Table 1 Clinical pathways for pregnant women in Quebec

Initial contact with service

• Following a positive pregnancy test, women make contact with the clinic for a prenatal consultation.

• Women are scheduled to meet with a nurse for 1 h after 5–6 weeks of pregnancy.

• At that meeting, women are provided with an information kit that includes a brochure created by the government on Down syndrome prenatal screening.

• Following a positive pregnancy test, women make contact with the obstetrics/gynecology service for a prenatal consultation.

• Following a positive pregnancy test, women make contact with the birthing center for a prenatal consultation.

• Women are invited to attend an evening information session to learn about midwifery care.

• Only women with low-risk pregnancies are eligible for this service.

• Women are contacted after 2–3 weeks to let them know if they have been assigned a midwife or are on a waiting list.

Initial contact with main prenatal care provider

• Women meet with their physician after 8–9 weeks of pregnancy.

• Women meet with a gynecologist after 9–11 weeks of pregnancy.

• Women meet with the midwife after 10–11 weeks of pregnancy.

Prenatal screening process

• At the initial meeting with the physician, the topic of Down syndrome prenatal screening is discussed.

• If the decision to take the maternal serum tests is made right away, the physician writes a prescription for the test.

• For women who need more time to think about the decision, the physician writes an open prescription for the test.

• Women make an appointment to take the first serum test at a local community health center or a private clinic in weeks 10–13 of their pregnancy.

• After the first serum test, women make an appointment for the second serum test in weeks 14–16 of their pregnancy.

• At the initial meeting with the gynecologist, the topic of Down syndrome prenatal screening is discussed.

• If the decision to take the maternal serum tests is made right away, a form is completed to prescribe both tests.

• Women make appointments to take the first serum tests at a local community health center or a private clinic during weeks 10-13 of their pregnancy.

• During that appointment, women will meet a nurse for one hour and discuss topics such as diet and physical activity during pregnancy.

• After the first serum test, women make an appointment for the second serum test in weeks 14–16 of their pregnancy.

• At the initial meeting with the midwife, the topic of Down syndrome prenatal screening is discussed.

• The midwife presents the government’s brochure on Down syndrome prenatal screening and explains women’s options.

• If the decision to take the maternal serum tests is made right away, the midwife administers the test at the birthing center during the same meeting.

• If women need more time to think about the decision, they can return home, call the birthing center for advice, and make another appointment with the midwife within the next few weeks.

• Women are scheduled to meet the midwife again after 14–16 weeks of pregnancy for another consultation and the second serum test.

Prenatal screening results announcing process

• Usually, the result is available 3–7 days after the second test.

• If the result is low-risk, the doctor waits until the next visit and gives them the result in the usual sequence.

• If the risk is high, the doctor calls the woman to inform her of the result and its meaning. The doctor recommends a genetic consultation to get a complete risk history and recommends further testing.

• The next meeting with the doctor is between 16 and 20 weeks of pregnancy.

• Usually, the result is available 3–5 days after the second test.

• Some OBGYNs call regardless of the result and others call only if the result is high-risk (there is a variation in practices).

• Women are scheduled for another visit as soon as possible if result is abnormal. If normal, usually around 20 weeks to review the results of the tests and follow-up.

• Usually, the result is available 3-4 days after the second test.

• The midwife calls the woman as soon as she receives her test result, whether the woman is at risk or not.

• When the risk is high, the midwife transfers the woman’s file to the geneticist.