On booking with Dr Cade you will receive a pack prior to your first visit with extensive information about your pregnancy care and various options. A condensed version with some of the more common questions is included here.
It is ideal but certainly not compulsory to have a pre-pregnancy planning visit. This may be as simple as addressing common questions and misconceptions or as complicated as reviewing difficult medical conditions or previous pregnancy complications.
The first visit in the pregnancy is scheduled at 10 weeks gestation unless there is a high risk to your pregnancy that needs addressing earlier. Subsequent visits are individualised depending on pregnancy risks or needs but are usually 4 weekly from 16 weeks, 3 weekly from 28 weeks then fortnightly from 34 weeks
The most accurate way of dating a pregnancy is with ultrasound: Dr Cade will provide this for you at your first visit. This can be done earlier than 10 weeks if you would like but rarely earlier than 6-7 weeks.
Ironically the “number of weeks” you are quoted is from the first day of bleeding of the last menstrual period and the pregnancy is actually two weeks younger than this (at 40 weeks your baby is actually 38 weeks old).
There are a number of screening tests for genetic conditions, the most common concern being Down Syndrome. These are all outlined in detail in your mailed booking pack. Many people find it worthwhile to have a personal discussion with their obstetrician about these, however it is worthwhile thinking about them beforehand or writing down any questions or concerns you might have. None need to be organised before your first visit at 10 weeks.
This usually is self-limiting and resolves by 20 weeks (often earlier) but can be distressing. Milder cases are often successfully treated with dietary modification and a supplement which contains Vitamin B6 and Ginger (eg Blackmores or Elevit “Morning Sickness” formulae which are different from the standard pregnancy supplements). Medication is safe but may carry some unfounded concern because of very questionable pregnancy safety classification systems. Nonetheless they should be discussed with an obstetrician or a GP with obstetric experience before starting.
Fee structures and out-of-pocket expenses in private care can be very difficult to understand. Private health insurance is designed to cover your hospital expenses and in-hospital procedures. They do not cover outpatient costs such as consultations or ultrasound scans – these are partially covered by Medicare. As most of obstetrics is outpatient care, it is reliant on Medicare not your private health fund for reimbursement. However, without private health insurance the hospital costs for your stay (admissions or after delivery) are high.
There used to be a Medicare “safety-net” scheme for obstetrics where a large proportion of costs were covered. Unfortunately this was scrapped by a previous federal government and private obstetrics now carries a variable degree of out-of-pocket expenses. Each obstetrician sets their own fee structure. In the pack you receive on booking this is outlined in detail or can be discussed on request with the practice secretaries.
Other services such as ultrasound scans, blood tests, anaesthetics or paediatrics may involve other out-of-pocket costs depending on the service and the provider.
It is hard (but not impossible) to meet all the demands of pregnancy with diet alone. In Australia, our diet is naturally low in iodine (which is important for both mother’s and baby’s thyroid function and baby’s neurological development) and women are also commonly low in iron (important as a “back-up” store for red blood cells and also for breastfeeding). It is very reasonable to routinely take a general pregnancy multi-vitamin (eg Elevit or Blackmores). Iron and Vitamin D are sometimes separately examined via blood tests and supplemented if required. Folic acid/folate 0.5mg should be started pre-pregnancy (2-3 months) and continued until week 12 (this prevents spinal fusion defects) but note that this is an ingredient in a normal pregnancy multivitamin – it does not need to be taken separately.
There is a huge amount of information and misinformation circulated about what pregnant women must not eat. It can turn a time of joy and excitement into a time of unnecessary worry and culinary disappointment. There is no doubt that certain infections in food can present a risk to the baby but these infections are rare in Australia. The government website “betterhealth.vic.gov.au” contains a useful pregnancy summary.
Almost all forms of exercise are safe before your booking visit at 10 weeks. The heart and blood volume changes of pregnancy (outlined in detail in your booking pack) are more noticeable by the end of the second trimester so no specific maximum heart rate needs to be adhered to this early on. Extreme exercise, however, can alter nutritional state and body temperature both of which can have an effect on a developing baby and clearly high-impact/contact sports are always best avoided.
There are no inherent risks to a developing baby in flying. The risk of labour (later pregnancy) or miscarriage (early pregnancy) vary greatly between individuals and should be discussed with your obstetrician. Later in pregnancy, there is also an increased risk of venous thromboembolism (DVT). Some specific pregnancy conditions may occasionally be a complete contraindication to flying. Before booking any flights always ask about the airline policy regarding pregnancy – these are extremely variable and no-one wants to be denied travel at the gate or, even worse, stranded overseas. It is very important to know if your travel insurance covers delivering overseas and to discuss with me the risk of this occurring. Costs can be hugely expensive.
Very few vaccinations are unsafe in pregnancy. Some are advised against but the risk is theoretical and not proven. In general it is usually best to wait until after the pregnancy for vaccination “top-ups” (eg Rubella) but there are several exceptions to this rule. It is very important for pregnant women to receive the seasonal flu vaccine (at any time) and a whooping cough booster (at about 30 weeks).
- It is safe to dye your hair during pregnancy.
- Sexual intercourse is safe unless you have certain specific pregnancy complications. People are often embarrassed to discuss this but it is a common concern and one gynaecologists are very used to and comfortable with discussing.
- It is safe to have a bath or a spa during your pregnancy. It is not possible to raise your core temperature to a degree that could affect your baby unless it is extraordinarily hot (probably intolerable) for a long period of time. Be wary that pregnancy usually drops your blood pressure and you may feel light-headed on standing up too quickly particularly in a warm environment.
- It is not necessary to routinely weigh yourself during pregnancy. If you want to that is fine – the average weight gain is usually 7-12kg.
- You can sleep on your back in the first and second trimester. Later in the third trimester prolonged periods of rest on the back can potentially decrease the blood return to your heart because the uterus and baby press backward onto the vena cava. The human body is a smart organism – most pregnant women do not feel comfortable on their back late in pregnancy anyway.