A Fresh Look at Family Planning

If you are looking to start a family, planning can seem like a daunting discussion. With all the information available, where do you start? We will take a brief look at the latest recommendations for pre-pregnancy preparation and choices for antenatal care.

Pre-Pregnancy Preparation

Getting ready to have a baby is an exciting time, and there are some things you can do to ensure you have a healthy pregnancy.

  • Folic acid – a dose of 0.5mg oral daily for at least 1 month prior to conception has been shown to significantly reduce the risk of neural tube defects. This dose should be continued until 12 weeks of pregnancy. Women with diabetes, or BMI >30, should take a larger 5mg dose during this time.
  • Iodine – a dose of 150 micrograms oral daily is recommended throughout pregnancy and breastfeeding.
  • Avoid smoking, alcohol, undercooked meats, cold processed meats, raw or smoked seafood, soft cheeses – this will help reduce the risk of contracting listeria, which can have serious, and even fatal consequences for a developing pregnancy.
  • Check your vaccination status – vaccines are now readily available for diseases such as rubella, chickenpox (varicella), and hepatitis B. Being up to date with these vaccinations means a much reduced risk of baby being affected should you be exposed to one of these viruses during your pregnancy.
  • Optimise your health – if you have diabetes, asthma, a mental health or other medical condition, work with your doctor to ensure this condition is well managed.
  • Genetic carrier screening – Screening for autosomal recessive conditions such as cystic fibrosis, Fragile X syndrome and spinal muscle atrophy is now available through selected providers with varying out of pocket costs depending on the extent of testing. More information on this test is available here

Now that you are set to try for a pregnancy, keep the following tips in mind:

  • Most couples fall pregnant within a year of trying. If you are having difficulty, are over 30 years old, or have an underlying medical condition such as polycystic ovarian syndrome, see your doctor early to get some extra advice and help.
  • Ovulation generally occurs 2 weeks before your period starts, so for a woman with a regular 28-day menstrual cycle, days 8-12 would be the ideal time to try for pregnancy (day 1 being the first day of your period).
  • Relax, and try not to be discouraged if you do not fall pregnant immediately. Support one another and let your doctor know if you are having any trouble.

Navigating Antenatal Care

There is a lot to do in 9 months, so let’s make sure you have the basics covered! Pregnancy care can be provided either publicly or privately in Australia. Choices include:

  • Public hospital care (public)
  • Midwifery group practice (public)
  • GP shared care (public/private) – your shared-care registered GP will perform antenatal visits, but you will still have a few appointments with the obstetrician to plan for delivery.
  • Private obstetric care (private)

For all public options of care, you will need to call the pregnancy referral line (Ph: 1300 368 820) to obtain a reference number and allocation for a hospital first visit appointment.

First trimester – Your doctor will confirm your pregnancy with a urine sample. You will then need a set of bloods and a urine sample to check your immunisation status, ensure you do not have any medical conditions that might affect a baby, and to check levels of iron and vitamin D. Your due date will be calculated using the first day of your last menstrual cycle, and if there is any uncertainty, a dating ultrasound can be done. The first trimester screen is performed at 9-13 weeks with a blood test and an ultrasound to determine the risk of having Down’s syndrome or Trisomy 13. If the risk is higher, a doctor can speak with you about whether you want more invasive tests done to confirm if the risk is real.

The harmony test (N1PT) looks for foetal DNA in maternal blood and can be done from 10 weeks gestation. It can tell you the sex of your baby, and looks at the risks of trisomy 13, 18 and 21. Any higher risk reading will prompt a discussion about whether you would like further invasive testing to confirm a diagnosis. This test is not routinely offered and costs around $400 out of pocket.

If you have not yet had a flu immunisation, it is recommended to have one at any time during pregnancy. The government provides this free of charge.

If you are at risk of diabetes (personal or family history gestation diabetes, BMI >30), you will be invited to have an early glucose tolerance test around 12-16 weeks gestation.

Second trimester – The morphology ultrasound occurs at 19-20 weeks gestation and will check that baby is growing normally. From 20 weeks, a booster for pertussis (whooping cough) is recommended. Maternal antibodies transfer across the placenta to provide some protection for the baby.

Third trimester –  A glucose tolerance test will be organised at this time to check for gestational diabetes.

Preparing for delivery – See a physio and work on your pelvic floor exercises. At 36 weeks, a low vaginal swab will be taken to find out your status for group B streptococcus. If positive for this bug, you may need antibiotics during delivery to protect baby. Normal vaginal delivery may be assisted with episiotomy, vacuum or forceps if needed. In some cases, a lower segment caesarean section is needed.

For further advice and to discuss a plan that suits you, please make an appointment with your Pro Health Care general practitioner.

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