Your Prenatal Care

We’ll be here for you before, during and after your pregnancy.

Whether you just found out you are pregnant or have known for a while, it can feel pretty overwhelming. Pregnancy care (also called prenatal care) changes depending on what stage (or trimester) of pregnancy you’re in. At Winona Health, our team of Women’s Health providers and nurses are here to support you every step of the way!

  • When you call to schedule your first appointment, we’ll ask about the first day of your last period, and it’s possible that a nurse may ask you a few other questions. We may ask you to go to the lab on the first floor of Winona Clinic to take a blood pregnancy test to confirm your pregnancy.
  • 8-10 weeks into your pregnancy, we’ll schedule a “New OB” visit with a nurse. OB stands for Obstetrics, which is the medical specialty for pregnancy (also called prenatal care) and childbirth. This appointment is an opportunity to update your medical information, have your first labs (urine and blood tests), and receive some helpful information. You will not hear the heartbeat or see an ultrasound at this appointment since baby is still quite small.
  • 12-14 weeks into your pregnancy, you’ll have your first visit with your Women’s Health provider. Plan for this appointment to be about an hour. You can bring your partner, a friend or support person if you’d like. Expect to hear a heartbeat and see your baby on ultrasound at this appointment!

Your healthcare provider will want to see you every four weeks during your second trimester. During these appointments, you can ask questions and talk about anything that is bothering you. You’ll be able to listen to the baby’s heartbeat. We’ll measure your abdomen to see how fast the baby is growing.

Tests to expect during your second trimester are:

  • An ultrasound to measure and check the baby for all of their vital organs. This is also an opportunity to see if the baby is a boy or girl if you choose to. This should be scheduled as close to 20 weeks into your pregnancy as possible.
  • Blood tests and possibly urine tests between 24-28 weeks. These are important to make sure your body is supporting you and your growing baby well.

  • Weeks 28-36, your healthcare provider will want to see you every two weeks. These appointments are like just like your second trimester appointments, and are another opportunity for you to ask questions!
  • At 36 weeks, your provider will collect a vaginal and rectal swab to check for an infection known as Group B Strep. If you are interested, they will also check to see if you are dilating (your cervix is starting to open).
  • From 36 weeks until birth, your provider will see you every week, and you can choose whether or not to have cervical exams at these appointments.

Please note: This is a summary of basic prenatal care. Additional tests and visits may be necessary depending on your Individual situation.

  • After your baby is born, it is still important to see your healthcare provider to make sure you are recovering well and thriving. This is called postpartum care.
  • We would like to see you two weeks and six weeks after your baby is born. During these appointments, we will ask you how you are doing, ensure you are feeling and coping well emotionally, and talk about birth control options that will work well for you.

Along the way — What to watch for and what to do

19 weeks and under

If you have heavy vaginal bleeding (for example, saturating a pad every hour) and uterine cramping, proceed to the Emergency Department.

Drink water and rest for 12 hours if:
• your bleeding is only spotting a single time and it happened after intercourse or after large/difficult/firm bowel movement.

Proceed to the Emergency Department if:
• the spotting continues
• you are bleeding more heavily, like a menstrual period
• you are cramping with any bleeding, even after resting and drinking plain water
• you are having other symptoms in addition to the bleeding
• you are feeling lightheaded or dizzy or lost consciousness

If you are RH NEGATIVE:
• follow the instructions above
• contact the Women’s Health within 24 hours of the start of the bleeding

Proceed to the Emergency Department if:
• you have been unable to hold down food for 24 hours
• you have been unable to hold down any liquid for 12 hours
• you have had liquid bowel movements for 24 hours
• you are feeling lightheaded or dizzy or lost consciousness

Call your provider’s office and schedule an appointment if:
• you are vomiting more than once daily even if you’re still able to hold down some food and liquid
• you have several episodes of liquid stool in less than 24 hours

Proceed to the Emergency Department.

Proceed to the Emergency Department if:
• you cannot void/pee at all for 6 to 8 hours
• you are having to take pain medication for the discomfort

Call your provider’s office and schedule an appointment for any other concerns.

Proceed to Emergency Department if:
• vision problems
• recurring headaches
• fever over 100 degrees F
• sudden swelling in your hands or face

Proceed to Urgent Care, your primary care provider’s office, or the Emergency Department.

20-36 weeks

If you have heavy vaginal bleeding (for example, saturating a pad every hour) and uterine cramping, proceed to the Emergency Department.

Drink water and rest for 12 hours if:
• your bleeding is only spotting a single time and it happened after intercourse or after large/difficult/firm bowel movement.

Proceed to the Emergency Department if:
• the spotting continues
• you are bleeding more heavily, like a menstrual period
• you are cramping with any bleeding, even after resting and drinking plain water
• you are having other symptoms in addition to the bleeding
• you are feeling lightheaded or dizzy or lost consciousness

If you are RH NEGATIVE:
• follow the instructions above
• contact the Women’s Health within 24 hours of the start of the bleeding

Proceed to the Emergency Department if:
• you have been unable to hold down food for 24 hours
• you have been unable to hold down any liquid for 12 hours
• you have had liquid bowel movements for 24 hours
• you are feeling lightheaded or dizzy or lost consciousness

Call your provider’s office and schedule an appointment if:
• you are vomiting more than once daily even if you’re still able to hold down some food and liquid
• you have several episodes of liquid stool in less than 24 hours

Proceed to Labor and Delivery if:
• the pain is severe and with sudden onset
• you are having uterine tightening every 5 minutes (timing the contractions from the start of one to the start of the next) lasting 1 minute for 1 hour

Proceed to the Emergency Department if:
• you cannot void/pee at all for 6 to 8 hours
• you are having to take pain medication for the discomfort

Call Women’s Health and schedule an appointment for any other concerns.

Proceed to Family Birth Center if:
• vision problems
• recurring headaches
• water has broken (if you think your bag of water has broken, try to note the time, color, odor and amount)
• decreased fetal movement
• you have a fall, even if you did not hit your belly

Call Family Birth Center for guidance.

37 weeks to delivery

If you have heavy vaginal bleeding (for example, saturating a pad every hour) and uterine cramping, proceed to the Emergency Department.

Drink water and rest for 12 hours if:
• your bleeding is only spotting a single time and it happened after intercourse or after large/difficult/firm bowel movement.

Proceed to the Emergency Department if:
• the spotting continues
• you are bleeding more heavily, like a menstrual period
• you are cramping with any bleeding, even after resting and drinking plain water
• you are having other symptoms in addition to the bleeding
• you are feeling lightheaded or dizzy or lost consciousness

If you are RH NEGATIVE:
• follow the instructions above
• contact the Women’s Health within 24 hours of the start of the bleeding

Proceed to the Emergency Department if:
• you have been unable to hold down food for 24 hours
• you have been unable to hold down any liquid for 12 hours
• you have had liquid bowel movements for 24 hours
• you are feeling lightheaded or dizzy or lost consciousness

Call your provider’s office and schedule an appointment if:
• you are vomiting more than once daily even if you’re still able to hold down some food and liquid
• you have several episodes of liquid stool in less than 24 hours

Proceed to Family Birth Center if:
• the pain is severe and with sudden onset
• you are having uterine tightening every 5 minutes (timing the contractions from the start of one to the start of the next) lasting 1 minute for 1 hour

Proceed to the Emergency Department if:
• you cannot void/pee at all for 6 to 8 hours
• you are having to take pain medication for the discomfort

Call Women’s Health and schedule an appointment for any other concerns.

Proceed to Family Birth Center if:
• vision problems
• recurring headaches
• water has broken (if you think your bag of water has broken, try to note the time, color, odor and amount)
• decreased fetal movement
• you have a fall, even if you did not hit your belly

Call Family Birth Center for guidance.

• bright red vaginal bleeding with severe, sudden onset abdominal pain
• something is protruding from your vagina

At Winona Health, it is our practice to ask and screen all women for use of tobacco, alcohol and other drugs including Marijuana. The purpose of screening is to allow education and treatment of a mother’s substance use, and not to punish or prosecute anyone. While Marijuana is commonly used recreationally, and is even legalized in many states, popularity or legalization does not overlook the fact that Marijuana is not recommended for use during pregnancy or breastfeeding.

During Pregnancy
  • Research shows that Marijuana does cross the placenta and fetuses do have detectable levels of THC in their bodies (brain, serum).
  • The full implications of any THC product during pregnancy is not known, but studies show that children who were exposed to marijuana in pregnancy have an increased risk of not growing as expected in utero as well as impaired cognition such as lower scores for visual problem solving, visual-motor coordination, decreased attention span and behavioral problems.
  • Winona Health, the American Academy of Pediatrics and American College of Obstetricians and Gynecologists all encourage pregnant women to discontinue use of marijuana for recreational use in addition to medicinal purposes in favor of an alternative therapy for which there is better pregnancy-specific safety data.
  • We do not report use of marijuana during pregnancy to any authorities, but the federal government considers it an illicit substance that must be reported once a baby is born. It is not our intention to have babies removed from their mothers, and under almost all circumstances this does not happen. However, we do want mothers informed that screening suggesting use of marijuana during pregnancy must be reported to child protective services within 24 hours of an infant’s birth.
  • With marijuana use in pregnancy and the exposure the infant has in the uterus, the pediatric team and nurses will pay extra attention to your infant in the hospital. The team will be monitoring for any signs of withdrawal or concerns and discharge before 48 hours (or 2 midnights) is not recommended, and sometimes it can be longer if needed.
  • After birth, breastfeeding is discouraged with maternal marijuana use due to concerns of it passing through the breast milk and affecting brain development of your infant. If you have a positive drug screen, this would be discussed further with the pediatric team in the hospital, but we do want you to be aware that it is strongly discouraged to breastfeed with marijuana use and you would be asked to sign another form like this acknowledging the risks.
During breastfeeding
  • There is not enough information available to evaluate the effects of marijuana use on infants being breastfed during maternal marijuana use—therefore it is discouraged.
  • What is known:
    • There is evidence to suggest that the use of marijuana could impair the production of breast milk.
    • Marijuana is detected in the breast milk of mothers with known marijuana use.
    • Marijuana concentrates in the fat found in breast milk and rapidly distributes to brain and fat. This is concerning because this also means it will deposit to the infant’s developing brain.
    • There is evidence to suggest that marijuana can impair neurodevelopment in the adolescent years when the brain is still developing, so there is similar concern that this could have more of a detrimental effect on the rapidly developing infant brain when used during pregnancy and breastfeeding.
  • There is no safe form of marijuana use as smoking is considered the same as vaping, eating, oils or other various methods.
  • The current research suggests that THC may remain in breast milk for 6 days, but this is under minimal use and those that use it more often could have components of it present for much longer.

All new or expectant parents receiving their drinking water from a private well should have their water tested for NITRATE contamination. Nitrate has caused methemoglobinemia (infant cyanosis or “blue baby disease”) in infants who have been given water or fed formula prepared with water having high nitrates.

CAUTION! Boiling water containing nitrates will cause the concentration of nitrates to INCREASE.

A domestic or private water supply should not contain nitrate concentrations in excess of 10 milligrams per liter expressed as nitrogen (10 mg/1N) for children under 2 years of age. If your well water test results exceed the above limits of nitrate concentration, then you should not drink the water. Your well and sewage system should be checked by licensed contractors (a list is available from the Winona County Planning & Environmental Services Department) for nitrates.

Be on the safe side — have your well water tested as soon as possible.

Water test information can be obtain from:
Winona County Planning & Environmental Services Department
225 West 2nd Street
Winona, MN 55987
507.457.6405

Approved by Winona County Planning & Environmental Services Department.

Fetal Movement Count

A fetal movement count — the number of your baby’s movement in a given period of time — can be an indicator of fetal well-being. A decrease or sudden change in movement can be a sign of a problem, and getting medical help quickly can save a distressed baby’s life.

Some healthcare providers only ask women with high-risk pregnancies to track their baby’s movements, while others ask all women to track movements starting at 28 weeks. Some expectant mothers like to do this as a way to bond with their baby and get to know his or her activity patterns. Ask your healthcare provider if he or she recommends that you track your baby’s movement, and let them know if doing so is stressful for you instead of pleasurable.

Count to 10 fetal movement method

To get started, download and print several copies of the chart. Fill in your current week of pregnancy at the top of the chart.

  • Get in a comfortable sitting or side-lying position. Relax and use this special time to concentrate on your baby. Partners can be included by resting their hands on your abdomen to help you feel the movements.
  • Using the printed chart, write down the time you feel the baby’s first movement in the ‘Start time’ box under the day of the week. Settle back and count the baby’s movements. Jabs, kicks, flutters, rolls, and twists are all considered movements. In the same column, place an ‘X’ in the box that corresponds with the amount of time it took to feel 10 movements (see example below). Many babies will take less than 30 minutes to complete 10 movements.
  • Your baby may be asleep or less active than usual during some of your counting periods. If so, wake your baby up by eating or drinking something, or by walking for 5 minutes. Then, start over with your counting.
  • Contact your healthcare provider or the labor and delivery unit if there is still decreased fetal movement after trying to wake your baby, if your baby makes fewer than 10 movements in 2 hours, or if your baby has a significant or sudden change in his or her movements.
  • Trust your instincts and contact your healthcare provider if you have any doubts about your baby’s well-being.

Fetal Movement Chart Sample

Contraction Timing

Once you start experiencing contractions, timing them can help indicate how your labor is progressing. Having this information can also help your healthcare provider assess how far along you are, and whether it’s time to head into the hospital or birthing center.

Always call your healthcare provider for specific instructions on when you should go to the hospital. It is generally advised to go when contractions are 5 minutes apart, last 1 minute each, and have stayed in that pattern for 1 hour.

Click the button below to learn how to time contractions and to download a printable contraction timing chart.

Your Pregnancy Resources

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