Pregnancy
Appointments
Congratulations, you’ve made it! You will need a referral from your GP to see a specialist for pregnancy care.
Your first pregnancy care appointment should be at around 10 weeks gestation = the number of weeks since the first day of your last normal period. At this appointment we will do an ultrasound scan, get to know each other and discuss:
tests that can be done to assist with a smooth pregnancy
how pregnancy care will work for you
what happens at future appointments
some important do’s and don’t’s
Subsequent appointments will focus on the well being of you and your baby, as well as answering any questions and planning for your birth.
Supplements
Studies have shown that supplementing with a pregnancy specific multivitamin will increase the chances of having a baby in the healthy weight range if your dietary intake is insufficient. Your placenta functions as a giant one way straw that allows the baby to take all of the nutrients he or she desires from your system, often leading to depletion in your iron and vitamin D levels. Early pregnancy symptoms of nausea and vomiting may be improved by taking B vitamins, specifically B6, as well as ginger. Fish oils (Omega-3 fatty acids) are beneficial for early fetal development and improved hand-eye coordination, and in some studies have been associated with a decrease in pre-term birth. If you have less than two serves of fish per week you may benefit from this supplement. Healthy thyroid function is supported by iodine supplementation, iodine is found in iodised salt, dairy, fish, seaweed, bread and eggs. Folic acid is required for about three months prior to conception and for the first trimester, or first three months of your pregnancy. Be mindful of your intake of soy products which contain high levels of plant based compounds called phyto-estrogens which mimic our body’s natural oestrogen.
Ultrasounds
Do you need an early pregnancy ultrasound scan? If you have a past history of an ectopic pregnancy or a miscarriage it will be beneficial to have an ultrasound scan performed between six to seven weeks of pregnancy, remembering that we count the start of pregnancy from the first day of your last normal period. If your periods are extremely irregular you will also benefit from this early ultrasound scan.
A simple ‘bedside’ ultrasound scan will be done at each pregnancy care appointment. You will have a formal ultrasound scan with a specialised doctor at 13-14 weeks and again at 20 weeks to monitor the baby’s growth and development, as well as the position of the placenta and the blood flow to the uterus. The due date will only be changed following the 13 week ultrasound scan if the discrepancy between your period date and the scan date is four days or more. If you have any pregnancy complications or have a higher risk pregnancy you will also have formal ultrasound scans during the third trimester of the pregnancy to monitor the growth and well-being of the baby.
Blood tests
Now that you are pregnant we want to know a little bit more about you. Routine early pregnancy blood tests include a full blood count and iron studies, confirming rubella and chicken pox immunity, screening for HIV, hepatitis B and C and syphilis, confirming your blood type and checking on your vitamin D levels. You should also have a urine test to exclude a urine infection. These tests can be ordered by your GP when you see them to request a referral to see your obstetrician.
There are also optional tests available to you. The first provides more information about the risk of a chromosomal complication for this pregnancy, known as the NIPT (Non-Invasive Prenatal Test) and is performed after 10 weeks. The second can estimate the risk of your pregnancy being complicated by high blood pressure, a condition known as pre-eclampsia, performed between 11-13+6 weeks.
Throughout the pregnancy we will monitor your bloods for anaemia and also screen for pregnancy/gestational diabetes.
Exercise
It is safe to exercise (within your means) throughout pregnancy. You may not feel up to it in the first trimester (when sometimes even a daily walk presents a challenge) due to the amount of energy the early pregnancy demands. We do not recommend contact sports or continuing anything that is too bouncy beyond your 20 weeks. But you may continue with all other forms of exercise as long as you feel well during and after. Stay well hydrated, do not overheat, and refuel within the first hour of intense activity. Physiotherapist’s recommend pregnancy pilates and swimming in order to support and strengthen core and pelvic floor. As the pregnancy advances you will start to slow down, listen to what your body is enjoying and start to adjust your exercise routine to match. Relaxin hormone is present throughout pregnancy, making joints more mobile than usual so take care when lifting or twisting. The effects of relaxin hormone on the pelvis may limit your ability to continue with some forms of exercise and if you start to experience pain or discomfort check in with a women’s health/pelvic floor specialising physiotherapist.
Travel
There is a lot to consider when planning a trip, or traveling for work. Early in pregnancy there may be complications for which you may want medical advice; consider if this will be available. You may suffer from increased nausea and vomiting, constipation and extreme fatigue which may make your vacation less pleasant.
With long periods of immobility you are at a slightly increased risk of a blood clot in your legs (DVT) so it is important to move around, to stay well hydrated and wear compression stockings.
Late in pregnancy you will feel less comfortable traveling, you will usually feel overheated in warm weather and there is a small risk of preterm birth. The safest time to travel is between 14 and 36 weeks of pregnancy, however the most comfortable time for most women is 14-32 weeks. International travel is restricted to 32 weeks by air and 28 weeks by sea. Some destinations pose an increased risk to pregnancy due to the presence of Zika virus and challenges with hygienic eating and drinking.
Diet, coffee and alcohol
It is safe to have up to 200mg caffeine before and during pregnancy, which is about two coffee’s per day. Alcohol is not recommended during pregnancy nor breast feeding as it is not possible to determine a safe amount. Infections such as listeria, toxoplasmosis and salmonella can cross the placenta and complicate pregnancy - wash food well, avoid raw meat/seafood/eggs, pate, deli meats, soft cheeses and pre-prepared salads. Use excellent food hygiene practices at home with any left overs. Once you have made it through your first trimester (the salty white carbohydrate diet trimester!) try and have a rainbow diet - different coloured vegetables and a portion of protein with each main meal. Think about decreasing your portion sizes and spread your intake over six meal times; breakfast, morning tea, lunch, afternoon tea, dinner and supper - your baby is hungry 24 hours per day. There is no one size fits all for the perfect weight gain in pregnancy. If you start in the healthy weight range then the recommended weight gain is from 5-15kg however if you are overweight when you conceive we recommend that you gain 5kg or less. You may want to have an appointment with a dietitian for support.
Vaccinations/immunisation
We recommend an annual flu vaccination at any stage during your pregnancy.
We also recommend that you have a whooping cough booster (Boostrix) between 24-32 weeks gestation in each pregnancy.
Covid-19 vaccination is also highly recommended at any stage during pregnancy.
Following vaccination your body will develop antibodies which protect you and your baby from these diseases during pregnancy and afterwards.
Any family members who will be holding your baby in their first six weeks should have had an annual flu vaccination, their Boostrix within 5 years and a Covid-19 vaccination.
Sleep position
We recommend that you do not fall asleep lying flat from 28 weeks onwards. Mother Nature does not want you to sleep deeply through the night during pregnancy so you are aware of your baby and also ready for when the baby arrives. Your sleep will be more interrupted in the third trimester and you will feel uncomfortable being flat. You do not need to stay on one side for the whole night, you can be tilted to the side, on your side, or tilted at a 45 degree angle on your back.
Fetal movement
Fetal movement matters especially from 28 weeks onwards. Kick counters are not recommended as they do not account for the variability in gestation and individuality of each pregnancy. From 28 weeks you are encouraged to become more aware of the times you expect to notice your baby moving inside, as many babies will develop a movement pattern (but not all). If you are concerned about your baby’s movements, whether they are too few or too frequent, please phone our midwives. Do not google, do not drink an iced water or eat chocolate! Just phone. Please.
Due date
The due date is 40 weeks from the first day of your last period, or the date confirmed by an early ultrasound scan. This represents the average gestation of a human, however our gestational period actually goes all the way to 42 weeks. Your due date is not necessarily the best date for your baby. In an uncomplicated pregnancy, we consider the best time to have a baby to be after 39 weeks and before 41 weeks. As you approach your 39 week appointment we will discuss the best timing for your birth.
Induction
Induction means we have decided to help you get into labour before it starts naturally, and augmentation means we are assisting your labour once it has started naturally.
Natural labour does not start at the right time for everyone. Induction is often thought of as medicalising a natural process. Some claim that induction causes a more painful labour and birth. Historically, induction has been associated with an increased risk of further intervention like epidural, forceps, episiotomy and caesarean section. There is older data that supports this association but more recent review has demonstrated that this evidence is flawed due to -
1) Inappropriate management of the induction
2) Induction for an at risk pregnancy that may have led to these outcomes or worse outcomes if the pregnancy had been continued.
It is not possible to compare apples with apples when studying induction of labour versus no induction of labour. Newer studies and reviews of older studies support induction of labour as a safe management option at the end of pregnancy, induction may actually reduce your risk of caesarean section and it does reduce the risk of a stillborn baby. It is most important that you understand the benefits and the risks that may be associated with an induction of your labour.
There are two phases to an induction of labour. The first is to get the cervix ready to dilate. This can be done with either hormonal gel/tape placed high in the vagina or by using a small balloon inside the cervix. If your cervix needs to be readied for your induction you will be admitted in the evening. For many people needing an induction the cervix is already ready - it has softened, started to shorten and is open. When this is the case your induction starts with the second phase - using a synthetic version of the labour hormone, oxytocin, in a drip to start contractions. This is best done after the waters are broken. Breaking the waters involves making a small hole in the membranes using a delicate instrument designed just for this purpose. It is not painful for you or the baby, however the internal examination may be uncomfortable.
Arrangements for safe practice
When I am taking annual leave or spending a weekend with my family you will be cared for by one of our small team of covering obstetricians
