You’re pregnant… but now what do you do?
Firstly, a massive congratulations! I sincerely hope that you are as excited as a kid in a candy store right now. If you are not, that is ok too. Some pregnancies are a massive shock to the system, and take many weeks to acknowledge and accept. While other pregnancies are dreamt about for many months or years. There is no ‘right’ way to be right now.
Once you have confirmed that you are pregnant with a home urine pregnancy test (step 1), it’s best that you make an appointment with your GP/local doctor to confirm your pregnancy (around 2 weeks post missed period, or 6 weeks pregnant), and discuss all the options for your care in your area. It’s good to have an idea of what’s available to you so you can have an honest discussion without feeling coerced.
It is also a good idea to have commenced, or commence some prenatal vitamins. Please seek out quality products (ie- hopefully you have already been to your GP/naturopath/pharmacist pre conception and discussed this!).
Your body is doing an extraordinary amount of work as it continually grows your little baby. Tiredness is massive in these early months, so please be kind to yourself and listen to your body. Rest when you can and need.
Morning sickness, or maybe ‘all day, every day’ sickness can be draining both physically and mentally. Try to have small frequent snacks. Even taking a small snack to bed with you to have first thing before you brave getting up can help!
Antenatal anxiety and depression are very common. Please seek help early from your GP/care provider if you feel you are struggling with your mental health. This can be due to many reasons. For some the shock of pregnancy, the hormonal imbalances or a pre disposition to mental health conditions may be the trigger. It doesn’t matter why you might be feeling the way you are, the earlier the treatment, the better the outcome for the family unit. PANDA are also a great resource.
Your GP may also offer you some early pregnancy tests including-
A blood test to confirm your pregnancy. This measures the pregnancy hormone within your body.
A ‘dating’ scan to clarify the date of conception, usually around 8 weeks gestation. This is generally not covered by Medicare as it is not considered essential.
Also a 12 week dating scan +/- genetic screening. Please discuss this with the provider who is recommending this, so you understand what exactly they are offering to test, the consequences of finding abnormalities and what they might mean for your family.
A urine sample to mainly check for infection.
A blood test to screen for Sexually transmissible diseases such as HIV, and Hepatitis B.
All of these tests (like everything in pregnancy!) are optional, and you can decline any or all if thay don’t suit your needs. I always say use your BRAIN (benefits, risks, alternatives, intuition, do Nothing) to help you make decisions and discussions around procedures easier. For instance, if you are 100% sure of your last normal menstrual cycle, and you know your cycles are regular, perhaps you would choose to not have a dating scan due to the unknown risks of ultrasound. Or maybe you would want to have that scan so you get to see your baby for the first time. Each choice is yours and you need to make it, but always remember to ask why, what happens to your care if you decline the intervention/test/care, and what are the risk factors involved?
Inform yourself and you will have the confidence to make the best decisions for you!
Here in Ballarat, and lots of other places in Australia, we have many different options for maternity care. Shared care, home birth, publicly funded maternity care, private maternity care and private obstetricians who work from both the public and private settings.
I want you to know that at no point in a pregnancy do you have to remain with a provider that is not supporting you in your pregnancy options. You can change providers, or ask for a second opinion, and it’s not as daunting as you think it would be.
What do they do and which system is going to work best for you?
Below is a summary of what ‘type’ of care each provider is likely to provide, however it is always good to discuss different options with your GP or book an appointment with different practitioners to see if you ‘gel’ with any particular person/setting. Each care provider will be different in personality and their obstetric/maternity practice.
Shared care- some GP’s offer a service called shared care, and just as the name suggests you are going to be cared for by both your GP and the public health care system (Occasionally a private obstetrician will do shared care too). This is a particularly good option for those of you who may be out of town and getting to appointments further away at major hospitals is more of a challenge, or simply because you have a cracking rapport with your GP and you trust them and want them to be a part of your team. To read more on shared care and it benefits click here.
Home Birth- sometimes people are scared of the words ‘home birth’. This is not free birth (free birth is where you actively choose to not have formal antenatal care throughout your pregnancy and birth). Home birthing is a very safe effective care model provided by Registered Midwives. When you are preparing for a home birth you also have a ‘transfer’ hospital (often public) that you will also have some appointments with incase you or your midwives decide to transfer your care there at any stage in your pregnancy or labour. The Birth House in Geelong, & MAMA in Melbourne both service the Ballarat area. Unfortunately, at the time of writing this piece, we do not have any Ballarat local home birth midwives.
Publicly funded maternity care- ‘The Public system’. The care provided by Ballarat Health Services, or any other public hospital is standardised and meant to be consistent across Australia. As you can imagine, like any care provider, it does depend upon current staff and clientele. When you are a public patient your care provider will most likely be different each appointment with different obstetricians also playing a role in your care if required. If you have a low risk pregnancy and birth your primary care provider will be a midwife. If you have a high risk pregnancy or a change in labour an Obstetrician (Doctor) will become your primary care provider. Some public hospitals have exceptional evidence based programs that are known to help support a mother, baby and family, such as midwifery led care (MLC) programs. This is the ‘gold standard as recommended by the World Health Organisation. MLC is a small team of midwives who you will be your primary care provider throughout your pregnancy & labour (BHS have a program called COCO which is team midwifery, not MLC). There are also birth centres throughout the country and some public hospitals offer a home birth service too. This system is funded by the government at no cost to the consumer.
Private Maternity Care- Not dissimilar to the public heath care system, however you pay (either your private health insurance if covered or pay your own way) to have care provided within a private hospital. For Ballarat people, St John of God is the only available private maternity hospital. You also need a practitioner that has admitting rights to the hospital (mostly an obstetrician) to accept you as their patient. Midwives will still look after you during and after birth, but your primary care provider will be your Obstetrician. The midwife caring for you in labour will contact your obstetrician if they believe your care needs escalating or when you are close to birthing. All appointments will be with your private obstetrician or practitioner.
*You can choose to be a private patient within the public system (with or without a private obstetrician)- please discuss this with your care provider or local public hospital.
Private Obstetric care- This is where you pay to have a choice in an Obstetrician throughout pregnancy & birth. You can choose to birth in either the public or private hospital setting (sometimes within the home too). Most private obstetricians have an ‘out of pocket’ payment, that your health insurance will not pay (regardless of where you are birthing). Your health insurance generally covers some of the obstetric fee, and your hospital stay (often you have a ‘gap’ to pay). While a midwife will still care for you while you are in hospital, in most cases you will see your obstetrician at antenatal appointments and they will always try to be at the birth of your baby (a midwife will be providing care to you during labour). Options in Ballarat for private obstetric care are Obstetrics and Gynacology (a clinic of a number of Obstetricians & IVF specialists), Dr Patrick Maloney & Dr Deepika Monga.
Listed below are some things that you may want to consider and investigate prior to choosing your care provider. Please note that although this is the evidence, it is important to work out what are the important factors for you and your family. This is your baby, no one else’s and you need to be confident in your care provider.
The World Health Organisation (WHO) recommends ‘Midwife-led continuity-of-care models, in which a known midwife or small group of known midwives supports a woman throughout the antenatal, intrapartum and postnatal continuum, are recommended for pregnant women in settings with well functioning midwifery programmes’, as the best model of care available. Press here to read their recommendation. Will the care provider(s) be known to you throughout your pregnancy, birth & postpartum period.
Things like the care providers rates of Caesarean section. Currently Australia’s Caesarean section rate is almost 40% for those women having their first baby. The WHO recommends this rate should be approximately 10-15%.
The rate of induction. Currently around 43% of first time mothers have an induced labour here in Australia.
Typically the rates of intervention are higher in the private maternity system. You can read about this here.
Check out the ‘Better Safer Care’ 2019 report the latest maternity statistics.
If they are a ‘Baby friendly health Initiative’ hospital/setting. Read about the BFHI here and why this might be something that is important to you.
Inform yourself and you will have the confidence to make the best decisions for you!
Once you have read (and digested!) this article, please check out the other articles on other testing etc that may be offered to you in pregnancy. The earlier you know about these things the better understanding and research you can do, to help you make the best choices for your family.
As always, I am available via email or phone (confidentially) to help discuss and of these options with you.
Rosie xx