while in Ontario they’re covered by provincial insurance. I did read on Reddit, though, that many people in Ontario choose to pay privately anyway, since waiting for a covered procedure starts at over a year.

Positive Test — What to Do Next

When it happened and the test came back positive, my first stop was BC HealthLink, followed by Reddit’s Vancouver community to ask for midwife clinic recommendations (more on that below) and OB-GYN recommendations as a backup. BC HealthLink turned out to be a really useful resource — it lays out all the steps you need to take and includes links and phone numbers for various services. Every province has its own site with all the information you need.

You’ll need to confirm the pregnancy. If you have a family doctor, they can order a blood HCG test; if you don’t, you can get a requisition at a walk-in clinic. In our case, we were being followed by a fertility clinic, so they ordered the test.

At the same time, we were deciding who we wanted to do our prenatal care with. In Canada there are two options: a midwife or an OB-GYN. Each has its pros and cons — let me break them down.

Midwife

A midwife is a registered maternity care provider. I don’t think there’s a direct equivalent in post-Soviet countries (though midwives technically exist), but in Western countries it’s a fairly common profession in this field. Midwives are not doctors — they have four years of education — but they are officially recognized healthcare providers. They typically work in clinics, often in teams with other midwives. Teams of two or more are common, so they can cover for each other. Midwives manage the entire pregnancy, attend the birth, and follow up with the baby and mother for the first six weeks postpartum.

A couple of years ago, my massage therapist told me she had her first pregnancy with an OB-GYN and her second with a midwife — and it was a completely different experience. She said she’d never go back to an OB-GYN. At the time I found that surprising, since an OB-GYN is a doctor and that seemed like the most important thing — but over time my thinking changed, because midwives have so many advantages!

Pros of midwife care:

• You can start being followed as early as 8 weeks.
• Appointments are very long — no one is rushing you. Typically 30 minutes to an hour, plenty of time for all your questions.
• They’re more accessible than OB-GYNs. At my clinic, non-urgent questions and requests (like getting a note, etc.) were answered within the day; urgent ones within 15 minutes, 24/7.
• If something goes wrong during the pregnancy, they’ll still refer you to an OB-GYN or another specialist as needed — and the midwife remains your main point of contact throughout.
• The birth will always be attended by someone from your midwife team.
• If you want a home birth, midwives will happily attend — they love home births, by all accounts. They arrive with all the necessary equipment.
• For the first six weeks postpartum, your midwife will be there: coming to your home to check on the baby and parents, giving advice, helping with breastfeeding, etc.

Cons: Honestly, I don’t see any downsides to midwife care. It all depends on the specific people, of course, but my team has five people and they’re all wonderful — responsive, understanding, and kind. The only thing some people might consider a downside is that a midwife isn’t a doctor. But knowing that you’ll be referred to a specialist if complications arise, that doesn’t really matter much.

One more thing: midwives are affiliated with specific hospitals. We, for example, prioritized BC Women’s Hospital and looked for midwife clinics attached to it.

OB-GYN

Since I don’t have personal experience with this route, I’ll just share my thoughts. Honestly, I don’t know many people who chose an OB-GYN for their prenatal care. This is largely because, despite being a doctor, there are quite a few downsides compared to midwife care:

• Care typically doesn’t begin until 20 weeks. Until then, you’re seen by your family doctor — or a walk-in clinic if you don’t have one (though I’m not entirely sure about this).
• Appointments are 10, maximum 15 minutes. For a first pregnancy, that feels very short — especially since until week 33 appointments are only monthly, and questions accumulate.
• There isn’t always an emergency line. If something happens outside office hours, you just go to the ER — you can’t consult your doctor.
• The birth isn’t necessarily attended by your own OB-GYN. It will likely be the on-call hospital doctor.
• OB-GYNs don’t attend home births.
• Right after delivery, you and the baby are transferred back to your family doctor. The OB-GYN doesn’t provide postpartum follow-up. If you don’t have a family doctor, that means a walk-in clinic — which is hard to imagine with a newborn.

I did recently learn, though, that even if you did your prenatal care with an OB-GYN, some midwives can start seeing you after delivery and manage the baby’s first six weeks. This happened to some friends of mine who couldn’t get a midwife for the pregnancy itself but signed up for postpartum care.

On the plus side — they’re a doctor! I’ve also heard that multiples (twins and up) are considered higher-risk pregnancies and are typically managed by OB-GYNs; midwives don’t often take those on. Though at our clinic, twins have definitely been born.

All things considered, looking at the pros and cons — and the fact that we had just moved to Vancouver and didn’t have a family doctor — we chose a midwife without much deliberation.

Decision Made — What Next?

After choosing midwife care, I went to check Reddit recommendations (I specifically asked for recs in our neighbourhood) and based on those, picked the clinic we wanted: Westside Midwives.

This is the moment to remember what country we live in and that the main principle here is: get in line first, figure it out later. This is VERY important, because everyone knows that anything can happen in the first trimester, and some people are afraid to sign up until it’s over. Don’t do that — you might miss out entirely. The moment you see two lines and know who you want to do your prenatal care with, fill out the intake forms on their websites and submit your applications. If something happens with the pregnancy, you can always cancel. But if you wait until the end of the first trimester, you can genuinely lose your chance to work with the people you wanted.

I submitted applications to two clinics. Once one confirmed they’d take me, I cancelled the other.

I also want to mention a service I signed up for that not many people seem to know about. Somewhere deep in BC HealthLink — or maybe on Reddit — I read about the option to register with a public nurse at a community health centre, and of course I signed up: Vancouver Coastal Health. About two weeks later, a public nurse called me and explained that she could check in with me throughout the entire pregnancy — helping with resources, finding information, answering questions, and so on. We didn’t have many contacts in Vancouver at the time, so I figured it couldn’t hurt. Sure enough, once a month she calls to check in, assess my anxiety levels (something I struggle with). She also helped me find a family doctor, sent nutrition resources, and even came to our home at 30 weeks to show me how to breastfeed. She’s basically a fairy godmother who, it turns out, can also track the child’s development until age 5. I genuinely recommend signing up — extra support from professionals on these topics is never a bad thing.

First Trimester

General Check-ups

A little about what follow-up looks like in the first trimester. As I mentioned, the first midwife appointment is usually at 8 weeks, though it can be later. Around 10–12 weeks, you’re sent for a dating ultrasound to confirm the due date. This can be done at any imaging centre in the city — not necessarily a specific hospital. Before 14 weeks, you’re also sent for a general blood panel: blood type, rubella antibody check (even if it was done before), and a urinalysis. Appointments are monthly, and they listen to the baby’s heartbeat and check blood pressure. In my case, nothing else was done at first trimester appointments — no weighing, no measuring the belly, no additional tests.

If your pregnancy happened under the care of a fertility clinic, they do the first ultrasound themselves — sometimes as early as 6 weeks depending on the situation. If everything looks good, they “discharge” you and send you to a midwife, family doctor, or OB-GYN.

Honestly, the monitoring feels like it starts quite late — a minimum of 8 weeks, which is already two months in. If something worries you, you can always go to the ER, but in general my midwife told me at the first appointment that if there’s bleeding, there’s nothing they can do and there’s no need to rush anywhere. I’ve never heard of anyone being admitted for observation in Canada during the first trimester the way it sometimes happens back in post-Soviet countries.

Mental Health

I struggle a lot with anxiety, so I was immediately recommended to sign up for the Reproductive Mental Health program at BC Women’s Hospital. However, the referral has to come from a family doctor, not a midwife — so I had to wait until I found one. Thanks to the pregnancy, I didn’t have to wait long (which is just extraordinary in Vancouver) — by the end of the first trimester I had a family doctor. My midwives deserve the credit: they gave me a list of clinics I could call and register with (they must have their own internal lists, since these clinics officially weren’t accepting new patients). I was put on the Reproductive Mental Health waitlist in May, and as is expected, I had to wait three and a half months for the first appointment — and they told me I was very lucky it was that short!

NIPT, Noninvasive Prenatal Testing

Around 10–12 weeks, genetic screening is recommended. There are a few ways to go about it:

Free through provincial insurance: an ultrasound is done first, and if anything looks off, you’re sent for a blood test.

Paid: a blood test done without a preliminary ultrasound.

We chose the second option — both because it’s more reliable regardless, and because I really didn’t want to imagine my anxiety levels sitting in a waiting room after being told something looked unusual on the ultrasound.

The standard NIPT blood test can be done through LifeLabs (if available in your province) for just over $500 CAD, through Dynacare (Harmony) for around $400 CAD (some midwives have a discount code, so it can come down to $300 CAD), or through the American lab Invitae for about $320 CAD. We initially chose LifeLabs out of sheer laziness — I didn’t want to figure out the Invitae process — but my midwife said it’s very easy and why spend the extra money. She was right: the midwives organized everything for me. I just went to a lab in downtown Vancouver on a Thursday, gave blood, the sample was sent to the US that night, and by Monday morning the midwives had checked the results and approved them for me to view (since everything was fine — if something had been off, they would have called). By Monday afternoon I had an email with all the results. As a nice bonus, you can find out the baby’s sex at this stage, since it’s determined from the blood in this same test.

Second Trimester

In the second trimester, appointments are still monthly and check the same things: the mother’s blood pressure and the baby’s heartbeat. Toward the end of the second trimester they started measuring my belly — specifically the uterus. Around 25 weeks, a general blood panel is ordered along with a glucose test (you drink a horrible sugary drink, wait an hour, and then give blood). If that result comes back borderline, you do a three-hour version. There’s also an ultrasound at 20 weeks — the longest one, and usually the last one of the pregnancy. It looks at how the baby’s organs are developing, and so on. My midwives booked this ultrasound for me directly at BC Women’s Hospital. The technician showed me the hands, feet, and other body parts and printed out a few photos.

There are no other tests in the second trimester, assuming an uncomplicated pregnancy. In my case, my platelets and iron started dropping. The iron can be brought up with supplements, but platelets are very hard to raise. I was told that if they dropped too much, I’d be referred to a hematologist.

Third Trimester

Starting at 33 weeks, appointments shift to every three weeks, then closer to the due date every two weeks, and then weekly. At one point I ended up with a month-long gap between appointments (due to holidays), and I asked if I could have an extra one just to feel better — and my midwife agreed without any hesitation. As the psychiatrist at Perinatal Mental Health told me: it’s in the midwife’s interest to do whatever they can to keep the mother calm, so don’t be afraid to voice your concerns and requests. Closer to my due date I was very anxious about some symptoms, and twice called the midwife pager (the emergency line) — and they came with me to the hospital (the Labour and Delivery ward) to make sure everything was okay. Every time I hesitated about whether to call the emergency line, but they always say: better to call than to sit and wonder what’s happening.

Around 36 weeks, one appointment is dedicated entirely to the birth plan: they note down all the mother’s wishes — hospital or home birth, preferences around pain relief, consent to postpartum procedures for the baby (like the vitamin K shot), how long the parents want to wait before cutting the cord, and so on. All of this goes into your profile and the hospital nurses take it into account when you’re admitted during labour. By the way, you can only go to the hospital when contractions are every 3 minutes and lasting one minute (the 3-1-1 rule) — sometimes 4 minutes depending on how far you live from the hospital.

At this same appointment, they tell you about the option to donate cord blood stem cells after the cord is cut. We had quite a laugh about this: only 4 hospitals in all of Canada participate in the program, including the one where I was going to give birth. I signed up as a donor immediately — but then laughed at the fact that they only collect the cells if you deliver Monday through Friday between 7 AM and 11 PM. So the cells are DESPERATELY needed and banners about it are everywhere, but they’ll only take them during business hours. Well! Our baby was born at 1:49 AM, so unfortunately no one collected the cells. But for wanting to donate, he was given a little hat at discharge 🙂

In terms of blood work — if the pregnancy is uncomplicated — a general blood panel is done once per trimester. Because my iron and platelets had been dropping since the second trimester, mine were checked monthly, then every two weeks, then weekly. Around 35–36 weeks a Group B Strep swab is also taken; if it comes back positive, antibiotics are required during a vaginal delivery. Depending on the clinic, urine testing seems to barely happen — I think it’s done only once, in the first trimester. I occasionally checked my own with home test strips.

Ultrasounds in the third trimester are not done in Canada for uncomplicated pregnancies. In some other countries you’d get one near the end to confirm the baby’s position, estimate weight, and so on — not here. If there are complications, of course, they’ll order one. I had an ultrasound at 30 weeks to check something related specifically to my health, but since the results were satisfactory, no further ultrasounds were ordered. However, closer to my due date due to my blood results, I was scheduled for phone appointments with an OB-GYN, a hematologist, and an anesthesiologist — all from BC Women’s Hospital. I really appreciated that the OB-GYN explained everything I could expect during the birth in terms of medications and procedures given my minor complications, answered all my questions, and even asked whether I consented to a blood transfusion if needed (some people decline for religious reasons).

In the third trimester, the Tdap vaccine is also recommended here. It protects against three diseases: measles, whooping cough (pertussis), and diphtheria. Since babies don’t receive this vaccine until two months of age, the mother passes immunity through the placenta, protecting the baby from birth until two months. Partners aren’t required to get it in Canada (though it is recommended for them in the US), but we decided to do it anyway since D.’s last one was in school. I personally had no side effects other than a small bruise at the injection site. Since my pregnancy coincided with flu and COVID season, I also got flu and COVID vaccines at 36 weeks. Pregnant women go to the front of the line — much appreciated.

It’s also recommended in the third trimester to see a pelvic floor physiotherapist. They can assess how prepared your muscles are for labour and recommend specific exercises. This isn’t covered by provincial insurance, but is usually covered by employer benefits like any physiotherapy.

Birth Prep Classes, Doulas, etc.

Since we knew almost nothing about preparing for labour, we wanted to take some kind of course — and the midwife strongly recommended it starting around week 25. There are many options: weekly evening classes over a month, a full-day intensive on a weekend, or online courses. After looking at the prices (typically $150–300 CAD) and reading comparisons between in-person and online, we decided to try the free online options. If questions remained, we could always ask the midwife, and basic skills like putting on a diaper would be covered at the hospital. I told the public nurse who calls me periodically that we were planning to do online courses, and she vetted their quality (making sure they were taught by certified professionals, not TikTok “experts”) and also sent me an additional course she’d heard good things about. I should also note that I specifically looked for Canadian materials, because recommendations in the US and Canada differ — including when to go to the hospital.

Here’s the list of free online courses we did:

• A recorded YouTube version of Holliday Tyson’s in-person course — she’s a well-known and very popular midwife. The course has three parts: prenatal, labour and birth, and postnatal. Overall, I really liked it as an introduction and I’m glad we started there — though I wanted more detail.
• The online course from Durham Region, which you can take at your own pace. It’s actually a whole set of courses covering everything from pregnancy to baby care. We loved it — incredibly comprehensive. There are videos of real people sharing their birth stories, and I immediately recognised from the accents that they were American, even though the course itself is Canadian.
• A two-day webinar from Markham Hospital — Tummy Talks. It ran on a convenient schedule: Saturday and Sunday from 9–11 AM. The funniest thing is that this course is built on the same material as above and even uses the same videos — but since it’s live, you can ask questions, and some of the audience questions were actually my favourite part. It was also nice that some content was tailored specifically to our province (you choose your province when registering).
• The only course we wanted to take in person was infant and child CPR. I knew that in a scary situation, memory can fail you — but if you’ve practised on a mannequin, at least your hands remember what to do. So we did a two-hour CPR course with mannequins.

Doula

At some point we considered whether we needed a doula — many people recommend them, including midwives. A doula is someone who provides emotional and physical support to the mother during labour: helping with breathing, massage, moral support — and crucially, she’s there from the very start of contractions all the way through to the end of delivery. As our midwife put it: if labour goes on for 20 hours, the partner needs to sleep, but the doula won’t lie down — she stays with you the whole time.

This all sounded great, so we went to look up how much their services cost (not covered by provincial insurance) — and found prices starting at $800 and going up from there. That said, the price includes two prenatal visits, labour support, and one postnatal visit. With a midwife, the pre- and post-visit components aren’t as necessary, but you can’t hire a doula for just the labour itself. The price felt too high, so we decided not to hire anyone.

There is one Vancouver midwife clinic — South Community Birth Program — where doula services are partially subsidised, and the final cost can range from zero to $200 CAD. That was actually the second clinic I had originally applied to, but we ended up not going there due to location.

Celebrations During Pregnancy

In Canada, as in the US, there are typically two celebrations during pregnancy.

Gender Reveal Party

In the middle of the pregnancy, people often throw a party to publicly reveal the baby’s sex. The event is called a gender reveal party — though I call it a sex reveal party, because we’ll find out the gender in about 18 years, haha. We didn’t do one: firstly, we found out the sex at 10 weeks through the NIPT blood test, so we didn’t need to wait for the 20-week ultrasound; and secondly, it felt like a very personal thing and I didn’t really want to find out the sex of our baby in front of a crowd. That said, we did go to a friend’s gender reveal last year and it was actually pretty fun.

Baby Shower

This party is usually held in the third trimester. The expectant parents typically put together a wish list called a baby registry, which can be created on various websites including Amazon. I prefer Amazon because everything is so well automated — no need to manually enter your address each time, gifts can be bought in two clicks. The baby shower is organized either by the parents themselves or by friends. There are usually silly games, gift opening, and everyone drinks except the expectant mother, haha.

We hadn’t planned to do a baby shower, since we don’t have many friends in Vancouver — but our friends in Toronto secretly organized one for us while we were there for their wedding. I came downstairs in the morning to make tea and was greeted by balloons, gifts, and all the wedding guests. It was just incredibly sweet — I didn’t immediately understand what was happening, since the whole weekend was supposed to be about the wedding, not some other people 🙂 We skipped the games (thankfully), but had breakfast off baby shower plates and opened gifts over the meal. One super thoughtful thing: one of the guests was writing down who gave what, and then handed me the list afterwards so I could send thank-you notes to everyone. I never would have thought of that detail on my own 🙂 The baby registry came in handy anyway, since some friends and acquaintances here asked for the link.

Other Tips

Amazon gives a discount if you created your baby registry there — it’s called the completion discount and activates a couple of months before your due date. It’s actually quite significant, and even if there are things you weren’t going to add to the registry and planned to buy yourself, it’s worth going through the registry to make the purchase. We did exactly that with the car seat.

Car Seat and Expiry Dates

Car seat safety in Canada is taken very seriously. You can only use seats approved for the Canadian market (they have a maple leaf sticker). Bringing car seats from the US is strictly prohibited — if you’re in an accident and the seat isn’t Canadian-approved, the insurance company won’t pay out. Car seats in Canada have a 5-year expiry date from the manufacturing date, after which they cannot be used.

We ordered a car seat from Amazon, and the manufacturing date turned out to be April 2022 (we bought it in September 2023). I complained, they sent another one with the same date and said they have no way to check the manufacturing date in advance (even though it’s printed on the box!). In the end I told them in a chat that we’d lost a year and a half of use on the seat, and they gave us a 20% discount. Thanks, I guess 🙂

Baby Stuff

Baby things cost an insane amount of money! I found a Facebook group in our neighbourhood called Kids-ilano, where people give away free children’s items of all ages — clothing, furniture, everything. Competition is fierce, but despite that, we got all of our baby clothes, some furniture, and more from there for free and in great condition. I only took what we needed for the first 3 months or so, since why clutter the apartment — an entire generation of babies could grow up before you actually need all that stuff. I really love this group because it’s local to our neighbourhood, so you can meet people and it’s an excuse to go for a walk. For bigger items (like a bassinet) we used Facebook Marketplace. The only things we bought new were the stroller (because it was heavily discounted by the manufacturer and the new price matched the used market price) and the car seat, for safety reasons.

Community

The most useful communities for me were on Reddit: r/pregnancy (global, though mostly Americans) and r/BabyBumpsCanada (not exclusively pregnancy-focused, but all Canadian). I also joined the Peanut app to try to meet other pregnant women in the area, but somehow didn’t find anyone nearby. Getting together with other pregnant people turned out to be its own challenge: some are working, some are too tired outside of work, some are just exhausted full stop. But I did manage to meet and somewhat befriend one woman (by Vancouver standards). I didn’t join any Russian-language groups or chats (like some “Moms of Vancouver” type thing) — they seem too toxic (sorry) and I honestly don’t understand the appeal or what they’d offer that English-language communities don’t.

Recommendations

If you want recommendations for everyone involved in our process:

• Fertility clinic in Vancouver — PCRM in Burnaby, Dr. K. Seethram.
• Westside Midwives, blue team — midwife clinic (though of course it depends on your neighbourhood).
• Invitae — for NIPT testing.
• Greig Associates X-ray and Ultrasound — first ultrasound (10–12 weeks).
• BC Women’s for all subsequent ultrasounds (though I’m not sure how much you can influence that, since I was already affiliated with that hospital through my midwives).

I do NOT recommend the Trio fertility clinic in Toronto, and especially Dr. Mahesan.

Partners and Pregnancy

One more thing I want to share — how much I love the way the partner is treated throughout this entire process, from pregnancy through to delivery. D. came with me to every appointment and every ultrasound, was with me through my three days of contractions at home (there was no other option — early labour happens at home), and of course through the birth in the hospital and the two days until we were discharged.

He was taken seriously by every single doctor, nurse, and midwife. Partners are treated as full family members and genuine co-parents in this whole process. I have to say — because of that, everything went much better than it might have. I constantly forget information, and D. remembered everything and told me what to do at the right moments — during pregnancy, during contractions, during the birth. I’m really grateful to the system here for this. Oh, and postpartum depression isn’t discussed only in relation to the mother at appointments — it’s discussed for partners too, and they ask each of you to watch out for the other.

That’s basically everything there is to say about prenatal care in Canada. As I mentioned at the start, I’ll write a separate post about the birth when I have the time and energy — hopefully before the kid turns 18.